Method and apparatus for minimally invasive knee arthroplasty

• US 20030212403A1
• Filed: 05/10/2002
• Published: 11/13/2003
• Est. Priority Date: 05/10/2002
• Status: Active Grant

• Current Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Original Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Inventors: Swanson, Todd V.
• Granted Patent: US 7,048,741 B2
• Time in Patent Office: Days
• US Class Current: 606/88
• CPC Class Codes: A61B 17/155 Cutting femur
• CPC Class Codes: A61B 17/157 Cutting tibia
• CPC Class Codes: A61B 17/158 Cutting patella
• CPC Class Codes: A61B 2017/564 Methods for bone or joint treatment
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61F 2/3886 for stabilising knees against anterior or lateral dislocations

Abstract

The invention is a method for performing a minimally invasive knee arthroplasty and components for this procedure. The method involves creating an incision along the medial or lateral aspect of a patient'"'"'s knee, exposing the knee joint, resecting the distal end of the femur, the proximal end of the tibia and the posterior patella through the medial or lateral incision, and connecting a femoral, tibial and patellar knee replacement component through the incision. Components include specialized femoral, tibial and patellar cutting guides for use in resecting the femur, tibia and patella through the medial or lateral incision. In one embodiment, the method is performed with the aid of an image guidance system. In another embodiment, the method is performed with instruments which align the components, such as the cutting guides, without the use of an image guidance system.

Claims

1. A method of total knee arthroplasty of a patient comprising the steps of:

creating an incision in a skin generally along the medial or lateral mid-line of the knee of the patient;

incising the ligaments, patellar retinaculum, and other soft tissue structure along the side and length of the skin incision, splitting the fiber of the structures longitudinally without transecting them;

accessing a knee joint of the patient through said incision;

resecting a distal end of a femur at said knee joint;

resecting a proximal end of a tibia at said knee joint;

resecting a posterior portion of a patella at said knee joint;

passing a femoral component through said incision;

connecting said femoral component to said resected distal end of said femur;

passing a tibial component through said incision;

connecting said tibial component to said resected proximal end of said tibia;

passing a patellar component through said incision; and

connecting said patellar component to said resected patella.

2. The method in accordance with claim 1 wherein said incision is no more than about 8-12 cm long.

3. The method in accordance with claim 1 wherein said step of resecting said femur includes the step of locating a femoral cutting guide exterior to said knee on the medial or lateral side of the distal femur, and utilizing a cutting implement with said femoral cutting guide to remove at least a portion of said femur.

4. The method in accordance with claim 3 wherein said femoral cutting guide comprises a body having a slot therein and said step of utilizing comprises passing a portion of said cutting implement through said slot.

5. The method in accordance with claim 1 wherein said step of resecting said tibia includes the step of locating a tibial cutting guide exterior to said knee along the medial or lateral side of the proximal tibia and utilizing a cutting implement with said tibial cutting guide to remove at least a portion of said tibia.

6. The method in accordance with claim 5 wherein said tibial cutting guide comprises a body having a slot therein and said step of utilizing comprises passing a portion of said cutting implement through said slot.

7. The method in accordance with claim 1 including the steps of associating at least one position sensor with said femur and determining a position of said femur using said at least one sensor.

8. The method in accordance with claim 7 including the step of calibrating a determined position of said femur to an image of said femur.

9. The method in accordance with claim 1 including the steps of associating at least one position sensor with said tibia and determining a position of said tibia using said at least one sensor.

10. The method in accordance with claim 9 including the step of calibrating a determined position of said tibia to an image of said tibia.

11. The method in accordance with claim 1 wherein said femoral component has a trough-shaped inner surface and said step of passing said femoral component through said incision comprises aligning said trough with said resected distal femur and extending said femoral component transversely through said incision into alignment with said distal femur and wherein said step of connecting said femoral component includes the step of locating a first portion of an impactor adjacent to said femoral component and a second portion of said impactor outside of said incision and applying force to said second portion of said impactor whereby said femoral component is impacted against said distal end of said femur.

12. The method in accordance with claim 1 wherein said step of passing said tibial component through said incision comprises extending said tibial component transversely through said incision, and wherein said step of connecting said tibial component includes the step of locating a first portion of an impactor adjacent to said tibial component and a second portion of said impactor outside of said incision and applying a force to said second portion of said impactor whereby said tibial component is impacted against said proximal end of said tibia.

13. The method in accordance with claim 1 wherein said incision is located laterally or medially of said mid-line generally along the mid-lateral line of the knee.

14. The method in accordance with claim 1 including the steps of resecting a posterior portion of a patella of said patient, passing a patellar component through said incision and connecting said patellar component to said patella.

15. The method in accordance with claim 14 including a patellar cutting guide having a first portion with a slot therein attached to a clamp which attaches to the patella and extending at least a portion of a cutting implement through said slot and said incision to cut at least a portion of said patella.

16. The method in accordance with claim 1 including the steps of generating an image of the knee of said patient, said image including femur, tibia and patella image location information;

associating at least one first position sensor with said femur, said tibia and said patella of said patient;

associating at least one second position sensor with a femoral cutting guide used to resect said distal end of said femur, a tibial cutting guide used to resect said proximal end of said tibia and a patellar cutting guide used to resect said posterior portion of said patella;

generating femur, tibia and patella position information using said at least one sensor;

generating femoral cutting guide, tibial cutting guide and patellar cutting guide information using said second sensor; and

comparing said generated femur, tibia and patella position information and said femoral, tibial and patellar cutting guide position information to said femur, tibia and patella image location information to locate said femoral, tibial and patellar cutting guide.

17. The method in accordance with claim 1 including the step of placing a first portion of an intramedullary rod into said intramedullary canal of said femur;

connecting a femoral cutting guide to a second portion of said rod extending from said knee; and

aligning said femoral cutting guide using said rod to resect said distal end of said femur.

18. The method in accordance with claim 1 including the step of placing an extra-medullary alignment guide external to said patient'"'"'s body along said tibia;

connecting a tibial cutting guide to said alignment guide; and

aligning said tibial cutting guide using said alignment guide to resect said proximal end of said tibia.

19. A patellar cutting guide for use in resecting a posterior portion of a patella through an incision generally located along the medial or lateral mid-line of a knee, comprising:

a stop for location posterior to a posterior portion of said patella;

a cutting guide, said cutting guide having a generally longitudinal slot therein for accepting a cutting implement for resecting a portion of said patella;

a clamp having at least one spike extending therefrom in a direction of said stop, said spike adapted to penetrate the skin and engage an anterior portion of said patella;

means for moving said clamp relative to said stop, whereby said clamp and stop may be moved into relative positions in which they secure said patella in a fixed position while said cutting implement is utilized to resect said patella.

20. The patellar cutting guide in accordance with claim 19 wherein said means for moving comprises a pivoting connection of said clamp and stop.

21. The patellar cutting guide in accordance with claim 20 wherein said pivoting connection comprises at least one pin, and including a first lever arm extending from a portion of said clamp opposite said pin and a second lever arm extending from a portion of said stop opposite said pin.

22. The patellar cutting guide in accordance with claim 19 wherein said cutting guide is connected to said clamp.

23. A method of resecting the posterior of a patella of a knee for acceptance of a patellar knee replacement component without dissecting the overlying skin, sub-cutaneous tissue and the bursa and without everting the patella comprising:

positioning a first stop adjacent said posterior of said patella;

engaging a second stop with an anterior portion of said patella;

positioning a cutting guide exterior to said knee; and

passing a cutting implement through said cutting guide and a medially or laterally located incision in said knee into engagement with said patella; and

removing a portion of said posterior of said patella with said cutting implement.

24. The method in accordance with claim 23 wherein said second stop includes a spike and said step of engaging said second stop comprises passing said spike through said overlying skin and sub-cutaneous tissue into engagement with said anterior portion of said patella.