AU2003261505B2 - A method of knee arthroplasty - Google Patents
A method of knee arthroplasty Download PDFInfo
- Publication number
- AU2003261505B2 AU2003261505B2 AU2003261505A AU2003261505A AU2003261505B2 AU 2003261505 B2 AU2003261505 B2 AU 2003261505B2 AU 2003261505 A AU2003261505 A AU 2003261505A AU 2003261505 A AU2003261505 A AU 2003261505A AU 2003261505 B2 AU2003261505 B2 AU 2003261505B2
- Authority
- AU
- Australia
- Prior art keywords
- patella
- knee
- proximal
- medial
- border
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
- 238000000034 method Methods 0.000 title claims description 41
- 210000003127 knee Anatomy 0.000 title claims description 25
- 238000011882 arthroplasty Methods 0.000 title claims description 15
- 210000004417 patella Anatomy 0.000 claims description 30
- 210000003314 quadriceps muscle Anatomy 0.000 claims description 13
- 210000002303 tibia Anatomy 0.000 claims description 13
- 210000002414 leg Anatomy 0.000 claims description 10
- 210000000629 knee joint Anatomy 0.000 claims description 8
- 210000000577 adipose tissue Anatomy 0.000 claims description 5
- 210000000426 patellar ligament Anatomy 0.000 claims description 5
- 210000004872 soft tissue Anatomy 0.000 claims description 5
- 210000004353 tibial menisci Anatomy 0.000 claims description 5
- 210000000689 upper leg Anatomy 0.000 claims description 5
- 238000002224 dissection Methods 0.000 claims description 3
- 210000003205 muscle Anatomy 0.000 claims description 3
- 239000000835 fiber Substances 0.000 claims 3
- 210000001087 myotubule Anatomy 0.000 claims 3
- 210000000988 bone and bone Anatomy 0.000 claims 2
- 238000002360 preparation method Methods 0.000 claims 1
- 210000001519 tissue Anatomy 0.000 claims 1
- 238000011883 total knee arthroplasty Methods 0.000 description 3
- 210000003423 ankle Anatomy 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 238000003780 insertion Methods 0.000 description 1
- 230000037431 insertion Effects 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 238000011084 recovery Methods 0.000 description 1
- 231100000241 scar Toxicity 0.000 description 1
- 210000002435 tendon Anatomy 0.000 description 1
- 230000000451 tissue damage Effects 0.000 description 1
- 231100000827 tissue damage Toxicity 0.000 description 1
Description
AUSTRALIA Patents Act 1990 COMPLETE SPECIFICATION STANDARD PATENT Applicant (s) SMITH & NEPHEW, INC. Invention Title: A METHOD OF KNEE ARTHROPLASTY The following statement is a full description of this invention, including the best method of performing it known to me/us: - 2 A METHOD OF KNEE ARTHROPLASTY The present invention relates to a method of arthroplasty on a knee joint of a patient. 5 The present invention relates particularly, although by no means exclusively, to a method of total knee arthroplasty. 10 One feature of the method of the present invention is that it allows a total knee arthroplasty to be performed through an incision smaller than 10 inches, and preferably smaller than 5 inches. 15 Another feature of the method of the present invention is that it allows a total knee arthroplasty to be performed without cutting the quad tendon or everting the patella. 20 The method of the present invention is based on an anteromedial approach to knee arthroplasty to minimise the learning curve for surgeons while minimising operation recovery time, blood loss, soft tissue damage, and incision length. 25 In overall terms, the method results in a faster, less painful return to function for the patient with a relatively small scar. 30 According to the present invention there is provided a method of arthroplasty on a knee joint of a patient that is characterised by an anteromedial approach to knee arthroplasty. 35 More particularly, according to the present invention there is provided a method of arthroplasty on a knee joint of a patient that includes an arthrotomy that H,\Bkrot\Keep\upeci\2003261505.doc 28/11/03 - 3 includes dissecting from medial to the tibial tubercle and around the medial border of the patella and up to the proximal border of the patella. 5 Preferably the arthrotomy includes identifying the distal extend of the vastus medialis and determining the orientation of the fibres. Preferably the arthrotomy includes making an 10 -oblique cut into the vastus medialis and separating the muscle fibres. Preferably the method includes retracting the patella laterally to expose the knee. 15 Preferably the method includes excising the fat pad both medially and laterally and leaving a small amount of fat deep under the patella tendon. 20 Preferably the method includes dividing the anterior horn of the medial meniscus and dissecting around the proximal medial tibia. Preferably the method includes placing a 25 retractor on the proximal medial tibia and releasing the proximal soft tissue attachments extending around the proximal medial tibia. Preferably the method includes making a small 30 window along the anterior surface of the distal femur. Preferably the method includes, prior to the arthrotomy step, a step of making a longitudinal incision over the anterior aspect of the knee along the medial 35 border of the patella extending approximately from the proximal tibial tubercle to the proximal extent of the patella to approximately the patella. HM\Bkrct\Keep\speci\2003261505.doc 28/11/03 - 4 Preferably the method includes, prior to the step of making the longitudinal incision in the knee, a step of positioning the leg on the operating table so that S the knee is flexed 70" to 900. A preferred embodiment of the method of arthroplasty on a knee joint of a patient in accordance with the present invention includes the following steps. 10 1. Leg Position Appropriate leg position is an important step. During the procedure the knee is flexed to 70* to 90*. 15 Hyperextension is used only intermittently for specific parts of the procedure, such as insertion of a tibial component. In order to aid holding the leg, a sandbag may be placed across from the contra-lateral ankle when positioning the patient on an operating table. 20 2. Incision With the leg fully extended, a longitudinal incision is made over the anterior aspect of the knee 25 along the medial border of the patella. The incision extends approximately from the proximal tibial tubercle to the proximal extent of the patella to one finger's breadth proximal to the patella. 30 3. Arthrotomy Begin medial to the tibial tubercle and extend dissection around the medial border of the patella. The arthrotomy extends up to the proximal border of the 35 patella. The distal extend of the vastus medialis is Hi\Bkrot\Keep\speci\2003261505.doc 29/11/03 - 5 identified and the orientation of the fibres is determined. An oblique cut is made into the vastus medialis and the muscle fibres are then spread approximately 2 centimetres. 5 4. Exposure With the leg extended, the patella is retracted laterally. 10 The fat pad is excised both medially and laterally leaving a small amount of fat deep under the patella tendon. 15 The anterior horn of the medial meniscus is divided and dissection is carried around the proximal medial tibia using electrocautery and a boxed osteotome. A retractor is placed on the proximal medial 20 tibia. The proximal soft tissue attachments extending around the proximal medial tibia are released in a standard fashion. A small window is made along the anterior surface 25 of the distal femur with the use of electrocautery to reference the anterior cortex. 5. Other steps. 30 Other steps as required are carried out to complete the knee arthroplasty. Many modifications may be made to the preferred embodiment described above without departing from the 35 spirit and scope of the invention. H.\Skrot\Keep\Ipeci\2003261505,doc 20/11/03
Claims (13)
1. A method of arthroplasty on a knee joint of a patient that includes an arthrotomy that includes 5 dissecting from medial to the tibial tubercle, extending to a medial border of the patella, up to the proximal border of the patella, and obliquely into the vastus medialis in a direction of fibres of the vastus medialis. 10 2. The method defined in claim 1 wherein the arthrotomy further includes identifying the distal extend of the vastus medialis and determining the orientation of the fibres of the vastus medialis prior to dissecting obliquely into the vastus medialis in the direction of the 15 fibres.
3. The method defined in claim 2 wherein the arthrotomy further includes separating the muscle fibres. 20 4. The method defined in claim 3 further includes retracting the patella laterally to expose the knee.
5. The method defined in claim 4 further includes excising the fat pad both medially and laterally and 25 leaving a small amount of fat deep under the patella tendon.
6. The method defined in claim 5 further includes dividing the anterior horn of the medial meniscus and 30 dissecting around the proximal medial tibia.
7. The method defined in claim 6 further includes placing a retractor on the proximal medial tibia and releasing the proximal soft tissue attachments extending 35 around the proximal medial tibia.
8. The method defined in claim 7 further includes 2486944_1 (GHMatters) 29/11/10 - 7 making a small window along the anterior surface of the distal femur.
9. The method defined in any one of the preceding 5 claims includes, prior to the arthrotomy step, a step of making a longitudinal incision over the anterior aspect of the knee along the medial border of the patella extending approximately from the proximal tibial tubercle to the proximal border of the patella to approximately the 10 patella.
10. The method defined in claim 9 further includes, prior to making the longitudinal incision in the knee, positioning the leg on the operating table so that the 15 knee is flexed 700 to 90*.
11. A method of arthroplasty on a knee joint of a patient that is characterised by an anteromedial approach to knee arthroplasty. 20
12. A method of arthroplasty on a knee joint of a patient including: an arthrotomy step comprising dissecting beginning at a position medial to a tibial tubercle and extending to a 25 medial border of a patella and up to a proximal border of the patella, identifying the distal extend of the vastus medialis and determining the orientation of the fibers, extending the dissection with an oblique cut into the vastus medialis in a direction of the fibers and 30 separating the muscle fibers; and an exposure step comprising retracting the patella laterally to expose the knee, excising the fat pad both medially and laterally and leaving a small amount of fat 35 deep under the patella tendon, dividing the anterior horn of the medial meniscus and dissecting around the proximal medial tibia, placing a retractor on the proximal soft 2486944 1 (GHMatters) 29/11/10 - 8 tissue attachments extending around the proximal medial tibia, and making a small window along the anterior surface of the distal femur. 5 13. The method of claim 12 further including, prior to the arthrotomy, making a longitudinal incision over an anterior aspect of the knee along the medial border of the patella extending approximately from the tibial tubercle to the border of the patella to approximately the patella. 10
14. The method of claim 12 or 13 further including, prior to making the longitudinal incision in the knee, positioning a leg of the patient on an operating table so that the knee is flexed 70* to 900. 15
15. The method of claim 3 further including retracting the patella laterally without everting the patella to expose the knee. 20 16. The method of claim 9 further including during prepration of the bones, positioning a leg of the patient on an operating table so that the knee is flexed 700 to
900. 25 17. The method of claim 13 further comprising, during preparation of the bones, positioning a leg of the patient on an operating table so that the knee is flexed 700 to 900. 30 18. A method of arthroplasty on a knee joint of a patient including: identifying the distal extend of the vastus medialis and determining the orientation of the fibers; dissecting from medial to a tibial tubercle and 35 extending to a medial border of a patella, up to a proximal border of the patella, and obliquely into the vastus medialis in a direction of the muscle fibers; and 2486944_1 (GHMatters) 29/11/10 - 9 separating the muscle fibers. 19. The method of claim 18 including: retracting the patella laterally to expose the knee; 5 excising the fat pad both medially and laterally and leaving a small amount of fat deep under the patella tendon; dividing the anterior horn of the medial meniscus and dissecting around the proximal medial tibia; 10 placing a retractor on the proximal soft tissue attachments extending around the proximal medial tibia; and making a small window along the anterior surface of the distal femur. 15 2486944_1 (GHMatters) 29/11/10
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| AU2003261505A AU2003261505B2 (en) | 2003-11-09 | 2003-11-09 | A method of knee arthroplasty |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| AU2003261505A AU2003261505B2 (en) | 2003-11-09 | 2003-11-09 | A method of knee arthroplasty |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| AU2003261505A1 AU2003261505A1 (en) | 2005-05-26 |
| AU2003261505B2 true AU2003261505B2 (en) | 2010-12-16 |
Family
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Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| AU2003261505A Expired AU2003261505B2 (en) | 2003-11-09 | 2003-11-09 | A method of knee arthroplasty |
Country Status (1)
| Country | Link |
|---|---|
| AU (1) | AU2003261505B2 (en) |
Citations (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20030130665A1 (en) * | 2000-03-10 | 2003-07-10 | Pinczewski Leo Arieh | Method of arthroplastly on a knee joint and apparatus for use in same |
-
2003
- 2003-11-09 AU AU2003261505A patent/AU2003261505B2/en not_active Expired
Patent Citations (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20030130665A1 (en) * | 2000-03-10 | 2003-07-10 | Pinczewski Leo Arieh | Method of arthroplastly on a knee joint and apparatus for use in same |
Also Published As
| Publication number | Publication date |
|---|---|
| AU2003261505A1 (en) | 2005-05-26 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| FGA | Letters patent sealed or granted (standard patent) | ||
| MK14 | Patent ceased section 143(a) (annual fees not paid) or expired |