Methods and instruments for performing radial impacting

• US 6,270,502 B1
• Filed: 12/11/1998
• Issued: 08/07/2001
• Est. Priority Date: 12/11/1998
• Status: Expired due to Term

• Current Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Original Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Inventors: Stulberg, S. David
• Primary Examiner(s): Recla, Henry J.
• Assistant Examiner(s): King, Anthony S.
• Application Number:
  US09/210,116
• Time in Patent Office: 970 Days
• Field of Search: 606/86, 606/94, 606/92, 606/98, 606/90, 606/80, 606/170, 606/96, 623/22
• US Class Current: 606/86.00R
• CPC Class Codes: A61B 17/82 for bone cerclage apparatus for manipulating wires or straps A61B17/8861; wires, bands or straps other than cerclage A61B17/842
• CPC Class Codes: A61B 17/885 Tools for expanding or compacting bones or discs or cavities therein A61B17/8805, A61B17/7097 take precedence
• CPC Class Codes: A61B 2017/0046 with a releasable handle; with handle and operating part separable for prosthetic joint-implanting tools A61F2/4603
• CPC Class Codes: A61B 2017/00469 for insertion of instruments, e.g. guide wire, optical fibre
• CPC Class Codes: A61F 2/30723 Plugs or restrictors for sealing a cement-receiving space tools for inserting plugs A61F2/4614; sealing collars for use during cementing A61B17/8808
• CPC Class Codes: A61F 2/36 Femoral heads ; Femoral endoprostheses
• CPC Class Codes: A61F 2/3662 Femoral shafts
• CPC Class Codes: A61F 2/4601 for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
• CPC Class Codes: A61F 2/4684 Trial or dummy prostheses
• CPC Class Codes: A61F 2002/2835 Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30616 Sets comprising a plurality of prosthetic parts of different sizes or orientations
• CPC Class Codes: A61F 2002/3069 Revision endoprostheses
• CPC Class Codes: A61F 2002/4631 the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2002/4662 for measuring penetration depth
• CPC Class Codes: A61F 2002/4667 for measuring torque
• CPC Class Codes: A61F 2002/4677 using a guide wire
• CPC Class Codes: A61F 2002/4681 by applying mechanical shocks, e.g. by hammering
• CPC Class Codes: A61F 2250/0064 Sets comprising a plurality of prosthetic parts of different sizes

Abstract

A radial impacting technique involves using a set of progressively larger radial impactors to pack a medullary canal in a radial direction toward the cortex. For revision cases, graft material, which may be either synthetic or bone graft material, is added into the medullary canal after the previously installed implant has been removed. Packing the medullary canal in the radial direction, as opposed to the conventional approach of packing in a distal direction, provides superior results. The radial impactors are preferably cannulated and may also have holes to assist in the removal of fluids from within the medullary canal. The profile impactors may be either cannulated or non-cannulated and prepare the medullary canal for receipt of the implant.

Claims

1. A method of preparing a medullary canal of a bone for receipt of a prosthetic implant by packing, graft material, comprising:

inserting a first packer into the medullary canal to pack said graft material, the first packer comprising;

(a) a first outer periphery at a reference position within the medullary canal and

(b) a working surface having a substantially circular cross-section throughout its entire length;

inserting at least a second packer into the medullary canal to pack said graft material, the second packer comprising;

(a) a second outer periphery at the reference position and

(b) a working surface having a substantially circular cross-section throughout its entire length, the second outer periphery being greater than the first outer periphery;

wherein inserting the second packer occurs after inserting the first packer so as to pack the medullary canal in a radial direction toward the cortex of the bone.

2. The method as set forth in claim 1, further comprising inserting graft material into the medullary canal and wherein the inserting of the first and second packers packs the graft material in the radial direction toward the cortex of the bone.

3. The method as set forth in claim 2, wherein the inserting of the graft material comprises inserting a synthetic graft material.

4. The method as set forth in claim 2, wherein the inserting of the graft material comprises inserting a bone graft material.

5. The method as set forth in claim 1, further comprising withdrawing fluid from within the medullary canal through at least one of the first or second packer.

6. The method as set forth in claim 5, wherein the withdrawing includes withdrawing fluid through a plurality of apertures in the at least one of the first or second packer.

7. The method as set forth in claim 1, further including inserting a guide wire into the medullary canal.

8. The method as set forth in claim 7, wherein the first and second packers are cannulated and the inserting of the first and second packers includes passing the guide wire through the first and second packers.

9. The method as set forth in claim 1, further including inserting at least one profile packer into the medullary canal, a portion of the profile packer having a shape that approximates a shape of a prosthetic implant.

10. The method as set forth in claim 9, further including inserting a second profile packer into the medullary canal following the one profile packer, a portion of the second profile packer having a shape that approximates a shape of a prosthetic implant, the second profile packer having a profiled outer periphery greater than a profiled outer periphery of the one profile packer at corresponding positions along lengths of the one and second profile packers.

11. The method as set forth in claim 9, wherein the one profile packer is cannulated and the method further includes inserting a guide wire into the medullary canal and guiding the one profile packer with the guide wire.

12. The method as set forth in claim 9, wherein the one profile packer is non-cannulated and the method further includes removing a guide wire from within the medullary canal prior to inserting the one profile packer.

13. The method as set forth in claim 1, further including inserting the prosthetic implant into the medullary canal.

14. The method as set forth in claim 1, further including inserting a third packer into the medullary canal, the third packer having a third outer periphery at the reference position, the third outer periphery being greater than the first outer periphery and greater than the second outer periphery.

15. The method as set forth in claim 1, further including removing a previously installed prosthetic implant from within the medullary canal prior to inserting the first and second packers.

16. The method as set forth in claim 1, wherein the inserting of the first and second packers includes symmetrically packing the medullary canal.

17. The method as set forth in claim 1, wherein the inserting of the first and second packers comprises inserting the first and second packers into a femur.

18. The method as set forth in claim 1, wherein the inserting of the first and second packers comprises inserting the first and second packers into a tibia.

19.The method as set forth in claim 1, wherein the inserting of the first and second packers comprises inserting the first and second packers into a humerus.

19. The method as set forth in claim 1, further comprising measuring the stability of the medullary canal with a torque wrench.

20. The method as set forth in claim 1, wherein the inserting comprises inserting at least one of the first or second packers into the medullary canal with a power driven instrument.

21. The method as set forth in claim 1, further comprising rotating at least one of the first or second packers after insertion in the medullary canal.

22. A method of preparing a medullary canal of a bone for receipt of a prosthetic implant by packing graft material, comprising:

inserting a first packer having an insertion end and working surface into the medullary canal, the working surface having a substantially circular cross-section throughout its entire length with the working surface generally decreasing in cross-section in a direction toward the insertion end;

inserting at least a second packer having an insertion end and working surface into the medullary canal, the working surface of the second packer having a substantially circular cross-section throughout its entire length and generally decreasing in cross-section in a direction toward the insertion end, diameters of the second packer being larger than the diameters of the first packer at corresponding positions along lengths of the first and second packers;

wherein inserting the first and second packers pack the medullary canal in a radial direction toward the cortex of the bone.

23. The method as set forth in claim 23, further comprising inserting graft material into the medullary canal and wherein the inserting of the first and second packers packs the graft material in the radial direction toward the cortex of the bone.

26. The method as set forth in claim 23, wherein inserting the first packer occurs before inserting the second packer.

27. The method as set forth in claim 23, wherein inserting the second packer occurs before inserting the first packer.

28. The method as set forth in claim 23, further comprising withdrawing fluid from within the medullary canal through at least one of the first or second packer.

30. The method as set forth in claim 23, further including inserting a guide wire into the medullary canal.

32. The method as set forth in claim 23, further including inserting at least one profile packer into the medullary canal, a portion of the profile packer having a shape that approximates a shape of a prosthetic implant.

36. The method as set forth in claim 23, further including inserting the prosthetic implant into the medullary canal.

37. The method as set forth in claim 23, further including inserting a third radial packer having a working surface and an insertion end into the medullary canal, at least part of the working surface having a circular cross-section and generally decreasing in cross-section in the direction toward the insertion end, wherein diameters of the third packer being larger than diameters of the first or second packer at corresponding positions along lengths of the first, second, and third packers.

38. The method as set forth in claim 23, further including removing a second prosthetic implant from within the medullary canal prior to inserting the first and second packers.

39. The method as set forth in claim 23, wherein inserting the first and second packers includes symmetrically packing the medullary canal.

40. The method as set forth in claim 23, wherein the inserting of the first and second packers comprises inserting the first and second packers into a femur.

41. The method as set forth in claim 23, wherein the inserting of the first and second packers comprises inserting the first and second packers into a tibia.

42. The method as set forth in claim 23, wherein the inserting of the first and second packers comprises inserting the first and second packers into a humerus.

43. The method as set forth in claim 23, further comprising measuring the stability of the medullary canal with a torque wrench.

44. The method as set forth in claim 23, wherein the inserting comprises inserting at least one of the first and second packers into the medullary canal with a power driven instrument.

45. The method as set forth in claim 23, further comprising rotating at least one of the first or second packers after insertion in the medullary canal.

24. The method as set forth in claim 24, wherein the inserting of the graft material comprises inserting a synthetic graft material.

25. The method as set forth in claim 24, wherein the inserting of the graft material comprises inserting a bone graft material.

29. The method as set forth in claim 29, wherein the withdrawing includes withdrawing fluid through a plurality of apertures in the at least one of the first or second packer.

31. The method as set forth in claim 31, wherein the first and second packers are cannulated and the inserting of the first and second packers includes passing the guide wire through the first and second packers.

33. The method as set forth in claim 33, further including inserting a second profile packer into the medullary canal following the one profile packer, a portion of the second profile packer having a shape that approximates a shape of a prosthetic implant, the second profile packer having a profiled outer periphery greater than a profiled outer periphery of the one profile packer at corresponding positions along lengths of the one and second profile packers.

34. The method as set forth in claim 33, wherein the one profile packer is cannulated and the method further includes inserting a guide wire into the medullary canal and guiding the one profile packer with the guide wire.

35. The method as set forth in claim 33, wherein the one profile packer is non-cannulated and the method further includes removing a guide wire from within the medullary canal prior to inserting the one profile packer.

46. A radial packer in combination with graft material for preparing a medullary canal for receipt of a prosthetic implant, comprising:

a radial packer having a smooth working surface, the working surface having a substantially circular cross-section throughout its entire length that generally decreases in diameter at an insertion end, the insertion end adapted to be inserted into the medullary canal; and

graft material for being inserted into the medullary canal, the graft material adapted to be packed by the packer in a radial direction relative to the medullary canal toward a cortex of the bone; and

an instrument for being coupled to the radial packer for rotating the radial packer after the packer is inserted into the medullary canal in order to pack the graft material in the medullary canal.

47. The combination as set forth in claim 47, wherein the graft material includes synthetic material.

48. The combination as set forth in claim 47, wherein the graft material includes bone graft material.

49. The combination as set forth in claim 47, wherein the radial packer is cannulated.

50. The combination as set forth in claim 47, wherein the radial packer has a plurality of apertures.

51. The combination as set forth in claim 47, further including a profile packer having a working surface of circular cross-section that generally decreases in diameter at an insertion end, the insertion end adapted to be inserted into the medullary canal.

52. The combination as set forth in claim 47, further including the prosthetic implant adapted to be inserted into the medullary canal.

53. The combination as set forth in claim 47, further including a guide wire adapted to be inserted into the medullary canal.

54. A collection of instruments for preparing a bone for receipt of a prosthetic implant, comprising:

a plurality of radial packers each having a smooth working surface adapted to pack the medullary canal in a radial direction toward the cortex of the bone, the radial packers being sized to have progressively larger outer peripheries at corresponding positions along the lengths of the radial packers and the radial packers each having a working surface having a substantially circular cross-section throughout its entire length;

at least one profile packer adapted to pack the medullary canal to define an aperture within the medullary canal bone of an approximate size and shape to receive at least part of the prosthetic implant, and

an instrument for being coupled to the radial packer for rotating the radial packer after the radial packer is inserted into the medullary canal in order to pack the graft material in the medullary canal.

55. The collection as set forth in claim 55, further including the prosthetic implant.

56. The collection as set forth in claim 55, wherein the radial packers are cannulated.

57. The collection as set forth in claim 55, wherein the at least one profile packer is cannulated.

58. The collection as set forth in claim 55, wherein the radial packers are non-cannulated.

59. The collection as set forth in claim 55, wherein the at least one profile packer is non-cannulated.

60. The collection as set forth in claim 55, further including a guide wire.

61. The collection as set forth in claim 55, further including a plurality of profile packers, a guide wire, the prosthetic implant, at least a second profile packer, a portion of the second profile packer having a shape that approximates a shape of a prosthetic implant, and at least one reamer.

62. The collection as set forth in claim 55, further including graft material.

63. A method of preparing a medullary canal for arthroplasty by packing graft material, comprising:

inserting a guide wire into the medullary canal;

inserting at least one cannulated radial packer to pack said graft material, the radial packer having an insertion end and working surface into the medullary canal, the working surface having a substantially circular cross-section throughout its entire length and generally decreasing in cross-section in a direction toward the insertion end; and

inserting at least one profile packer into the medullary canal, a portion of the profile packer having a shape that approximates a shape of a prosthetic implant.

64. The method as set forth in claim 64, further comprising inserting the prosthetic implant into the medullary canal.

65. The method as set forth in claim 64, further comprising removing the guide wire prior to inserting the profile packer.

66. The method as set forth in claim 64, wherein inserting the at least one radial packer includes inserting a plurality of cannulated radial packers with radial packers having progressively larger outer peripheries at corresponding positions along lengths of the radial packers.

67. The method as set forth in claim 64, wherein inserting the at least one profile packer includes inserting a plurality of profile packers with successive profile packers having progressively larger outer peripheries at corresponding positions along lengths of the profile packers.

68. The method as set forth in claim 64, further comprising measuring the stability of the medullary canal with a torque wrench.

69. The method as set forth in claim 64, wherein the inserting comprises inserting the at least one radial impactor into the medullary canal with a power driven instrument.

70. The method as set forth in claim 64, further comprising rotating the at least one radial packer after insertion into the medullary canal.

71. A method of preparing a medullary canal for arthroplasty by packing graft material, comprising:

inserting at least one radial packer to pack the graft material, the radial packer having an insertion end and working surface into the medullary canal, the working surface having a substantially circular cross-section throughout its entire length and generally decreasing in cross-section in a direction toward the insertion end;

inserting at least one profile packer into the medullary canal, a portion of the profile packer having a shape that approximates a shape of a prosthetic implant; and

inserting a prosthetic implant into the medullary canal.

72. The method as set forth in claim 72, further including inserting a guide wire into the medullary canal and wherein inserting the at least one radial packer includes inserting a cannulated radial packer.

73. The method as set forth in claim 72, wherein inserting the at least one radial packer includes inserting a plurality of radial packers with successive radial packers having progressively larger outer peripheries at corresponding positions along lengths of the radial packers.

74. The method as set forth in claim 72, wherein inserting the at least one profile packer includes inserting a plurality of profile packers with successive profile packers having progressively larger outer peripheries at corresponding positions along lengths of the profile packers.

75. The method as set forth in claim 72, further comprising measuring the stability of the medullary canal with a torque wrench.

76. The method as set forth in claim 72, wherein the inserting comprises inserting the at least one radial impactor into the medullary canal with a power driven instrument.

77. The method as set forth in claim 72, further comprising rotating the at least one radial packer after insertion into the medullary canal.

78. A collection of instruments for use in performing arthroplasty, comprising:

at least one radial packer adapted to be inserted into a medullary canal for packing graft material, each radial packer having a working surface that is generally tapered and having a substantially circular cross-section throughout its entire length, an insertion end of the radial packer having a smaller outer periphery than an outer periphery of a more distal position along a length of the radial packer;

a stem implant having a portion adapted to be inserted into the medullary canal; and

an instrument for being coupled to the radial packer for rotating the radial packer after the radial packer is inserted into the medullary canal in order to pack the graft material in the medullary canal;

wherein outer peripheries of the at least one radial packer are smaller than outer peripheries of the stem implant at corresponding positions along lengths of the at least one radial packer and stem implant.

79. The collection of instruments as set forth in claim 79, wherein the at least one radial packer is cannulated.

80. A radial packer in combination with graft material for preparing a medullary canal for receipt of a prosthetic implant, comprising:

a radial packer having a smooth working surface, the working surface having a substantially circular cross-section throughout its entire length that generally decreases in diameter at an insertion end, the insertion end adapted to be inserted into the medullary canal;

graft material for being inserted into the medullary canal, the graft material adapted to be packed by the packer in a radial direction relative to the medullary canal toward the cortex; and

a torque wrench for measuring the stability of an implant.

81. A collection of instruments for preparing a bone for receipt of a prosthetic implant, comprising:

a plurality of radial packers each having a smooth working surface adapted to pack the medullary canal in a radial direction toward the cortex of the bone, the radial packers being sized to have progressively larger outer peripheries at corresponding positions along the lengths of the radial packers and the radial packers each having a working surface having a substantially circular cross-section throughout its entire length;

at least one profile packer adapted to pack the medullary canal to define an aperture within the medullary canal bone of an approximate size and shape to receive at least part of the prosthetic implant; and

a torque wrench for measuring the stability of an implant.

82. A method of preparing a medullary canal of a bone for receipt of a prosthetic implant by packing graft material, comprising:

inserting a packer having a working surface into the medullary canal to pack said graft material, the working surface of the packer having a substantially circular cross-section throughout its entire length, and

rotating the radial packer for a continuous period of time in one direction,

wherein the inserting the packer packs the medullary canal in a radial direction toward the cortex of the bone.