WO2018183681A1 - Système et procédé d'arthroplastie de la hanche - Google Patents

Système et procédé d'arthroplastie de la hanche Download PDF

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Publication number
WO2018183681A1
WO2018183681A1 PCT/US2018/025149 US2018025149W WO2018183681A1 WO 2018183681 A1 WO2018183681 A1 WO 2018183681A1 US 2018025149 W US2018025149 W US 2018025149W WO 2018183681 A1 WO2018183681 A1 WO 2018183681A1
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WO
WIPO (PCT)
Prior art keywords
leg
positioning apparatus
assembly
patient
major surface
Prior art date
Application number
PCT/US2018/025149
Other languages
English (en)
Inventor
Adriaan BOVENDEERT
Stefan Gijsbert VAN DE GEER
Richard H.M. GOOSSENS
Original Assignee
Biomet Manufacturing, Llc
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Biomet Manufacturing, Llc filed Critical Biomet Manufacturing, Llc
Publication of WO2018183681A1 publication Critical patent/WO2018183681A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/10—Parts, details or accessories
    • A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205—Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • A61G13/125—Ankles or feet
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/0036—Orthopaedic operating tables
    • A61G13/0081—Orthopaedic operating tables specially adapted for hip surgeries

Definitions

  • This document pertains generally, but not by way of limitation, to orthopedic devices, and, more particularly, to apparatuses that aid in the support and positioning of the leg of a patient during a procedure such as a total hip arthroplasty.
  • a total hip arthroplasty (THA) procedure can be performed to repair a diseased or damaged hip joint and replace it with a hip prosthesis.
  • This disclosure pertains generally to apparatuses, systems, and methods for hip arthroplasty including THA and other hip related procedures.
  • the present inventors have recognized, among other things, systems, assemblies and methods that can utilize a combination of a table attachment and a positioning apparatus can improve access to the hip joint and make it easier for the surgeon to optimally position the patient's leg and execute a manual prosthesis check while eliminating the need for an additional trained assistant during the procedure.
  • the combination of the table attachment and the positioning apparatus can also be configured to reduce the likelihood of undesired mechanical traction being placed on the leg and hip joint.
  • Example 1 is an assembly for use in a hip arthroplasty that can optionally include a table attachment and a positioning apparatus.
  • the table attachment can include a plate and having a first major surface.
  • the table attachment can be attachable to and detachable from an operating table.
  • the positioning apparatus can be configured to hold at least a distal portion of a leg of a patient during the hip arthroplasty.
  • the positioning apparatus can be moveable relative to the first major surface to a desired location on the plate and is attachable to the first major surface in the desired location for positioning the leg of the patient as desired.
  • the positioning apparatus can have a first portion that is selectively positionally adjustable to allow the leg to be moveable in three degrees of freedom while the positioning apparatus holds the least the distal portion of the leg and is attached to the table attachment in the desired location.
  • Example 2 the assembly of Example 1, wherein the distal portion of the leg can optionally include at least a foot of the patient.
  • Example 3 the assembly of any one or any combination of Examples 1-2, wherein the first portion of the positioning apparatus can comprise a boot assembly that holds at least the foot, and wherein the assembly can further include: a base configured to rest on the first major surface and attach thereon, and a ball and socket joint coupling the base to the boot assembly.
  • Example 4 the assembly of Example 3, wherein a portion of the boot assembly can be selectively detachable from and attachable to the ball and socket joint.
  • Example 5 the assembly of any one or any combination of Examples 3-4, wherein the base can attach to the first major surface via a suction cup.
  • Example 6 the assembly of Example 5, wherein the base can include an actuator configured to pivot to facilitate a vacuum within the suction cup.
  • Example 7 the assembly of any one or any combination of Examples 3-6, wherein the ball and socket joint can be selectively positionally lockable to fix a position of the boot assembly and can be selectively positionally unlockable to allow for rotational adjustment of the boot assembly to allow for movement of the leg in the three degrees of freedom.
  • Example 8 the assembly of any one or any combination of Examples 1-7, wherein the three degrees of freedom can comprise rotational degrees of freedom and the leg of the patient can be rotatable in roll, pitch and yaw.
  • a system for use in a hip arthroplasty can optionally include a table attachment and a positioning apparatus.
  • the table attachment can include a plate and having a first major surface.
  • the table attachment can be configured to attach to and detach from an operating table.
  • the positioning apparatus can be configured to hold at least a foot of a patient during the hip arthroplasty and can be configured to be moveable relative to the first major surface to a desired location on the plate.
  • the positioning apparatus can be configured to attach to the first major surface in the desired location for positioning a leg of the patient as desired.
  • the positioning apparatus can have a boot assembly that holds at least the foot of the patient and can be selectively rotationally positionally adjustable while the positioning apparatus holds the least the distal portion of the leg and is attached to the table attachment in the desired location.
  • the system of Example 9 can further optionally include: a base configured to rest on the first major surface and attach thereon, and a ball and socket joint configured to couple the base to the boot assembly.
  • Example 11 the system of Example 10, wherein a portion of the boot assembly can be selectively detachable from and attachable to the ball and socket joint.
  • Example 12 the system of any one or any combination of Examples 10-11, wherein the base can be configured to attach to the first major surface via a suction cup.
  • Example 13 the system of Example 12, wherein the base can include an actuator configured to pivot to facilitate a vacuum within the suction cup.
  • Example 14 the system of any one or any combination of Examples 10-13, wherein the ball and socket joint can be selectively positionally lockable to fix a position of the boot assembly and can be selectively positionally unlockable to allow for rotational adjustment of the boot assembly to move the leg while the positioning apparatus is attached to the table attachment in the desired location.
  • a hip arthroplasty method that can optionally include: attaching a table attachment to an operating table, receiving a distal portion of a leg of the patient within a positioning apparatus, positioning the patient on the operating table such that the positioning apparatus and the leg of the patient are supported by a table attachment, positioning the leg by moving the positioning apparatus relative to the table attachment, affixing the positioning apparatus to the table attachment when a desired location of the leg is achieved, and adjusting a rotational position of the leg while the positioning apparatus retains the distal portion of the leg and is affixed to the table attachment in the desired location.
  • Example 16 the method of Example 15, wherein affixing optionally includes generating a vacuum in a suction cup attached to the positioning apparatus against the table attachment.
  • Example 17 the method of any one or any combination of Examples 15-16, wherein adjusting the rotational position of the leg optionally includes selectively positionally locking the positioning apparatus to fix a position of a rotatable portion thereof and selectively positionally unlocking the positioning apparatus to allow for rotational adjustment of the rotatable portion to move the leg while the positioning apparatus is attached to the table attachment in the desired location.
  • Example 18 the method of any one or any combination of Examples 15-17, can further optionally include detaching a second portion of the positioning apparatus from a remainder of the positioning apparatus to check one or both of a length of the leg and an impingement of a hip joint.
  • Example 19 the method of Example 18, can further optionally include reattaching the second portion of the positioning apparatus to the remainder of the positioning apparatus to during a check of the stability of the hip joint.
  • Example 20 is an assembly comprising means to implement of any of Examples 1-19.
  • Example 21 is a system to implement of any of Examples 1-19.
  • Example 22 is a method to implement of any of Examples 1-19.
  • FIG. 1 is a highly schematic view of an operating room during THA using a table attachment according to one example of the present disclosure.
  • FIGS. 2A-2B show free body diagrams of lower body of a patient showing forces applied to the lower body during THA including the hip joint according to one example of the present disclosure.
  • FIG. 3 is a perspective view of a system and an assembly for use during THA or another hip arthroplasty, the system and assembly including a table attachment and a positioning apparatus according to one example of the present disclosure.
  • FIG. 4 is an enlarged perspective view of a lower body of the patient and showing the assembly and system of FIG. 3 in further detail.
  • FIG. 5 shows another perspective view of the system and assembly of FIGS. 3 and 4.
  • FIGS. 6 and 7 are perspective views of the positioning apparatus according to one example of the present disclosure.
  • FIG. 7A is an exploded view of the positioning apparatus showing the various components thereof according to an example of the present disclosure.
  • FIG. 7B is a cross section of a frame of the positioning apparatus of FIGS. 7 and 7A according to an example of the present disclosure.
  • FIG. 7C is a perspective view of an attachment mechanism of the positioning apparatus of FIGS. 7 and 7A according to an example of the present disclosure.
  • FIG. 7D is a perspective view of a socket assembly of the positioning apparatus of FIGS. 7 and 7A according to an example of the present disclosure.
  • FIGS. 7E and 7F are plan views of a boot assembly, a connection plate and coupling mechanisms of the positioning apparatus of FIGS. 7 and 7A according to an example of the present disclosure.
  • FIG. 7G shows a perspective view of a release button and the coupling mechanisms of FIGS. 7E and 7F according to an example of the present disclosure.
  • FIGS. 7H and 71 are cross-sections of the release button and coupling mechanisms of FIG. 7G according to an example of the present disclosure.
  • FIG. 7J is a cross-section of the socket assembly capturing the ball and other components of the positioning apparatus of FIGS. 7, 7 A and 7D according to an example of the present disclosure.
  • FIGS. 7K and 7L are cross-sections of the frame, a suction cup, and attachment mechanisms of the positioning apparatus of FIGS. 7, 7A, 7B and 7C according to an example of the present disclosure.
  • FIGS. 8-10 are perspective views of a second attachment mechanism according to another example of the present disclosure.
  • FIG. 11 is a plan view of a mid-body of the patient showing a perineal post according to an example of the present disclosure.
  • FIG. 12 is a perspective view of the table attachment according to an example of the present disclosure.
  • FIG. 12A is an exploded view of the table attachment including a plate, rails and other components according to an example of the present disclosure.
  • FIG. 13 is a second perspective view of the table attachment according to an example of the present disclosure.
  • FIGS. 14-29 show a surgical method for THA or another type of hip arthroplasty that utilizes the table attachment and the positioning apparatus previously shown according to an example of the present disclosure.
  • FIG. 30 is a perspective view of a second system and second assembly for use during THA or another hip arthroplasty, the system and assembly including another table attachment and another positioning apparatus according to one example of the present disclosure.
  • FIG. 31 is a plan view of the table attachment of FIG. 30 including indicia of leg position according to one example of the present disclosure.
  • FIG. 32A and 32B show displays of rotational and traction forces and/or patient movement that can be used as part of the second system according to one example of the present disclosure.
  • FIG. 33 is a perspective view of the positioning apparatus of FIG. 30 including a solid case, leg positioner and a swivel-castor system according to one example of the present disclosure.
  • FIG. 1 shows such additional assistant 10 aiding the surgeon 12 during the procedure.
  • Such additional assistant 10 is typically utilized to aid in operation, assembly, etc. of a table attachment 11.
  • FIGS. 2A-2B show free body diagrams (FBD) where relatively large amounts of mechanical traction 13 are present. This large amount of traction can result in complications for the patient as discussed above. For example, a large amount of mechanical traction if improperly applied can result from the table attachment such as the table attachment 11 in FIG. 1 being improperly utilized and can cause injury to the leg.
  • FIG. 3 shows a perspective view of a system 20 that can be utilized as an assembly 22 during the THA.
  • the system 20 and assembly 22 can include a table attachment 24 and a positioning apparatus 26.
  • the table attachment 24 can include one or more rails 30 and a plate 32.
  • the system 20 and the assembly 22 can include a specifically designed perineal post 33 configured to couple to a surgical table 29.
  • the table attachment 24 is configured to support both the legs 27A and 27B of a patient 28 by cantilever connection to the surgical table 29.
  • the table attachment 24 can be attachable to and detachable from the table 29 utilizing the one or more rails 30.
  • These one or more rails 30 e.g., plate rails
  • Such coupling can be facilitated by reception of the corresponding rails 34 around, within or between the one or more rails 30 and/or with the use of fasteners, clamps, brackets and other mechanical coupling mechanisms, for example.
  • the table 29 can be equipped with a portion designed to support and couple with the table attachment 24.
  • the one or more rails 30 can be disposed adjacent to and along two edges 36 of the plate 32.
  • the plate 32 can be disposed on and coupled to the one or more rails 30.
  • the plate 32 can be configured to have a first major surface 38 configured to be substantially flat to aid in support and positioning of the leg 27 A.
  • the positioning apparatus 26 can be configured to hold at least a foot 40 and/or a distal portion 42 of the leg 27A of the patient 28 such as the tibia bone, etc. during the THA.
  • the positioning apparatus 26 can be moveable relative to the first major surface 38 to a desired location on the plate 32 and can be attachable to the first major surface 38 in the desired location for positioning the leg 27 A of the patient 28 as desired.
  • FIG. 4 is another perspective view showing a distal portion of the patient 28 including the legs 27A and 27B as well as the system 20 and assembly 22.
  • FIGS. 5 and 6 are yet further perspective views of the system 20 and assembly 22.
  • FIGS. 4-6 show the table attachment 24 and the positioning apparatus 26 in further detail.
  • the table attachment 24 can include the one or more rails 30 (FIG. 5), the plate 32, edges 36 and the first major surface 38.
  • the positioning apparatus 26 can include a boot assembly 50, a ball and socket joint 52 and a base 54.
  • FIGS. 4 and 5 show the plate 32 can be shaped with a tapered proximal portion such that the proximal parts of the proximal edges 36 extend toward one another. Hence, this tapering can provide easier access to the one or more rails 30 (FIG. 5) and legs 27A and 27B (FIG. 4), for example.
  • the positioning apparatus 26 can be attached to the first major surface 38 of the desired location on the plate 32 and holding the leg 27A of the patient 28 in a desired position.
  • the positioning apparatus 26 can have a first portion 56
  • the positioning apparatus 26 can be selectively positionally adjustable to allow the leg 27A to be moveable in three degrees of freedom while the positioning apparatus 26 can be attached to the first major surface 38 in the desired location.
  • the positioning apparatus 26 can fixable to the plate 32 to limit movement of the leg 27A such that the leg 27A does not have a fourth degree of freedom.
  • the positioning apparatus 26 can be selectively decoupled from the plate 32 and moved (e.g., translated) relative thereto to a different position on the first major surface 38 of the plate 32 to allow for movement of the leg 27A in a fourth degree of freedom.
  • the positioning apparatus 26 can be selectively positioned on the first major surface 38 of the plate 32 and can be attached thereto.
  • the base 54 can be configured with feet 58 (FIG. 6) that rest on the first major surface 38 to provide support and stability for the positioning apparatus 26 on the first major surface 38.
  • the base 54 can additionally include fixation mechanism(s) to facilitate attachment to the plate 32.
  • fixation mechanism(s) to facilitate attachment to the plate 32.
  • One such attachment comprising a suction cup, is illustrated subsequently.
  • fixation mechanisms such as pins, screws, tongues and grooves, clamps or the like are also contemplated.
  • the boot assembly 50 can be configured to hold at least the foot 40 (FIG. 4) and/or the distal portion 42 (FIG. 4) of the leg 27A of the patient 28.
  • the ball and socket joint 52 can couple the boot assembly 50 to the base 54.
  • the ball and socket joint 52 can facilitate movement of the leg 27 A in the three degrees of freedom (roll, pitch and yaw) while the base 54 can be attached to the first major surface 38 in the desired location.
  • the boot assembly 50 can be selectively detached from the ball and socket joint 52 to allow the surgeon or assistant to perform various checks including a check of leg length, leg stability and impingement.
  • FIGS. 7 and 7 A show the positioning apparatus 26 in greater detail including components previously described including the boot assembly 50, the ball and socket joint 52, the base 54, the first portion 56 and the feet 58.
  • the positioning apparatus 26 illustrated also includes additional components.
  • the boot assembly 50 can include a brace 60, connection mechanisms 62A and 62B, second connection mechanisms 62A' and 62B' (FIG. 7A), a connection plate 64 and a release button 66.
  • the ball and socket joint 52 can include a socket assembly 68, a ball 70 (FIG. 7A), a ball and socket handle 72 and a nipping bolt 74 (FIG. 7A).
  • the base 54 can include the feet 58, a frame 76, a support bracket 78, a suction cup 80 (FIG. 7A), an attachment handle 82, and attachment mechanism 84A.
  • the boot assembly 50 can be attachable to and detachable from the ball and socket joint 52 and, when the boot assembly 50 is coupled to the ball and socket joint 52, the ball and socket joint 52 can couple the boot assembly 50 to the base 54 but can allow relative movement of the boot assembly 50 relative to the base 54.
  • the brace 60 can include a frame 88 with a foot support portion 90, a heal support portion 92 (FIG. 7A) and a shank support portion 94. Buckles 96 can couple to the frame 88 in various portions to retain the foot and lower leg of the patient.
  • the heal support 92 (FIG. 7A) can be inflatable or made of a formable material such as a plastic to fixate the heel of the patient when inserted in the brace 60.
  • the brace 60 can be selectively connected to and disconnected from the connection mechanisms 62A and 62B via the second connection mechanisms 62A' and 62B' (FIG. 7A) as will be discussed in further detail subsequently.
  • the connection mechanisms 62A and 62B can be connected to the connection plate 64 (e.g., by fasteners as shown).
  • the connection mechanism 62A can be configured to receive the release button 66 at least partially therein. According to one example, the release button 66 can be moveable within the connection mechanism 62A due to actuation (e.g., pressing) by the surgeon or assistant.
  • FIGS. 7E and 7F show the connection mechanisms 62A and 62B, the connection plate 64, the release button 66, the boot assembly 50 with the brace 60 in further detail.
  • FIG. 7E shows a view with the boot assembly 50 separated from the connection plate 64 and the connection mechanisms 62A and 62B but still coupled with second connection mechanisms 62A' and 62B' .
  • FIG. 7E also provides further detail of the construct of the connection mechanism 62B and the second connection mechanism 62B', which are configured to couple together as is further shown in FIG. 7F.
  • the second connection mechanism 62B' can be configured to be inserted in and received by the connection mechanism 62B.
  • the connection mechanism 62B' can have mating features with the connection mechanism 62B.
  • FIG. 7F shows the boot assembly 50 mounted to the connection plate 64 via the connection mechanisms 62A and 62B and the second connection mechanisms 62A' and 62B', which are configured to couple together.
  • FIGS. 7G, 7H and 71 show further details of the connection mechanism 62A, the second connection mechanism 62A' and the release button 66.
  • the connection mechanism 62A can receive the release button 66 as shown.
  • the connection mechanism 62A can include a recess 502, sidewalls 504 (FIG. 7G) and a projection 506.
  • the projection 506 can include a lip feature 508.
  • the second connection mechanism 62A' can include a body 510, a first projection 512 and a second projection 514.
  • the first projection 512 can include a lip feature 516 and the second projection 514 can include a lip feature 518.
  • the release button 66 can include an actuation end 520, body 522 (FIGS. 7H and 71) and a projection 524.
  • the projection 524 can include a lip feature 526.
  • the sidewalls 504 form a portion of the recess 502.
  • the release button 66 can be retained by and is moveable within the connection mechanism 62A biased by a spring 528 to make contact with the second connection mechanism 62 A' .
  • FIGS. 7H and 71 illustrate a coupling between the connection mechanism 62A, the second connection mechanism 62A' facilitated by the release button 66.
  • the second connection mechanism 62A' can be partially received in the recess 502.
  • the projection 506 can mate with the first projection 512 via coupling of the lip feature 508 with the lip feature 516, which are configured to mate with one another.
  • the arrangement can also facilitate coupling of the second projection 514 with the projection 524 via coupling of the lip feature 518 with the lip feature 526.
  • These lip features 518 and 526 can be configured to mate as shown best in FIG. 71.
  • the spring 528 force the release button 66 upward and can maintain coupling of the lip features 518 and 526 (and hence the boot assembly 50 with the remainder of the positioning apparatus). However, actuation of the release button 66 by pressing on the actuation end 520 can move the body 522, depress the spring 528 and move the lip features 518 and 526 out of coupling contact. This can then allow the second connection mechanism 62A' to be pivoted out of the recess 502 as indicated by arrow.
  • connection plate 64 can include an aperture 98 (FIG. 7 A) configured to receive an extension portion 100 (FIGS. 7A, 7J and 10) of the ball 70.
  • the ball 70 can be received in the socket assembly 68 and can be selectively moveable therein with three degrees of freedom thus allowing the connection plate 64 and other portions of the boot assembly 50 to be selectively moveable with the three degrees of freedom previously described.
  • the socket assembly 68 can comprise a two-piece 102 A and 102B assembly with the two pieces 102 A and 102B can be connected together (e.g., by fasteners as shown in FIG. 7A).
  • FIG. 7D shows the socket assembly 68 from a second perspective.
  • the socket assembly 68 can include the recess 124 configured to receive the ball 70 (FIG. 7 J) therein.
  • the recess 124 can facilitate movement of the ball 70 with three degrees of freedom as previously described.
  • a portion of the ball and socket handle 72 and the nipping bolt 74 can be received in a recess 530 of the socket assembly 68.
  • the nipping bolt 74 can be held in place by a fastener 534, which can keep the nipping bolt 74 from turning and can also be tightened or loosened to adjust the position of the nipping bolt 74.
  • the nipping bolt 74 can connect the first piece 102A to the second piece 102B as shown in FIG. 7 J.
  • the ball and socket handle 72 is coupled to the nipping bolt 74 via a threaded connection. Rotation of the ball and socket handle 72 on the nipping bolt 74 can force the ball and socket handle 72 against a ring 536 and the first piece 102A. This force can move the first piece 102A relative to the second piece 102B and can reduce a clearance within the recess 124 configured to receive the ball 70. This reduced clearance, when eliminated or substantially reduced can substantially fix a position of the ball 70 within the recess 124.
  • the ball and socket handle 72 can be rotated to a position where the clamping type force is not applied on the first piece 102A such that sufficient clearance within the recess 124 relative to the ball 70 exists to facilitate movement of the ball 70 to a desired position without undue difficulty.
  • the ball and socket handle 72 can be selectively actuated restrain the ball 70 from movement in the socket assembly 68 (in particular in the recess 124).
  • the ball and socket joint 52 can be selectively positionally lockable (via the ball and socket handle 72, the nipping bolt 74 and the socket assembly 68) to fix a position of the boot assembly 50 and can be selectively positionally unlockable to allow for rotational adjustment of the boot assembly 50 to move the leg in the three degrees of freedom.
  • the feet 58 can be configured to rest on the plate 32 (FIGS. 4-6) as previously described to support the base 54.
  • the feet 58 can extend from and be moveable (e.g., by threading within apertures of the frame 76) relative to the frame 76 to adjust the position of the frame 76 relative to the plate 32.
  • the frame 76 can include arms 104 configured to support and receive the feet 58.
  • the support bracket 78 can connect to the frame 76 and can extend relatively vertically therefrom.
  • the support bracket 78 can connect with the socket assembly 68 (e.g., via fasteners). The support bracket 78 can thus position the socket assembly 68 spaced from the frame 76.
  • the suction cup 80 can be utilized to fix the base 54 to the plate 32 (FIGS. 4-6) in the desired location on the first major surface as previously described.
  • the suction cup 80 can be disposed below a first surface 108 of the frame 76 and can be partially received in a recess (shown subsequently in FIGS. 7B, 7K and 7L) of the frame 76.
  • the suction cup 80 can connect with the frame 76 and can additionally connect with an attachment mechanism 84B (shown in FIGS. 7K and 7L).
  • FIG. 7B shows a cross-sectional view of the frame 76 including the first surface 108 and an aperture 106.
  • the frame 76 can include a recess 114 that communicates with the aperture 106.
  • the recess 114 can be configured to receive a portion of the suction cup 80 (FIG. 7A) therein.
  • FIGS. 7K and 7L show the frame 76 including the recess 114 and the aperture 106 previously shown in FIG. 7B, and additionally showing the suction cup 80, the attachment handle 82, and the attachment mechanism 84A previously shown in FIGS. 7 and/or 7 A.
  • FIGS. 7K and 7L further show a second attachment mechanism 84B and a spring 550.
  • FIG. 7K shows the suction cup 80 in a non- fixated configuration resting on the first major surface 38 of the plate 32. In such a configuration, the positioning apparatus 26 is moveable relative to the plate 32 along the first major surface 38.
  • FIG. 7L shows the suction cup 80 in a fixated configuration affixed to the first major surface 38 in the desired position.
  • the attachment handle 82 can be connected to the attachment mechanism 84A. Such connection can be via a thread connection, for example.
  • the attachment mechanism 84 A can be connected to the connection mechanism 84B such as via a pin 110.
  • the attachment mechanism 84B can extend through the frame 76 via the aperture 106 in the frame 76 and can extend through the recess 114 and into the suction cup 80.
  • the spring 550 can be disposed within the recess 114 and can contact the first surface 108 of the frame 76 and the top of the suction cup 80. The spring 550 can bias the suction cup 80 toward the non-fixated configuration of FIG. 7K.
  • the pin 110 connection of the attachment mechanism 84A with the attachment mechanism 84B can facilitate pivoting of the attachment mechanism 84A relative to the attachment mechanism 84B and the frame 76 between the position of FIG. 7K and the position of FIG. 7L. This pivoting can be accomplished via actuation by the attachment handle 82.
  • the attachment mechanism 84A can be shaped such that pivoting of the attachment mechanism 84A (from the position shown in FIG. 7K to the position of FIG. 7L) moves the attachment mechanism 84B linearly so as to draw the suction cup 80 into the recess 114 and thereby increase the volume within the suction cup 80 to create a vacuum for affixing the suction cup 80 (and the positioning apparatus 26) to the first major surface 38 in the desired position.
  • FIG. 7C shows the attachment mechanism 84 A in further detail including a first aperture 116 for threaded coupling with the attachment handle 82 (FIGS. 7, 7 A, 7K and 7L) and apertures 118 for receiving the pin 110 (FIGS. 7K and 7L) to couple with the attachment mechanism 84B for pivotal movement relative thereto.
  • the attachment mechanism 84A also includes surfaces 120 and 122 along different edges thereof. These surfaces 120 and 122 are configured to have different spacing from the apertures 118 and pin 110 in order to facilitate the linear movement of the attachment mechanism 84B (illustrated in FIGS. 7K and 7L) and the suction cup 80 (FIGS. 7 A, 7K and 7L) for purposes of achieving the vacuum within the suction cup 80 for fixation.
  • the attachment mechanism 84A can, by rotating the attachment handle 82 upwards, create an upward force, and therefore, increase the volume under the suction cup 70. This increase in volume creates a vacuum, strong enough for the required fixation of positioning of the positioning apparatus.
  • FIGS. 8-10 show a second positioning apparatus 126 of similar construction to that of the positioning apparatus 26 previously described.
  • a ball and socket joint 152 of the second positioning apparatus 126 utilizes a ball and socket handle 172 and the nipping bolt (not shown) similar to the example positioning apparatus 26 of FIGS. 3 -7 A.
  • the second positioning apparatus 126 can operate in the manner previously discussed with actuation by the surgeon or assistant to facilitate movement of the leg (positioning in a desired orientation) and then locking of such leg position when the desired orientation is achieved.
  • a boot assembly 150 of the second positioning apparatus 126 can include indicia 160 such as sight levels, gages, or the like, for example, to aid in positioning of the boot assembly 150 in the desired orientation.
  • FIG. 11 is a plan view of the perineal post 33 that can couple to the surgical table 29 as previously illustrated with reference to FIG. 3.
  • the perineal post 33 can be substantially flat along a first edge 200 but can be curved along a second edge 202.
  • the first edge 200 can be positioned to face the medial portion of the hip joint being replaced in the TKA.
  • the curved second edge 202 can oppose the first edge 200 and can be positioned to face a medial portion of a second hip joint that is not being replaced in the TKA.
  • FIGS. 12, 12A and 13 show the table attachment 24 as previously described in further detail.
  • the table attachment 24 can include the one or more rails 30 (e.g., a first rail 30A, a second rail 30B, a third rail 30C and a fourth rail 30D) as shown in FIG. 12A, the plate 32, edges 36 and the first major surface 38 as previously described.
  • the plate 32 can include an aperture 204 therethrough.
  • the aperture 204 can facilitate grasping of the table attachment 24 by a hand of the assistant to facilitate attachment, detachment, and transport of the table attachment 24.
  • the plate 32 and first major surface 38 can be dimensioned to be wide enough between edges 36 and long enough to support both legs of the patient as shown and described herein.
  • the plate 32 can be configured with the flat first major surface 38 and can be constructed of appropriate materials such as plastics to facilitate fixation via the suction cup using a vacuum as previously described.
  • the first rail 30A and the second rail 30B can be positioned adjacent one side of the table attachment 24 and at least the first rail 30A can be coupled to the plate 32.
  • the third rail 30C and fourth rail 30D can be positioned adjacent a second side of the table attachment 24 and at least the third rail 30C can be coupled to the plate 32.
  • the second side can oppose the one side.
  • the rails 30A, 30B, 30C and 30D can provide rigidity to the plate 32 in addition to facilitating coupling of the table attachment 24 to the table.
  • the first rail 30A and the second rail 30B can be vertically stacked relative to one another with the first rail 30A disposed closer to the plate 32 than the second rail 30B.
  • the third rail 30C and the fourth rail 30D can be vertically stacked relative to one another with the third rail 30C disposed closer to the plate 32 than the fourth rail 30D.
  • the first rail 30A and the third rail 30C can be similarly shaped with a same cross-sectional profile and/or length.
  • the second rail 30B and fourth rail 30D can be similarly shaped with a same cross-sectional profile and/or same length.
  • the first rail 30A, the second rail 30B, the third rail 30C and the fourth rail 30D can be configured to support the plate 32 on corresponding rails of the operating table.
  • each of the rails 30A, 30B, 30C and 30D include attachment features such as groove that facilitate coupling and decoupling of the table attachment 24 to the corresponding rails.
  • the grooves can be configured to allow for position adjustment of the table attachment 24 relative to the table by sliding movement, for example.
  • the third rail 30C include first groove 210C and a second groove 212C.
  • the first rail 30A (FIG. 12A) can include can have matching grooves of a similar configuration to those of the first groove 2 IOC and second groove 212C, respectively.
  • the fourth rail 30D can include a first groove 210D and a second groove 212D.
  • the second rail 30B (FIG. 12 A) can include grooves that can have a similar configuration to those of the first groove 210D and second groove 212D, respectively.
  • the first groove 2 IOC can be positioned to interface with and be spaced from the first groove 210D.
  • a similar arrangement of grooves is shown in FIG. 12A with respect to the first rail 30A and the second rail 3 OB.
  • the first grooves 2 IOC and 210D (and grooves of the first rail 30A and second rail 3 OB) in combination can be configured to receive portions of the corresponding rails of the operating table.
  • the first grooves 2 IOC and 210D can receive opposing sides of one corresponding rail of the operating table.
  • the grooves of the first rail 30A and the second rail 3 OB can receive opposing side of a second corresponding rail of the operating table.
  • the second grooves 212C and 212D can be configured to receive fasteners and/or portions of coupling plates 214 as shown in FIGS. 12-13.
  • the table attachment 24 can include coupling assemblies 213 that each include a coupling plate 214.
  • Each coupling plate 214 can be symmetrically shaped having first and second portions including apertures configured to received fasteners 218 therein.
  • the fasteners 218 can additionally be received in second apertures 220 in rails 30A, 30B, 30C and 30D within the second grooves 212A, 212B, 212C and 212D as shown in FIG. 12 A, for example.
  • the fasteners 218 can affix the coupling plate 214 to the rails 30A, 30B, 30C and 30D.
  • the coupling plates 214 can space the rails 30A and 30B and 30C and 30D apart in the manner shown in FIGS. 12 and 13.
  • each of the coupling assemblies 213 can additionally include a nipping bolt 222 (FIG. 12 A), a central aperture and a handle 226.
  • the nipping bolt 222 (FIG. 12A) can be received in and extend through the central aperture.
  • the handle 226 can be used to rotate the nipping bolt 222 to facilitate movement of the nipping bolt 222 into and/or against the corresponding rail of the operating table when the corresponding rail is received in the grooves 2 IOC and 210D, for example.
  • the corresponding rail can include an aperture (not shown) configured to align with the central aperture and receive the nipping bolt 222 (FIG. 12A).
  • the corresponding rail need not have an aperture but movement of the nipping bolt 222 (FIG. 12 A) against the corresponding rail can force the corresponding rail into a secure contact with an inner side of the grooves 2 IOC and 210D (and corresponding grooves in the rails 30A and 30B) to facilitate fixation.
  • the coupling assemblies 213 can connect the rails 30A, 30B, 30C and 30D to the operating table.
  • FIGS. 14-29 show the TKA being performed with the systems and assemblies described herein.
  • Such systems and assemblies can include the table attachment 24 and the positioning apparatus 26.
  • FIG. 14 shows an assistant in the process of coupling the table attachment 24 to the surgical table 29.
  • the table attachment 24 can be attachable to and detachable from the table 29 utilizing the one or more rails 30 as previously described such as by coupling with the corresponding rails 34 of the table 29.
  • the table 29 can be equipped with a pillow portion that is removed and a remaining portion 300 can support and couple with the table attachment 24.
  • the table attachment 26 can be placed on the portion 300 and the one or more rails 30 can be coupled with the corresponding rails 34 as previously discussed.
  • the patient 28 has been placed on the table 29 with both legs 27A and 27B supported by the table attachment 24.
  • the patient 28 and table 29 can be draped with the legs 27A and 27B being undraped and exposed.
  • the legs 27A and 27B can be sterilized. Incision lines and interval can be drawn on the thigh and shank to check leg length.
  • the positioning apparatus 26 can be placed on the table attachment 24 and on the leg 27 A of the patient 28.
  • the positioning apparatus 26 can be moveable (suction cup is unlocked).
  • the ball and socket joint 52 (FIG. 16) can be locked such that no rotation occurs.
  • the boot assembly 50 can be oriented to provide the leg 27A be in a neutral position.
  • the patient's legs may be draped by a second sheet (e.g., transparent sheet).
  • a second sheet e.g., transparent sheet.
  • Various surgical tasks can be performed at this step including skin incision, muscular dissection, cauterization of circumflex vessels, dissection of fibers from rectus, exposure of capsule and removal of the capsule. It should be understood that the remainder of the surgical method of FIGS. 16-29 the legs 27 A and 27B could be draped in the manner of FIG. 15. However, such draping has been removed from FIGS. 16-29 for clarity.
  • FIG. 16 shows the ball and socket joint 52 can be unlocked and the boot assembly 50 rotated to provide the leg 27A with external rotation.
  • An osteotomy of the femoral head can be performed at this time. The surgeon can palpate the lesser trochanter to further guide the level of the final bone neck resection.
  • the surgeon can apply a small amount of traction to the leg 27A.
  • the femoral head can be removed.
  • the acetabulum can be exposed and inspected, reamed and a cup impacted and liner inserted.
  • the position of the cup can be checked using x-ray or another imaging modality.
  • the method can return the leg 27A back to the neutral position by rotation of the boot assembly 50. This can be accomplished by unlocking the ball and socket joint 52, rotating the boot assembly 50 and then relocking the ball and socket joint 52 when the desired position has been achieved.
  • FIG. 19 shows the ball and socket joint 52 unlocked and rotated to move the boot assembly 50 and the leg 27A rotated to an abducted externally rotated position.
  • a femoral holding instrument that is hand held (not shown) can be applied to the hip joint. This instrument can be used to elevate the femur and release some posterior soft tissue.
  • FIG. 20 shows the leg 27A being further externally rotated (e.g., between 90 and 135 degrees). This can be accomplished by unlocking, rotating and locking the ball and socket joint 52 to achieve a new desired position.
  • the knee can be placed in a slight amount of flexion (e.g., greater than 45 degrees).
  • FIG. 21 shows the table 29 and the table attachment 24 moved put the hip joint in extension (table attachment angled at about 20 to 30 degrees from horizontal).
  • the leg 27 A can then be abducted (e.g. angled about 20 to 40 degrees from the neutral position) as shown in FIG. 21. Abducting the leg 27 A can be accomplished by moving the positioning apparatus 26 position on the plate 32 of the table attachment 24 to a desired position.
  • the positioning apparatus 26 can then be reaffixed to the plate 32 (e.g., by application of the suction cup for example as previously discussed).
  • the femoral osteotomy plane can then be visualized and the femoral canal opened.
  • Instrumentation such as an offset canal finder can be utilized if needed.
  • the femoral canal can be broached and a trial implant and femoral head can be inserted into the hip joint.
  • FIG. 22 shows the leg 27A returned to the neutral position from the abducted position. This can be accomplished by releasing the suction cup, for example, and then moving the positioning apparatus 26 across the plate 32 to another desired position. Such movement can be accomplished by sliding the positioning apparatus 26 along the first major surface 38 of the plate 32.
  • FIG. 22 also shows the ball and socket joint 52 can be unlocked to allow the leg 27A to be rotated. The ball and socket joint 52 can optionally then be relocked.
  • FIG. 23 shows the table 29 and the table attachment 24 raised back to the neutral horizontal position.
  • the hip joint can be relocated by applying a gentle internal rotation on the hip via rotation facilitated by the ball and socket joint 52 (which can be unlocked) and the boot assembly 50. A small amount of traction can also be applied to the leg 27A during this process to relocate the hip.
  • FIG. 24 shows the leg 27A can be checked for length and stability by applying manual traction as shown in FIG. 25.
  • the hip joint can be palpated during this process.
  • FIG. 26 shows the method can include a posterior impingement assessment. This can be accomplished by removing the selectively detachable brace 60 from a remainder of the positioning apparatus 26 (e.g., by actuation of the release button). After the posterior impingement assessment, the brace 60 can be attached back to the remainder of the positioning apparatus 26.
  • FIG. 27 shows an anterior impingement assessment being performed by external rotation of the hip joint. This can be accomplished by unlocking the ball and socket joint 52 and rotating the ball and socket joint 52 to externally rotate the leg 27A.
  • the table 29 and table attachment 24 can be angled during this process (e.g., angled from the horizontal position defined by the remainder of the table 29) to place the hip joint in extension if desired.
  • FIG. 28 shows the hip joint being dislocated.
  • the table 29 and table attachment 24 have been raised so as to be returned to the neutral position (e.g., placed back at substantially a horizontal position relative to the remainder of the table 29).
  • the ball and socket joint 52 can be unlocked to facilitate external rotation of the hip joint and may be relocked in a desired position.
  • external rotation of the hip joint along with applying some amount of traction to the leg 27A can be utilized.
  • the trial components previously inserted can be removed. Permanent prostheses can be implanted.
  • the hip can then be relocated using the method discussed in FIG. 23.
  • the leg can also be placed back in the neutral position shown in FIG. 22 and the access to the hip joint can be closed.
  • the patient can be removed from the table 29 and the table attachment 24 and the positioning apparatus 26 can be cleaned and then removed from the operating space.
  • FIGS. 30-33 show a system 402 and assembly 404 according to another example.
  • the system 402 and assembly 404 can include a table attachment 424 and positioning apparatus 426.
  • the system 402 and assembly 404 can additionally include a motion tracker 406 as shown in FIG. 30.
  • the positioning apparatus 426 can include a force measurement system 408, a solid case 410 and leg positioner 412 as shown in FIGS. 30 and 33.
  • the solid case 410 can include indicia 414 of rotation of the leg 127 A.
  • the table attachment 424 can include a plate 416 with indicia 418 of a position of the leg 127A (FIGS. 30 and 33) on the plate 416.
  • the system 402 and assembly 404 can include displays 420 and 422 that display information from the motion tracker 406 (FIG. 30), force measurement system 408 (FIGS. 30 and 33), indicia 414 (FIG. 33) and/or indicia 418 (FIG. 31).
  • the degree/amount of rotation and traction on the leg 127A can be displayed for the surgeon.
  • the table attachment 424 can comprise the plate 416 constructed in a manner similar to the plate 32 previously discussed.
  • the indicia 418 can indicate the position of the legs 127A (FIG. 30 and 33) and/or 127B (FIG. 30) of the patient. For example, a neutral position can be indicated, +/- 15 degrees, +/- 30 degrees, etc. Other increments of indication are contemplated.
  • the leg positioner 412 can rest on and can be affixable to the table attachment 424.
  • the leg positioner 412 can receive, move and/or rotate the solid case 410.
  • the solid case 410 can be configured to receive the patient's distal portion of the leg 127A including the foot 130.
  • Movement of the leg positioner 412 can induce traction of the leg 127 A that can be measured by the force measurement system 408 (e.g., a spring system) coupled between the leg positioner 412 and the solid case 410.
  • movement of the leg positioner 412 can be the result of a swivel-castor system 432 housed within the leg positioner 412.
  • the wheels 434 of the swivel-castor system can have an electric motor on the inside or coupled thereto and can rotate and contact and drive the solid case 410.
  • the lower distal leg 127A can be placed in the solid case 410 which can be cylindrical.
  • the solid case 410 can be placed in the leg positioner 412.
  • Low friction can enable rotation of the leg 127A (rather the solid case 410 being driven).
  • the plate 416 (FIGS. 30 and 31) can be disposed below the leg 127 A.
  • the leg positioner 412 can be positioned atop of the plate 416 (FIGS. 30 and 31).
  • the leg positioner 412 can be moveable so as to float on the plate 416 (FIGS. 30 and 31). Air pressure, bearings, low friction materials, etc. can facilitate this "float" arrangement of the leg positioner 412 atop the plate 416 (FIGS. 30 and 31).
  • leg positioner 412 to the plate 416 (FIGS. 30 and 31).
  • different methods can be used; such as by highly increasing friction by rubbers, suction cups, magnets, etc.
  • the same mechanisms can be used for highly increasing friction for fixing the solid case 410 in the leg positioner 412.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Accommodation For Nursing Or Treatment Tables (AREA)

Abstract

L'invention concerne des appareils, des systèmes et des procédés relatifs à l'arthroplastie de la hanche. Selon un exemple, l'appareil peut comprendre un dispositif de fixation à une table et un appareil de positionnement. Le dispositif de fixation à une table peut comprendre une plaque ayant une première surface principale et peut être fixé à une table d'opération et détaché de celle-ci. L'appareil de positionnement peut être conçu pour maintenir au moins une partie distale d'une jambe d'un patient. L'appareil de positionnement peut être fixé à la première surface principale à un emplacement souhaité pour positionner la jambe du patient selon les besoins. L'appareil de positionnement peut comprendre une première partie dont la position peut être réglée de manière sélective pour permettre à la jambe d'être mobile dans trois degrés de liberté tandis que l'appareil de positionnement maintient au moins la partie distale de la jambe et est fixé au dispositif de fixation à la table à l'emplacement souhaité.
PCT/US2018/025149 2017-03-30 2018-03-29 Système et procédé d'arthroplastie de la hanche WO2018183681A1 (fr)

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US201762478916P 2017-03-30 2017-03-30
US62/478,916 2017-03-30

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US11103367B2 (en) 2019-02-15 2021-08-31 Encore Medical, L.P. Acetabular liner

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3020017A (en) * 1958-12-30 1962-02-06 William S Watson Placement devices for use in medical, surgical, orthopedic, and like work
US7740016B1 (en) * 2005-06-28 2010-06-22 Modern Way Immobilizers, Inc. Ankle and foot immobilizer
US8132278B1 (en) * 2010-01-04 2012-03-13 Imp Inc. Sterile operating table extension
US20130019883A1 (en) * 2011-07-22 2013-01-24 Stryker Corporation Multi-position limb holder
US20160228317A1 (en) * 2015-02-10 2016-08-11 Ronald M. Carn Adjustable surgical support system

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3020017A (en) * 1958-12-30 1962-02-06 William S Watson Placement devices for use in medical, surgical, orthopedic, and like work
US7740016B1 (en) * 2005-06-28 2010-06-22 Modern Way Immobilizers, Inc. Ankle and foot immobilizer
US8132278B1 (en) * 2010-01-04 2012-03-13 Imp Inc. Sterile operating table extension
US20130019883A1 (en) * 2011-07-22 2013-01-24 Stryker Corporation Multi-position limb holder
US20160228317A1 (en) * 2015-02-10 2016-08-11 Ronald M. Carn Adjustable surgical support system

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US11103367B2 (en) 2019-02-15 2021-08-31 Encore Medical, L.P. Acetabular liner

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