Instrumentation for minimally invasive joint replacement and methods for using same

• US 6,702,821 B2
• Filed: 08/28/2001
• Issued: 03/09/2004
• Est. Priority Date: 01/14/2000
• Status: Expired due to Term

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: The Bonutti 2003 Trust A
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): REIP, DAVID OWEN
• Application Number:
  US09/941,185
• Publication Number:
  US 20020029045A1
• Time in Patent Office: 924 Days
• Field of Search: 606/79, 606/80, 606/82, 606/86, 606/87, 606/88, 606/89, 623/20.14, 623/20.15, 623/20.21, 128/898
• US Class Current: 606/88
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/68 Internal fixation devices , including fasteners and spinal fixators, even if a part thereof projects from the skin bone staples A61B17/0642
• CPC Class Codes: A61B 17/80 Cortical plates , i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
• CPC Class Codes: A61B 17/866 Material or manufacture
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable, resorptive for implantable prostheses A61F2210/0004
• CPC Class Codes: A61B 2017/0408 Rivets other bone rivets A61B17/68; rivets for connecting prosthetic parts A61F2002/30433, A61F2220/0041
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/0619 thermoplastic, e.g. for bonding, welding, fusing or cutting the suture by melting it suture cutters A61B17/0467; ultrasonic cutters A61B17/320068; electrically heated instruments A61B18/08
• CPC Class Codes: A61B 2017/867 with integral locking or clamping means
• CPC Class Codes: A61F 2/30734 Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
• CPC Class Codes: A61F 2/367 Proximal or metaphyseal parts of shafts trochanteric devices connected to said proximal parts A61F2/30739
• CPC Class Codes: A61F 2/38 for elbows or knees
• CPC Class Codes: A61F 2002/30062 (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/30065 thermoplastic, i.e. softening or fusing when heated, and hardening and becoming rigid again when cooled
• CPC Class Codes: A61F 2002/30736 Augments or augmentation pieces, e.g. wedges or blocks for bridging a bone defect
• CPC Class Codes: A61F 2210/0004 bioabsorbable
• CPC Class Codes: A61F 2210/0071 thermoplastic

Abstract

An improved method of performing surgery on a joint in a patient'"'"'s body, such as a knee, includes making an incision in a knee portion of one leg while a lower portion of the one leg is extending downward from an upper portion of the one leg and while a foot connected with the lower portion of the one leg is below a support surface on which the patient is disposed. The incision is relatively short, for example, between seven and thirteen centimeters. A patella may be offset from its normal position with an inner side of the patella facing inward during cutting of a bone with a cutting tool. During cutting of the bone, one or more guide members having opposite ends which are spaced apart by a distance less than the width of an implant may be utilized to guide movement of a cutting tool.

Claims

1. A method of performing surgery on a patient'"'"'s knee, said method comprising the steps of supporting the patient on a support surface, making an incision in a knee portion of one leg of the patient, moving a guide member having opposite ends which are spaced apart by a distance which is less than two thirds (⅔

) of a distance between tips of lateral and medial epicondyles on a femur in an upper portion of the one leg of the patient into the incision, positioning the guide member on the femur in the one leg of the patient with opposite ends of the guide member substantially aligned with an axis through the lateral and medial epicondyles on the femur in the one leg of the patient, moving a cutting tool through the incision into engagement with a guide surface on the guide member, cutting the femur in the one leg of the patient with the cutting tool, said step of cutting the femur includes moving the cutting tool along the guide surface on the guide member, and positioning an implant in engagement with the femur in the one leg of the patient, wherein the implant has a transverse length that is larger than the guide surface length.

2. A method as set forth in claim 1 further including the step of moving a patella in the knee portion of the one leg of the patient from a normal position of the patella to an offset position with an inner side of the patella facing inward.

3. A method as set forth in claim 1 wherein said step of making an incision includes making an incision which has a length of between about seven and about thirteen centimeters.

4. A method as set forth in claim 1 further including the step of expanding the incision by applying force against opposite edges of the incision, said step of moving a guide member into the incision is at least partially performed while the incision is expanded.

5. A method as set forth in claim 1 further including the step of moving an endoscope through the incision to a portion of the knee portion opposite from the incision and inspecting the portion of the knee portion opposite from the incision through the endoscope.

6. A method as set forth in claim 5 wherein said step of inspecting the portion of the knee portion opposite from the endoscope includes viewing the implant through the endoscope.

7. A method as set forth in claim 5 wherein said step of inspecting a portion of the knee portion opposite from the incision is at least partially performed prior to performance of said step of positioning an implant in engagement with the femur in the one leg of the patient.

8. A method of performing surgery on a patient'"'"'s knee, said method comprising the steps of supporting the patient on a support surface, making an incision in a knee portion of one leg of the patient, moving a guide member having opposite ends which are spaced apart by a distance which is less than two thirds (⅔

) of a distance between tips of lateral and medial epicondyles on a femur in an upper portion of the one leg of the patient into the incision, positioning the guide member on the femur in the one leg of the patient with opposite ends of the guide member substantially aligned with an axis through the lateral and medial epicondyles on the femur in the one leg of the patient, moving a cutting tool through the incision into engagement with a guide surface on the guide member, cutting the femur in the one leg of the patient with the cutting tool, said step of cutting the femur includes moving the cutting tool along the guide surface on the guide member, and positioning an implant in engagement with the femur in the one leg of the patient, wherein said steps of making an incision in a knee portion of the one leg of the patient, moving a guide member into the incision, positioning the guide member on the femur, cutting the femur, and positioning an implant in engagement with the femur are performed with a lower portion of the one leg of the patient extending downward from an upper portion of the one leg and with a foot connected with the lower portion of the one leg of the patient below the support surface.

9. A method of performing surgery on a patient'"'"'s knee, said method comprising the steps of supporting the patient on a support surface, making an incision in a knee portion of one leg of the patient, moving a guide member having opposite ends which are spaced apart by a distance which is less than two thirds (⅔

) of a distance between tips of lateral and medial epicondyles on a femur in an upper portion of the one leg of the patient into the incision, positioning the guide member on the femur in the one leg of the patient with opposite ends of the guide member substantially aligned with an axis through the lateral and medial epicondyles on the femur in the one leg of the patient, moving a cutting tool through the incision into engagement with a guide surface on the guide member, cutting the femur in the one leg of the patient with the cutting tool, said step of cutting the femur includes moving the cutting tool along the guide surface on the guide member, and positioning an implant in engagement with the femur in the one leg of the patient wherein said step of cutting the femur includes forming a surface on the femur which has a dimension in a direction parallel to a central axis of the guide surface which is greater than the distance between the opposite ends of the guide member.

10. A method of performing surgery on a joint in a patient'"'"'s body, said method comprising the steps of flexing the joint, making an incision in body tissue which extends around the joint while the joint is flexed, said step of making an incision includes making an incision which has a length of less than thirteen centimeters, moving a guide member through the incision, said guide member having opposite ends which are spaced apart by a distance which is less than two thirds (⅔

) of a distance across an end portion of at least one bone at a location where the distance across the end portion of the one bone is a maximum, positioning the guide member on the end portion of the one bone while the joint is flexed, moving a cutting tool through the incision into engagement with the one bone at the joint while the joint is flexed, cutting the one bone at the joint with the cutting tool while the joint is flexed, said step of cutting the one bone at the joint includes moving the cutting tool along a guide surface on the guide member and cutting bone to form a cut surface which extends across the end portion of the one bone and has a dimension extending parallel to a longitudinal central axis of the guide surface which is greater than the length of the guide surface, and positioning an implant in engagement with the one bone while the joint is flexed.

11. A method as set forth in claim 10 further including the step of inserting at least one retractor into the incision while the joint is flexed and holding back a margin of the incision with the one retractor to increase exposure of the one bone at the joint while the joint is flexed.

12. A method as set forth in claim 10 further including the steps of inserting a first retractor into the incision while the joint is flexed, inserting a second retractor into the incision while the joint is flexed, and expanding the incision while the joint is flexed by separating opposite margins of the incision under the influence of force applied to opposite margins of the incision by the first and second retractors.

13. A method as set forth in claim 12 further including the step of cutting the one bone at the joint with the cutting tool while the joint is flexed is at least partially performed while performing said step of expanding the incision.

14. A method as set forth in claim 10 further including the steps of rotating a first portion of the patient extending in a first direction from the joint about an axis extending along the first portion of the patient while the joint is flexed and after having performed said step of cutting the one bone at the joint.

15. A method as set forth in claim 10 further including the steps of positioning a guide member relative to the one bone while the joint is flexed, said step of cutting the one bone includes utilizing a guide surface on the member to position the cutting tool during making of an initial portion of a cut in the one bone, and completing the cut in the one bone while guiding the cutting tool with a surface formed during making of the initial portion of the cut in the one bone.

16. A method of performing surgery on a joint in a patient'"'"'s body, said method comprising the steps of flexing the joint, making an incision in body tissue which extends around the joint while the joint is flexed, said step of making an incision includes making an incision which has a length of less than thirteen centimeters, moving a cutting tool through the incision into engagement with at least one bone at the joint while the joint is flexed, cutting the one bone at the joint with the cutting tool while the joint is flexed, pivoting a first portion of the patient extending in a first direction from the joint sidewardly in a direction transverse to normal movement of the first portion of the patient during flexion and extension of the joint while the joint is flexed and after having performed said step of cutting the one bone at the joint, and positioning an implant in engagement with the one bone while the joint is flexed.

17. A method as set forth in claim 16 wherein the step of pivoting a first portion of the patient sidewardly is performed with the first portion of the patient suspended from a second portion of the patient which extends in a second direction from the joint.

18. A method of performing surgery on a joint in a patient'"'"'s body, said method comprising the steps of flexing the joint, making an incision in body tissue which extends around the joint while the joint is flexed, said step of making an incision includes making an incision which has a length of less than thirteen centimeters, moving a cutting tool through the incision into engagement with at least one bone at the joint while the joint is flexed, cutting the one bone at the joint with the cutting tool while the joint is flexed, and positioning an implant in engagement with the one bone while the joint is flexed, wherein said step of positioning an implant in engagement with the one bone includes providing an implant having first and second portions which are separate from each other, moving the first portion of the implant through the incision into engagement with the one bone, moving the second portion of the implant through the incision into engagement with the one bone, and interconnecting the first and second portions of the implant while they are disposed in engagement with the one bone.

19. A method of performing surgery on a patient'"'"'s knee, said method comprising the steps of supporting the patient on a support surface, said step of supporting the patient on a support surface includes supporting an upper portion of one leg of the patient above the support surface with a leg support having a surface which is disposed beneath a posterior surface area on the upper portion of the one leg with a lower portion of one leg of the patient extending downward from the upper portion of the one leg so that a foot connected with the one leg of the patient is below the support surface, making an incision in a knee portion of the one leg of the patient while the upper portion of the one leg is supported above the support surface by the leg support and the foot connected with the one leg of the patient is below the support surface, said step of making an incision in the knee portion of the one leg includes making an incision having a length of less than about thirteen centimeters, said step of making an incision includes making an incision adjacent to an edge portion of the patella in the knee portion of the one leg of the patient, moving the patella from its normal position to an offset position with an inner side of the patella facing inward, moving a guide member having opposite ends which are spaced apart by a distance which is less than a distance between lateral and medial epicondyles on a femur in the upper portion of the one leg of the patient into the incision, positioning the guide member on the femur in the one leg of the patient with opposite ends of the guide member substantially aligned with an axis through the lateral and medial epicondyles on the femur while the upper portion of the one leg is supported above the support surface by the leg support and the foot connected with the one leg of the patient is below the support surface, moving a cutting tool into engagement with the femur in the upper portion of the one leg of the patient, cutting the femur in the upper portion of the one leg of the patient with the cutting tool, said step of cutting the femur with the cutting tool includes moving the cutting tool along a guide surface on the guide member while the patella is offset from its normal position relative to the femur with the inner side of the patella facing inward, said step of cutting the femur with the cutting tool is performed with the upper portion of the one leg of the patient supported above the support surface by the leg support and with the foot connected with the one leg of the patient below the support surface, moving the cutting tool away from the femur, moving the guide member away from the femur, positioning an implant in engagement with the femur, and closing the incision while the upper portion of the one leg is supported above the support surface by the leg support and the foot connected with the one leg is below the support surface.

20. A method as set forth in claim 19 wherein the lower portion of the one leg of the patient is suspended from the upper portion of the one leg of the patient during performance of said steps of making an incision in the knee portion of the one leg of the patient, cutting the femur with the cutting tool, and closing the incision.

21. A method as set forth in claim 19 further including the step of expanding the incision by applying force against opposite edge portions of the incision while the upper portion of the one leg is supported above the support surface by the leg support and the foot connected with the one leg of the patient is below the support surface.

22. A method as set forth in claim 19 further including the steps of bending the knee portion of the one leg of the patient, and generating images of the knee portion of the one leg of the patient after performing said step of making an incision in the knee portion of the one leg of the patient and prior to performing said step of closing the incision.

23. A method as set forth in claim 19 further including the steps of moving a leading end portion of an endoscope through the incision, and visually inspecting a posterior portion of the knee portion of the one leg of the patient through the endoscope.

24. A method as set forth in claim 19 wherein said step of positioning an implant in engagement with the femur includes providing an implant having first and second portions which are separate from each other, moving the first portion of the implant through the incision into engagement with the femur, and interconnecting the first and second portions of the implant while they are disposed in engagement with the femur.

25. A method as set forth in claim 19 wherein said step of cutting the femur in the upper portion of the one leg of the patient includes utilizing the guide surface on the guide member to position the cutting tool during making of an initial portion of a cut in the femur, and completing the cut in the femur while guiding the cutting tool with a surface formed during making of the initial portion of the cut in the femur.

26. A method as set forth in claim 19 further including the step of effecting relative movement between the incision and bones in the one leg of the patient by moving the lower portion of the one leg of the patient relative to the upper portion of the one leg of the patient while the upper portion of the one leg of the patient is supported above the support surface by the leg support and the foot connected with the one leg of the patient is below the support surface.

27. A method as set forth in claim 19 further including the step of providing an output signal which is a function of tension in a ligament extending between the femur and bones in a lower portion of the one leg of the patient.

28. A method as set forth in claim 19 further including the step of moving the lower portion of the one leg of the patient between a first position in which an ankle portion of the one leg of the patient is disposed on a first side of a reference plane and a second positioning which the ankle portion of the one leg of the patient is disposed on a second side of the reference plane while the upper portion of the one leg is supported above the support surface by the leg support and the foot connected with the one leg of the patient is below the support surface, the reference plane extends through the knee portion of the one leg of the patient and extends perpendicular to a longitudinal central axis of the upper portion of the patient'"'"'s one leg.

29. A method as set forth in claim 19 further including the step of cutting the patella in the knee portion of the one leg of the patient while the patella is disposed in the normal position relative to the knee portion of the one leg with an inner side of the patella facing inward.

30. A method of performing surgery on a patient'"'"'s knee, said method comprising the steps of supporting the patient on a support surface, making an incision in a knee portion of one leg of the patient, connecting a guide member with at least one bone in the one leg of the patient, moving a cutting tool through the incision into engagement with the one bone in the one leg of the patient, moving the cutting tool along a guide surface on the guide member during making of an initial portion of a cut in the one bone, completing the cut in the one bone while guiding the cutting tool with a surface formed during making of the initial portion of the cut, and positioning an implant in engagement with the one bone in the one leg of the patient, wherein the implant has a transverse length that is larger than the guide surface length.

31. A method as set forth in claim 30 further including the steps of bending the knee portion of the one leg of the patient, and generating images of the knee portion of the one leg of the patient after performing said step of making an incision in the knee portion of the one leg of the patient and prior to closing the incision.

32. A method as set forth in claim 30 further including the steps of moving a leading end portion of an endoscope through the incision, and visually inspecting a portion of the knee portion of the one leg of the patient through the endoscope.

33. A method as set forth in claim 30 further including the step of effecting relative movement between the incision and bones in the one leg of the patient by moving the lower portion of the one leg of the patient relative to the upper portion of the one leg of the patient while a foot connected with the one leg of the patient is below the support surface.

34. A method as set forth in claim 30 further including the step of providing an output signal which is a function of tension in a ligament extending between bones in the one leg of the patient.

35. A method as set forth in claim 30 further including the step of moving a lower portion of the one leg of the patient between a first position in which an ankle portion of the one leg of the patient is disposed on a first side of a reference plane and a second position in which the ankle portion of the one leg of the patient is disposed on a second side of the reference plane while a foot connected with the one leg of the patient is below the support surface, the reference plane extends through the knee portion of the one leg of the patient and extends perpendicular to a longitudinal central axis of the upper portion of the patient'"'"'s one leg.

36. A method as set forth in claim 30 further including the step of cutting the patella in the knee portion of the one leg of the patient while the patella is disposed in a normal position relative to the knee portion of the one leg with an inner side of the patella facing inward.

37. A method of performing surgery on a patient'"'"'s knee, said method comprising the steps of supporting the patient on a support surface, making an incision in a knee portion of one leg of the patient, connecting a guide member with at least one bone in the one leg of the patient, moving a cutting tool through the incision into engagement with the one bone in the one leg of the patient, moving the cutting tool along a guide surface on the guide member during making of an initial portion of a cut in the one bone, completing the cut in the one bone while guiding the cutting tool with a surface formed during making of the initial portion of the cut, and positioning an implant in engagement with the one bone in the one leg of the patient, wherein a lower portion of the one leg of the patient is suspended from an upper portion of the one leg during performance of said steps of making an incision in the knee portion of the one leg of the patient, and cutting the one bone with the cutting tool.

38. A method of performing surgery on a patient'"'"'s knee, said method comprising the steps of supporting the patient on a support surface, making an incision in a knee portion of one leg of the patient, expanding the incision by applying force against opposite edge portions of the incision while a foot connected with the one leg of the patient is below the support surface, connecting a guide member with at least one bone in the one leg of the patient, moving a cutting tool through the incision into engagement with the one bone in the one leg of the patient, moving the cutting tool along a guide surface on the guide member during making of an initial portion of a cut in the one bone, completing the cut in the one bone while guiding the cutting tool with a surface formed during making of the initial portion of the cut, and positioning an implant in engagement with the one bone in the one leg of the patient.

39. A method of performing surgery on a patient'"'"'s knee, said method comprising the steps of supporting the patient on a support surface, making an incision in a knee portion of one leg of the patient, connecting a guide member with at least one bone in the one leg of the patient, moving a cutting tool through the incision into engagement with the one bone in the one leg of the patent, moving the cutting tool alone a guide surface on the guide member during making of an initial portion of a cut in the one bone, completing the cut in the one bone while guiding the cutting tool with a surface formed during making of the initial portion of the cut, and positioning an implant in engagement with the one bone in the one leg of the patient, wherein said step of positioning an implant in engagement with the one bone in the one leg of the patient includes providing an implant having first and second portions which are separate from each other, moving the first portion of the implant through the incision into engagement with the one bone, and interconnecting the first and second portions of the implant while they are disposed in engagement with the one bone.