US20050234462A1 - Method and instrumentation for performing minimally invasive hip arthroplasty - Google Patents
Method and instrumentation for performing minimally invasive hip arthroplasty Download PDFInfo
- Publication number
- US20050234462A1 US20050234462A1 US11/030,019 US3001905A US2005234462A1 US 20050234462 A1 US20050234462 A1 US 20050234462A1 US 3001905 A US3001905 A US 3001905A US 2005234462 A1 US2005234462 A1 US 2005234462A1
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- Prior art keywords
- broach
- segments
- core shaft
- instrument
- handle
- 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.)
- Abandoned
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS 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
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
Definitions
- This invention relates to methods and instruments for performing hip arthroplasty, and more particularly to broach instruments and methods for preparing the proximal femur to receive a femoral implant as part of an implantable hip prosthesis.
- the femur is prepared by passing instrumentation through a small posterior lateral incision.
- This posterior incision is similar to the incision made when performing a conventional femoral intramedullary nailing procedure except that the incision is located somewhat more superior.
- a second, anterior incision is made to facilitate the introduction of instrumentation for preparation of the acetabulum as well as to expose the femur from the anterior side. The surgeon is able to view the femur and resect the femoral head from this anterior side. Access along the femoral axis for reamers and broaches is most readily accomplished, however, through the posterior lateral incision.
- the femur is broached through the posterior lateral incision while the femur is viewed through the anterior incision.
- a broach instrument for preparing the proximal medullary canal of a femur for receiving a hip stem implant comprises a segmented broach head which includes a first broach segment defining a longitudinal axis, and a second broach segment laterally engageable with the first broach segment in vivo, the second broach segment being aligned with the first broach segment on the longitudinal axis when engaged therewith.
- Another aspect of the present invention is a novel method of preparing the proximal medullary canal of a patient's femur using a multi-part broaching instrument which includes a broach handle and a segmented broach head having a plurality of broach segments.
- the method comprises making a small anterior incision adjacent a patient's femur, inserting the broach segments sequentially through the anterior incision, interconnecting the plurality of broach segments in vivo, connecting the broach handle to the broach segments, and broaching the proximal medullary canal with the assembled multi-part broach instrument.
- FIG. 1 is a side view of an assembled instrument according to one embodiment of the present invention.
- FIG. 2 is an exploded side view of the instrument of FIG. 1
- FIG. 3 illustrates placement and insertion of the parts of the instrument of FIG. 1 within a patient.
- FIG. 4 is an exploded side view of another embodiment of the present invention.
- FIG. 5 is a detail view, partially in cross section, of the embodiment of FIG. 4 .
- FIG. 6 is a side view of a further embodiment of the instrument of the present invention.
- FIG. 7 is an exploded side view of the embodiment shown in FIG. 6 .
- FIG. 8 illustrates insertion and assembly of the parts of the instrument of FIG. 7 within a patient.
- one approach to reducing the size of the incisions is to divide the broaching instrument used to broach the proximal medullary canal of the patient's femur into separate pieces, allowing the size of the incisions necessary to accommodate passage of the broach pieces to be reduced.
- the multi-piece broach instrument may include a laterally segmented broach head that may be inserted through the incisions and assembled within the patient, further reducing the size of the incisions necessary to accommodate passage of the broach segments into the patient.
- a multi-part broaching instrument 10 generally comprises a core shaft 12 , a laterally divided or segmented broach head 14 , and a broach handle 16 .
- Core shaft 12 shown in FIG. 2 , has a rigid shaft 18 terminating in a threaded distal end portion 20 and a proximal grip or knob 22 .
- Broach handle 16 has an impact surface 24 , an axial bore 26 for receiving the core shaft 12 , a recess 28 for receiving the grip 22 and an anti-rotation key 30 for preventing the broach head 14 from rotating about the core shaft 12 during use.
- the broach head 14 may be laterally divided or segmented into a plurality of broach segments as shown in FIG. 2 .
- a distal broach segment 32 has a tip 34 sized and shaped to guide the instrument 10 into the femoral canal, a threaded aperture 36 for receiving the threaded end portion 20 of the core shaft 12 , and a receiver slot 38 about the threaded aperture 36 , shown as a dovetail type design.
- An intermediate broach segment 40 has an axial bore 42 therethrough positioned to align with the axial bore 26 of the broach handle 16 when assembled, a second receiver slot 44 about the axial bore 42 and a connector portion 46 , shown as a dovetail type design, for insertion into the receiver slot 38 of the distal broach segment 32 .
- a proximal broach segment 48 has an axial bore 50 therethrough positioned to align with the axial bores 42 , 26 of the intermediate broach segment 40 and the broach handle 16 when assembled, and a second connector portion 52 , also shown as a dovetail type design, for insertion into the second receiver slot of the intermediate broach segment.
- the broach segments and the handle may have a rectangular or curved cross-section, and the broach segments may be serrated partially or completely around the circumference thereof.
- the instrument 10 is assembled during a total hip arthroplasty procedure as shown in FIG. 3 .
- the broach segments 32 , 40 and 48 are preferably inserted one at a time through the anterior incision 54 in the body of the patient 56 .
- Segment 32 may be inserted first and positioned in the proximal medullary canal, then segment 40 may be inserted and laterally connected to segment 32 , and then segment 48 may be inserted and laterally connected to segment 40 .
- intermediate segment 40 may be inserted after segments 32 and 48 and connected therebetween.
- the broach handle 16 is preferably inserted through the posterior incision 58 in the body of the patient 56 .
- the core shaft 12 is preferably advanced through the axial bores 26 , 42 and 50 of the broach handle 16 and broach segments 40 , 48 .
- the core shaft 12 is rotated so that the threaded end portion 20 engages the threaded aperture 36 of the distal broach segment 32 so that the broach segments 32 , 40 and 48 are drawn together against the broach handle 16 .
- the core shaft restrains lateral movement of the broach segments to a degree by simple insertion therein, but its threaded tip is preferably screwed into broach segment 32 sufficiently to create a compression force which tightly secures the broach segments.
- the instrument 10 is preferably removed and disassembled in reverse order.
- the core shaft 12 is preferably rotated so that the threaded end portion 20 disengages the threaded aperture 36 of the distal broach segment 32 and is then removed from the broach segments 32 , 40 , 48 and broach handle 16 .
- the broach handle 16 is preferably removed from the posterior incision 58 of the patient 56 .
- the broach segments 32 , 40 , 48 are then preferably removed from the patient 56 through the anterior incision 54 one at a time.
- a multi-part broaching instrument 110 employs a push-type design in which a core shaft 112 pushes against the distal broach segment 132 of a laterally segmented broach head 114 , cooperating with the broach handle 116 to put the broach segments 132 , 140 and 148 in tension.
- the core shaft 112 may have an unthreaded distal tip 120 and the distal broach segment 132 may have an unthreaded mating aperture 136 .
- the distal broach segment 132 may have no aperture other than the receiver slot in its dovetail joint.
- the broach segments 132 , 140 , 148 and the broach handle 116 are restrained longitudinally by their interconnected dovetail joints, and the core shaft 112 , which is threaded into the broach handle 116 , is used to create a tension force in the broach segments 132 , 140 , 148 by turning the knob 122 clockwise (for a right-handed thread as illustrated) to advance it toward the adjacent surface of the broach handle 116 .
- the advancing distal tip 120 of the core shaft 112 engages the closed distal end of aperture 136 in the distal broach segment 132 and thus applies a distally directed force against that broach segment, thereby putting all the broach segments and the handle in tension.
- a push-type design may alternatively be implemented with oppositely threaded portions on the two opposite ends of the core shaft.
- core shaft 112 may have left-hand threads on its distal end which act in opposition to the right-hand threads on its proximal end in the handle. That is, when rotated clockwise, the core shaft tends to back out of the distalmost broach segment and thereby further pushes on that segment as the threaded proximal end of the core shaft moves distally in the broach handle.
- the same core shaft may alternatively be used to put the broach segments in compression, by rotating the core shaft sufficiently in the counter-clockwise direction and thereby tending to draw the broach segments tightly together.
- the core shaft may have a hook-type end which engages the distalmost broach segment and pulls it toward the other broach segments as the core shaft is retracted in the broach handle.
- the broaching instrument is otherwise assembled and used in the same way as broaching instrument 10 previously described and illustrated.
- a multi-part broaching instrument 210 generally comprises a flexible core shaft 212 , an offset broach handle 216 and, a laterally segmented broach head 214 as previously described and shown.
- Flexible core shaft 212 may be made of nitinol (NiTi) or wound cable terminating in a threaded end 220 and a tightening grip or knob 222 .
- Offset broach handle 216 has an internal bore 226 for receiving core shaft 212 , a recess 228 for receiving the tightening grip 222 and an anti-rotation key 230 for preventing the broach head 214 from rotating about core shaft 212 during use.
- the instrument 210 is assembled during a total hip arthroplasty procedure as shown in FIG. 8 .
- the broach segments 232 , 240 , 248 are preferably inserted one at a time through an anterior incision 254 made in the body of the patient 256 as previously described.
- the offset broach handle 216 is then preferably inserted through the anterior incision 254 and positioned adjacent the broach head segments 232 , 240 , 248 .
- the flexible core shaft 212 is then preferably advanced through the internal bore 226 of the offset broach handle 216 and the axial bores 242 , 250 of the broach head segments 240 , 248 .
- the core shaft 212 is rotated so that the threaded end 220 of the core shaft 212 is threadedly engaged with the threaded aperture 236 of the distal broach segment 232 , creating a compression force that draws the broach segments 232 , 240 , 248 tightly against the offset broach handle 216 .
- the instrument 210 is manipulated through the anterior incision 254 in the body of the patient 256 to broach the femoral canal 260 in preparation for receiving the hip stem implant.
- the instrument 210 is preferably removed and disassembled in reverse order.
- the flexible core shaft 212 is preferably rotated so that the threaded end 220 disengages the threaded aperture 236 of the distal broach segment 232 and is then removed from the broach segments 232 , 240 , 248 and offset broach handle 216 .
- the offset broach handle 216 is preferably removed from the anterior incision 254 in the body of the patient 256 .
- a core shaft is described above as a preferred means for applying an axial force to the parts of the segmented broach head
- alternative means are contemplated, such as a peripheral strap, a pair of peripheral straps, or other device extending alongside the broach segments, e.g., in a longitudinal groove therein, for creating a compression force.
- Rigid and semi-rigid rods and other peripheral devices are also contemplated in certain embodiments for creating tension in the broach segments.
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Abstract
Description
- This application claims the benefit of U.S. Provisional Patent Application No. 60/534,270, filed Jan. 5, 2004, and U.S. patent application Ser. No. 10/912,644, filed Aug. 5, 2004, both of which applications are hereby incorporated by reference along with the following applications filed on Jan. 5, 2005: Attorney Docket No. 13007-24B entitled Method And Instrumentation For Performing Minimally Invasive Hip Arthroplasty and filed in the name of Troy W. Hershberger and Kimberly S. Parcher, and Attorney Docket No. 13007-24C entitled Method And Instrumentation For Performing Minimally Invasive Hip Arthroplasty and filed in the name of Troy W. Hershberger.
- This invention relates to methods and instruments for performing hip arthroplasty, and more particularly to broach instruments and methods for preparing the proximal femur to receive a femoral implant as part of an implantable hip prosthesis.
- In one popular method of performing a total hip arthroplasty through two incisions, the femur is prepared by passing instrumentation through a small posterior lateral incision. This posterior incision is similar to the incision made when performing a conventional femoral intramedullary nailing procedure except that the incision is located somewhat more superior. A second, anterior incision is made to facilitate the introduction of instrumentation for preparation of the acetabulum as well as to expose the femur from the anterior side. The surgeon is able to view the femur and resect the femoral head from this anterior side. Access along the femoral axis for reamers and broaches is most readily accomplished, however, through the posterior lateral incision. The surgeon bluntly divides the fibers of the gluteus maximus through the posterior incision to develop a small tunnel through which he may pass the femoral broaches, reamers and, eventually, the femoral implant. The femur is broached through the posterior lateral incision while the femur is viewed through the anterior incision.
- There are disadvantages associated with the prior method and instrumentation described above. These include the necessity of making the posterior lateral incision large enough to accommodate passage of the femoral broach and other instrumentation. Also, damage may be caused to the muscle fibers as well as the skin margins by excessive stretching of tissue and by repeatedly passing the broach and other instrumentation into and out of the posterior lateral incision.
- According to one aspect of the present invention, a broach instrument for preparing the proximal medullary canal of a femur for receiving a hip stem implant comprises a segmented broach head which includes a first broach segment defining a longitudinal axis, and a second broach segment laterally engageable with the first broach segment in vivo, the second broach segment being aligned with the first broach segment on the longitudinal axis when engaged therewith.
- Another aspect of the present invention is a novel method of preparing the proximal medullary canal of a patient's femur using a multi-part broaching instrument which includes a broach handle and a segmented broach head having a plurality of broach segments. The method comprises making a small anterior incision adjacent a patient's femur, inserting the broach segments sequentially through the anterior incision, interconnecting the plurality of broach segments in vivo, connecting the broach handle to the broach segments, and broaching the proximal medullary canal with the assembled multi-part broach instrument.
- The objects and advantages of the present invention will be more apparent upon reading the following detailed description in conjunction with the accompanying drawings.
-
FIG. 1 is a side view of an assembled instrument according to one embodiment of the present invention. -
FIG. 2 is an exploded side view of the instrument ofFIG. 1 -
FIG. 3 illustrates placement and insertion of the parts of the instrument ofFIG. 1 within a patient. -
FIG. 4 is an exploded side view of another embodiment of the present invention. -
FIG. 5 is a detail view, partially in cross section, of the embodiment ofFIG. 4 . -
FIG. 6 is a side view of a further embodiment of the instrument of the present invention. -
FIG. 7 is an exploded side view of the embodiment shown inFIG. 6 . -
FIG. 8 illustrates insertion and assembly of the parts of the instrument ofFIG. 7 within a patient. - For the purpose of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, such alterations and further modifications in the illustrated device and such further applications of the principles of the invention as illustrated therein being contemplated as would normally occur to one skilled in the art to which the invention relates.
- It is desired to reduce the size of incisions necessary to perform a total hip arthroplasty in order to minimize trauma to the gluteus muscles and other underlying tissue adjacent the hip joint. According to the present invention, one approach to reducing the size of the incisions is to divide the broaching instrument used to broach the proximal medullary canal of the patient's femur into separate pieces, allowing the size of the incisions necessary to accommodate passage of the broach pieces to be reduced. The multi-piece broach instrument may include a laterally segmented broach head that may be inserted through the incisions and assembled within the patient, further reducing the size of the incisions necessary to accommodate passage of the broach segments into the patient.
- In a first embodiment of the present invention, shown in
FIG. 1 , amulti-part broaching instrument 10 generally comprises acore shaft 12, a laterally divided or segmentedbroach head 14, and abroach handle 16.Core shaft 12, shown inFIG. 2 , has arigid shaft 18 terminating in a threadeddistal end portion 20 and a proximal grip orknob 22.Broach handle 16 has animpact surface 24, anaxial bore 26 for receiving thecore shaft 12, arecess 28 for receiving thegrip 22 and ananti-rotation key 30 for preventing thebroach head 14 from rotating about thecore shaft 12 during use. - The
broach head 14 may be laterally divided or segmented into a plurality of broach segments as shown inFIG. 2 . Adistal broach segment 32 has atip 34 sized and shaped to guide theinstrument 10 into the femoral canal, a threadedaperture 36 for receiving the threadedend portion 20 of thecore shaft 12, and areceiver slot 38 about the threadedaperture 36, shown as a dovetail type design. Anintermediate broach segment 40 has anaxial bore 42 therethrough positioned to align with theaxial bore 26 of thebroach handle 16 when assembled, asecond receiver slot 44 about theaxial bore 42 and aconnector portion 46, shown as a dovetail type design, for insertion into thereceiver slot 38 of thedistal broach segment 32. Aproximal broach segment 48 has anaxial bore 50 therethrough positioned to align with theaxial bores intermediate broach segment 40 and thebroach handle 16 when assembled, and asecond connector portion 52, also shown as a dovetail type design, for insertion into the second receiver slot of the intermediate broach segment. The broach segments and the handle may have a rectangular or curved cross-section, and the broach segments may be serrated partially or completely around the circumference thereof. - The
instrument 10 is assembled during a total hip arthroplasty procedure as shown inFIG. 3 . First, thebroach segments anterior incision 54 in the body of thepatient 56.Segment 32 may be inserted first and positioned in the proximal medullary canal, thensegment 40 may be inserted and laterally connected tosegment 32, and thensegment 48 may be inserted and laterally connected tosegment 40. Alternatively,intermediate segment 40 may be inserted aftersegments broach handle 16 is preferably inserted through theposterior incision 58 in the body of thepatient 56. Next, thecore shaft 12 is preferably advanced through theaxial bores broach handle 16 andbroach segments core shaft 12 is rotated so that the threadedend portion 20 engages the threadedaperture 36 of thedistal broach segment 32 so that thebroach segments broach handle 16. The core shaft restrains lateral movement of the broach segments to a degree by simple insertion therein, but its threaded tip is preferably screwed intobroach segment 32 sufficiently to create a compression force which tightly secures the broach segments. Once assembled, theinstrument 10 is manipulated through theposterior incision 58 of thepatient 56 to broach thefemoral canal 60 in preparation for receiving the hip stem implant. - When the broaching procedure is completed, the
instrument 10 is preferably removed and disassembled in reverse order. First, thecore shaft 12 is preferably rotated so that the threadedend portion 20 disengages the threadedaperture 36 of thedistal broach segment 32 and is then removed from thebroach segments broach handle 16. Next, thebroach handle 16 is preferably removed from theposterior incision 58 of thepatient 56. Finally, thebroach segments patient 56 through theanterior incision 54 one at a time. - In another embodiment of the present invention, shown in
FIGS. 4 and 5 , a multi-part broaching instrument 110 employs a push-type design in which acore shaft 112 pushes against thedistal broach segment 132 of a laterally segmentedbroach head 114, cooperating with thebroach handle 116 to put thebroach segments core shaft 112 may have an unthreadeddistal tip 120 and thedistal broach segment 132 may have anunthreaded mating aperture 136. Alternatively, thedistal broach segment 132 may have no aperture other than the receiver slot in its dovetail joint. Thebroach segments broach handle 116 are restrained longitudinally by their interconnected dovetail joints, and thecore shaft 112, which is threaded into thebroach handle 116, is used to create a tension force in thebroach segments knob 122 clockwise (for a right-handed thread as illustrated) to advance it toward the adjacent surface of thebroach handle 116. The advancingdistal tip 120 of thecore shaft 112 engages the closed distal end ofaperture 136 in thedistal broach segment 132 and thus applies a distally directed force against that broach segment, thereby putting all the broach segments and the handle in tension. - A push-type design may alternatively be implemented with oppositely threaded portions on the two opposite ends of the core shaft. For example, instead of having an unthreaded distal tip,
core shaft 112 may have left-hand threads on its distal end which act in opposition to the right-hand threads on its proximal end in the handle. That is, when rotated clockwise, the core shaft tends to back out of the distalmost broach segment and thereby further pushes on that segment as the threaded proximal end of the core shaft moves distally in the broach handle. The same core shaft may alternatively be used to put the broach segments in compression, by rotating the core shaft sufficiently in the counter-clockwise direction and thereby tending to draw the broach segments tightly together. In another alternative embodiment, the core shaft may have a hook-type end which engages the distalmost broach segment and pulls it toward the other broach segments as the core shaft is retracted in the broach handle. The broaching instrument is otherwise assembled and used in the same way as broachinginstrument 10 previously described and illustrated. - In a further embodiment of the invention, shown in
FIGS. 6-8 , a multi-part broaching instrument 210 generally comprises aflexible core shaft 212, an offsetbroach handle 216 and, a laterally segmentedbroach head 214 as previously described and shown.Flexible core shaft 212 may be made of nitinol (NiTi) or wound cable terminating in a threadedend 220 and a tightening grip orknob 222. Offsetbroach handle 216 has aninternal bore 226 for receivingcore shaft 212, arecess 228 for receiving the tighteninggrip 222 and ananti-rotation key 230 for preventing thebroach head 214 from rotating aboutcore shaft 212 during use. - The instrument 210 is assembled during a total hip arthroplasty procedure as shown in
FIG. 8 . First, thebroach segments anterior incision 254 made in the body of thepatient 256 as previously described. Next, the offsetbroach handle 216 is then preferably inserted through theanterior incision 254 and positioned adjacent thebroach head segments flexible core shaft 212 is then preferably advanced through theinternal bore 226 of the offsetbroach handle 216 and theaxial bores broach head segments core shaft 212 is rotated so that the threadedend 220 of thecore shaft 212 is threadedly engaged with the threadedaperture 236 of the distal broach segment 232, creating a compression force that draws thebroach segments broach handle 216. Once assembled, the instrument 210 is manipulated through theanterior incision 254 in the body of thepatient 256 to broach thefemoral canal 260 in preparation for receiving the hip stem implant. - When the broaching procedure is completed, the instrument 210 is preferably removed and disassembled in reverse order. First, the
flexible core shaft 212 is preferably rotated so that the threadedend 220 disengages the threadedaperture 236 of the distal broach segment 232 and is then removed from thebroach segments broach handle 216. Next, the offsetbroach handle 216 is preferably removed from theanterior incision 254 in the body of thepatient 256. - While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiment has been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected. For example, while a core shaft is described above as a preferred means for applying an axial force to the parts of the segmented broach head, alternative means are contemplated, such as a peripheral strap, a pair of peripheral straps, or other device extending alongside the broach segments, e.g., in a longitudinal groove therein, for creating a compression force. Rigid and semi-rigid rods and other peripheral devices are also contemplated in certain embodiments for creating tension in the broach segments.
Claims (17)
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US11/030,019 US20050234462A1 (en) | 2004-01-05 | 2005-01-05 | Method and instrumentation for performing minimally invasive hip arthroplasty |
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Also Published As
Publication number | Publication date |
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US7854769B2 (en) | 2010-12-21 |
US7976545B2 (en) | 2011-07-12 |
US7833228B1 (en) | 2010-11-16 |
US20050234463A1 (en) | 2005-10-20 |
US20050234470A1 (en) | 2005-10-20 |
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