Apparatus and method for minimally invasive total joint replacement

• US 20030236523A1
• Filed: 05/05/2003
• Published: 12/25/2003
• Est. Priority Date: 06/14/2001
• Status: Active Grant

• Current Assignee: Cayenne Medical Incorporated (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Alexandria Research Technologies, LLC
• Inventors: Johnson, Wesley D., Engh, Gerard
• Granted Patent: US 7,604,637 B2
• Time in Patent Office: Days
• US Class Current: 606/81
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1628 Motors; Power supplies
• CPC Class Codes: A61B 17/1631 Special drive shafts, e.g. flexible shafts A61B17/1642, A61B17/164 take precedence
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 2017/00398 using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/00539 hydraulically
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0268 for the knee
• CPC Class Codes: A61B 2017/0275 for the hip
• CPC Class Codes: A61B 2017/1602 Mills
• CPC Class Codes: A61F 2/30724 Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity
• CPC Class Codes: A61F 2/30767 Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/30942 for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
• CPC Class Codes: A61F 2/34 Acetabular cups
• CPC Class Codes: A61F 2/3662 Femoral shafts
• CPC Class Codes: A61F 2/38 for elbows or knees
• CPC Class Codes: A61F 2/3859 : Femoral components
• CPC Class Codes: A61F 2/3872 : Meniscus for implantation between the natural bone surfaces
• CPC Class Codes: A61F 2/3877 : Patellae or trochleae
• CPC Class Codes: A61F 2/389 : Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2/4603 : for insertion or extraction of endoprosthetic joints or of accessories thereof
• CPC Class Codes: A61F 2/4609 : of acetabular cups
• CPC Class Codes: A61F 2/4684 : Trial or dummy prostheses
• CPC Class Codes: A61F 2002/30092 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2002/30616 : Sets comprising a plurality of prosthetic parts of different sizes or orientations
• CPC Class Codes: A61F 2002/30884 : Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
• CPC Class Codes: A61F 2002/30894 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/3895 : unicompartimental
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2002/4681 : by applying mechanical shocks, e.g. by hammering
• CPC Class Codes: A61F 2002/4693 : hydraulic
• CPC Class Codes: A61F 2002/4694 : pneumatic
• CPC Class Codes: A61F 2210/0014 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00029 : Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
• CPC Class Codes: A61F 2310/00952 : Coating, pre-coating or prosthesis-covering structure made of bone cement, e.g. pre-applied PMMA cement mantle

Abstract

A method and apparatus for minimally invasive total joint replacement. The method involves sculpting the articular surface of a second bone that normally articulates with a first bone by attaching a bone sculpting tool directly or indirectly to the first bone with the tool in bone sculpting engagement with the articular surface of the second bone, and then sculpting the articular surface of the second bone with the joint reduced and moving one bone with respect to the other. An implant is placed to replace the articular surface of the second bone using an impaction device directly or indirectly attached to the first bone, wherein the force to place the implant is reacted by the second bone and the first bone.

Claims

27. A method of sculpting the articular surface of a second bone that normally articulates with a first bone in a joint, the method comprising the steps of:

providing a bone sculpting tool;

attaching the bone sculpting tool to the first bone in a position for sculpting the articular surface of the second bone;

aligning the bone sculpting tool with the second bone; and

sculpting the articular surface of the second bone by engaging the bone sculpting tool with the articular surface of the second bone.

1. An apparatus for sculpting the articular surface of a second bone that normally articulates with a first bone, the apparatus comprising:

a bone sculpting tool including an attachment portion for attaching the bone sculpting tool to the first bone in a position for sculpting the articular surface of the second bone.

2. The apparatus of claim 1, further comprising a mount for attachment to the attachment portion, the mount being adapted for attachment to the femur.

3. The apparatus of claim 1, wherein the bone sculpting tool is configured for attachment to a femur in a position for sculpting the articular surface of an acetabulum.

4. The apparatus of claim 3, wherein the attachment portion is adapted for direct attachment to the femur.

5. The apparatus of claim 3, wherein the attachment portion is adapted for indirect attachment to the femur.

6. The apparatus of claim 5, wherein the attachment portion is adapted for attachment to a femoral trial.

7. The apparatus of claim 5, wherein the attachment portion is adapted for attachment to a femoral broach.

8. The apparatus of claim 5, wherein the attachment portion is adapted for attachment to a femoral stem.

9. The apparatus of claim 3, wherein the bone sculpting tool is designed for rotation.

10. The apparatus of claim 3, wherein the bone sculpting tool is designed for oscillation.

11. The apparatus of claim 3, wherein the bone sculpting tool comprises a hemispherical reamer.

12. The apparatus of claim 3, further including a drive mechanism for driving the bone sculpting tool.

13. The apparatus of claim 12, wherein the drive mechanism is integral to a mount.

14. The apparatus of claim 12, wherein the drive mechanism is integral to a femoral trial.

15. The apparatus of claim 12, wherein the drive mechanism is configured for attachment to a femoral stem.

16. The apparatus of claim 3, wherein the bone sculpting tool is adapted for elongation.

17. The apparatus of claim 16, wherein the bone sculpting tool has an axis of rotation, and the elongation is along the axis of rotation.

18. The apparatus of claim 16, further including a lead screw for elongation of the bone sculpting tool.

19. The apparatus of claim 16, further including shims for elongation of the bone sculpting tool.

20. The apparatus of claim 16, further including a pneumatic powered device for elongation of the bone sculpting tool.

21. The apparatus of claim 12, wherein the drive mechanism comprises a gearbox.

22. The apparatus of claim 12, wherein the drive mechanism comprises a worm and worm gear combination

23. The apparatus of claim 12, wherein the drive mechanism comprises a bevel gear combination.

24. The apparatus of claim 12, wherein the drive mechanism includes a motor.

25. The apparatus of claim 12, further including a flexible drive shaft for connecting the drive mechanism to a motor.

26. The apparatus of claim 24, wherein the motor is a surgical power drill.

28. The method of claim 27, wherein the step of attaching the bone sculpting tool to the first bone includes attaching the bone sculpting tool to a mount and attaching the mount to the first bone.

29. The method of claim 27, wherein the step of attaching the bone sculpting tool to the first bone includes attaching the bone sculpting tool directly to the first bone.

30. The method of claim 27, wherein the step of attaching the bone sculpting tool to the first bone includes attaching the bone sculpting tool indirectly to the first bone.

31. The method of claim 27, wherein:

the step of attaching the bone sculpting tool to the first bone comprises attaching the bone sculpting tool to a femur;

the step of aligning the bone sculpting tool with the second bone comprises placing the bone sculpting tool in the acetabulum; and

the step of sculpting the articular surface of the second bone by engaging the articular surface of the second bone comprises sculpting the articular surface of the acetabulum by engaging the articular surface of the acetabulum.

32. The method of claim 31, wherein the step of attaching the bone sculpting tool to the femur includes attaching the bone sculpting tool directly to the femur.

33. The method of claim 31, wherein the step of attaching the bone sculpting tool to the femur includes attaching the bone sculpting tool indirectly to the femur.

34. The method of claim 33, wherein the step of attaching the bone sculpting tool to the femur comprises the steps of attaching the bone sculpting tool to a femoral trial and placing the femoral trial in the femur.

35. The method of claim 33, wherein the step of attaching the bone sculpting tool to the femur comprises the steps of attaching the bone sculpting tool to a broach and placing the broach in the femur.

36. The method of claim 33, wherein the step of attaching the bone sculpting tool to the femur comprises the steps of attaching the bone sculpting tool to a femoral implant and implanting the femoral implant in the femur.

37. The method of claim 31, further including the steps of elongating the bone sculpting tool to engage the acetabulum and tensioning soft tissue structures spanning the joint.

38. The method of claim 31, further including the step of retracting the bone sculpting tool to ease the step of placing the bone sculpting tool within the acetabulum.

39. An apparatus for imparting force between adjacent bones to secure an implant, the apparatus comprising:

an impaction device including an attachment portion for attaching the impaction device to the first bone; and

an implant for securing to a second bone.

40. The apparatus of claim 38, further including a surgical navigation system for positioning, aligning, and the implant with respect to the second bone.

41. The apparatus of claim 38, further including a surgical navigation system for positioning, monitoring and aligning the impaction device with respect to the second bone.

42. The apparatus of claim 38, further comprising a mount for attachment to the attachment portion, the mount being adapted for attachment to the femur.

43. The apparatus of claim 38, wherein the implant is an acetabular shell and the impaction device is configured to secure the acetabular shell in the acetabulum.

44. The apparatus of claim 43, further comprising an adapter for attaching the acetabular shell to the impaction device.

45. The apparatus of claim 44, wherein the adapter restricts the acetabular shell from rotating.

46. The apparatus of claim 43, wherein the attachment portion is adapted for direct attachment to the femur.

47. The apparatus of claim 43, wherein the attachment portion is adapted for indirect attachment to the femur.

48. The apparatus of claim 47, wherein the attachment portion is adapted for indirect attachment to the femur via attachment to a femoral trial.

49. The apparatus of claim 47, wherein the attachment portion is adapted for indirect attachment to the femur via attachment to a broach.

50. The apparatus of claim 47, wherein the attachment portion is adapted for indirect attachment to the femur via attachment to a femoral stem.

51. The apparatus of claim 38, wherein the impaction device is a pneumatic impaction hammer.

52. The apparatus of claim 38, wherein the impaction device is a linear actuator.

53. The apparatus of claim 38, wherein the impaction device is a hydraulic piston.

54. The apparatus of claim 38, wherein the impaction device is spring activated.

55. The apparatus of claim 38, wherein the impaction device is configured for activation for a single impaction cycle for each activation.

56. The apparatus of claim 38, wherein the impaction device is configured for activation for multiple impactions cycles while activated.

39-1. The apparatus of claim 38, further including an external alignment guide for orientating the implant.

57. A method of securing an implant to a second bone that articulates with a first bone, the method comprising the steps of:

providing an impaction device;

attaching the impaction device to the first bone;

placing an implant on the impaction device and aligning the implant with the second bone; and

imparting force to the implant, the force being reacted with the second bone and the first bone.

58. The method of claim 57, wherein the step of imparting force is performed once per an activation cycle.

59. The method of claim 57, wherein the step of imparting force is performed multiple times per an activation cycle.

60. The method of claim 57, further comprising the steps of positioning, aligning and monitoring the acetabular shell with a surgical navigation system.

61. The method of claim 57, further comprising the steps of positioning, aligning and monitoring the impaction device with a surgical navigation system.

62. The method of claim 57, wherein:

the step of attaching the impaction device to the first bone comprises attaching the impaction device to a femur;

the step of placing an implant on the impaction device and aligning the implant with the second bone comprises placing an acetabular shell on the impaction device and positioning the acetabular shell within an acetabulum; and

the step of imparting force to the implant comprises imparting force to the acetabular shell, the force being reacted with the acetabulum and the femur.

63. The method of claim 62, wherein the step of attaching the impaction device to the femur includes attaching the impaction device directly to the femur.

64. The method of claim 62, wherein the step of attaching the impaction device to the femur includes attaching the impaction device indirectly to the femur.

65. The method as in claim 64, wherein the step of attaching the impaction device to the femur comprises the steps of attaching the impaction device to a femoral trial and placing the femoral trial in the femur.

66. The method of claim 64, wherein the step of attaching the impaction device to the femur comprises the steps of attaching the impaction device to a broach and placing the broach in the femur.

67. The method of claim 64, wherein the step of attaching the impaction device to the femur comprises the steps of attaching the impaction device to a femoral implant and implanting the femoral implant in the femur.

68. A system for minimally invasive sculpting and replacing the articular surface of a second bone that normally articulates with a first bone, the system comprising:

a bone-sculpting apparatus comprising a bone-sculpting tool including a tool attachment portion for attaching the bone sculpting tool to the first bone in a position for sculpting the articular surface of the second bone; and

an impaction apparatus for providing force between the first bone and the second bone, the impaction apparatus comprising an impaction device including an impaction attachment portion for attaching the impaction device to the first bone.

69. The system of claim 68, wherein the impaction apparatus further comprises an adapter for mounting the implant.

70. The system of claim 68, wherein further including a visualization apparatus, irrigation apparatus, and a suction apparatus all configured as a single device.

71. The system of claim 68, further comprising a visualization apparatus comprising a light source, an imaging base, an imaging device, and a display.

72. The system of claim 70, wherein the visualization apparatus further includes a monitoring system.

73. The system of claim 71, wherein the imaging base is integral to a mount configured for attachment to the attachment portion of the bone sculpting apparatus, the mount being attachable to the first bone.

74. The system of claim 71, further including an irrigation apparatus integral to the imaging base.

75. The system of claim 71, further including a suction apparatus integral to the imaging base.

76. The system of claim 71, further including an irrigation apparatus and a suction apparatus integral to the imaging base.

77. The system of claim 68, further including an irrigation apparatus.

78. The system of claim 68, further including a suction apparatus.

79. The system of claim 68, further including a surgical navigation system for positioning, aligning and monitoring the implant.

80. The system of claim 68, further including a surgical navigation system for positioning, aligning and monitoring the impaction device.

81. A method of sculpting, in a surgical site, the articular surface of a second bone that normally articulates with a first bone, the method comprising the steps of:

providing a bone sculpting tool;

attaching the bone sculpting tool to the first bone;

aligning the bone sculpting tool with the second bone and sculpting the articular surface of the second bone by engaging the bone sculpting tool with the articular surface of the second bone;

providing an implant;

providing an impaction apparatus comprising an impaction device configured for attachment to the first bone;

attaching the impaction apparatus to the first bone;

placing the implant on the impaction apparatus and imparting force to the implant to secure the implant to the second bone, the force being reacted by the second bone and the first bone.

82. The method of claim 81, further including a monitoring device including a visualization apparatus, an irrigation apparatus, and a suction apparatus.

83. The method of claim 81, further comprising the steps of providing a visualization apparatus comprising a light source, an imaging base, an imaging device, and a display system and visualizing the surgical site with the visualization apparatus.

84. The method of claim 81, further comprising the steps of providing an irrigation apparatus and a suction apparatus and clearing the surgical site of bone debris and blood using the irrigation apparatus and the suction apparatus.

85. The method of claim 81, further comprising the step of clearing the site of bone debris and blood using the irrigation apparatus and the suction apparatus.

86. The method of claim 81, further comprising the steps of positioning, aligning and monitoring the implant with a surgical navigation system.

87. The method of claim 81, further comprising the steps positioning, aligning and monitoring the impaction device with a surgical navigation system.

88. The method of claim 81, wherein:

the step of attaching the bone sculpting tool to the first bone comprises attaching the bone sculpting tool to a femur;

the step of aligning the bone sculpting tool with the second bone and sculpting the articular surface of the second bone comprises placing the bone sculpting tool within an acetabulum and sculpting articular surface of the acetabulum;

the step of attaching the impaction apparatus mount to the first bone comprises attaching the impaction apparatus mount to a femur;

and the step of imparting force to the implant comprises imparting force to an acetabular shell for securing the acetabular shell to the acetabulum, the force being reacted by the acetabulum and the femur.