WO2018183849A2

WO2018183849A2 - Devices and methods for treating developmental dysplasia of the hip

Info

Publication number: WO2018183849A2
Application number: PCT/US2018/025407
Authority: WO
Inventors: Kangqiao LI; Mason Bettenga; Jeffrey Wyman; Soshi Uchida; Paul Alexander Torrie
Original assignee: Smith & Nephew, Inc.
Priority date: 2017-03-30
Filing date: 2018-03-30
Publication date: 2018-10-04
Also published as: JP2020530313A; CN110650693B; CN110650693A; WO2018183849A3

Abstract

Surgical techniques and instruments to standardize and streamline shelf acetabuloplasty. The methods of this disclosure include: 1) preparing a bone graft using a standardized graft sizer; 2) locating and creating an insertion site using an offset parallel guide and a cannulated chiseling device, such as an osteotome or a modified drill guide; and 3) fixating the bone graft using a pusher. Optionally, a suture anchor can be used to further fixate the bone graft to the bone. Examples of graft sizers used to size the bone graft are also disclosed.

Description

DEVICES AND METHODS FOR TREATING DEVELOPMENTAL DYSPLASIA

OF THE HIP

FIELD

This disclosure relates generally to hip surgeries and, more particularly, to implants, surgical methods, and instrumentation for treating developmental dysplasia of the hip.

BACKGROUND

Developmental dysplasia of the hip (DDH) is a dislocation of the hip joint primarily found in infants and young children. In some patients, the acetabulum (the socket of the hipbone into which the head of the femur fits) is too shallow and the femoral head may slip out of the socket, either part of the way or completely. In some cases, the ligaments that help to hold the joint in place are also stretched. While the degree of hip looseness, or instability, varies among children with DDH, DDH can lead to decreased mobility, arthritis and pain in the hip joint. In severe cases, surgical acetabulum reconstruction may be indicated.

Acetabular shelf arthroplasty, or "shelf acetabuloplasty," is one example of an endoscopic technique for acetabulum reconstruction in treating DDH. This technique provides the hip with a wider weight-bearing surface by placing a cortico-cancellous bone graft on the acetabulum. Current shelf acetabuloplasty consists of trimming and drilling holes in the bone graft, locating the acetabulum with two passing pins, creating an insertion site using an osteotome on top of the pins, and sliding the graft along the passing pins for graft fixation. However, these steps are usually performed in a free-hand fashion, which can lead to inconsistencies in graft preparation, pin placement, insertion site preparation and graft fixation.

BRIEF SUMMARY

Described herein are novel surgical techniques and instruments to standardize and streamline shelf acetabuloplasty. The methods of this disclosure include: 1) preparing a bone graft using a standardized graft sizer; 2) locating and creating an insertion site using an offset parallel guide and a cannulated chiseling device, such as an osteotome or a modified drill guide; and 3) fixating the bone graft using a pusher. Optionally, a suture anchor can be used to further fixate the bone graft to the bone. All aspects of the methods of this disclosure are designed to reproduce a consistent surgical outcome in a controlled manner. Advantageously, the additional anchor fixation provides improved graft fixation strength and prevents the graft from backing up into the joint space and therefore damaging surrounding tissue.

Further examples of the devices and methods of this disclosure may include one or more of the following, in any suitable combination.

In examples, a method for acetabulum reconstruction of this disclosure includes: 1) trimming a bone graft to a pre-selected length using a first side of a graft sizer; 2) trimming the bone graft to a pre-selected width and angle using a second side of the graft sizer, the second side opposite the first side; 3) creating at least two bores through the bone graft; 4) inserting a first end of a first pin member and a first end of a second pin member into the acetabulum; 5) creating an insertion site in the acetabulum; 6) advancing the bone graft toward the insertion site by passing a second end of the first pin member and a second end of the second pin member through individual ones of the at least two bores in the bone graft; and 7) securing the bone graft to the insertion site of the acetabulum. In examples, a cross-section of the sized bone graft is substantially rectangular. The pre-selected length of the sized bone graft is about 30 mm and the pre-selected width of the sized bone graft is about 25 mm. The pre-selected height of a first side of the bone graft is between about 7 mm and about 8 mm and the pre-seiected height of a second side of the bone graft is between about 2 mm and about 3 mm.

In further examples of the method, inserting the first end of the first pin member and the first end of the second pin member into the acetabulum includes passing the first pin member and the second pin member through a first aperture and a second aperture, respectively, in a guide, the guide for ensuring accurate placement of the first pin member and the second pin member. Creating the insertion site includes excavating, with an osteotome, the insertion site to a pre-selected depth which, in examples, is about 20 mm. Excavating the insertion site with the osteotome includes advancing the osteotome toward the acetabulum by passing the osteotome over the second end of the first pin member and the second end of the second pin member. Advancing the bone graft toward the acetabulum includes advancing the bone graft toward the acetabulum with a pusher, the pusher configured for passage over the second end of the first pin member and the second end of the second pin member. Securing the bone graft to the insertion site includes securing the bone graft with a suture anchor. Examples of another method for acetabulum reconstruction of this disclosure include: 1) trimming a bone graft to a pre-selected length and width using a graft sizer; 2) inserting a first pin member and a second pin member through the bone graft; 3) creating an insertion site in the acetabulum; 4) inserting the bone graft, the first pin member, and the second pin member into the insertion site; 5) advancing the bone graft toward the acetabulum; and 6) securing the bone graft to the insertion site of the acetabulum. In examples, a cross-section of the sized bone graft is substantially trapezoidal. The pre-selected length of the sized bone graft is between about 25 mm and about 30 mm. The pre-selected width of a first end of the bone graft is between about 16 mm and about 17 mm and the pre-selected width of a second end of the bone graft is between about 25 mm and about 28 mm. A height of a first side of the bone graft is between about 7 mm and about 8 mm and a height of a second side of the bone graft is between about 2 mm and about 3 mm.

Further examples of the method include inserting a third pin member into the acetabulum. Inserting the third pin member into the acetabulum includes passing the third pin member through an aperture in a guide, the guide for ensuring accurate placement of the third pin member. Creating the insertion site in the acetabulum includes: a) passing a drill guide over the third pin member; b) removing the third pin member from the acetabulum and the drill guide; c) inserting the drill through the drill guide; and d) drilling the insertion site to a first pre-selected depth. In examples, the first pre-selected depth is about 10 mm. The method further includes excavating the insertion site with a slot dilator to a second preselected depth. In examples, the second pre-selected depth is about 20 mm. Advancing the bone graft toward the acetabulum includes advancing the bone graft toward the acetabulum with a pusher, the pusher configured for passage over the first pin member and the second pin member.

Examples of a bone graft sizer of this disclosure include a generally rectangular body having a top surface and a bottom surface opposite the top surface. A first, generally square opening extends from an approximate midpoint of the top surface through a first side surface of the body. A second, generally triangular opening in the bottom surface extends through a front surface of the body. At least two through holes extend through a second side surface of the body opposite the first side surface and are in communication with, the second opening. The first opening is configured to size a length of a hone graft and the second opening is configured to size a width and an angle of the bone graft.

Examples of another bone graft sizer of this disclosure include a generally rectangular body having a top surface. An opening in the top surface extends through a front surface and a rear surface of the body and is defined between a first block portion and a second block portion of the body. The first block portion has grooves extending therethrough in communication with an exterior of the body. Tvvo angled slots extend through portions of the first block member and the opening. The two angled slots terminate in and are in

communication with a transverse slot in the opening. The two angled slots and the transverse slot are configured for passage of a cutting device. The transverse slot is configured to size a length of a bone graft with the cutting device and the tvvo angled slots are configured to size a width of the bone graft with the cutting device.

These and other features and advantages will be apparent from a reading of the following detailed description and a review of the associated drawings. It is to be understood that both the foregoing general description and the following detailed description are explanatory only and are not restrictive of aspects as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosure will be more fully understood by reference to the detailed description, in conjunction with the following figures, wherein:

FIGS. 1A-M illustrate a first method of preparing a bone graft using an exemplary graft sizer of this disclosure;

FIG. 2 illustrates a first exemplary offset guide of this disclosure;

FIGS. 3 A-F illustrate a first method for treating DDH using the sized bone graft of FIG. 1 M and the offset guide of FIG. 2;

FIGS. 4A-H illustrate a second method of preparing a bone graft using an exemplary graft sizer of this disclosure;

FIGS. 5A and 5B illustrate a second exemplary offset guide of this disclosure,

FIGS. 6A-C illustrate an exemplar}_' modified drill guide of this disclosure;

FIGS. 7A-J illustrate a second method for treating DDH using the sized bone graft of FIG. 4F, the offset guide of FIG. 5 A, and the modified drill guide of FIG. 6A; and FIGS. 8A-C illustrate a method of fixing a sized bone graft to an acetabulum using a suture anchor.

DETAILED DESCRIPTION

In the description that follows, like components have been given the same reference numerals, regardless of whether they are shown in different examples. To illustrate example(s) in a clear and concise manner, the drawings may not necessarily be to scale and certain features may be shown in somewhat schematic form. Features that are described and/or illustrated with respect to one example may be used in the same way or in a similar way in one or more other examples and/or in combination with or instead of the features of the other examples.

As used in the specification and claims, for the purposes of describing and defining the invention, the terms "about" and "substantially" are used to represent the inherent degree of uncertainty that may be attributed to any quantitative comparison, value, measurement, or other representation. The terms "about" and "substantially" are also used herein to represent the degree by which a quantitative representation may vary from a stated reference without resulting in a change in the basic function of the subject matter at issue. "Comprise,"

"include," and/or plural forms of each are open ended and include the listed parts and can include additional parts that are not listed. "And/or" is open-ended and includes one or more of the listed parts and combinations of the listed parts.

Referring now to FIGS. 1 A-M, a first method of forming a bone graft 1 12 using an exemplar}- graft sizer 100 of this disclosure is illustrated. As shown, the graft sizer 100 of this disclosure provides for controlled trimming and preparation of a bone graft for use in shelf acetabuloplasty. However, it is contemplated by this disclosure that the graft sizer 100 could be used in other types of surgical repair, such as a glenohumeral instability repair. The graft sizer 100 of this disclosure can be made of polymers, metals or other suitable materials, and is intended to be reusable.

Turning now to FIGS. 1 A and 1 B, the exemplary graft sizer 100 of this disclosure is shown in the form of a generally rectangular block having a top surface 114 (FIG. 1 A) and a bottom surface 16 (FIG. I B). The top surface 1 14 comprises a first, generally square opening 118 extending from an approximate midpoint of the top surface 1 14 through a first side surface 120. The bottom surface 1 16 comprises a second, generally triangular opening 122 extending through a front surface 1 10. At least two through holes 124a, 124b extend through a second side surface 126 of the graft sizer 100 and are in communication with the second opening 122.

As shown in FIG. 1 C, to shape the bone graft 1 12, a section of bone, typically harvested from the patient's iliac crest, is placed inside the first opening 118 of the graft sizer 100 and trimmed, for example, with a sagittal saw (not shown), to the desired lengt L (FIG. ID). As illustrated in FIG. IE, the trimmed bone graft 1 12 is now sized to fit within the second opening 122 of the graft sizer 100. The bone graft 1 12 is secured to the second opening 122 by drilling at least two drill pins 128a, 128b, which may be 2.4 mm drill pins, through the bone graft 112 (FIG. IF). As shown in FIG. IG, once secured, the bone graft 1 12 can be trimmed to the desired width W (FIG. I i I) and angle A (FIG. I I). The at least two drill pins 128a, 128b can then be removed from the bone graft 112, for example, with a pin remover (not shown).

FIGS. 1J and IK illustrate the bone graft 112 before (FIG. 1 J) and after (FIG. IK) sizing. As can be seen in FIG. I , a cross-section of the sized bone graft is substantially rectangular. For shelf acetabuloplasty, a size and shape of the sized bone graft 112 is selected to cover the femoral head of a hip joint, as further described below. For example, the length L of the sized bone graft may be about 30 mm and the width W may be about 25 mm. A height H¹ of the taller end may be about 7-8 mm while the height H² of the shorter end may be about 2-3 mm. However, the size and shape of the bone graft 1 12 is variable and depends upon the application in which it is used. Notably, the sized bone graft 112 now contains at least two bores 130a, 130b extending through the bone graft 112, In other examples, shown in FIGS. 1L and 1M, use of a graft sizer 100 with three through holes 124a, 124b, 124c results in a sized bone graft 112 comprising three bores 130a, 130b, 130c corresponding to the through holes 124a, 124b, 124c of the graft sizer 100.

An exemplary offset guide 150 of this disclosure will now be discussed with regard to FIG. 2. In the example shown in FIG. 2, offset guide 150 generally includes a rectangular head portion 152 and an elongate, tubular handle 156. The handle 156 may comprise surface features for aiding a user in firmly grasping the handle 156. The head portion 152 includes a number of apertures 154a, 154b, 154c, 154d and 154e extending through the head portion 152. While five apertures are shown in FIG. 2, three or more apertures are contemplated by this disclosure. The central aperture 154c is configured to receive the proximal end of a hollow aimer shaft 158. The aimer shaft 158 is sized for the passage of a drill pin, as further described below. Initially, aimer shaft 158 is disposed within the central aperture 154c of the head portion 152 such that the aimer shaft 158 extends along a first longitudinal axis L¹. A distal end of the aimer shaft 158 includes a beveled opening 160 and a projection member 162. The projection member 160 further comprises a distally-extending finger 164, which extends along a second longitudinal axis L². In FIG. 2, it can be seen that the longitudinal axis L² of the finger 162 is offset from the longitudinal axis L¹ of the aimer shaft 156 by an offset distance D. In examples, the offset distance D may be about 7 mm. However, other suitable offset distances D are contemplated by this disclosure. The offset guide 150 is used to ensure consistent and accurate placement of the bone graft on the acetabulum, as further described below.

Use of the sized bone graft 1 12, such as the three-bored bone graft 12 of FIG . 1M, and the offset guide 150 of FIG. 2 during shelf acetabuloplasty will now be discussed with reference to FIGS, 3A-G. In FIG. 3 A, a generalized detail of a human hip joint 10 is shown. For simplicity, only the major regions of the hip anatomy are illustrated, including the pelvis 12 and the femur 14, including the femoral head 14a. As discussed above, in a healthy anatomy, the femoral head 14a engages snugly with the acetabulum 16, and more particularly with the inner concave surface 16a of the acetabulum 16. Where the femoral head 14a meets the acetabulum 16 is referred to generally as the hip joint 10.

Turning now to FIG. 3B, to begin the repair, the aimer shaft 1 56 of the offset guide 150 is advanced through a portal into the hip joint 10 toward the acetabulum 16. A lateral edge of the finger 164 of the aimer shaft 156 is pressed slightly against the inner rim of the acetabulum 16 to position the aimer shaft 156. A first drill pin 174, which may be a 2,4 mm drill pin, is then inserted through the aimer shaft 156 such that the drill pin 174 exits the beveled opening 160 and is inserted into the acetabulum 16. Next, as shown in FIG. 3C, a second drill pin 180 and a third drill pin 182, which may be 2.4 mm drill pins, are passed through two of the remaining apertures 154a, 154b, 154d, 154e of the offset guide 150 (FIG. 2) into the acetabulum 16, such that each of the second drill pin 180 and the third drill pin 182 are disposed either side of the first drill pin 174. The offset guide 150, including the aimer shaft. 156, are then removed from the hip joint 10, leaving the first drill pin 174, the second drill pin 180 and the third drill pin 182 in place in the acetabulum 16. Each of the first drill pin 174, the second drill pin 180 and the third drill pin 182 are then overdrilled with a cannulated drill (not shown), which may be a 7 mm drill, to a pre-selected depth within the acetabulum 16. The pre-selected depth may be about 20 mm from the surface of the acetabulum 16. The first drill pin 174 is then removed from the hip joint 10 leaving the second drill pin 180 and the third drill pin 182 in place in the acetabulum 16.

Turning now to FIG. 3D, a cannulated chiseling device, such as an osteotome 132, is next passed over the second drill pin 180 and the third drill pin 182 such that the second drill pin 180 and the third drill pin 182 extend through the osteotome 132. The osteotome 132 includes an obturator 134 extending through a central channel 140 for preventing debris from entering the channel 140 during insertion of the osteotome 132 into the hip joint 10. The osteotome 132 is then advanced, for example, with a mallet (not shown), to the depth within the acetabulum 16 corresponding to the pre-selected overdrii] depth described above. In examples, the depth may be about 20 mm. The osteotome 132 may comprise serrated edges 144 or other surface marking features for indicating an insertion depth of the osteotome 132, Thus, the osteotome 132 is used to excavate an insertion slot 142 within the acetabulum 16 to the insertion depth which is sufficient to allow insertion of the pre-sized bone graft, as further described below. The obturator 134 is then removed from the channel 140 of the osteotome 132. Optionally, an anchor attached to a suture (not shown) can then be delivered through the channel 140 of the osteotome 134 into the acetabulum 16 such that the anchor is fully seated within the acetabulum 16 and the free ends of the attached suture extrude into the insertion slot 142. The osteotome 134 is then removed from the hip joint 10.

Turning now to FIG. 3E, the sized bone graft 112 is now ready for fixation to the acetabulum 16. The bone graft 1 12, as well, as a cannulated pusher 144, are passed over the second drill pin 180 and the third drill pin 182 such that the second drill pin 180 and the third drill pin 182 extend through the side bores 130a, 130c, respectively in the bone graft 1 12 and through the pusher 144. The free ends of the suture 138, where present, can be passed through the central bore 130b of the bone graft 1 12. The bone graft 1 12 is advanced toward the acetabulum 16, for example, by applying a pound-in force to the end of the pusher 144, until the bone graft 112 is fully wedged into the insertion slot 142. The pusher 144, the second pin 180 and the third pin 182 are then then removed from the hip joint 10, leaving the bone graft 1 12 in place. The bone graft 112 now covers the femoral head 14a (FIG. 3F), thus providing the hip joint 10 with a wider weight-bearing surface. The free ends of the suture 138, where present, can then be tensioned and passed through an auxiliary anchor, such as a button (not shown). A surgical knot can be tied in the suture 138 over the button to further fixate the bone graft 112 to the acetabulum 16. The free ends of the suture 138 can then be trimmed, and the repair completed.

Referring now to FIGS. 4A-E, a second method of forming a bone graft 212 using an exemplary graft sizer 200 of this disclosure is illustrated. As shown, the graft sizer 200 of this disclosure provides for controlled trimming and preparation of a bone graft for use in shelf acetabuloplasty. However, it is contemplated by this disclosure that the graft sizer 200 could be used in other types of surgical repair, such as a gienohumeral instability repair. The graft sizer 200 of this disclosure can be made of polymers, metals or other suitable materials, and is intended to be reusable.

Turning now to FIG. 4A, the exemplary graft sizer 200 of this disclosure is shown in the form of a generally rectangular block having a top surface 214. The top surface 214 comprises a first, generally square opening 218 extending through a front surface 210 and a rear surface 216 of the graft sizer 200 and is defined between a first block 206 and a second block 208. The first block 206 further comprises grooves 204a, 204b extending through the first block 206 and in communication with the exterior of the graft sizer 200. In examples, the grooves 204a, 204b are spaced about 0 mm apart. The second block 208 further comprises through holes 224a, 224b, the purpose of which will be described below. Extending through portions of the first block 206 and the opening 218 are two angled slots 220 sized for passage of a cutting device, such as a sagittal saw. The two angled slots 220 terminate in and communicate with a transverse slot 222, also configured for the passage of a cutting device. Use of the slots 220, 222 will be described in more detail below.

FIG. 4B illustrates a bone graft 212 located within the opening 218 of the graft sizer 200 in the space defined between the angled slots 220 and the transverse slot 222, The bone graft 212 may be harvested from the patient's iliac crest and may be pre-angled during the harvesting process. The bone graft 212 is pressed onto the graft sizer 200 by hand such that the taller end is aligned against the first block 206. The bone graft 212 is then trimmed to the desired length by extending the cutting device 230 through the transverse slot 222, Next, as shown in FIG. 4C, two drill pins 228a, 228b, which may be 1.2 mm drill pins, are drilled through the respective grooves 204a, 204b of the first block 206, the bone graft 212 and the second block 208, such that the drill pins 228a, 228b exit the through holes 224a, 224b in the second block 208 and the bone graft 212 is fixed on the graft sizer 200, The bone graft 212 can then be trimmed to a desired width by extending the cutting device 230 through the angled slots 220 (FIG. 4D). Because of the angle of the angled slots 220, a cross-section of the sized bone graft 212 is substantially trapezoidal. In FIG. 4E, the drill pins 228a, 228b are retracted from the second block 208 such that the sized bone graft 212 can be freely lifted from the graft sizer 200 by lifting the drill pins 228a, 228b through the grooves 204a, 204b. The sized bone graft 212 and drill pins 228a, 228b are now ready to be inserted into the repair site (FIG. 4F).

As shown in FIGS. 4G and 4H, it is contemplated by this disclosure that two different graft sizers 200 could be used to create two differently-sized bone grafts 212. I examples, a length L of a "medium" sized bone graft 212 (as viewed from a top surface) may be about 25 mm. A width W¹ of the narrow end may be about 16 mm and a width W² of the wide end may be about 25 mm. In examples, a length L of a "large" sized bone graft 212 may be about 30 mm. A width W¹ of the narrow end may be about 17 mm and a width W² of the wide end may be about 28 mm. In both examples, a height H² of the narrow end (as viewed from a side surface) may be about 2 mm, while a height H¹ of the wider end may be about 7-8 mm.

A second example of an offset guide 250 of this disclosure will now be illustrated with, regard to FIGS. 5A and 5B. In the example of FIG. 5 A, offset guide 250 generally includes a cannulated head portion 252 and an elongate handle 256. The handle 256 may comprise finger notches, as shown, or other surface features to aid the user in firmly grasping the handle 256. The head portion 252 is configured to receive the proximal end of a hollow aimer shaft 258. The aimer shaft 258 is sized for the passage of a drill pin 274, which may be a 2.4 mm drill pin, the purpose of which will be described in more detail below. Initially, aimer shaft 258 is disposed within the head portion 252 such that the aimer shaft 258 extends along a first longitudinal axis L¹. A distal end of the aimer shaft 258 includes a beveled opening 260 and a projection member 262. The projection member 260 further comprises a distally- extending finger 264, which extends along a second longitudinal axis L². In FIG. 2, it can be seen that the longitudinal axis L² of the finger 262 is offset from the longitudinal axis L¹ of the aimer shaft 256 by an offset distance D. In examples, the offset distance D may be about 7 mm. However, other suitable offset distances D are contemplated by this disclosure. The offset guide 250 is used to ensure consistent and accurate placement of the bone graft on the acetabulum, as further described below. In FIG. 5B, it can also be seen that a surface of the drill pin 274 is provided with a number of markings 254 to indicate a length that the drill pin 274 extends distally from the offset guide 250.

An example of a modified drill guide 232 of this disclosure will now be illustrated with regard to FIGS. 6A-C. As shown in FIG. 6A, the drill guide 232 comprises a generally elongate, flat body 236 having a proximal end 268 and a distal end 270, with an open cannulation 226 (FIG. 6B) extending from the proximal end 268 to the distal end 270. An obturator 234 is configured to be slidably disposed within the cannulation 226 such that it extends slightly distal to the distal end 270 of the drill guide 232 but cannot slide through the distal end 270. The obturator 234 further includes an internal channel 240 for passage of the drill pin 274, as further described below.

FIG. 6B is a detailed view of the distal end 270 of the drill guide 232 wit the obturator 234 removed from the cannulation 226. In FIG. 6B, it can be seen that the distal end 270 of the drill guide 232 comprises at least one sharp point 272, which may be two points as shown, for biting into bone. The drill guide 232 and points 272 are further illustrated from a top view in FIG. 6C. As shown in FIG. 6C, when the obturator 234 is removed from the cannulation 226, the drill guide 232 is configured for passage of a drill 280, which may be a 4.5 mm drill. The drill 280 comprises a proximal annular rim 276, a diameter of which is selected such that it cannot enter the drill guide 232, When the drill 280 is full seated within the drill guide 232, the annular rim 276 abuts the proximal end 268 of the drill guide 232 and the drill bit 278 extends about 10 mm from the distal end 270 of the drill guide 232. The purpose of this configuration will be described in more detail below.

Use of the sized bone graft 212 of FIG. 4F, the offset guide 250 of FIG. 5A, and the modified drill guide 232 of FIG. 6A during shelf acetabuloplasty will now be discussed with reference to FIGS. 7A-J. The method described below is in many ways similar to the method described above with regard to FIGS. 3A-G, except that the second drill pin 180 and the third drill pin 182 originally passed through the offset guide 150 are now pre-assembled with the sized bone graft 212, The modified drill guide 232 and a slot dilator take the place of the osteotome 132 for excavating the insertion slot 142 to a pre-selected depth, as described in more detail below. In both cases, all aspects of the methods are designed to reproduce a consistent surgical outcome in a controlled manner.

Turning now to FIG. 7 A, to begin the repair, the aimer shaft 256 of the offset guide

250 is advanced through a portal into the hip joint 10 toward the acetabulum 16. A lateral edge of the fi nger 264 (FIG. 5 A) of the aimer shaft 256 is pressed slightly against the inner rim of the acetabulum 16 to position the aimer shaft 256. The drill pin 274 is then inserted through the aimer shaft 256 and used to drill a hole, which may be about 15 mm deep, into the acetabulum 16. The offset guide 250, including the aimer shaft 256, is then removed from the hip joint 10, leaving the drill pin 274 in place in the acetabulum 16 (FIG. 7B).

Next, as shown in FIG. 7C, the modified drill guide 232, including the obturator 234, are passed over the drill pin 274 such that the drill pin 274 extends through the obturator 234. The drill guide 232 is then pounded into the acetabulum 16, for example, with a mallet (not shown), such that the drill guide 232 is advanced into the acetabulum 16. Advancing the drill guide 232 into the acetabulum 16 causes the points 272 of the drill guide 232 to engage bone and the obturator 234 to protrude from the distal end 270 of the drill guide 232 (FIG. 7D). The obturator 234 and the drill pin 274 are then removed from the hip joint 10, leaving the drill guide 232 extending from the acetabulum 16. As shown in FIG. 7E, the drill 280 is then passed through the drill guide 232 and drilled to a hard stop, i.e., about 10 mm deep within the acetabulum 16. As shown in FIG. 7F, the drill 280 is swept from side to side within the drill guide 232 until all bony material within the reach of the drill 280 is removed to create the insertion slot 242. The drill 280 and the drill guide 232 are then removed from the hip joint 10.

Turning now to FIG. 7G, a slot dilator 282 is next introduced into the insertion slot

242, As shown in more detail in FIG. 7H, the slot dilator 282 may comprise serrated edges 244 or other surface marking features for indicating an insertion depth of the slot dilator 282. The slot dilator 282 is advanced into the insertion slot 242, for example, with a mallet (not shown), until the 20 mm marking (not shown) on the slot dilator 282 reaches just below the acetabulum 16. The slot dilator 282 is then removed from the hip joint 10. Turning now to FIG. 71, the sized hone graft 212 is no ready for fixation to the acetabulum 16. Using the drill pins 228a, 228b, the bone graft 212 is advanced into the insertion slot 242. A cannulated pusher 244 is then passed over the drill pins 228a, 228b such that the drill pins 228a, 228b extend through the pusher 244. The bone graft 212 is advanced toward the acetabulum 16, for example, by applying a pound-in force to the end of the pusher 244, until the bone graft 212 is fully wedged into the acetabulum 16. The pusher 244 and the drill pins 228a, 228b are then then removed from the hip joint 10, leaving the bone graft 212 in place. The bone graft 212 now covers the femoral head 14a (FIG. 7 J), thus providing the hip joint 10 with a wider weight-bearing surface.

Additional fixation of the bone graft 212 to the acetabulum 16 may optional ly be accomplished by deploying one or more anchors (not shown) attached to sutures into the insertion slot 242 through the holes in the bone graft 212 created by the drill pins 228a, 228b. Any suitable anchor known in the art may be used for this purpose. In examples, the anchor may be a bioabsorbable anchor. As shown in FIG. 8A, the sutures 238 may be pulled through the bone graft 212 by a suture passer 290 or other device. The free ends of the suture 238 are then tensioned and passed through an auxiliary anchor, such as a button 246 (FIG. 8B). A surgical knot 248 is then tied in the suture 238 over the button 246 to further fixate the bone graft 212 to the acetabulum 16 (FIG 8C). The free ends of the suture 238 can then be trimmed, and the repair completed.

While this disclosure has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the spirit and scope of the present application as defined by the appended claims. Such variations are intended to be covered by the scope of this present application. As such, the foregoing description of examples of the present application is not intended to be limiting, the full scope rather being conveyed by the appended claims.

Claims

CLAIMS What is claimed is:

1. A method for acetabulum reconstruction comprising:

trimming a bone graft to a pre-selected length using a first side of a graft sizer;

trimming the bone graft to a pre-selected width and angle using a second side of the graft sizer, the second side opposite the first side;

creating at least two bores through the bone graft;

inserting a first end of a first pin member and a first end of a second pin member into the acetabulum;

creating an insertion site in the acetabulum;

advancing the bone graft toward the insertion site by passing a second end of the first pin member and a second end of the second pin member through individual ones of the at least two bores in the bone graft; and

securing the bone graft to the insertion site of the acetabulum.

2. The method of claim 1, wherein a cross-section of the sized bone graft is substantially rectangular.

3. The method of claim 1, wherein inserting the first end of the first pin member and the first end of the second pin member into the acetabulum comprises passing the first pin member and the second pin member through a first aperture and a second aperture, respectively, in a guide, the guide for ensuring accurate placement of the first pin member and the second pin member.

4. The method of claim 1, wherein creating the insertion site comprises excavating, with an osteotome, the insertion site to a pre-selected depth.

The method of claim 4, wherein the pre-selected depth is about 20 mm.

6. The method of claim 4, wherein excavating the insertion site with the osteotome comprises advancing the osteotome toward the acetabulum by passing the osteotome over the second end of the first pin member and the second end of the second pin member.

7. The method of claim 1, wherein advancing the bone graft toward the acetabulum comprises advancing the bone graft toward the acetabulum with a pusher, the pusher configured for passage over the second end of the first pin member and the second end of the second pin member.

8. The method of claim 1 , wherein the pre-selected length of the sized bone graft is about 30 mm and the pre-selected width of the sized bone graft is about 25 mm.

9. The method of claim 1, wherein the pre-selected height of a first side of the bone graft is between about 7 mm and about 8 mm and the pre-selected height of a second side of the bone graft is between about 2 mm and about 3 mm.

10. The method of claim 1, wherein securing the bone graft to the insertion comprises securing the bone graft with a suture anchor.

1 1. A method for acetabulum reconstruction comprising:

trimming a bone graft to a pre-selected length and width using a graft sizer;

inserting a first pin member and a second pin member through the bone graft;

creating an insertion site in the acetabulum;

inserting the bone graft, the first pin member, and the second pin member into the insertion site;

advancing the bone graft toward the acetabulum; and

securing the bone graft to the insertion site of the acetabulum.

12. The method of claim 11, wherein a cross-section of the sized bone graft is

substantially trapezoidal.

13. The method of claim 11, further comprising inserting a third pin member into the acetabulum.

14. The method of claim 13 wherein inserting the third pin member into the acetabulum comprises passing the third pin member through an aperture in a guide, the guide for ensuring accurate placement of the third pin member.

15. The method of claim 13, wherein creating the insertion site in the acetabulum comprises:

passing a cannulated drill guide over the third pin member;

removing the third pin member from the acetabulum and the drill guide;

inserting the drill through the drill guide; and

drilling the insertion site to a first pre-selected depth.

16. The method of claim 15, wherein the first pre-selected depth is about 10 mm.

17. The method of claim 11, further comprising excavating the insertion site with a slot dilator to a second pre-selected depth.

18. The method of claim 17, wherein the second pre-selected depth is about 20 mm.

19. The method of claim 11, wherein advancing the bone graft toward the acetabulum comprises advancing the bone graft toward the acetabulum with a pusher, the pusher configured for passage over the first pin member and the second pin member.

20. The method of claim 11, wherein the pre-se!ected length of the sized bone graft is between about 25 mm and about 30 mm.

21. The method of claim 11, wherein the pre-selected width of a first end of the bone graft is between about 16 mm and about 17 mm and the pre-selected width of a second end of the bone graft is between about 25 mm and about 28 mm.

22. The method of claim 1 1 , wherein a height of a first side of the bone graft is between about 7 mm and about 8 mm and a height of a second side of the bone graft is between about 2 mm and about 3 mm.

23. A bone graft sizer for use in a surgical repair, the sizer comprising:

a generally rectangular body having a top surface and a bottom surface opposite the top surface;

a first, generally square opening extending from an approximate midpoint of the top surface through a first side surface of the body;

a second, generally triangular opening in the bottom surface extending through a front surface of the body; and

at least two through holes extending through a second side surface of the body opposite the first side surface, the at least two through holes in communication with the second opening;

wherein the first opening is configured to size a length of a bone graft; and wherein the second opening is configured to size a widt and an angle of the bone graft.

24. A bone graft sizer for use in a surgical repair, the sizer comprising:

a generally rectangular body having a top surface;

an opening in the top surface extending through a front surface and a rear surface of the body, the opening defined between a first block portion and a second block portion of the body,

the first block portion comprising grooves extending therethrough in communication with an exterior of the body; and

two angled slots extending through portions of the first block member and the opening, the two angled slots terminating in and in communication with a transverse slot in the opening, t e two angled slots and t e transverse slot configured for passage of a cutting device;

wherein the transverse slot is configured to size a length of a bone graft with the cutting device; and wherein the two angled slots are configured to size a width of the bone graft with the cutting device.