Method and apparatus for performing a minimally invasive total hip arthroplasty

• US 6,676,706 B1
• Filed: 04/26/2000
• Issued: 01/13/2004
• Est. Priority Date: 04/26/2000
• Status: Expired due to Fees

• Current Assignee: Zimmer Incorporated (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Zimmer Technology Incorporated (Zimmer Biomet Holdings, Inc.)
• Inventors: Zwirkoski, Paul A., Mears, Dana, Greig, Kevin
• Primary Examiner(s): Smith, Jeffrey A.
• Assistant Examiner(s): Priddy, Michael B.
• Application Number:
  US09/558,044
• Time in Patent Office: 1,357 Days
• Field of Search: 606/86, 606/87, 606/90, 606/91, 606/99, 623/22.11, 623/22.21, 623/22.4, 623/23.11, 623/23.15, 128/898
• US Class Current: 623/22.4
• 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 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 17/142 with reciprocating saw blades, e.g. with cutting edges at the distal end of the saw blades
• CPC Class Codes: A61B 17/144 with cutting edges at the side of the saw blades
• CPC Class Codes: A61B 17/15 Guides therefor arrangements for guiding straight saw blades in general B23D51/025
• CPC Class Codes: A61B 17/151 for corrective osteotomy
• 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 17/1735 for rasps or chisels
• CPC Class Codes: A61B 17/175 for preparing the femur for hip prosthesis insertion
• CPC Class Codes: A61B 17/1796 for holes for sutures or flexible wires
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/8866 for gripping or pushing bones, e.g. approximators joint distractors A61B17/025
• CPC Class Codes: A61B 17/8872 Instruments for putting said fixation devices against or away from the bone A61B17/7074, A61B17/808 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 2090/08021 of the patient or his organs
• CPC Class Codes: A61F 2/0095 Packages or dispensers for prostheses or other implants for intraocular lenses A61F2/1691; for dental surgery A61C19/02
• CPC Class Codes: A61F 2/32 for the hip
• CPC Class Codes: A61F 2/34 : Acetabular cups
• CPC Class Codes: A61F 2/36 : Femoral heads ; Femoral endoprostheses
• CPC Class Codes: A61F 2/4603 : for insertion or extraction of endoprosthetic joints or of accessories thereof
• CPC Class Codes: A61F 2/4607 : of hip femoral endoprostheses
• CPC Class Codes: A61F 2/4609 : of acetabular cups
• CPC Class Codes: A61F 2/4684 : Trial or dummy prostheses
• CPC Class Codes: A61F 2002/30718 : Means for protecting prosthetic parts, e.g. during operation
• CPC Class Codes: A61F 2002/3403 : Polar aperture
• CPC Class Codes: A61F 2002/3611 : Heads or epiphyseal parts of femur
• CPC Class Codes: A61F 2002/3621 : pierced with a longitudinal bore
• CPC Class Codes: A61F 2002/3625 : Necks
• CPC Class Codes: A61F 2002/4622 : having the shape of a forceps or a clamp
• CPC Class Codes: A61F 2002/4627 : with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
• CPC Class Codes: A61F 2002/4628 : with linear motion along or rotating motion about an axis transverse to the instrument axis or to the implantation direction, e.g. clamping
• CPC Class Codes: A61F 2002/4629 : connected to the endoprosthesis or implant via a threaded connection
• 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: A61G 13/0036 : Orthopaedic operating tables devices for stretching fractured limbs A61F5/04
• CPC Class Codes: B25B 13/06 : of socket type
• CPC Class Codes: B25B 13/48 : for special purposes
• CPC Class Codes: B25B 13/481 : for operating in areas having limited access
• CPC Class Codes: B25B 7/02 : Jaws
• CPC Class Codes: B27G 17/06 : Rasps
• CPC Class Codes: F16D 3/20 : one coupling part entering a sleeve of the other coupling part and connected thereto by sliding or rolling members F16D3/18, F16D3/24 take precedence

Abstract

A method and apparatus for performing a minimally invasive total hip arthroplasty. An approximately 3.75-5 centimeter (1.5-2 inch) anterior incision is made in line with the femoral neck. The femoral neck is severed from the femoral shaft and removed through the anterior incision. The acetabulum is prepared for receiving an acetabular cup through the anterior incision, and the acetabular cup is placed into the acetabulum through the anterior incision. A posterior incision of approximately 2.5-3.75 centimeters (1-1.5 inches) is generally aligned with the axis of the femoral shaft and provides access to the femoral shaft. Preparation of the femoral shaft including the reaming and rasping thereof is performed through the posterior incision, and the femoral stem is inserted through the posterior incision for implantation in the femur. A variety of novel instruments including an osteotomy guide; an awl for locating a posterior incision aligned with the axis of the femoral shaft; a tubular posterior retractor; a selectively lockable rasp handle with an engagement guide; and a selectively lockable provisional neck are utilized to perform the total hip arthroplasty of the current invention.

Claims

1. A method for performing a total hip arthroplasty, comprising:

making an anterior incision;

making a poster or incision;

preparing an acetabulum to receive an acetabular cup through said anterior incision;

seating an acetabular cup in said acetabulum through said anterior incision;

preparing a femur to receive a femoral stem; and

seating said femoral stem in said femur.

2. The method of claim 1, wherein said anterior incision has a length of about 3.75-5 cm.

3. The method of claim 1, wherein said step of preparing a femur to receive a femoral stem comprises preparing said femur to receive said femoral stem through said posterior incision.

4. The method of claim 1, wherein said step of seating said femoral stem in said femur comprises inserting said femoral stem through said posterior incision and thereafter seating said femoral stem in said femur.

5. A method of performing a total hip arthroplasty, comprising:

preparing a femur to receive a femoral stem;

placing a protective bag over said femoral stem;

inserting the femoral stem and the protective bag into a patient; and

seating said femoral stem in said femur.

6. The method of claim 5, wherein said step of seating said femoral stem comprises:

incising the distal end of said protective bag as said femoral stem approaches said femur; and

progressively pulling said protective bag away from said femoral implant while inserting said femoral implant into said femur.

7. A method for performing a total hip arthroplasty, comprising:

placing a patient i supine position;

palpating a femoral neck;

making an anterior incision having a length of about 3.75 to 5 centimeters in line with said femoral neck to expose underlying muscle;

performing a blunt dissection of said underlying muscle to expose a capsule of a hip joint;

incising said capsule;

retracting a portion of said capsule to visually expose said femoral neck;

providing an osteotomy guide having a handle, an alignment portion affixed to said handle for aligning with a central femoral axis, and a cut guide affixed to said handle;

aligning said alignment portion with said femoral axis, with said cut guide lying on said femoral neck;

marking a cut path defined by said cut guide;

cutting along said cut path to remove a cut portion from a femoral shaft, said cut portion comprising a femoral head and a portion of said femoral neck;

incising a ligamentum teres femoris;

in situ morselizing said cut portion as necessary for removal through said anterior incision;

removing said cut portion through said anterior incision;

reaming an acetabulum;

seating an acetabular cup in said acetabulum;

inserting a curved awl having a substantially straight distal end into said anterior incision;

aligning said distal end of said awl with said femoral axis;

palpating a location of said distal end of said awl;

making a poster or incision having a length of about 2.5 to 3.75 centimeters at said location of aid distal end of said awl;

performing a blunt dissection to provide an access through said posterior incision to expose said femoral shaft;

inserting a retractor into said access, said retractor comprising;

a rasp tunnel sized to allow passage of a femoral rasp therethrough;

a reamer tunnel sized to allow passage of a femoral reamer therethrough, said reamer tunnel nested in said rasp tunnel; and

a guide tube sized to allow passage of a guide wire therethrough, said guide tube nested in said reamer tunnel;

passing a guide wire through said guide tube and into the cancellous bone of a femur;

removing said guide tube from said retractor;

positioning said guide wire in a cannula of a femoral reamer;

guiding said femoral reamer to said femoral shaft with said guide wire;

reaming said femoral shaft with said femoral reamer while observing through said anterior incision;

removing said reamer tunnel from said retractor;

positioning a rap in said femoral shaft using said guide wire to properly position said rasp, while observing through said anterior incision;

removing said guide wire;

removing said r tractor from said posterior incision;

positioning a trial acetabular liner in said acetabular cup through said anterior incision;

affixing a provisional neck to said rasp through said anterior incision;

affixing a provisional head to said provisional neck through said anterior incision;

performing a trial reduction with said trial acetabular liner, said provisional neck and said provisional head in place;

dislocating the provisional head;

removing said trial acetabular liner through said anterior incision;

removing said provisional neck and head through said anterior incision;

removing said rasp through said posterior incision;

seating a final ac tabular liner in said acetabular cup through said anterior incision;

inserting a femoral implant through said posterior incision;

inserting a final femoral head through said anterior incision;

affixing said final femoral head to said femoral implant;

reducing the hip; and

closing said incisions.

8. The method of claim 7, wherein said step of palpating a femoral neck comprises palpating an anterior superior iliac spine and a greater trochanter of said femur.

9. The method of claim 7, wherein said step of incising said capsule comprises incising an H-pattern in said capsule.

10. The method of claim 7, wherein said step of retracting a portion of said capsule comprises suturing said portion of said capsule to subcutaneous tissue.

11. The method of claim 7, wherein said rasp tunnel includes a protrusion for aligning said rasp tunnel with said femoral shaft, and wherein said method further comprises aligning said protrusion with said femoral shaft after inserting said retractor into said access.

12. The method of claim 7, wherein said rasp tunnel includes exterior threads, and wherein said step of inserting a retractor into said access comprises threading said retractor into said access.

13. The method of claim 7, wherein said step of positioning a rasp in said femoral shaft comprises:

locking said rasp to a rasp handle comprising;

a cannular insertion member, said cannular insertion member having a distal rasp engagement guide an elongate aperture, and a guide aperture, said elongate aperture sized to accommodate a flexible cable;

an engagement slot for selectively engaging a proximal end of said flexible cable;

selectively actuatable grip operable to tension said flexible cable;

lock for selectively locking said grip in a position to tension said flexible cable; and

an impact surface for receiving blows to place or remove a rasp;

positioning said guide wire in a guide aperture of said rasp and said guide aperture of said rasp handle;

guiding said rasp and said cannular insertion member through said rasp tunnel to a proximal end of said femoral shaft using said guide wire;

impacting said i pact surface to position said rasp in said femoral shaft;

unlocking said grip;

releasing said flexible cable from said engagement slot of said rasp handle; and

removing said rasp handle.

14. The method of claim 13, wherein said step of locking said rasp to a rasp handle comprises:

engaging a distal end of said flexible cable in said rasp;

inserting said flexible cable through said elongate aperture of said rasp handle;

guiding said distal rasp engagement guide into a rasp engagement guide receiving portion on said rasp

engaging said proximal end of said flexible cable in said engagement slot of said rasp handle; and

tensioning said flexible cable.

15. The method of claim 7, wherein said step of affixing a provisional neck to said rasp through said anterior incision comprises:

unlocking a provisional neck having a lock mechanism;

inserting said provisional neck into said anterior incision;

positioning said provisional neck on said rasp; and

locking said provisional neck to said rasp.

16. The method of claim 14, wherein said step of removing said rasp comprises:

reinserting said flexible cable through said elongate aperture;

reinserting said cannular insertion member through said posterior incision;

guiding said distal rasp engagement guide into said rasp engagement guide receiving portion;

engaging said proximal end of said flexible cable in said engagement slot;

tensioning said flexible cable; and

impacting said impact surface to remove said rasp from said femoral shaft.

17. The method of claim 7, wherein said step of inserting a femoral implant through said posterior incision comprises:

locking said femoral implant to a femoral stem insertion tool;

placing said femoral implant and a distal end of said femoral stem insertion tool in a bag;

inserting said oral implant and said distal end of said femoral stem insertion tool through said posterior incision;

viewing the progression of said femoral implant to said femur through said anterior incision;

incising the distal end of said bag with a scalpel inserted through said anterior incision as said femoral stem approaches said femoral shaft; and

progressively pulling said bag away from said femoral implant while continuing to insert said femoral implant into said femur.