EA007729B1 - Apparatus for hip joint surgery - Google Patents

Apparatus for hip joint surgery Download PDF

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Publication number
EA007729B1
EA007729B1 EA200501303A EA200501303A EA007729B1 EA 007729 B1 EA007729 B1 EA 007729B1 EA 200501303 A EA200501303 A EA 200501303A EA 200501303 A EA200501303 A EA 200501303A EA 007729 B1 EA007729 B1 EA 007729B1
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EA
Eurasian Patent Office
Prior art keywords
end
prosthesis
patient
femur
femoral
Prior art date
Application number
EA200501303A
Other languages
Russian (ru)
Other versions
EA200501303A1 (en
Inventor
Юджин Шерри
Майкл Иган
Original Assignee
Интернэшнл Пэйтент Оунерз (Кайман) Лимитед
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Publication date
Priority to AUPR8657A priority Critical patent/AUPR865701A0/en
Priority to AUPR943401 priority
Application filed by Интернэшнл Пэйтент Оунерз (Кайман) Лимитед filed Critical Интернэшнл Пэйтент Оунерз (Кайман) Лимитед
Publication of EA200501303A1 publication Critical patent/EA200501303A1/en
Publication of EA007729B1 publication Critical patent/EA007729B1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657Measuring instruments used for implanting artificial joints
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14Surgical saws ; Accessories therefor
    • A61B17/15Guides therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1604Chisels; Rongeurs; Punches; Stamps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1664Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip
    • A61B17/1666Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip for the acetabulum
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A61B17/1746Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip for the acetabulum
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8866Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92Impactors or extractors, e.g. for removing intramedullary devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A61B17/175Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip for preparing the femur for hip prosthesis insertion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/885Tools for expanding or compacting bones or discs or cavities therein
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/32Joints for the hip
    • A61F2/34Acetabular cups
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4684Trial or dummy prostheses
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30537Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/30538Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting angular orientation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/32Joints for the hip
    • A61F2/36Femoral heads ; Femoral endoprostheses
    • A61F2/3609Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/3611Heads or epiphyseal parts of femur
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4619Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof for extraction
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4623Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof having a handle portion, e.g. integral with the implanting tool
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4687Mechanical guides for implantation instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0004Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
    • A61F2250/0006Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting angular orientation

Abstract

The surgeon grasps the jig (140) by its handle (141) and manipulates the head (210) of the jig through the patient wound and onto the femoral neck (4), as best illustrated in figure 67. The head (210) of the jig (140) includes jig location means in the form of an elongate rod which acts as a spacer (142). The spacer (142) has an end (211) which abuts the trochanteric fossa so as to position the slot (143) of the jig (140) at the required position, which, in the preferred embodiment, is between 5mm and 25mm, and most preferably 15mm, from the trochantic fossa. Additional jig location means are provided by a surface (212) adapted to receive a bone formation. This surface (212) is provided by contours (146) on the base of the head (210) which are adapted to mate with contours of the femur. The slot (143) is oriented generally perpendicularly to the elongate dimension of the rod (142). The slot (143) functions as a surgical tool guide means which is positioned by the jig (140) at the correct position for osteotomisation of the neck (4). Advantageously, osteotomisation takes place whilst the femoral head (3) is still disposed within the acetabulum.

Description

The present invention relates to a surgical device for use in hip joint endoprosthesis replacement surgery, and in particular, relates to a device adapted for use in surgical operations on patients of various anatomical structures.

Description of the prior art

In the known methods of performing a hip joint arthroplasty, the surgeon usually first makes a large initial incision to expose the hip joint. Then the surgeon usually performs a manipulation of the patient's leg to dislodge the femur. It is often necessary to make a significant effort to effect the bias. Excessive manipulation and application of force can cause collateral damage to the patient, and this can lead to postoperative pain and / or increase the healing period. Then the head of the femur is cut along the neck. In the femoral joint, the cavity is expanded to receive the prosthesis of the acetabular cup (for example, type L-ΙΝΚ THOR), and a prosthesis of the femoral stem is inserted into the body of the femur (for example, type C.Е.Р.). Usually, the surgeon focuses the cutting and spreading tools on the eye, which can lead to minor shifts. Therefore, after installing the prosthesis, there may be visually imperceptible inconsistencies between the prosthesis of the acetabular cup and the prosthesis of the femoral head. As a result, problems such as leg displacement, abnormal leg length and / or abnormal soft tissue tension can occur. In addition, ultimately, inconsistent components of the prosthesis can wear out much faster, which leads to aseptic weakening of the components and may necessitate a repetition of the operation, (see, for example, υδ 5601563A (VINKE e! A1.) From 11.02.1997, ϋδ 5709689A ( ΕΕΗΗΑΝΤΕ e! A1.) Of 01/20/1998, ϋδ 5916220А (ΜΑ8ΙΝΙ) of 06/29/1999, υδ 5980526A (ΙΟΗΝδΟΝ e! A1.) Of 09.11.1999, EP 466659 A2 (O. SNEMA8CO1 8.N.L.) of 01/15/1992).

Any discussion of a known level in this description should in no way be considered as an assumption that it is either widely known or forms part of general knowledge in this field.

Summary of Invention

The basis of the present invention is the task to overcome or reduce at least one of the disadvantages of a known level or create a useful alternative.

According to one aspect of the invention, a device is proposed for use in a surgical operation of a hip joint arthroplasty, which comprises a spacer having a first end with a hole for receiving a prosthetic leg of the femur, a guiding means at the first end, a mounting surface forming one side of said first end, and the mounting surface adapted to engage the acetabular cup prosthesis to determine the displacement of the cup and leg, so that when using the cup was in this ratio with the acetabulum of the patient.

Preferably, the mounting surface defines a plane for mating with the corresponding prosthesis plane of the acetabular cup. The spacer may further comprise a handle extending from said first end, and said plane forms an acute angle in the range of 5 to 25 °, more preferably 15 °, with the plane formed by the handle extending from the first end.

In one embodiment, the plane is formed by a semicircular surface, and said hole has a groove capable of receiving the end of the prosthesis of the femoral leg, protruding from the osteotomized neck of the femur.

The guide means may comprise a plurality of guide marks to determine the required position of the acetabular cup to facilitate the expansion of the patient's acetabulum. Alternatively, or additionally, the guide means comprises an orientation directioning means capable of indicating whether the mounting surface is in a predetermined ratio with the acetabulum of the patient.

In one embodiment, the spacer comprises an installation handle having a body forming a distal end and a proximal end, an indicator located at or near the proximal end, and a connector located at or near the distal end for attaching the acetabular cup prosthesis, and the indicator is able to indicate whether the prosthesis of the acetabular cup is in a given orientation with respect to at least the first plane in the control system.

In accordance with another aspect, a method is proposed for extracting an osteotomised femoral head from a patient's hip joint, which consists in performing one or both of the following operations:

a) drill a hole in the femoral head, screw the self-tapping threaded element into the hole, and exert an outward force on the threaded element, which in turn affects the femoral head, and / or

- 1 007729

B) wedge the end of the spoon under the head of the femur and use the spoon as a lever to act with an outward force on the head of the femur.

In another aspect, a method is proposed for inserting an acetabular cup prosthesis into an extended acetabulum of a patient, comprising:

a) install the prosthesis of the acetabular cup on the installation tool of the cup,

b) manipulate the cup installation tool so that the prosthesis of the acetabular cup is located next to the extended acetabulum,

c) orient the cup installation tool so that the prosthesis of the acetabular cup is in an anatomically correct orientation for insertion into the extended acetabulum, and

b) drive a cup of the acetabular prosthesis into the extended acetabulum.

Preferably, the cup installation tool has an installation handle, as described above, and said indicator is used in step c) to determine whether the prosthesis of the acetabular cup is in said anatomically correct orientation relative to the first plane.

In accordance with the following aspect of the invention, a method is proposed for determining the size of the length of a cervical prosthesis during a hip joint arthroplasty operation, which consists in:

a) install the prosthesis of the femoral leg in the femur of the patient so that the end of the femur leg protrudes from the end of the femur,

b) place a test head on the end of the prosthesis of the femoral stem,

c) use a spacer installation tool to position the spacer between the test head and the end of the femur,

b) orient the installation tool so that the probe head is in an anatomically correct orientation,

e) check the anatomical correctness of the length of the leg, and / or tension of the tissues, and / or the tension of the muscles of the patient,

ί) repeat steps c), b) and e) with spacers of different thickness or with different number of spacers until the patient’s foot length and / or tissue tension and / or muscle tension is anatomically acceptable, and take note strut thickness or the number of struts that gives the best result, and

e) correlate the spacer thickness or the number of spacers determined in step ί) with the required cervical prosthesis length according to a predetermined correlation pattern.

In accordance with another aspect, a method is proposed for performing a hip joint arthroplasty operation on a patient, namely, that

a) expose the first femoral bone formation and the second femoral bone formation of the patient,

b) impose a clamp having means of guiding the surgical instrument on the first femoral bone formation so that the means of guiding the surgical instrument is near the second femoral bone formation,

c) using a surgical instrument guiding tool to guide the cutting tool to perform an osteotomy of the second bone formation, and

b) remove the severed femoral head from the patient's hip joint.

Brief Description of the Drawings

Hereinafter, preferred embodiments of the present invention will be described in more detail, by way of example only, with reference to the accompanying drawings, in which FIG. 1 is a perspective view of a clip according to one embodiment of the present invention; FIG. 2 is a plan view of the clamp shown in FIG. 1, fig. 3 is a side view of the clamp shown in FIG. 1; FIG. 4 is a front view of the clip shown in FIG. 1; FIG. 5 shows a large skewer, neck and head of the femur with marks illustrating the places in which three existing incision lines intersect the neck of the femur, and the method of engaging the clamp with the formations on the femur, FIG. 6 is a perspective view of a strut; FIG. 7 is a plan view of the strut shown in FIG. 6; FIG. 8 is a perspective view of a spoon; FIG. 9-16, inclusive, are views showing some of the steps of a preferred method for performing a hip joint arthroplasty, where FIG. 15 and 16 are schematic diagrams; FIG. 17 - femur, FIG. 18 is a plan view of another strut; FIG. 19 is a side view of the strut shown in FIG. 18, FIG. 20 is a front view of an alternate strut; FIG. 21 is a top view of the strut shown in FIG. 20,

- 2 007729 of FIG. 22 is a left side view of the struts shown in FIG. 20, FIG. 23 is a front view of another alternative strut; FIG. 24 shows, on an enlarged scale, a part of the spacer with an illustration of the method of hooking the prosthesis of the acetabular cup, FIG. 25, 26 and 27 are side views, in plan and from the end of another embodiment of a clip according to the present invention; FIG. 28 is a plan view of the drill; FIG. 29 is a plan view of a spoon; FIG. 30 is a plan view of the extractor; FIG. 31 and 32 are views of the piercer in plan and side, respectively; FIG. 33 and 34 are plan views of a left and right cup holder, FIG. 35 is a plan view of the handle assembly; FIG. 36 is a plan view of the installation handle; FIG. 37 and 38, respectively, views of the first strut from the side and in plan; FIG. 39 and 40 are respectively views of the second strut from the side and in plan; FIG. 41 and 42 are views of the third spacer from the side and in plan, respectively; FIG. 43 and 44 are respectively views of the mounting frame from the side and in plan; FIG. 45 is a sectional view of the piercer assembly; FIG. 46 and 47 are respectively views of a screwdriver key from the side and in plan; FIG. 48 and 49 are respectively side views and in plan of the rotary head of the screwdriver key shown in FIGS. 46 and 47; FIG. 50 and 51 are plan views of spacer elements for operation on the left and right hip joint, respectively, FIG. 52 and 53 are, respectively, views of an additional spacer of average width in plan and from the end; FIG. 54 and 55 are respectively views of the additional spacer of large width in plan and from the end, FIG. 56 is a side view of a pin extractor; FIG. 57 and 58 are respectively views of the pin in plan and from the end, FIG. 59-62 - types of screws in the plan; FIG. 63, 64 and 65 are views of another embodiment of the clip according to the invention from the side, top and end, respectively, FIG. 66 is a perspective view of the patient immediately before the start of the operation of a hip joint endoprosthesis, showing the pelvic holder and the place of the initial incision relative to the protrusion of the greater trochanter; FIG. 67 is a perspective view of a clamp according to a second embodiment of the invention, applied to the femur prior to the osteotomy of the femoral neck; FIG. 68 is a perspective view showing the end of the extractor shown in FIG. 30 applied to an osteotomized femoral head; FIG. 69 is a perspective view of a portion of a prosthesis installation tool of the acetabular cup applied to the acetabulum of the patient, and FIG. 70 is a perspective view showing a portion of a spacer installation tool attached to a patient's acetabulum.

Detailed description of preferred embodiments of the invention.

FIG. 1 shows a surgical clamp 1 designed to be applied to the femur 2, as best seen in FIG. 17, the femur 2 contains the head of the femur 3, the neck 4 of the femur, which often, though not always, serves as an incision, and the large skewer 5. If the surgeon uses hip joint prostheses of the ot.o. R. and prostheses of the femoral leg of the CEPP type, it is necessary to osteotomize (in other words, cut off) the head of the femur 3, and the incision is made along the line transverse to the neck of the femur, approximately 1.5 cm from the base of the greater trochanter 5. Of course, other prostheses, such as prostheses of the ΜΆΚΟΚΘΝ TNK and 8P2 brand, may require an incision in other parts of the femur 2, for example, on a large skewer 5. For such applications, the geometry of clamp 1 is adapted accordingly.

The clamp 1 comprises a clamp placement means 6 capable of mating with bone formations 3, 4 and 5 in order to place the clamp 1 in a predetermined relationship with the bone 2. Clamp 1 also has a tool 7 for guiding a surgical instrument, positioned relative to the clamp placement means 6 that when clamp 1 is associated with bone formations 3, 4 and 5, the means of guiding the surgical instrument are capable of guiding the surgical instrument, for example, the blade making a reciprocating motion, to a certain place on bone formation.

The clamp 1 has a housing 8. One aspect of the clamp placement means 6 is implemented in the form of first and second opposing brackets 9 and 10 located on the housing 8. Brackets 9 and 10 are able to mate with the neck 4 of the femur. Each brackets 9 and 10 have a longitudinal dimension, oriented so that when clamp 1 mates with the neck 4 of the femur, the longitudinal dimension of brackets 9 and 10

- 3 007729 oriented in almost the same direction as the longitudinal measurement of the neck 4 of the femur. This is best seen in FIG. 5, where lines 11 and 12 show the places where braces 9 and 10, respectively, engage with the neck of the femur. Staples 9 and 10 snap onto the neck 4 of the femur. Each bracket 9 and 10 has an arcuate shape with a center of curvature extending along a longitudinal dimension.

Another aspect of the clamping direction means 6 is a surface 13 capable of receiving bone formation, such as the femoral head 3. In a preferred embodiment, the surface 13 has the shape of an inverted V, as best seen in FIG. The surface 13 in the form of an inverted V is formed by an element 14 in the form of an inverted V, mounted on the housing 8 through the transverse element 16. The element 14 in the form of an inverted V is transversely relative to the brackets 9 and 10. The part of the femoral head 3, on which the element 14 is superimposed in the form of an inverted V, shown by lines 15 in FIG. five.

Another aspect of the clamp placement means 6 is the side wall 17 of the housing 8, the shape of which allows it to mate with a bone formation. More specifically, the side wall 17 has an arcuate shape with a curvature of a shape that fits to the natural curvature of the large skewer 5. The line along which the side wall 17 is almost adjacent to the natural curvature of the large skewer 5 is best shown by line 18 in FIG. five.

Thus, the preferred clamping variant shown in FIG. 1-5, mates with bone formations on the femur 2 through brackets 9 and 10, which engage the femoral neck, the V-shaped element that engages part of the femoral head, and the arcuate lateral wall 17, adjacent to the natural curvature of the greater trochanter.

These accommodation tools together allow the clamp 1 to be placed precisely on the femur 2 and held in this position to help with the osteotomy of the neck 4 of the femur. Alternatively, the clamp 1 can be oriented in another way, so that the element 14 in the form of an inverted V is adjacent to the neck 4 of the femur, and the brackets 9 and 10 to the head of the femur. The clamp 1 can be further secured in position by inserting one or more fasteners, such as pins, through the housing 8 or the brackets 9 and 10 into the head 3 of the femur. In this case, damage to the femoral head 3 with fasteners does not matter, as the head 3 must be osteotomized. Fixing the clamp 1 by inserting the pins into the head of the femur 3 can be used as an aid in removing the femoral head after making the incision, as will be described in more detail below.

In the embodiment shown in FIG. 1-5, the tool 7 means the direction of the surgical instrument is placed between the element 14 in the form of an inverted V and staples 9 and 10. It prevents the clamp 1 from rotating or moving under the force that can be transferred from the surgical tool to the clip 1. The tool 7 means the direction of the surgical tool the shape of one or more grooves 20 located inside the housing 8. The preferred embodiment has three grooves 20. Each groove is located in a different transverse direction on the housing 8 to allow the surgeons to guide the grooves 20 The tool is more than one predetermined spot on the bone formation. Specified places are chosen in such a way as to correspond to prostheses of various sizes. For example, for one type of prosthesis, an osteotomy of the femoral neck 4 is required at a position 1.5 cm from the base of the greater trochanter 5, therefore one of the slots 20 is positioned so as to guide the surgical instrument to this position. Each groove 20 extends transversely through the housing 8 and is capable of receiving and guiding a surgical instrument, such as a blade, making a reciprocating motion, such as a hacksaw saw. The position of the grooves 20 after the clamp 1 has been mated to the femur 2 is shown by lines 21 in FIG. 5. Other preferred options (not shown) are adapted to guide other tools, for example, one directional tool can be made in the form of a hollow cylindrical element capable of guiding a rotating drill bit.

Although not shown in FIG. 1-4, the preferred embodiment has a handle located on the housing 8. The handle is long enough to protrude out of the patient's body when clip 1 is associated with bone formation. This allows the surgeon to manipulate the clamp 1 outside the patient's body to interface with the femur 2.

The preferred method of performing a surgical operation is particularly suitable for the operation of a hip joint in cases of osteoarthritis, rheumatoid arthritis and osteonecrosis. However, it is usually not recommended in the following circumstances: for use on patients with large anatomical deformities of the head or neck of the femur, or if the patient is obese, which makes it difficult to palpate anatomical bindings.

During the preferred method of performing a hip joint endoprosthesis replacement operation on a patient, a posterior-lateral surgical approach is preferred, although other approaches are also possible. Indeed, other surgical approaches may be required if the posterolateral approach is contraindicated, for example, because of a previously severely injured sciatic nerve.

- 4 007729

The implementation of the preferred method begins with stage a), the exposure of the greater trochanter 5 and neck 4 of the femur of the patient. To do this, an initial incision is made on the patient's hip from 3 to 7 cm long, preferably 5 cm. One end of the incision starts approximately 1-3 cm behind the large skewer 5 and bends backwards from it. The posterior side of the femoral neck 4 is opened by separating the patient’s triceps muscle tendon, which can be marked for subsequent reattachment. Also make excision of the capsule to completely expose the neck 4 of the femur. It should be noted that at this stage the head 3 of the femur does not move. The patient's leg is held in a position of approximately 45 ° relative to the vertical, preferably with the help of a footholder. The surgeon may also use a frontal illuminator.

In step b), a clamp 1 having a means 7 for guiding a surgical instrument is placed on the femur 2 so that the means 7 is located near the neck 4 of the femur, as shown in FIG. 9. In this case, the clamp 1 preferably has the configuration described above. Proper mating of the clamp 1 with the femur 2 causes the tool 7 direction of the surgical instrument to be located approximately at a predetermined distance from the base of the greater trochanter 5. More specifically, the predetermined distance is from 10 to 20 mm, and in a preferred embodiment at least one of the grooves 20 are located at a distance of 15 mm from the base of the large skewer 5.

Optionally, the surgeon can make a notch 22 on the neck 4 on the side of the head 3 of the femur in place 26 of the osteotomy incision to facilitate the consistent removal of the head of the femur from the acetabulum. The incision 22 is preferably made before the osteotomy incision. It can be done by lightly hitting the blade with the blade on the neck 4 or the head 3 of the femur.

In step c), a means of guiding the surgical instrument is used to guide the cutting tool to osteotomize the femoral neck. Usually, the saw blade is fed through one of the grooves 20 in order to position it on the neck 4 of the femur at the site of the osteotomy, although other cutting tools can be used. The saw is then turned on to perform a reciprocating movement, and the saw blade gradually moves across the neck of the femur 4, as directed by the groove 20, until the head 3 and part of the neck of the femur 4 are osteotomized.

In step b), the severed head of the femur is removed from the patient’s hip joint. For this you can use a number of different methods. For example, the spoon 23 shown in FIG. 8, to extract the severed femoral head 4 from the joint. The notch 22 can be a convenient place from which it is possible to lift the head of the femur 3 with the help of a spoon 23, as shown in FIG. 10. The portion 24 of the spoon 23 has a cutting tool, such as a sharpened edge, which helps cut the tendon 25, which holds the femoral head 3 inside the hip joint 26. The hardened edge 24 is positioned between two projections 27 and 28, which help the surgeon to manipulate the spoon 23 in such a way so that the sharpened edge 24 goes towards the tendon 25. In other words, the surgeon places the spoon 23 so that the projections 27 and 28 are on both sides of the tendon 25, then the spoon is shifted along its longitudinal axis in the direction of the tendon 25 so that Paradise 24 cut the tendon 25.

An alternative method of removing the femoral head 4 can be used if the clamp is fixed with pins on the femoral head 3, as mentioned above. In this case, you can apply a force to the clamp 1, which is transmitted through the pins to the head 3 of the femur. In some cases, this effort alone may be sufficient to remove the femoral head 3 from the hip joint. In other cases, this effort may help another removal tool, such as the spoon 23, mentioned above.

Professionals will understand that osteotomy of the neck 4 of the femur before removing the severed head 3 of the femur eliminates the need for prior displacement of the hip joint, which is characteristic of a known level, and this eliminates or reduces possible damage and simplifies the surgical procedure. After removal of the severed femoral head 3, the operation of the hip joint arthroplasty can be completed according to a known technique. However, several additional enhancements to a known surgical procedure will be described below.

A known method of implanting a femoral prosthesis into the body of the femur involves inserting a bone rammer into the femoral canal. An alternative preferred method is proposed in which

e) put the guide wire 29 in the femoral canal 30 of the body 31 of the femur of the patient (see 11),

1) use guide wire 29 to guide the flexible reamer 32 to drill a hole in the femoral canal 30, and

d) insert the prosthesis of the femoral leg 33 into the opening so that the first end 34 of the prosthesis of the femoral leg 33 protrudes from the end of the body 31 of the femur. Alternatively, you can use

- 5 007729 removable test leg instead of the final femoral leg 33. Then, after checking the hip joint and obtaining a satisfactory result, the actual components are implanted in place of the removable test components.

In the known method of expanding the cavity in the acetabulum, the expansion tool is installed on the eye. On the contrary, the preferred stage of expansion of the acetabulum for receiving the prosthesis of the acetabular cup is that

11) place the first end 34 into the acetabulum of the patient, 1) insert spacers 35 (also called lollipops) between the end of the femur body 31 and the acetabulum,

_)) use the strut 35 to determine the control points 36 on the patient's acetabulum (see Fig. 12), and

j) use control points 36 to provide directions for expanding the acetabulum.

More specifically, in step 1) spacers 35 are used, examples of which are shown in FIG. 6 and 7. The purpose of their application is to place the femur approximately in the position that it will assume after the end of the operation. The marks 40 on the struts 35 serve to define the control points in the step _)). Preferably, the test points 36 are burned onto the acetabulum using a heating element that functions like a heated soldering iron tip. The spacers 35 have a handle 37 and a groove 38 for placement on the first end 34 of the prosthesis of the femoral leg 33.

The center of the control points 36, defined in stage _)), is the starting point for the extension of the acetabulum in stage k). This is a more accurate and consistent alternative to the known method of expansion, in which they are oriented towards the eye.

Another example of struts 100 that can be used in steps 1) and C is shown in FIG. 20-24. These struts 100 have an outer peripheral edge 123, the radius of curvature of which essentially corresponds to the radius of curvature of the prosthesis of the acetabular cup 104. In a preferred embodiment, the radius of curvature of the outer circumferential edge 123 corresponds to the radius of curvature of the smallest cup from the set of prostheses of the cups 104 of the acetabulum. At stage _)), the surgeon uses edge 123 as a guide when burning test points 36 on the acetabulum before expanding at stage k).

In a known method of performing a hip joint arthroplasty operation, the surgeon professionally assesses the required size of the components of the prosthesis, namely the length of the neck / head and the size of the prosthesis of the acetabular cup. The hip joint is then temporarily assembled using test components having an estimated size. If the resulting test joint is not satisfactory, for example, due to improper tissue tension, it is disassembled and test components of a different size are used. The preferred method provides an alternative to this known procedure by using spacers 35. As best seen in FIG. 18, one or more struts 35 or 45 have a central spherical surface 48, which follows the shape of the femoral head, to perform the function of the test femoral head. In some embodiments, the spherical surface 48 is a hemisphere corresponding to a portion of the head of the prosthesis. A spacer 35 or 45, having a spherical surface 48, is positioned on the first end 34 of the prosthesis of the femoral leg 33, closest to the acetabulum, so that the spherical surface 48 faces the acetabulum. The thickness 39 of each strut 35 is chosen with respect to the dimensions of the available prosthesis components. For example, one known component of an endoprosthesis has three sizes: 40 mm, 43.5 mm and 47 mm. In this case, the thickness 39 of at least two spacers 35 is 3.5 mm in order to correspond to the size of the increments between the existing components of the prosthesis. These two struts have flat parallel surfaces 46 and 47. The effect of using different size endoprosthesis components can be copied using different numbers of struts 41 or struts 41 of different thickness. For example, FIG. 14 shows the edges of three spacers 35 superimposed on the first end 34 of the prosthesis of the femoral stem 33. Thus, the distance achieved using the component of the prosthesis 47 mm in size is copied. If two spacers 35 are used, they copy the distance associated with the 43.5 mm prosthesis component, etc. As best seen in FIG. 14, the other strut 45 has a wedge shape. This wedge-shaped shape determines the anteversion (or orientation) of the prosthesis of the acetabular cup and the prosthesis of the femoral stem. Reverse wedge shape is required if anterior or antero-lateral surgical approach is adopted. The tapered shape tapers from a maximum width of 14 mm to a minimum width of approximately 3.5 mm.

Other forms of the spacers 100 for adjusting the anteversion of the prosthesis of the acetabular cup 103 are shown in FIG. 20-24. The spacer 100 has a handle 101, forming the first end 102. The installation means 103 is located at or near the first end 102. The mounting means 103 is able to mate with the prosthesis of the acetabular cup 104, so that when used, the cup 103 is in a predetermined ratio with the acetabulum of the patient.

The mounting means 103 forms a plane 105 capable of adhering to the corresponding plane 106 of the prosthesis of the acetabular cup 104. The setting means 103 has a means of engagement in the form of one or more brackets 119 capable of engaging with the internal concave

- 6 007729 surface 120 of the prosthesis cups 104 of the acetabulum. The plane 105 is formed by a semicircular surface 107 and is located at an acute angle 111 relative to the plane 112 formed by the handle 101. Therefore, the installation tool 103 takes the form of a wedge-shaped element 110 located at the first end 102. The angle 111 is preferably from 5 to 25 °. More preferably, the angle 111 is from 10 to 20 °, and in a preferred embodiment, the angle 111 is approximately equal to 15 °. This angle 111 is chosen in such a way as to correspond to the natural angle of inclination of the hip joint.

In a preferred embodiment, the geometry of the installation means relative to the handle is chosen so that it corresponds to the posterior lateral surgical approach for surgery on the hip joint. Of course, other surgical approaches may require slightly modified geometry, for example in FIG. 23 shows a different handle geometry as compared to FIG. 20, which is more suitable for other surgical approaches. A common task is to ensure that when the strut 100 is applied to the open end 34 of the femoral prosthesis 33, the installation means 103 position the prosthesis of the acetabular cup 104 with anteversion essentially identical to the desired anteversion of the acetabular prosthesis cup 104 after the operation.

The alignment means 103 has a groove 108 that is able to receive the protruding end 34 of the prosthesis of the femoral leg 33. When the end 34 of the femoral leg 33 is placed inside the groove 108, the spacer 100 engages with the femoral leg 33 just as the spacer 45 engages with the end 34 of the femoral stem in FIG. 14.

The angular inclination of the prosthesis of the acetabular cup relative to the prosthesis of the femoral stem 33 should mirror and reflect as closely as possible the natural geometry of the hip joint. When the spacer 100 rotates around the axis of rotation 118, the inclination direction changes at an angle of 15 °. In order for the surgeon to determine whether the installation tool 103 is located in a predetermined ratio with the patient's acetabulum, the orientation guidance tool 109 is placed on the strut 100 or near its second end 113. The orientation guidance tool 109 has a plumb 114, which is located rotatably on the strut 100 and hangs down almost vertically by gravity. The plummet 114 is rotatably attached to the circular element 115 of the spacer 100 by means of a pin 116. The test point 117 is located on the strut 100 in such a way that the plumb 114 hangs down over the control point 117 when the installation tool 103 is located in a predetermined ratio with the acetabulum of the patient. In other words, when the spacer 100 assumes a predetermined rotational position relative to the axis of rotation 118, the plumb line 114 hangs over the control point 117, as seen in FIG. 20 and 23. Therefore, if the patient is lying on its side, the groove 108 is aligned with the end 34 of the femoral prosthesis and the strut 100 rotates around the axis 114 until the plumb 114 is aligned with the reference point 117, and the prosthesis of the acetabulum cup 103 will have the required anteversion with respect to the femoral stem 33. That is, with proper use, the spacer ensures that the wider end 121 of the wedge-shaped element 110 will be located in the direction of the patient's front side, and the narrow end 122 in the direction of the patient's back side. Thus, the inclination of 15 ° is directed towards the external front side of the patient, mirroring the natural geometry of the hip joint.

More specifically, the preferred method for determining the required size of the component of the prosthesis is as follows:

1) place the test head 41 on the first end 34,

t) place the test cup 42 of the acetabulum in the extended acetabulum (see Fig. 13),

n) placing the test head 41 in the test cup 42 of the acetabulum, and

o) insert one or more spacers 35 between the end of the femur body 31 and the test head 41 until the required fit is reached between the test head 41 and the acetabulum test cup 42 (see Figures 13,14,15 and 16 ), and

p) correlate the number or size of spacers 35 with the required size of the component of the prosthesis.

The surgeon determines in step o) whether the necessary fit between the test head 41 and the acetabulum test cup 42 has been achieved by examining such factors as tissue tension, component alignment, and foot length. After determining the required size of the component of the prosthesis in step p), the trial components 41 and 42 of the prosthesis (FIG. 15) are replaced with the final components 43 and 44 of the prosthesis (FIG. 16), although at this point the acetabulum cup is not fixed. Further use of the spacers 35 makes it possible to determine the exact and final orientation of the cup 44 relative to the femoral leg 33, then the cup 44 is firmly strengthened for a permanent fit into place. In the prosthesis cup 44 of the acetabulum insert a gasket, and then the head 43 of the prosthesis and set it down. After confirming the range of motion of the new joint, the layers are closed and the tendon of the triceps is reattached.

FIG. Figures 25-65 depict tools that together form an option for performing a preferred procedure for hip arthroplasty. The tool kit includes a second version of the clamp 140 (Fig. 25-27) for laying on the femur 2 in the acetabulum

- 7 007729 to create a place for osteotomy of the neck 4 of the femur. This preferred procedure begins with the patient being placed in a lateral position in which the operated side is on top, as shown in FIG. 66. It is preferable to use the pelvic holder 230 to keep the patient in the desired position. In addition, before the operation and during it, it is preferable to lower the temperature of the limb of the patient.

The opening of the operation site begins with an incision of approximately 5 cm in length along line 231, approximately 2 cm behind the protrusion (shown by line 232 in Fig. 66) of the greater trochanter 5. Then the incised fascia is incised, and the surgeon performs a blunt dissection until neck 4 of the femur 2 does not open. Self-retaining retractors are used under the skin line and in the gaps. The back of the neck 4 of the femur is opened by detaching the tendon of the triceps and short external rotator muscles, which are tagged for later attachment. Excision of the capsule opens the trochanteric fossa (i.e., the base of the greater trochanter 5), and also opens the neck 5 of the femur, and then the available osteophytes of the hinge cavity are removed. In contrast to the known methods of hip arthroplasty, at this moment the head 3 is not removed. The surgeon can use a headlight to increase visibility. Preferably, any irrigation fluid used during the operation is cooled to reduce bleeding.

The foot is placed in the foot holder and held at an angle of 45 ° to the vertical. The surgeon takes the clamp 140 by the handle 141 and manipulates the clamp head 210 in the patient's wound and on the neck 4 of the femur, as shown in FIG. 67. The head 210 of the clamp 140 comprises means for accommodating the clamp in the form of an elongated rod, which acts as a spacer 142. The spacer 142 has an end 211 that rests against the spitting hole to place the groove 143 of the clamp 140 at a predetermined position, which is preferably at a distance from 5 to 25 mm and more preferably 15 mm from the trochanteric fossa.

The first embodiment of the clamp 140 shown in FIG. 67, is intended for use on the patient's left hip joint. Another option clamp 140 is designed for use on the patient's right hip joint. The only significant difference between these options is that the spacer 142 is located on opposite sides of the head 210.

Additional clamp placement means are provided by a surface 212 capable of receiving bone formation. This surface 212 has contours 146 at the base of the head 210, which are able to mate with the contours of the femur.

After the clamp is properly positioned, the locking means, such as the pins 243 shown in FIG. 57 and 58, is passed through the holes 144 in the head 210 of the clip 140 into the head of the femur 3.

The groove 143 is oriented at an acute angle to the longitudinal dimension of the rod 142, and this angle depends on the desired angle of incision corresponding to the specific components of the prosthesis used in this operation. The groove 143 performs the function of guiding the surgical instrument, which is placed by the clamp 140 in the correct position for the osteotomy of the neck 4. As noted earlier, the osteotomy is performed when the neck 3 of the femur is still in the acetabulum. If necessary, the surgeon may also perform a secondary proximal wedge osteotomy.

After osteotomy of the neck 4, the head 3 of the femur is bent forward and removed using one or more possible variants. The drill bit 147 shown in FIG. 28, for drilling a hole 233 in the head 3 of the femur. Then, a self-tapping threaded element 148 of the extractor 149 is screwed into the hole 223 by screwing the handle 150. After entering the head 3 of the femur, the surgeon exerts an outward force on the handle 150, which in turn acts on the head 3 of the femur to remove it. Another option, which can optionally be used with extractor 149, is provided with a spoon 151. The distal end tapers to an edge that can be stuck under the head 3 of the femur to aid in removing the head 3 from the acetabulum. The tapered end 152 can also be used to dissect the tendon that holds the head 3 in the acetabulum. Other removal options include incision, or dissection, of the head 3.

For the next stage of the operation, the patient's leg is fixed perpendicular to the operating table. The proximal femur is prepared according to a standard technique using the awl trocar and guide. Pointed retractors (such as Notapi) are placed on each side of the neck 4 of the femur. Alternatively, a wide blunt retractor under the neck 4 can be attached to lift it.

The bone rammer is mounted on the piercer 153 on the leading surface 154 and fixed with a pin 156. The bone rammer is inserted into the longitudinal axis of the femur with the aid of the piercer 153 with the blows of a surgical hammer or other suitable tool on the proximal end of the 157. This process forms an empty space in the femoral canal for the subsequent introduction of the prosthesis of the femoral leg 34 (see below). The leading surface 154 of the piercer 153 is shifted away from the elongated longitudinal element 155 in order to facilitate the surgeon to introduce bone

- 8 007729 tamping in the right direction with the fit of the piercer 153 and its manipulation through the wound of the patient. This reduces the risk that the bone rammer will be inserted into the femur at an angle and the outer end of the femur may crack. Then use the roasting dilator to create a circular plane at the end of the neck 4. After that, the femur is ready for the introduction of the prosthesis of the femoral leg, which is done after inserting the prosthesis of the acetabular cup, as will be described below.

The surgeon then places the patient's limb in a neutral position on the operating table to prepare for the expansion of the acetabulum. The sharp extractor is placed on the front edge of the acetabulum. Then the acetabulum is gradually expanded by increasing the diameters.

To insert the acetabular cup prosthesis into the extended acetabulum, the cup fitting tool 167 is assembled from the following three components: the installation handle 159 shown in FIG. 36, the handles 213 shown in FIG. 35, and the left or right cup holder 158 of the cup shown in FIG. 33 and 34, respectively. The installation handle 159 has a housing 182, which forms the distal end 161 and the proximal end 223, and between them is the handle 182. At the proximal end 223 there is a plumb-shaped indicator 172. The plumb indicator 172 is able to show whether the prosthesis of the acetabular cup is in the specified orientation relative to at least the first plane in the control system. The connector, which contains the sleeve 163 with internal thread, is located at the distal end 161.

Depending on the situation, the left or right cup holder 158 is attached to the installation handle 159 through fastening means 160 located at the proximal end 164 of the cup holder 158. More specifically, the fastening means 160 has a protrusion 169 that is wedged in a connector at the distal end 161 of the installation handle 159 to ensure proper relative alignment between the two components. After jamming with each other, the sleeve 163 with internal thread engages with the external thread 224 on the cup holder 158, connecting them to each other.

The handle 213 provides the surgeon with an additional lever mechanism when manipulating the cup setting tool 167.

To connect the handle 213 with the cup holder 158, the external thread 163 on the handle 213 forms a threaded connection with the internal thread 162 located inside the cup holder 158. The assembled cup installation tool 167 is shown in FIG. 69 (together with a portion of the cup holder 158, hidden by the introduction of 234 patients into the wound).

In the next step, an acetabular cup prosthesis of the appropriate size is attached to the cup installation tool 167. Depending on the size of the prosthesis of the acetabular cup, a spacer 174, 215 or 216 may be required. The spacers of different widths, shown in FIG. 37-42, can be connected to the first end of the 168 lug 170, which is located at the distal end 165 of the cup holder 158. More specifically, the protrusion 166 on the strut 174 is connected by a press fit with a corresponding hole 214 at the first end 169 of the boss 170.

The surgeon selects a strut 174, 215 or 216, having a width corresponding to the size of the prosthesis of the acetabular cup, inserted into the patient's joint. For the smallest cup, the strut 174 is not required. Spacers 174, 215 and 216 are disposable items made of plastic that can withstand only one use in an operation. The tool kit includes four screws 217, 218, 219 and 220 of different lengths, shown respectively in FIG. 59-62. Therefore, such an assembly of the screw and spacer provides four prosthesis sizes for the acetabular cup, namely:

acetabular cup size 1: screw 217 without strut, acetabular cup size 2: screw 218 with strut 174, acetabular cup size 3: screw 219 with strut 215 and acetabular cup size 4: screw 220 with strut 216.

Preferably, the screws 217, 218, 219 and 220 have an internal hex socket 221. Each screw has a length that is sufficient to pass along the axis through the hole 214 in the boss 170, with the screw head 222 located near the second end 171 of the boss 170, and the threaded end 223 extends beyond the first end of the boss 170 and the place where the strut 174, 216 or 216 of any type can engage with the first end 168. The protruding tip of the threaded end 223 is connected by means of the thread to the prosthesis of the cup 104 of the acetabulum. Thus, the prosthesis of the acetabular Cup is installed on the tool 167 installation Cup. More specifically, the acetabular cup is connected to the cup holder 158 so that the concave surface of the acetabular cup faces the second end 171 of the boss 170.

The surgeon then manipulates the cup insertion tool 167 in the wound 234, as shown in FIG. 69 so that the cup is located next to the extended acetabulum. Next, it is necessary to orient the cup setting tool 167 so as to ensure that the cup is in an anatomically correct orientation for insertion into an extended acetabulum. This is achieved by using the indicator 172 on the installation handle 159 in combination with the installation frame 176.

- 9 007729

Indicator 172 has a needle 173, which acts as a plumb. The needle 173 is rotatably mounted on the installation handle 159 and hangs substantially vertically under the influence of a local gravitational field. The indicator allows the surgeon to properly align the acetabular cup at least in the first plane by positioning the cup setting tool 167 so that the rotating needle 173 of the plumb line 172 is aligned with the reference point, made in the form of a fixed needle 175.

The mounting frame 176 shown in FIG. 43 and 44 can be used to accurately position the acetabular cup prosthesis in a plane other than that affected by plumb 172. The mounting frame 176 contains a frame element 177, which forms the first end 178 and the second end 179. The frame element 177 has the shape of a letter b , when viewed from the side, and the shape of the letter A, when viewed from above. Resistant platform 180 is located on the first end 178 and is able to adhere to a flat surface, in particular, to the vertical side of the desktop. For example, the surgeon may use the knee to press the stop pad 180 to the side of the operating table. The second end 179 of the mounting frame 176 is located near the patient’s thigh.

The engagement means in the form of a mortise element 181 is located at the second end 179 and is positioned so as to protrude toward the patient’s thigh. The open end groove 225 in the slot member 181 forms a semicircular surface 226 having an inner radius of curvature that coincides with the outer radius of curvature of the housing 182 of the installation handle 159. In other words, the groove 225 is of such size that it allows to receive and guide the housing 182 of the installation handle 159 This geometry is such that the connection of the installation handle 159 with the engagement tool 181 forces the installation handle 159 to adopt a predetermined orientation relative to the second plane (different from the first plane associated with the plumb 172). This is ensured by the fact that the groove element 181 has a sufficient width 227 to ensure that when the housing 182 is connected to the groove element 181, the longitudinal axis of the housing 182 coincides with the axis of the groove element 181. More specifically, when the housing 182 is located in the groove element 181, the housing 182 is essentially perpendicular to the side of the desktop.

Preferably, the patient’s hip is fixed on the operating table in a predetermined position relative to the operating table, for example, using a pelvic holder 230 and / or other means of fixing the patient’s position on the operating table. The surgeon can be confident that the prosthesis of the acetabular cup is properly positioned to be installed in the patient’s thigh if each of the following conditions is met:

The patient's thigh is in a predetermined position on the operating table, the first end 178 of the mounting frame 176 rests against the operating table next to the patient's thigh, so that the mortise element 181 faces the patient’s thigh, the housing 182 of the installation handle 159 is connected to the mortise element 181, and the rotating needle 173 plumb line combined with a fixed needle 175, indicating that the prosthesis of the acetabular cup is located in a given orientation.

At this point, the surgeon uses the piercer assembly 183, shown in FIG. 45, to firmly place the acetabular cup in the extended acetabulum. More specifically, the master head 184 of the piercer assembly 183 is placed at the second end 171 of the boss 170 and hit the impact surface 185 with a surgical hammer or similar tool while the surgeon holds the piercer assembly 183 by the handle 186. In this way, the prosthesis of the cup is fixed in the extended acetabulum.

The screwdriver key 187 is preferably the hex key shown in FIG. 46 and 47, which mates with an internal hex socket 221 of screws 217, 218, 219 or 220 used to fix the prosthesis of the acetabular cup on the holder 158 of the cup. The hex key 187 has a rounded leading end, which allows you to work with the screw 217, 218, 219 or 220 from a number of angles except the straight direction. This gives the surgeon a certain degree of freedom to adapt to the difficulties associated with directing a screw through the wound of 234 patients. The hex key 187 also has a handle 189 to facilitate rotation of the drive head 188. After the screw 217, 218, 219 or 220 is detached from the acetabular cup prosthesis, the cup holder 158 is removed from the patient's body.

If desired, the acetabular cup prosthesis can optionally be further secured in an extended acetabulum using fixing means, such as a screw, which is passed through the acetabular cup into the patient's pelvis. Then a gasket is inserted into the cup of the acetabular prosthesis, and a blunt retractor can be inserted under the gasket to prevent subsequent displacement.

Now the patient's leg is brought into an upright position to allow the insertion of the femoral leg 33, for example a CPPP type leg, into the femoral canal. After insertion, the end 34 of the leg 33 protrudes from the end of the femur.

Next, you need to determine the length of the femoral prosthesis, which is necessary for the leg to have the correct length and proper tension of the tissues and muscles after the operation. A short test head is placed on the prosthetic femoral stem and set the hip joint. As best seen in FIG. 70, now assemble the spacer setting tool 189 by attaching the left or right

- 10 007729 of the spacer element 190, depending on the need, on the handle installation assembly 159 in the same way that the cup holder 158 was previously attached to the handle assembly 159. That is, the protrusion 191 is wedged in the hole located at the distal end 161 of the handle assembly 159, and the sleeve 163 is connected by a thread with a proximal end 192 of the spacer element 190. Also similar to the previous assembly of the cup setting tool 167, the handle 162 is screwed into the spacer element along the internal thread 193 provided near the proximal end 192 of the spacer element 190. In other words, the assembly of the spacer installation tool 189 simply starts with the cup installation tool 167 and replaces the cup holder 158 with the spacer member 190.

The spacer element 190 comprises a spacer 194, which has a groove 195 capable of engaging with the end 34 of the femoral leg 33. This positions the spacer 194 between the test head and the end 34 of the femur, as shown in FIG. 70 (although in the drawing the test head is hidden in the extended acetabulum). When properly positioned, the test head is located in the hemispherical surface 203. The surgeon can again use the plumb 172 and mounting frame 176 to ensure that the strut 194 and the test head are oriented anatomically in the right way, with the following checks.

When the strut 194 is in place, the surgeon checks whether the leg length is sufficient, and / or the tension of the tissues, and / or the tension of the muscles. If not, the surgeon retrieves the strut fitting tool 189 and clamps an additional strut 196 of medium width (shown in FIGS. 52 and 53) on the strut 194. The additional strut 196 of average width is clamped on the strut 194 due to the elements of the press fit 198 provided on these two components . If the length of the leg, and / or the tension of the tissues, and / or the tension of the muscles is still not sufficient, the process is repeated again with an extra spacer 197 of great thickness, which is used instead of the spacer 196 of medium thickness.

In other words, the verification process is repeated with struts 194, 196 or 197 of different thickness (or with a different number of struts) until an anatomically correct leg length and / or tissue tension and / or muscle tension is reached. Then the surgeon takes note of the spacer thickness (or the number of spacers) that gives the best results, and correlates it with the required length of the cervical prosthesis according to a predetermined correlation pattern. For example, if the correct leg length, and / or tissue tension, and / or muscle tension is achieved without the need for an extra strut 196 or 197, then use the shortest cervical prosthesis. If the correct foot length, etc. achieved by using an additional spacer 196 of medium thickness, then a prosthetic neck of medium length is used. If the correct foot length, etc. achieved using an extra large width 197 spacer, the longest cervical prosthesis is used. Of course, it is also possible to provide other correlation schemes for other preferred methods.

This process of determining the size of the endoprosthesis, necessary to obtain the correct length of the leg, etc., is preferable to the known method in which the hip joint is repeatedly displaced until the correct size of the endoprosthesis components is determined.

After that, the joint is displaced, and the test components of the endoprosthesis are replaced with real components, after which the joint is set. The surgeon then verifies that the patient’s leg has the correct amount of movement and double-checks whether the acceptable leg length, tissue tension and muscle tension have been achieved. The surgeon finishes the surgery in a standard way, attaching the triceps tendon and short external rotator muscles and closing the different layers. For assistance in postoperative rehabilitation, it is recommended to use a cryo-cuff in the joint area.

You can use the extractor 199 pins, if you want to save the pins 243, which were previously inserted into the head 3 of the femur and remained immersed in it after the head 3 was removed from the patient's body. It may also be necessary to carry out tests on the femoral head 3, in which case it may be necessary to remove the pins 243. The pin 243 can be inserted into the hole 202 behind the engagement element 203, spreading the tongues 200 and 201 radially to the sides. Then, the tongues are squeezed radially together, so that the engagement element 203 exerts a transverse force on serifs 228 located near the end 229 of the pin 243, thereby forcing the pin extractor 199 to firmly grip the pin 243. After that, a longitudinal force is exerted on the pin extractor 199, which transferred to the pin 243 and helps to remove the pin 243 from the severed head 3 of the femur. The longitudinal force can be applied by hammering the protrusion 204.

It should be understood that the preferred method of performing a hip joint endoprosthesis replacement operation provides a number of advantages compared with known methods. In particular, the hip joint does not require displacement before osteotomy, the accuracy and consistency of the expansion of the femur canal and the acetabulum increases, and the process of determining the required size and orientation of the endoprosthesis components generally requires fewer checks and causes fewer errors. Usually, with such a surgical procedure, the ligaments and muscle joints are subjected to minimal disturbances, which allows for faster rehabilitation of the patient with less postoperative pain. Additional benefits associated with preferred options include

- 11 007729 reduction of scarring, reduction of blood loss and its clotting, lower risk of infection, shorter hospital stay and reduced cost of the operation.

Despite the fact that the invention has been described with reference to specific examples, specialists will understand that it can be implemented in many other forms.

Claims (53)

  1. CLAIM
    1. A device for use in a hip joint arthroplasty operation comprising a spacer having a first end with an opening for receiving a prosthetic leg of the femur, a guiding means at the first end, a mounting surface forming one side of the first end, the mounting surface adapted to engage with the acetabular prosthesis cups to determine the displacement of the cups and legs, so that when using the cup was in a predetermined ratio with the acetabulum of the patient.
  2. 2. The device according to claim 1, in which the mounting surface forms a plane for mating with the corresponding prosthesis plane of the acetabular cup.
  3. 3. The device according to claim 1 or 2, in which the spacer further comprises a handle extending from the first end.
  4. 4. The device according to claim 2, wherein said plane forms an acute angle with a plane formed by said handle extending from the first end, said angle being in the range of from 5 to 25 °.
  5. 5. The device according to claim 4, in which the said angle is in the range from 10 to 20 °.
  6. 6. The device according to claim 5, in which the said angle is approximately 15 °.
  7. 7. Device according to any one of claims 2 to 6, in which said plane is formed by a semicircular surface.
  8. 8. A device according to any one of claims 1 to 7, wherein said opening comprises a groove capable of receiving an end of a prosthetic femoral stem protruding from an osteotomized femoral neck.
  9. 9. A device according to any one of claims 1 to 8, wherein said guide means comprises a plurality of guide marks for determining the required position of the acetabular cup for simplifying the expansion of the patient's acetabulum.
  10. 10. A device according to any one of claims 1 to 9, in which said guide means comprises orientation direction means capable of indicating whether the mounting surface is located in a predetermined ratio with the acetabulum of the patient.
  11. 11. Device according to any one of claims 1 to 10, wherein said guiding means comprises a plumb bob located rotatably on a spacer spaced from said first end so as to hang substantially vertically under the action of gravity.
  12. 12. The device according to claim 11, wherein said guiding means further comprises a control point located on the strut, so that the plumb hangs down through the control point when the mounting surface is located in a predetermined ratio with the acetabulum of the patient.
  13. 13. Device according to any one of claims 1 to 12, in which the mounting surface has an engagement means capable of engaging with the prosthesis of the acetabular cup.
  14. 14. The device according to item 13, in which the means of engagement has one or more brackets, made with the possibility of mating with the inner surface of the prosthesis of the acetabular Cup.
  15. 15. Device according to any one of claims 1 to 14, in which the mounting surface forms an outer circumferential edge having a radius of curvature substantially corresponding to the radius of curvature of the prosthetic acetabular cup.
  16. 16. Device according to any one of claims 1 to 15, in which the spacer includes an installation handle having a body forming a distal end and a proximal end, an indicator located at or near the proximal end, and a connector located at or near the distal end, to attach the prosthesis to the acetabular cup, and the indicator is able to indicate whether the prosthesis of the acetabular cup is in a given orientation with respect to at least the first plane in the control system.
  17. 17. A device for use in a hip joint endoprosthesis replacement operation, comprising an installation handle having a body forming a distal end and a proximal end, an indicator located at or near the proximal end, and a connector located at or near the distal end for attaching the acetabular prosthesis cups,
    - 12 007729 and the indicator is able to indicate whether the prosthesis of the acetabular cup in a given orientation with respect to at least the first plane in the control system.
  18. 18. The device according to claim 17, in which said control system has a local gravitational field.
  19. 19. The device according to p, in which the indicator contains a plumb line, located rotatably on the housing to hang essentially vertically under the action of a local gravitational field.
  20. 20. The device according to claim 17, further comprising a control point located on the body, so that the plumb hangs down through the control point when the prosthesis of the acetabular cup is in a given orientation relative to the first plane.
  21. 21. A device according to any one of claims 17-20, further comprising a handle located between said distal end and proximal end.
  22. 22. A device according to any one of claims 17 to 21, further comprising a mounting frame adapted for use with a mounting handle, the mounting frame comprising a first end adapted to abut against a flat surface for setting the second end of the mounting frame to a relatively flat surface, and means gearing located at the second end and capable of engaging with the setting handle.
  23. 23. The device according to p. 22, in which the means of engagement has a groove with an open end.
  24. 24. The device according to p. 22 or 23, in which the groove with an open end forms a semicircular surface having an inner radius of curvature, consistent with the outer radius of curvature of the housing installation handle.
  25. 25. Device according to any one of paragraphs.22-24, in which the means of engagement has such a geometry that the engagement of the installation handle with the means of engagement forces the installation handle to accept a predetermined orientation relative to the installation frame.
  26. 26. A device according to any one of claims 22-25, wherein the engagement of the installation handle in the engagement means causes the installation handle to adopt a predetermined orientation relative to at least a second plane different from the first plane.
  27. 27. Device according to any one of paragraphs.22-26, additionally having a predetermined position of the patient's hip relative to the operating table, so that if each of the conditions:
    The patient's hip is in a predetermined position, the first end of the mounting frame rests against the flat surface of the operating table, the body of the mounting handle is engaged with the means of engagement of the mounting frame, and the indicator of the mounting handle indicates that the prosthesis of the acetabular cup is in the desired position, then the prosthesis of the acetabular cup is for insertion into the patient's hip joint.
  28. 28. The device according to p. 27, in which the flat surface of the operating table is the side of the operating table and in which the second end is located near the thigh of the patient.
  29. 29. A method of extracting an osteotomized femoral head from a patient’s hip joint, which consists in performing one or both of the following operations:
    a) drill a hole in the femoral head, screw the self-tapping threaded element into the hole, and exert an outwardly directed force on the threaded element, which in turn affects the femoral head, and / or
    b) wedge the end of the spoon under the head of the femur and use the spoon as a lever to act with an outward force on the head of the femur.
  30. 30. The method of inserting the prosthesis of the acetabular Cup in the extended acetabulum of the patient, namely, that
    a) install the prosthesis of the acetabular cup on the installation tool of the cup,
    b) manipulate the cup installation tool so that the prosthesis of the acetabular cup is located next to the extended acetabulum,
    c) orient the cup installation tool so that the prosthesis of the acetabular cup is in an anatomically correct orientation for insertion into the extended acetabulum, and
    b) drive a cup of the acetabular prosthesis into the extended acetabulum.
  31. 31. The method of claim 30, wherein the cup installation tool has an installation handle according to claim 22 and said indicator is used in step c) to determine if the prosthesis of the acetabular cup is in said anatomically correct orientation relative to the first plane.
  32. 32. The method of claim 31, wherein in step c) the mounting frame of claim 22 is further used to orient the prosthesis of the acetabular cup in an anatomically correct orientation relative to a second plane different from the first plane.
  33. 33. The method according to claim 32, wherein in step c) additional sub-steps are performed:
    c1) place the patient's thigh at a predetermined position on the operating table, c2) abut the first end of the mounting frame on the flat surface of the operating table,
    - 13 007729 c3) enter the body of the installation handle into engagement with the means of engagement of the mounting frame, c4) use the indicator of the installation handle to indicate whether the prosthesis of the acetabular cup is in anatomically correct orientation.
  34. 34. The method of determining the size of the length of the cervical prosthesis during surgery of the hip joint arthroplasty, which consists in the fact that
    a) install the prosthesis of the femoral leg in the femur of the patient so that the end of the femur leg protrudes from the end of the femur,
    b) place a test head on the end of the prosthesis of the femoral stem,
    c) use a spacer installation tool to position the spacer between the test head and the end of the femur,
    b) orient the installation tool so that the probe head is in an anatomically correct orientation,
    e) check the anatomical correctness of the length of the leg, and / or tension of the tissues, and / or the tension of the muscles of the patient,
    ί) repeat steps c), b) and e) with spacers of different thickness or with different number of spacers until the patient’s foot length and / or tissue tension and / or muscle tension is anatomically acceptable, and take note strut thickness or the number of struts that gives the best result, and
    e) correlate the spacer thickness or the number of spacers determined in step ί) with the required cervical prosthesis length according to a predetermined correlation pattern.
  35. 35. A method for performing a hip arthroplasty operation on a patient, namely, that
    a) expose the first femoral bone formation and the second femoral bone formation of the patient,
    b) impose a clamp having means of guiding the surgical instrument on the first femoral bone formation so that the means of guiding the surgical instrument is near the second femoral bone formation,
    c) using a surgical instrument guiding tool to guide the cutting tool to perform an osteotomy of the second bone formation, and
    b) remove the severed femoral head from the patient's hip joint.
  36. 36. The method according to p, in which the first femoral bone formation is a large spit, and the second femoral bone formation is the neck of the femur.
  37. 37. The method of Claim 35 or 36, wherein in step a) an initial incision is made on the patient's hip from 3 to 7 cm long.
  38. 38. The method according to clause 37, in which one end of the incision is at a distance of approximately 1-3 cm behind the greater trochanter and bends back from this end.
  39. 39. The method according to any of claims 35 to 38, wherein in step a) the back side of the femoral neck is opened by separating the tendon of the triceps of the patient.
  40. 40. The method according to claim 39, wherein the triceps tendon is labeled for subsequent reattachment.
  41. 41. The method according to any of paragraphs.35-40, in which at stage a) produce a dissection of the capsule to expose the neck of the femur.
  42. 42. The method according to any of paragraphs.35-41, in which the leg of the patient is held in a position approximately 45 ° from the vertical during at least some of the stages of the operation.
  43. 43. The method according to § 42, in which the position of the legs hold foot holders.
  44. 44. The method according to any of paragraphs.35-43, which additionally make a notch in the femoral neck on the side of the femoral head, where an osteotomy incision is made.
  45. 45. The method according to any of paragraphs.35-44, in which additionally
    e) put the guide wire in the channel of the body of the femur of the patient,
    ί) use a guide wire to guide a flexible reamer to drill a hole in the femoral canal, and
    d) insert the prosthesis of the femoral leg into the said opening so that the first end of the femoral leg protrudes from the end of the body of the femur.
  46. 46. The method according to item 45, which further
    11) put said first end in the acetabulum of the patient,
    ί) insert struts between the end of the body of the femur and the acetabulum,
    _)) use a spacer to determine the control points on the acetabulum of the patient, and
    k) use control points as a guide when extending the acetabulum.
  47. 47. The method according to claim 46, wherein further
    l) place a test head prosthesis at said first end,
    t) place the test acetabular cup in the extended acetabulum,
    p) place a trial prosthesis head in a trial acetabular cup and
    - 14 007729
    o) insert struts between the end of the femur body and the test cup of the acetabulum until the necessary fit between the test head prosthesis and the test cup of the acetabulum is achieved, and
    p) correlate the number or size of spacers with the required size of the component of the prosthesis.
  48. 48. A method for performing a hip arthroplasty operation on a patient, namely, that
    ί) expose the greater skewer and neck of the femur of the patient,
    i) make an osteotomy of the femoral head, ίίί) insert the prosthetic femoral stem or trial femoral stem into the body of the patient's femur so that the first end of the femoral stem protrudes beyond the end of the femur, помещν) place the first end into the patient's acetabulum,
    ν) impose one or more struts on the first end of the femoral stem, νί) use one or more struts to determine control positions on the acetabulum, and νίί) use control positions to direct the extension of the acetabulum.
  49. 49. The method of claim 48, wherein said spacers are labeled to indicate reference positions.
  50. 50. The method according to p. 48 or 49, in which at the stage νίί) determine the center of control positions and use this center as the center of expansion.
  51. 51. A method for performing a hip arthroplasty operation on a patient, namely, that
    A) expose the greater skewer and neck of the femur of the patient,
    B) produce an osteotomy of the femoral head,
    C) insert the prosthesis of the femoral leg or trial femoral leg into the body of the patient's femur so that the first end of the femur leg protrudes beyond the end of the body of the femur,
    ϋ) insert the prosthesis of the acetabular cup or test acetabular cup into the patient's extended acetabulum,
    E) impose one or more struts on the first end of the femoral leg until the required tension of the tissues in the region of the patient’s hip joint is reached, and
    E) correlate the number or size of spacers with the required size of the component of the prosthesis.
  52. 52. The method according to § 51, in which the required size of the component of the prosthesis refers to the length of the neck of the component of the prosthesis of the neck and femoral head.
  53. 53. A method for performing a hip arthroplasty operation on a patient, namely, that
    A) expose the greater skewer and neck of the femur of the patient,
    B) produce an osteotomy of the femoral head,
    C) insert the prosthesis of the femoral leg or trial femoral leg into the body of the patient's femur so that the first end of the femur leg protrudes beyond the end of the body of the femur,
    ϋ) insert the prosthesis of the acetabular cup or test acetabular cup into the patient's extended acetabulum,
    E) impose one or more struts on the first end of the femoral stem to determine the required orientation of the acetabular cup relative to the femoral stem.
    -15 007729
EA200501303A 2001-11-02 2002-11-01 Apparatus for hip joint surgery EA007729B1 (en)

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