UNIVERSAL DOUBLE OFFSET SURGICAL INSTRUMENT

• US 20100121331A1
• Filed: 11/20/2009
• Published: 05/13/2010
• Est. Priority Date: 11/18/2003
• Status: Active Grant

• Current Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Original Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Inventors: Gibson, Luke A., Kelman, David C., Sharp, Jeffrey A.
• Granted Patent: US 8,657,824 B2
• Time in Patent Office: Days
• US Class Current: 606/80
• 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 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/164 intramedullary
• CPC Class Codes: A61B 17/1659 Surgical rasps, files, planes, or scrapers
• CPC Class Codes: A61B 17/1668 for the upper femur A61B17/164 takes precedence
• CPC Class Codes: A61B 2017/0046 with a releasable handle; with handle and operating part separable
• 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 2/4607 of hip femoral endoprostheses
• CPC Class Codes: A61F 2/4657 Measuring instruments used for implanting artificial joints for surgical instruments A61B90/06
• CPC Class Codes: A61F 2002/4635 using minimally invasive surgery

Abstract

Instruments for use in anterior approach total hip arthroplasty. Instruments according to certain embodiments of the invention connect to a shaping member such as a broach, reamer or osteotome that is used to prepare the intramedullary canal of a desired femur or other bone for total hip arthroplasty. Such an instrument according to such embodiments can be configurable to allow operation on either the left or right leg, and in doing so to provide lateral offset and anterior offset of the instrument handle relative to the shaping member so that the patient'"'"'s gut, musculature or other bodily portions may be avoided while still providing desired leverage and control over the shaping member to prepare the intramedullary canal.

Claims

1. An instrument for shaping a medullary canal of both a patient'"'"'s left leg and right leg, comprising:

(a) a handle that includes a handle longitudinal axis;

(b) a shaping member including;

structure configured to shape bone;

a shaping member longitudinal axis, and

a connecting structure that includes an interpositional cooperation structure;

(c) an offset member that physically connects the handle to the shaping member, the offset member extending in an offset direction that includes a first directional component in a first direction orthogonal to the longitudinal axis of the shaping member, and a second directional component in the direction of the shaping member longitudinal axis;

(d) the offset member including;

(i) a first opening adapted to receive the shaping member connecting structure, the first opening configured to receive the shaping member connecting structure in a manner whereby the shaping member longitudinal axis is substantially parallel to the handle longitudinal axis;

(ii) a second opening adapted to receive the shaping member connecting structure, the second opening configured to receive the shaping member connecting structure in a manner whereby the shaping member longitudinal axis is substantially parallel to the handle longitudinal axis; and

(e) a retention device or member comprising an actuator and at last one interpositional structure, the retention device or member configured to interpose the at least one interpositional structure relative to the interpositional cooperation structure of the shaping member connecting structure when the actuator is actuated.

2. The instrument of claim 1, wherein the shaping member comprises a reference plane and the first and second openings are configured to receive the shaping member connecting structure in a manner such that the first direction orthogonal to the longitudinal axis of the shaping member bisects the angle formed by the shaping member reference plane when the shaping member is connected to the first opening and the shaping member reference plane when the shaping member is connected to the second opening.

3. The instrument of claim 1, wherein the shaping member comprises a reference plane and the first and second openings are configured to receive the shaping member connecting structure in a manner such that when the shaping member is connected to the first opening, the shaping member reference plane is substantially orthogonal to the shaping member reference plane when the shaping member is connected to the second opening.

4. The instrument of claim 1, wherein the shaping member is a broach.

5. The instrument of claim 1, wherein the shaping member is a femoral shaping member for preparation of a central femoral cavity for receiving a stem of a femoral component of a prosthetic hip.

6. The instrument of claim 1, further comprising a strike plate with a first beveled surface that corresponds to the first opening on the offset member and a second beveled surface that corresponds to the second opening on the offset member.

7. The instrument of claim 1, wherein the offset member extends in at least two offset directions.

8. The instrument of claim 1, wherein the offset direction includes a third directional component that is orthogonal to the first directional component, the second directional component, and the longitudinal axis of the shaping member.

9. The instrument of claim 1, wherein the offset member includes a first abutment surface and a second abutment surface, the first abutment surface corresponding to the first opening and configured to abut a proximal surface of the shaping member, the second abutment surface corresponding to the second opening and configured to abut a proximal surface of the shaping member.

10. The instrument of claim 1, wherein the actuator of the retention device or member includes an over-center linkage configured to lock the interpositional structure in place when interposed with the interpositional cooperation structure of the shaping member connecting structure, and wherein the interpositional structure comprises at least one pawl.

11. The instrument of claim 1, wherein the actuator of the retention device or member includes a wedge, the interpositional structure includes at least one claw, and the wedge is configured to urge the at least one claw into interposed position with the interpositional cooperation structure of the shaping member connecting structure.

12. An instrument for operating on a medullary canal for installation of a prosthetic stem component in a patient, comprising:

a handle including an elongated shaft extending approximately in a negative z-direction;

a first offset capable of extending in a first direction that includes an x-directional component or a negative x-directional component;

a second offset extending in a second direction that includes a negative y-directional component;

the handle connected to either the first or second offset;

an insertion member extending from either the first offset or the second offset in an insertion member direction that includes a negative z-directional component;

wherein the negative y-directional component and negative z-directional components are orthogonal to each other and orthogonal to the x-directional component and the negative x-directional component, and

wherein the handle and the insertion member are positioned with respect to one another in a non-planar relationship.

13. The instrument of claim 12, wherein one of the offsets is connected to the handle via a pivot capable of rotating relative to the handle such that one of the offsets extends in approximately an x-direction or a negative x-direction in order to configure the instrument for use with a right leg or a left leg of the patient.

14. The instrument of claim 12, wherein the handle is configured to connect to the second offset on either a first side of the handle that faces the x direction or a second side of the handle that faces the negative x direction in order to form the first offset.

15. The instrument of claim 12, wherein the insertion member further comprises cutting elements.

16. An instrument for operating on a medullary canal for installation of a prosthetic stem component in a patient, comprising:

a handle including an elongated shaft extending in an approximately negative z-direction;

an offset connected to the handle, the offset extending in a first direction that includes a negative y-directional component and capable of extending in a second direction that includes an x-directional component or a negative x-directional component;

a shaping member extending from the offset in a shaping member direction that includes a negative z-directional component, wherein the negative y-directional component and negative z-directional components are orthogonal to each other and orthogonal to the x-directional component and the negative x-directional component,

wherein the handle and the shaping member are positioned with respect to one another in a non-coplanar relationship, and

wherein the shaping member further comprises cutting elements.

17. The instrument of claim 16, wherein the offset is connected to the handle via a pivot, and the handle and pivot are capable of rotating relative to each other such that the offset extends in a direction that includes an x-directional component or a negative x-directional component in order to configure the instrument for use with a right leg or a left leg of the patient.

36. The instrument of claim 16, further comprising a separate adapter component that comprises the offset.

18. An instrument for operating on a medullary canal for installation of a prosthetic stem component in a patient, comprising:

a handle member including a first section that extends in a negative z-direction;

a second section that extends in a direction having an x-directional component or a negative x-directional component and a negative y-directional component; and

a third section that extends in a direction that includes a negative z-directional component wherein the negative y-directional component and the negative z-directional components are orthogonal to each other and the negative y-directional component and the negative z-directional components are orthogonal to the x-directional component and the negative x-directional component;

a strike plate configured to connect to the first section or the third section of the handle member; and

a shaping member configured to connect to the first section or the third section of the handle member;

wherein

when the strike plate is connected to the first section of the handle member and the shaping member is connected to the third section of the handle member, the instrument is configured for operating on a first leg of the patient, and when the strike plate is connected to the third section of the handle member and the shaping member is connected to the first section of the handle member, the instrument is configured for operating on a second leg of the patient.

19. An instrument according to claim 18, wherein the shaping member is a femoral shaping member.

20. An instrument according to claim 18, wherein the shaping member is a broach.

21. A method of installing a prosthetic stem component into the medullary canal of a right leg or a left leg of a patient, comprising the steps of:

obtaining an instrument capable of shaping a medullary canal of both a patient'"'"'s left leg and right leg, comprising;

(a) a handle that includes a handle longitudinal axis;

(b) a shaping member including;

structure configured to shape bone;

a shaping member longitudinal axis, and

a connecting structure that includes an interpositional cooperation structure;

(c) an offset member that physically connects the handle to the shaping member, the offset member extending in an offset direction that includes a first directional component in a first direction orthogonal to the longitudinal axis of the shaping member, and a second directional component in the direction of the shaping member longitudinal axis;

(d) the offset member including;

(i) a first opening adapted to receive the shaping member connecting structure, the first opening configured to receive the shaping member connecting structure in a manner whereby the shaping member longitudinal axis is substantially parallel to the handle longitudinal axis;

(ii) a second opening adapted to receive the shaping member connecting structure, the second opening configured to receive the shaping member connecting structure in a manner whereby the shaping member longitudinal axis is substantially parallel to the handle longitudinal axis; and

(e) a retention device or member comprising an actuator and at last one interpositional structure, the retention device or member configured to interpose the at least one interpositional structure relative to the interpositional cooperation structure of the shaping member connecting structure when the actuator is actuated;

selecting either the left leg or the right leg of the patient as the leg for installation of the prosthetic stem component;

configuring the instrument to operate on the selected leg by connecting the shaping member to the first opening or the second opening;

inserting the instrument into the medullary canal of the selected leg through a surgical incision;

operating on the medullary canal of the selected leg with the instrument;

removing the instrument from the medullary canal of the selected leg;

installing the prosthetic stem component in the medullary canal of the selected leg; and

completing the surgery.

22. The method of claim 21, wherein:

the step of obtaining an instrument capable of shaping a medullary canal of both a patient'"'"'s left leg or a right leg includes obtaining an instrument that includes a strike plate connected to the handle, the strike plate including a first beveled surface that corresponds to the first opening on the offset member and a second beveled surface that corresponds to the second opening on the offset member; and

the step of operating on the medullary canal of the selected leg with the instrument includes striking the instrument on a predetermined one of the first beveled surface and the second beveled surface.

23. A method of installing a prosthetic stem component into the meduallary canal of a right leg or a left leg of a patient, comprising the steps of:

obtaining an instrument capable of operating on the medullary canal of the right leg or the left leg of the patient for installation of a prosthetic stem component, comprising a handle including a shaft extending downward approximately in a negative z-direction, a first offset configured to extend from a bottom of the elongated shaft in a first direction that includes an x-directional component or a negative x-directional component, a second offset extending from the first offset in a second direction that includes a negative y-directional component, and a shaping member including structure configured to shape bone, the shaping member extending downward from the second offset in a shaping member direction that includes a negative z-directional component, wherein the negative y-directional component and the negative z-directional component are orthogonal to each other, and the negative y-directional component and the negative z-directional component are orthogonal to the x-directional component and the negative x-directional component, and wherein the handle and the shaping member are positioned with respect to one another in a non-planar relationship;

selecting either the left leg or the right leg of the patient as the leg for installation of the prosthetic stem component;

configuring the instrument to operate on the selected leg by causing the first offset to extend from the handle in either the direction that includes the x-directional component or the direction that includes the negative-x directional component;

inserting the instrument into the medullary canal of the selected leg through a surgical incision;

operating on the medullary canal of the selected leg with the instrument;

removing the instrument from the medullary canal of the selected leg;

installing the prosthetic stem component in the medullary canal of the selected leg; and

completing the surgery.

24. The method of claim 23, wherein:

the step of obtaining an instrument capable of operating on the medullary canal of the right leg or the left leg of the patient includes obtaining an instrument that includes a strike plate connected to the handle, the strike plate including a first beveled surface that corresponds to the first opening on the offset member and a second beveled surface that corresponds to the second opening on the offset member; and

the step of operating on the medullary canal of the selected leg with the instrument includes striking the instrument on a predetermined one of the first beveled surface and the second beveled surface.

25. The method of claim 23, wherein the step of inserting the instrument into the medullary canal of the selected leg comprises inserting the instrument into an anterior surgical incision.

26. The method of claim 23, wherein the step of inserting the instrument into the medullary canal of the selected leg comprises inserting the instrument into a minimally invasive surgical incision.

27. The method of claim 23, wherein the step of inserting the instrument into the medullary canal of the selected leg comprises inserting the instrument into a surgical incision that is from approximately 4 cm to approximately 16 cm in length.

28. The method of claim 23, wherein the step of inserting the instrument into the medullary canal of the selected leg comprises inserting a femoral shaping member.

29. The method of claim 23, wherein the step of inserting the instrument into the medullary canal of the selected leg comprises inserting a broach.

30. A method of installing a prosthetic stem component into the meduallary canal of a right leg or a left leg of a patient, comprising the steps of:

obtaining an instrument capable of operating on the medullary canal of the right leg or the left leg of the patient for installation of a prosthetic stem component, the instrument comprising;

a handle including an elongated shaft extending approximately in a negative z-direction;

an offset connected to the handle, the offset extending in a first direction that includes a negative y-directional component and capable of extending in a second direction that includes an x-directional component or a negative x-directional component;

a shaping member extending downward the offset in a shaping member direction that includes a negative z-directional component,

wherein the negative y-directional component and negative z-directional components are orthogonal to each other and orthogonal to the x-directional component and the negative x-directional component,

wherein the handle and the shaping member are positioned with respect to one another in a non-planar relationship, and

wherein the shaping member further comprises cutting elements;

selecting either the left leg or the right leg of the patient as the leg for installation of the prosthetic stem component;

configuring the instrument to operate on the selected leg by causing the first offset to extend from the handle in either the direction that includes the x-directional component or the direction that includes the negative-x directional component;

inserting the instrument into the medullary canal of the selected leg through a surgical incision;

operating on the medullary canal of the selected leg with the instrument;

removing the instrument from the medullary canal of the selected leg;

installing the prosthetic stem component in the medullary canal of the selected leg; and

completing the surgery.

31. The method of claim 30, wherein:

the step of obtaining an instrument capable of operating on the medullary canal of the right leg or the left leg of the patient includes obtaining an instrument that includes a strike plate connected to the handle, the strike plate including a first beveled surface that corresponds to the first opening on the offset member and a second beveled surface that corresponds to the second opening on the offset member; and

the step of operating on the medullary canal of the selected leg with the instrument includes striking the instrument on a predetermined one of the first beveled surface and the second beveled surface.

32. The method of claim 31, wherein the step of inserting the instrument into the medullary canal of the selected leg comprises inserting a femoral shaping member.

33. The method of claim 31, wherein the step of inserting the instrument into the medullary canal of the selected leg comprises inserting a broach.

34. A method of installing a prosthetic stem component into the medullary canal of a right leg or a left leg of a patient, comprising the steps of:

obtaining an instrument capable of operating on a medullary canal for installation of a prosthetic stem component in a patient, comprising;

a handle member including a first section that extends in a negative z-direction;

a second section that extends in a direction having (i) an x-directional component or a negative x-directional component and (ii) a negative y-directional component; and

a third section that extends in a direction that includes a negative z-directional component wherein the x-directional component, the negative y-directional component and the negative z-directional components are orthogonal to each other;

a strike plate configured to connect to the first section or the third section of the handle member; and

and a shaping member configured to connect to the first section or the third section of the handle member;

wherein

when the strike plate is connected to the first section of the handle member and the shaping member is connected to the third section of the handle member, the instrument is configured for operating on a first leg of the patient, and when the strike plate is connected to the third section of the handle member and the shaping member is connected to the first section of the handle member, the instrument is configured for operating on a second leg of the patient;

selecting either the left leg or the right leg of the patient as the leg for installation of the prosthetic stem component;

configuring the instrument to operate on the selected leg by connecting the shaping member to one of the first or third section of the handle and connecting the strike plate to the other of the first or third section of the handle;

inserting the instrument into the medullary canal of the selected leg through a surgical incision;

operating on the medullary canal of the selected leg with the instrument;

removing the instrument from the medullary canal of the selected leg;

installing the prosthetic stem component in the medullary canal of the selected leg; and

completing the surgery.

35. The method of claim 34, wherein:

the step of obtaining an instrument capable of operating on a medullary canal includes obtaining an instrument wherein the strike plate includes a first beveled surface that corresponds to the left leg of the patient and a second beveled surface that corresponds to the right leg of the patient; and

the step of operating on the medullary canal of the selected leg with the instrument includes striking the instrument on a predetermined one of the first beveled surface and the second beveled surface.

37. An adapter capable of joining a handle to a shaping member for shaping a medullary canal of a patient'"'"'s leg, the handle having a handle longitudinal axis and the shaping member having a shaping member longitudinal axis, the adapter comprising:

(a) a body;

(b) at least one post connected to the body and configured to connect to the handle; and

(c) a cavity that receives the insertion member in a locking manner,

wherein a longitudinal axis of the post relative to a longitudinal axis of the cavity is oriented to connect the shaping member in a manner whereby the shaping member longitudinal axis is substantially parallel to the handle longitudinal axis; and

wherein the adapter extends in an offset direction that includes a first directional component in a first direction orthogonal to the longitudinal axis of the shaping member, and a second directional component in the direction of the shaping member longitudinal axis.

38. The adapter of claim 37, wherein the adapter comprises two posts, one of the posts being configured for shaping the medullary canal of a patient'"'"'s right leg and the other of the posts being configured for shaping the medullary canal of a patient'"'"'s left leg.