Precision hip joint replacement method

• US 6,156,069 A
• Filed: 02/04/1999
• Issued: 12/05/2000
• Est. Priority Date: 02/04/1999
• Status: Expired due to Term

• Current Assignee: MicroPort Orthopedics Holdings, Inc. (MicroPort Scientific Corp.)
• Original Assignee: Harlan C Amstutz
• Inventors: Amstutz, Harlan C.
• Primary Examiner(s): Mancene, Gene
• Assistant Examiner(s): Robert, Eduardo C.
• Application Number:
  US09/244,353
• Time in Patent Office: 670 Days
• Field of Search: 623/22, 623/23, 623/22.12, 623/22.11, 623/23.11, 623/908, 623/915, 623/22.15, 606/89, 606/90, 606/91, 606/93, 606/96
• US Class Current: 623/22.11
• CPC Class Codes: A61B 17/15 Guides therefor arrangements for guiding straight saw blades in general B23D51/025
• 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 17/1668 for the upper femur A61B17/164 takes precedence
• CPC Class Codes: A61B 17/175 for preparing the femur for hip prosthesis insertion
• CPC Class Codes: A61B 17/8802 Equipment for handling bone cement or other fluid fillers
• CPC Class Codes: A61B 2017/00902 transparent or translucent
• CPC Class Codes: A61F 2/30767 Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/32 for the hip
• CPC Class Codes: A61F 2/34 Acetabular cups
• CPC Class Codes: A61F 2/3603 implanted without ablation of the whole natural femoral head endoprosthetic cartilage A61F2/30756
• CPC Class Codes: A61F 2/4609 of acetabular cups
• CPC Class Codes: A61F 2/4657 Measuring instruments used for implanting artificial joints for surgical instruments A61B90/06
• CPC Class Codes: A61F 2002/3009 Transparent or translucent
• CPC Class Codes: A61F 2002/30616 Sets comprising a plurality of prosthetic parts of different sizes or orientations
• CPC Class Codes: A61F 2002/308 oblong
• CPC Class Codes: A61F 2002/30802 arcuate
• CPC Class Codes: A61F 2002/30808 parallel
• CPC Class Codes: A61F 2002/30812 perpendicular with respect to each other
• CPC Class Codes: A61F 2002/30827 Plurality of grooves
• CPC Class Codes: A61F 2002/30831 perpendicular with respect to each other
• CPC Class Codes: A61F 2002/30878 : with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
• CPC Class Codes: A61F 2002/30934 : Special articulating surfaces
• CPC Class Codes: A61F 2002/30968 : Sintering
• CPC Class Codes: A61F 2002/3456 : ellipsoidal or having a flattened polar region
• CPC Class Codes: A61F 2002/4619 : for extraction
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2002/4658 : for measuring dimensions, e.g. length
• CPC Class Codes: A61F 2250/0091 : transparent or translucent
• CPC Class Codes: A61F 2310/00011 : Metals or alloys
• CPC Class Codes: A61F 2310/00029 : Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
• CPC Class Codes: A61F 2310/00413 : Coating made of cobalt or of Co-based alloys

Abstract

A metal-to-metal surface hip joint replacement method includes the steps of forming a hard metallic spherical femoral surface replacement prosthesis having a central tapered stem and a mating metallic socket prosthesis, with a sphericity tolerance of about one to three microns, a spacing tolerance of about 100 to 300 microns, and slightly greater spacing at the equatorial zone, mounting a centrally located guide pin on the femoral ball or head, using an apertured relocator guide when needed, using a saw cutoff guide with multiple slots for axial adjustments, using a cylindrical starter drill for initial positioning of the drilling of a tapered central opening, and using a tapered guide pin located in the tapered opening for guiding a chamfering step.

Claims

1. A precision hip joint replacement method involving a metallic femoral surface replacement prosthesis and a metallic acetabular surface replacement prosthesis for a femur having a main body portion and a ball or head coupled to the upper end of the main portion of the femur by a neck, said head and neck having a center and a central axis, said femoral head having an outer surface and an extreme outer end, and said prosthesis having a lower edge, said method comprising the steps of:

a.) forming a hard metallic spherical surface replacement prosthesis, with an extent slightly greater than a hemisphere, and with a central tapered stem;

b.) forming both an entirely metallic acetabular socket prosthesis and said metallic surface replacement femoral head prosthesis with a high degree of spherical accuracy and tolerances, but with slightly increased spacing tolerance at the equatorial zone of each said prostheses;

c.) mounting a guide pin centered on the femoral ball, or head, and extending toward the center of the neck joining the ball to the upper end of the main portion of the femur;

d.) using a feeler gauge to check the alignment of the guide pin with the axis of the femoral neck;

e.) relocating the pin to the center of the axis of the femoral neck using an apertured relocation guide;

f.) reaming the outer surface of the femoral head to a cylindrical configuration using the centrally mounted pin as a guide;

g.) mounting a saw cutoff guide extending around the femoral head, with said saw cutoff guide having a plurality of laterally extending slots with a lateral guide pin extending from said head through a selected one of said slots, to axially locate said cutoff guide;

h.) using a saw and said cutoff guide, cut off the extreme outer end of the femoral head thereby forming outer corners of the cylindrically formed head;

i.) mounting a tower guide on said saw cutoff guide;

j.) using a cylindrical drill, bore a starter hole for the stem of the metallic replacement femoral prostheses;

k.) using a tapered drill matching the shape of the femoral prosthesis stem and said starter hole, bore a tapered hole to a measured depth into the head and neck of the femur;

l.) inserting a tapered guide pin into the tapered hole;

m.) using the tapered guide pin for alignment, chamfer the outer corners of the cylindrically formed femoral head thereby completing the formation of the exposed modified surface of the femoral head;

n.) mounting a guide gauge on said tapered guide pin and checking for a uniform small clearance for cement all the way around the modified surface of said femoral head; and

o.) applying cement to the exposed modified surface of said femoral head and within the femoral prosthesis, and mounting the femoral prosthesis on the femoral head and removing excess cement following seating of the femoral prosthesis;

whereby an even layer of cement is located between said femoral prosthesis and the outer surface of said femoral head, when the tapered stem of said prosthesis is fitted down into said tapered hole, and said cement seals the lower edge of said prosthesis around the modified head and the adjacent neck of the femur.

2. A method as defined in claim 1 wherein the sphericity tolerances of said acetabular and femoral prostheses is between one and three microns over most of the mating surfaces of said prostheses.

3. A method as defined in claim 1 wherein said prostheses have central polar zones and mating surfaces, and wherein the spacing tolerance at the polar zone of said prostheses is slightly greater than the spacing tolerance on most of the mating surfaces of said prostheses.

4. A method as defined in claim 1 wherein said acetabular prosthesis is formed with a plurality of recesses in its edge, for holding said prosthesis during the positioning of said prosthesis.

5. A precision hip joint replacement method involving a metallic femoral surface replacement prosthesis and a metallic acetabular surface replacement prosthesis for a femur having a main body portion and a ball or head coupled to the upper end of the main portion of the femur by a neck, said head and neck having a center and a central axis, said femoral head having an outer surface and an extreme outer end, and said prosthesis having a lower edge, said method comprising the steps of:

a.) forming a hard metallic spherical surface replacement prosthesis, with an extent slightly greater than a hemisphere, and with a central tapered stem;

b.) forming both an entirely metallic acetabular socket prosthesis and said metallic surface replacement femoral head prosthesis with a high degree of spherical accuracy and tolerances, but with slightly increased spacing tolerance at the equatorial zone of each said prosthesis, wherein the sphericity tolerance of said acetabular and femoral prostheses is between one and five microns over most of the mating surfaces of said prostheses;

c.) mounting a guide pin centered on the femoral ball, or head, and extending toward the center of the neck joining the ball to the upper end of the main portion of the femur;

d.) reaming the outer surface of the femoral head to a cylindrical configuration using the centrally mounted pin as a guide;

e.) mounting a saw cutoff guide extending around the femoral head;

f.) using a saw, cut off the extreme outer end of the femoral head thereby forming outer corners of the cylindrically formed head;

g.) mounting a tower guide on said femoral head;

h.) using a tapered drill matching the shape of the femoral prosthesis stem, boring a tapered hole to a measured depth into the head and neck of the femur;

i.) using a centrally located guide pin for alignment, chamfering the outer corners of the cylindrically formed femoral head; and

j.) firmly mounting the femoral prosthesis on the femoral head.

6. A method as defined in claim 5 including providing a plurality of interconnected slots in said cutoff guide, and fixing said cutoff guide in a selected slot to guide cutting off the outer end of said femoral ball to match the configuration of the femoral prosthesis.

7. A method as defined in claim 5 wherein said prostheses have central polar zones and mating surfaces, and wherein the spacing tolerance at the polar zone of said prostheses is slightly greater than the spacing tolerance on most of the mating surfaces of said prostheses.

8. A precision hip joint replacement method as defined in claim 5 wherein the mounting of said saw cutoff guide includes using a saw cutoff guide having a plurality of spaced openings with a guide pin extending laterally from said femoral head through a selected one of said openings, to accurately position said cutoff guide.

9. A precision hip joint replacement method as defined in claim 8 wherein the mounting of said saw cutoff guide involves the use of openings in the form of interconnected parallel slots.

10. A precision hip joint replacement method as defined in claim 5 further including the steps of using a feeler gauge to check the alignment of the guide pin with the central axis of the femoral head and neck, and relocating the pin to the center of said central axis using an apertured relocator guide.

11. A precision hip joint replacement method as defined in claim 10 wherein said relocating step includes the use of a relocator guide having a first generally circular opening for receiving said guide pin, and a second opening which is substantially larger than said first opening.

12. A precision hip joint replacement method as defined in claim 5 including the step of boring a starter hole for the stem of the femoral prosthesis using a drill which is cylindrical over most of its length, aligned by said tower guide, prior to boring the tapered hole.

13. A precision hip joint replacement method as defined in claim 5 including the step of using a tapered guide pin mounted in said tapered hole as a guide for said chamfering step.

14. A precision hip joint replacement method as defined in claim 5 including the additional steps of mounting a tapered guide pin in said tapered hole, and checking the modified configuration of said femoral head by using a transparent plastic cup shaped member having the shape of the femoral prosthesis without the stem, and verifying the configuration of the femoral head for receiving the femoral prosthesis.

15. A precision hip joint replacement method involving a metallic femoral surface replacement prosthesis and a metallic acetabular surface replacement prosthesis for a femur having a main body portion and a ball or head coupled to the upper end of the main portion of the femur by a neck, said head and neck having a center and a central axis, said femoral head having an outer surface and an extreme outer end, and said prosthesis having a lower edge, said method comprising the steps of:

a.) forming a hard metallic spherical surface replacement prosthesis, with an extent slightly greater than a hemisphere, and with a central tapered stem;

b.) mounting a guide pin centered on the femoral ball, or head, and extending toward the center of the neck joining the ball to the upper end of the main portion of the femur;

c.) using a feeler gauge to check the alignment of the guide pin with the axis of the femoral stem;

d.) relocating the pin to the center of the axis of the femoral neck using an apertured relocation guide;

e.) reaming the outer surface of the femoral head to a cylindrical configuration using the centrally mounted pin as a guide;

f.) mounting a saw cutoff guide extending around the femoral head;

g.) using a saw, cut off the extreme outer end of the femoral head;

mounting a tower guide on said saw cutoff guide thereby forming outer corners of the cylindrically formed head;

h.) using a cylindrical drill, bore a starter hole for the stem of the metallic replacement femoral prosthesis;

i.) using a tapered drill matching the shape of the femoral prosthesis stem, bore a tapered hole to a measured depth into the head and neck of the femur;

j.) insert a tapered guide pin into the tapered hole;

k.) using the tapered guide pin for alignment, chamfer the outer corners of the cylindrically formed femoral head;

l.) mounting a guide gauge on said tapered guide pin and verifying the configuration of the femoral head for receiving the femoral prosthesis; and

m.) firmly mounting the femoral prosthesis on the femoral head.

16. A method as defined in claim 15 including providing a plurality of interconnected slots in said cutoff guide, and fixing said cutoff guide in a selected slot to guide cutting off the outer end of said femoral ball to match the configuration of the femoral prosthesis.

17. A method as set forth in claim 15 wherein said forming step includes forming both an entirely metallic acetabular socket prosthesis and said metallic surface replacement femoral head prosthesis with a high degree of spherical accuracy and tolerances, but with slightly increased spacing tolerances at the equatorial zone of said prostheses.

18. A method as defined in claim 17 wherein said prostheses have central polar zones and mating surfaces, and wherein the spacing between said acetabular and femoral prostheses is between one hundred and three hundred microns over most of the mating surfaces of said prostheses.

19. A method as defined in claim 17 wherein said prostheses have central polar zones and mating surfaces, and wherein the spacing tolerance at the polar zone of said prostheses is slightly greater than the spacing tolerance on most of the mating surfaces of said prostheses.

20. A precision hip joint replacement method involving a metallic femoral surface replacement prosthesis and a metallic acetabular surface replacement prosthesis for a femur having a main body portion and a ball or head coupled to the upper end of the main portion of the femur by a neck, said head and neck having a center and a central axis, said femoral head having an outer surface and an extreme outer end, and said prosthesis having a lower edge, said method comprising the steps of:

a.) forming a hard metallic spherical surface replacement prosthesis, with an extent slightly greater than a hemisphere, and with a central tapered stem;

b.) forming both an entirely metallic acetabular socket prosthesis and said metallic surface replacement femoral head prosthesis with a high degree of spherical accuracy and tolerances;

c.) mounting a guide pin centered on the femoral ball, or head, and extending toward the center of the neck joining the ball to the upper end of the main portion of the femur;

d.) using a feeler gauge to check the alignment of the guide pin with the axis of the femoral stem;

e.) relocating the pin to the center of the axis of the femoral neck using an apertured relocation guide;

f.) reaming the outer surface of the femoral head to a cylindrical configuration using the centrally mounted pin as a guide;

g.) mounting a saw cutoff guide extending around the femoral head;

h.) using a saw, cut off the extreme outer end of the femoral head thereby forming outer corners of the cylindrically formed head;

i.) mounting a tower guide on said femoral head;

j.) using a tapered drill matching the shape of the femoral prosthesis stem, boring a tapered hole to a measured depth into the head and neck of the femur;

k.) using a centrally located guide pin for alignment, chamfering the outer corners of the cylindrically formed femoral head; and

l.) firmly mounting the femoral prosthesis on the femoral head.

21. A precision hip joint replacement method involving a metallic femoral surface replacement prosthesis and a metallic acetabular surface replacement prosthesis for a femur having a main body portion and a ball or head coupled to the upper end of the main portion of the femur by a neck, said head and neck having a center and a central axis, said femoral head having an outer surface and an extreme outer end, and said prosthesis having a lower edge, said method comprising the steps of:

a.) forming a hard metallic spherical surface replacement prosthesis, with an extent slightly greater than a hemisphere, and with a central tapered stem;

b.) forming both an entirely metallic acetabular socket prosthesis and said metallic surface replacement femoral head prosthesis with a high degree of spherical accuracy and tolerances;

c.) mounting a guide pin centered on the femoral ball, or head, and extending toward the center of the neck joining the ball to the upper end of the main portion of the femur;

d.) reaming the outer surface of the femoral head to a cylindrical configuration using the centrally mounted pin as a guide;

e.) mounting a saw cutoff guide extending around the femoral head, with said saw cutoff guide having a plurality of laterally extending slots with a lateral guide pin extending through a selected one of said slots, to axially locate said cutoff guide;

f.) using a saw, cut off the extreme outer end of the femoral head thereby forming outer corners of the cylindrically formed head;

g.) mounting a tower guide on said femoral head;

h.) using a tapered drill matching the shape of the femoral prosthesis stem, boring a tapered hole to a measured depth into the head and neck of the femur;

i.) using a centrally located guide pin for alignment, chamfering the outer corners of the cylindrically formed femoral head; and

j.) firmly mounting the femoral prosthesis on the femoral head.

22. A precision hip joint replacement method involving a metallic femoral surface replacement prosthesis and a metallic acetabular surface replacement prosthesis for a femur having a main body portion and a ball or head coupled to the upper end of the main portion of the femur by a neck, said head and neck having a center and a central axis, said femoral head having an outer surface and an extreme outer end, and said prosthesis having a lower edge, said method comprising the steps of:

a.) forming a hard metallic spherical surface replacement prosthesis, with an extent slightly greater than a hemisphere, and with a central tapered stem;

b.) forming both an entirely metallic acetabular socket prosthesis and said metallic surface replacement femoral head prosthesis with a high degree of spherical accuracy and tolerances;

c.) mounting a guide pin centered on the femoral ball, or head, and extending toward the center of the neck joining the ball to the upper end of the main portion of the femur;

d.) reaming the outer surface of the femoral head to a cylindrical configuration using the centrally mounted pin as a guide;

e.) mounting a saw cutoff guide extending around the femoral head;

f.) using a saw, cut off the extreme outer end of the femoral head thereby forming outer corners of the cylindrically formed head;

g.) mounting a tower guide on said femoral head;

h.) using a cylindrical drill guided by said tower guide, bore a starter hole for the stem of the metallic replacement femoral prostheses;

i.) using a tapered drill matching the shape of the femoral prosthesis stem, boring a tapered hole located by said starter hole to a measured depth into the head and neck of the femur;

j.) using a centrally located tapered guide pin for alignment, chamfering the outer corners of the cylindrically formed femoral head; and

k.) firmly mounting the femoral prosthesis on the femoral head.

23. A precision hip joint replacement method involving a metallic femoral surface replacement prosthesis and a metallic acetabular surface replacement prosthesis for a femur having a main body portion and a ball or head coupled to the upper end of the main portion of the femur by a neck, said head and neck having a center and a central axis, said femoral head having an outer surface and an extreme outer end, and said prosthesis having a lower edge, said method comprising the steps of:

a.) forming a hard metallic spherical surface replacement prosthesis, with an extent slightly greater than a hemisphere, and with a central tapered stem;

b.) forming both an entirely metallic acetabular socket prosthesis and said metallic surface replacement femoral head prosthesis with a high degree of spherical accuracy and tolerances;

c.) mounting a guide pin centered on the femoral ball, or head, and extending toward the center of the neck joining the ball to the upper end of the main portion of the femur;

d.) reaming the outer surface of the femoral head to a cylindrical configuration using the centrally mounted pin as a guide;

e.) mounting a saw cutoff guide extending around the femoral head;

f.) using a saw, cut off the extreme outer end of the femoral head thereby forming outer corners of the cylindrically formed head;

g.) mounting a tower guide on said femoral head;

h.) using a tapered drill matching the shape of the femoral prosthesis stem, boring a tapered hole to a measured depth into the head and neck of the femur;

i.) insert a tapered guide pin into said tapered hole;

j.) using said tapered guide pin for alignment, chamfering the outer corners of the cylindrically formed femoral head; and

k.) firmly mounting the femoral prosthesis on the femoral head.