Method and Apparatus for Arthroscopic Assisted Arthroplasty of the Hip Joint

• US 20090281545A1
• Filed: 03/05/2009
• Published: 11/12/2009
• Est. Priority Date: 03/05/2008
• Status: Active Grant

• Current Assignee: Allston J. Stubbs
• Original Assignee: Allston J. Stubbs
• Inventors: Stubbs, Allston J.
• Granted Patent: US 8,828,008 B2
• Time in Patent Office: Days
• US Class Current: 606/87
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1615 Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1668 for the upper femur A61B17/164 takes precedence
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1721 for applying pins along or parallel to the axis of the femoral neck
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 17/175 for preparing the femur for hip prosthesis insertion
• CPC Class Codes: A61B 2017/0275 for the hip
• CPC Class Codes: A61F 2/32 for the hip
• CPC Class Codes: A61F 2/34 Acetabular cups
• CPC Class Codes: A61F 2/3609 Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts A61F2/3601 takes precedence
• CPC Class Codes: A61F 2/4607 of hip femoral endoprostheses
• CPC Class Codes: A61F 2/4609 of acetabular cups
• CPC Class Codes: A61F 2002/30299 umbrella-shaped or mushroom-shaped
• CPC Class Codes: A61F 2002/30579 with mechanically expandable devices, e.g. fixation devices
• CPC Class Codes: A61F 2002/3615 having a concave shape, e.g. hemispherical cups
• 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 2230/0093 Umbrella-shaped, e.g. mushroom-shaped

Abstract

Devices, systems and methods for performing arthroscopic evaluations and procedures in and near the hip joint are provided. An arthroscopic assisted arthroplasty system is useful in the treatment of arthritic hip conditions, conserving healthy tissue, and limiting iatrogenic injury associated with traditional surgical exposures. A guide wire system employing retrograde and antegrade reamers along the femoral neck is useful in anatomic placement of instrumentation without formal hip dislocation. Fluoroscopy and computer assisted navigation enhance the system, methods, and apparatus. Acetabular and femoral collapsible prosthetic forms are useful in arthroscopic assisted placement. The devices, systems, and methods are effective to assist an operating surgeon in the addressing mild to moderate arthritic conditions of the femoral head and acetabulum where tissue conservation and surgical exposure morbidities should be limited.

Claims

1-11. -11. (canceled)

12. A system for performing an arthroscopic arthroplasty procedure with respect to a hip joint of a human patient, the hip joint being defined by a femoral head extending from a femoral neck of a femur, and an acetabulum of a pelvis, said system comprising:

a distraction device adapted to be engaged between the femur and the pelvis, and operable to distract the hip joint by separating the femoral head from the acetabulum;

an alignment device adapted to be engaged between the femur and the pelvis and operable to maintain the distracted hip joint in accordance with a normal hip joint alignment;

a jig device adapted to be aligned along the femoral neck of the femur, the jig device being configured to receive a boring device and to guide the boring device for boring a channel through the femoral neck, along an axis extending longitudinally therealong, the channel extending through the femoral head toward the acetabulum;

an acetabular prosthesis and a complementarily-configured femoral head prosthesis, each of the prostheses being configured to be directed through the channel to the hip joint for application to the corresponding one of the acetabulum and the femoral head, the acetabular prosthesis being configured to receive the femoral head prosthesis upon removal of the distraction device from the hip joint; and

a joint preparation device configured to extend through the channel into the distracted hip joint;

the joint preparation device being configured to osteotomize one of the femoral head and the acetabulum for receiving the respective one of the femoral head prosthesis and the acetabular prosthesis, prior to the application thereof.

13. A system according to claim 12, wherein the jig device further comprises:

a cannulated element adapted to interact with the femoral neck opposite the femoral head, and being configured to receive the boring device therethrough;

a guide tip portion adapted to engage the femoral head in opposition to the cannulated element, the cannulated element and guide tip portion being aligned along the longitudinal axis of the femoral neck; and

a frame element operably engaged between the cannulated element and the guide tip portion, the frame element being configured to adjustable so as to vary a length between the cannulated element and the guide tip portion, and a deflection angle of the guide tip portion with respect to the longitudinal axis.

14. A system according to claim 13, wherein the frame element further comprises a first frame portion operably engaged with the guide tip portion and a second frame portion operably engaged with the cannulated element, the first and second frame portions being configured to adjustably engage each other along an at least partially arcuate engagement path for varying the length and deflection angle.

15. A system according to claim 14, further comprising a securement device operably engaged between the first and second frame portions, the securement device being configured to selectively secure the first and second frame element with respect to each other upon attaining a desired length and deflection angle.

16. A system according to claim 13, wherein the jig device further comprises at least one alignment element capable of being detected by one of a computer device and an imaging system to facilitate placement of one of the cannulated element and the guide tip portion with respect to the femoral neck.

17. A system according to claim 12, wherein the joint preparation device further comprises at least one reaming blade, the at least one reaming blade capable of being inserted into the hip joint through the channel and having a shaft element associated therewith, the shaft element being configured to cooperate with the at least one reaming blade so as to rotate the at least one reaming blade about the longitudinal axis of the femoral neck to osteotomize one of the femoral head and the acetabulum for receiving the respective one of the femoral head prosthesis and the acetabular prosthesis.

18. A system according to claim 17, wherein the shaft element further comprises an elongate cannula member configured to extend through the channel and into the hip joint, the cannula member having a proximal end and a distal end, the distal end being configured to house at least one reaming blade coupled to a control member, the control member extending from the at least one reaming blade along the cannula member and through the proximal end thereof, the at least one reaming blade being deployable into the hip joint by longitudinal extension of the control member to direct the at least one reaming blade out of the cannula member, and manipulation of the control member to extend the at least one reaming blade laterally outward of the longitudinal axis, for subsequent rotation thereof about the longitudinal axis.

19. A system according to claim 18, wherein the laterally-extended at least one reaming blade is further configured to be rotatable about the longitudinal axis, by rotation of one of the control member and the cannula member, for osteotomizing one of the femoral head and the acetabulum for receiving the respective one of the femoral head prosthesis and the acetabular prosthesis.

20. A system according to claim 19, wherein the at least one reaming blade is configured to be rotatable through rotation of the cannula member, and wherein the distal end of the cannula member defines opposed slots extending parallel to the longitudinal axis, the slots being configured to receive the laterally-extended at least one reaming blade upon retraction of the control member through the channel, and to secure the at least one reaming blade to the cannula member so as to allow the cannula member to rotate the at least one reaming blade.

21. A system according to claim 17, wherein the at least one reaming blade includes a proximal blade portion configured to be rotated about the longitudinal axis to osteotomize the acetabulum for receiving the acetabular prosthesis.

22. A system according to claim 17, wherein the at least one reaming blade includes a proximal blade portion configured to be rotated about the longitudinal axis to osteotomize the femoral head for receiving the femoral head prosthesis.

23. A system according to claim 17, wherein the joint preparation device is configured to be retractable from the hip joint through the channel defined by the femoral neck.

24. A system according to claim 12, wherein the acetabular prosthesis and the femoral head prosthesis are each configured to be directed through the channel defined by the femoral neck for insertion into the hip joint.

25. A system according to claim 24 wherein the acetabular prosthesis further comprises an acetabular shell portion expandable into a substantially hemispherical shell configuration corresponding to the osteotomized acetabulum for receipt thereby.

26. A system according to claim 25, wherein the acetabular prosthesis further comprises an expandable hemispheric truss device operably engaged with the acetabular shell portion, the hemispheric truss device being configured to cooperate with the acetabular shell portion so as to expand the acetabular shell portion within the osteotomized acetabulum such that the acetabular shell portion is disposed between the osteotomized acetabulum and the hemispheric truss device.

27. A system according to claim 26, further comprising an acetabular prosthesis placement element including an acetabular prosthesis cannula element configured to receive the acetabular shell portion having the hemispheric truss device operably engaged therewith, the acetabular prosthesis cannula element being configured to carry the acetabular shell portion and the hemispheric truss device to the osteotomized acetabulum, the hemispheric truss device being coupled to a deployment device configured to expand the hemispheric truss device and the acetabular shell portion operably engaged therewith, within the osteotomized acetabulum.

28. A system according to claim 26, wherein the acetabular prosthesis further comprises an acetabular liner portion expandable into a substantially hemispherical shell configuration corresponding to the acetabular shell portion having the hemispheric truss device therein, for receipt thereby, such that the hemispheric truss device is disposed between the acetabular shell portion and the acetabular liner portion.

29. A system according to claim 24, wherein the femoral head prosthesis further comprises a femoral head shell portion expandable into a substantially hemispherical shell configuration corresponding to the acetabular liner portion of the acetabular prosthesis, for receipt thereby upon removal of the distraction device from the hip joint.

30. A system according to claim 29, wherein the femoral head prosthesis further comprises an expandable hemispheric truss device operably engaged with the femoral head shell portion, the hemispheric truss device being configured to cooperate with the femoral head shell portion so as to expand the femoral head shell portion to extend over the osteotomized femoral head such that the hemispheric truss device is disposed between the osteotomized femoral head and the femoral head shell portion.

31. A system according to claim 30, further comprising a femoral head prosthesis placement element including a femoral head prosthesis cannula element configured to receive the femoral head shell portion having the hemispheric truss device operably engaged therewith, the femoral head prosthesis cannula element being configured to carry the femoral head shell portion and the hemispheric truss device to the osteotomized femoral head, the hemispheric truss device being coupled to a deployment device configured to expand the hemispheric truss device and the femoral head shell portion operably engaged therewith, within the hip joint.

32. A system according to claim 31, wherein the deployment device is operably engaged with at least the hemispheric truss device, and the hemispheric truss device having the femoral head shell portion operably engaged therewith is configured to engage the osteotomized femoral head upon retraction of the deployment device along the channel outwardly of the hip joint such that the hemispheric truss device is disposed between the osteotomized femoral head and the femoral head shell portion.

33. A system according to claim 32, further comprising a prosthesis securement element configured to operably engage the deployment device about an entrance to the channel defined by the femoral neck so as to secure the femoral head prosthesis to the osteotomized femoral head.

34. A system according to claim 12, wherein the alignment device further comprises at least one alignment element capable of being detected by one of a computer device and an imaging system to facilitate maintenance of the distracted hip joint in accordance with a normal hip joint alignment.

35. A method of performing an arthroscopic arthroplasty procedure with respect to a hip joint of a human patient, the hip joint being defined by a femoral head extending from a femoral neck of a femur, and an acetabulum of a pelvis, said method comprising:

distracting the hip joint by separating the femoral head from the acetabulum, using a distraction device adapted to be engaged between the femur and the pelvis;

maintaining the distracted hip joint in accordance with a normal hip joint alignment using an alignment device adapted to be engaged between the femur and the pelvis;

boring a channel through the femoral neck, along an axis extending longitudinally therealong and such that the channel extends through the femoral head toward the acetabulum, using a jig device adapted to be aligned along the femoral neck of the femur and configured to receive and guide a boring device;

directing each of an acetabular prosthesis and a complementarily-configured femoral head prosthesis through the channel to the hip joint;

applying the acetabular prosthesis and the femoral head prosthesis to the corresponding one of the acetabulum and the femoral head, the acetabular prosthesis being configured to receive the femoral head prosthesis upon removal of the distraction device from the hip joint; and

osteotomizing one of the femoral head and the acetabulum for receiving the respective one of the femoral head prosthesis and the acetabular prosthesis, prior to the application thereof, using a joint preparation device configured to extend through the channel into the distracted hip joint.