Method for trochanteric reattachment

• US 8,574,235 B2
• Filed: 05/19/2011
• Issued: 11/05/2013
• Est. Priority Date: 02/03/2006
• Status: Expired due to Fees

• Current Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Inventors: Stone, Kevin T.
• Primary Examiner(s): STEWART, JASON-DENNIS NEILKEN
• Application Number:
  US13/111,564
• Publication Number:
  US 20110224799A1
• Time in Patent Office: 901 Days
• Field of Search: 606 69- 75, 623 1911- 1914, 623/22.11
• US Class Current: 606/74
• 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 17/82 for bone cerclage apparatus for manipulating wires or straps A61B17/8861; wires, bands or straps other than cerclage A61B17/842
• CPC Class Codes: A61B 17/842 Flexible wires, bands or straps A61B17/72, A61B17/82, A61B17/86 take precedence
• CPC Class Codes: A61B 2017/0406 Pledgets
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/06185 hollow or tubular hollow suture needles A61B2017/061
• CPC Class Codes: A61F 2/30739 Devices connected to the proximal part of an endoprosthetic femoral shaft for reinforcing or replacing the trochanters, e.g. the greater trochanter proximal parts of endoprosthetic femoral shafts A61F2/367; non-prosthetic trochanteric devices A61B17/74
• CPC Class Codes: A61F 2/36 Femoral heads ; Femoral endoprostheses
• CPC Class Codes: A61F 2/4607 of hip femoral endoprostheses
• CPC Class Codes: A61F 2002/30462 retained or tied with a rope, string, thread, wire or cable
• CPC Class Codes: A61F 2002/30578 having apertures, e.g. for receiving fixation screws
• CPC Class Codes: A61F 2002/30785 parallel

Abstract

A method for trochanteric reattachment can include positioning a femoral prosthesis relative to a proximal portion of a femur. A first portion of a self-locking adjustable flexible member construct can be coupled to a first attachment region of the prosthesis, and a second portion of the self-locking adjustable flexible member construct can be coupled to a second attachment region of the femoral prosthesis, where the second portion can be opposite the first portion. A trochanter can be positioned relative to the femur and a trochanteric engaging region of the prosthesis, and the self-locking adjustable flexible member construct can be positioned around an outer surface of the trochanter. Free ends of the self-locking adjustable flexible member construct can be tensioned to draw the trochanter into secure engagement with the prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot.

Claims

1. A method for trochanteric reattachment, comprising:

positioning a femoral prosthesis relative to a proximal portion of a femur;

coupling a first portion of a self-locking adjustable flexible member construct to a first attachment region of the femoral prosthesis;

coupling a second portion of the self-locking adjustable flexible member construct to a second attachment region of the femoral prosthesis, the second portion being opposite the first portion;

positioning a trochanter relative to the femur and a trochanteric engaging region of the femoral prosthesis;

positioning the self-locking adjustable flexible member construct around an outer surface of the trochanter; and

tensioning free ends of the self-locking adjustable flexible member construct to draw the trochanter into secure engagement with the femoral prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot;

positioning at least one of the plurality of separate self-locking adjustable flexible member constructs around the outer surface of the trochanter in an overlapping manner with another one of the plurality of separate elf-locking adjustable flexible member constructs so as to form an X-shaped pattern.

2. The method of claim 1, wherein coupling the first portion of the self-locking adjustable flexible member construct to the first attachment region includes coupling the first portion of a plurality of separate self-locking adjustable flexible member constructs to discrete attachment areas of the first attachment region of the femoral prosthesis;

and

wherein coupling the second portion of the self-locking adjustable flexible member construct to the second attachment region includes coupling the second portion of the plurality of separate self-locking adjustable flexible member constructs to discrete attachment areas of the second attachment region of the femoral prosthesis.

3. A method for trochanteric reattachment, comprising:

positioning a femoral prosthesis relative to a proximal portion of a femur;

coupling a first portion of a self-locking adjustable flexible member construct to a first attachment region of the femoral prosthesis;

coupling a second portion of the self-locking adjustable flexible member construct to a second attachment region of the femoral prosthesis, the second portion being opposite the first portion;

positioning a trochanter relative to the femur and a trochanteric engaging region of the femoral prosthesis;

positioning the self-locking adjustable flexible member construct around an outer surface of the trochanter; and

tensioning free ends of the self-locking adjustable flexible member construct to draw the trochanter into secure engagement with the femoral prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot;

wherein coupling the first portion of the self-locking adjustable flexible member construct to the first attachment region includes coupling a first adjustable loop of the self-locking adjustable flexible member construct to the first attachment region of the femoral prosthesis; and

wherein coupling the second portion of the self-locking adjustable flexible member construct to the second attachment region includes coupling a second adjustable loop of the self-locking adjustable flexible member construct to the second attachment region of the femoral prosthesis.

4. The method of claim 3, wherein coupling the first adjustable loop of the self-locking adjustable flexible member construct to the first attachment region includes positioning a first flexible anchor slidably coupled to the first adjustable loop through a first aperture defined by the first attachment region and retaining the first flexible anchor relative to the first attachment region;

and

wherein coupling the second adjustable loop of the self-locking adjustable flexible member construct to the second attachment region includes positioning a second flexible anchor slidably coupled to the second adjustable loop through a second aperture defined by the second attachment region and retaining the second flexible anchor relative to the second attachment region.

5. The method of claim 3, wherein coupling the first adjustable loop of the self-locking adjustable flexible member construct, to the first attachment region includes positioning the first adjustable loop over a tab extending from the first attachment region of the femoral prosthesis and retaining the first adjustable loop relative to the first attachment region;

and

wherein coupling the second adjustable loop of the self-locking adjustable flexible member construct to the second attachment region includes positioning the second adjustable loop over a tab extending from the second attachment region of the femoral prosthesis and retaining the second adjustable loop relative to the second attachment region.

6. The method of claim 3, further comprising:

forming a first bore through a portion of the trochanter so as to align with the first attachment region of the femoral prosthesis;

passing the first portion of the self-locking adjustable flexible member construct through the first bore;

forming a second bore through another portion of the trochanter so as to align with the second attachment region of the femoral prosthesis; and

passing the second portion of the self-locking adjustable flexible member construct through the second bore.

7. A method for trochanteric reattachment, comprising:

positioning a femoral prosthesis relative to a proximal portion of a femur;

coupling a first portion of a self-locking adjustable flexible member construct to a first attachment region of the femoral prosthesis;

coupling a second portion of the self-locking adjustable flexible member construct to a second attachment region of the femoral prosthesis, the second portion being opposite the first portion;

positioning a trochanter relative to the femur and a trochanteric engaging region of the femoral prosthesis;

positioning the self-locking adjustable flexible member construct around an outer surface of the trochanter; and

tensioning free ends of the self-locking adjustable flexible member construct to draw the trochanter into secure engagement with the femoral prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot;

wherein coupling the first portion of the self-locking adjustable flexible member construct to the first attachment region of the femoral prosthesis includes coupling the first portion of a pair of adjustable loops of the self-locking adjustable flexible member construct to a discrete attachment area of the first attachment region of the femoral prosthesis; and

wherein coupling the second portion of the self-locking adjustable flexible member construct to the second attachment region of the femoral prosthesis includes coupling the second portion of the pair of adjustable loops to a discrete attachment area of the second attachment region of the femoral prosthesis.

8. The method of claim 7, wherein coupling the first portion of the pair of adjustable loops of the self-locking adjustable flexible member construct to the discrete attachment area of the first attachment region includes coupling a first flexible anchor slidably coupled to the pair of adjustable lobos through a first aperture of the first attachment region and retaining the pair of adjustable loops relative to the first aperture;

and

wherein coupling the second portion of the pair of adjustable loops to the discrete attachment area of the second attachment region includes coupling a second flexible anchor slidably coupled to the pair of adjustable loops through a second aperture of the second attachment region and retaining the pair of adjustable loops relative to the second aperture.

9. A method for trochanteric reattachment, comprising:

positioning a femoral prosthesis relative to a proximal portion of a femur;

coupling a first portion of a self-locking adjustable flexible member construct to a first attachment region of the femoral prosthesis;

coupling a second portion of the elf-locking adjustable flexible member construct to a second attachment region of the femoral prosthesis, the second portion being opposite the first portion;

positioning a trochanter relative to the femur and a trochanteric engaging region of the femoral prosthesis;

positioning the self-locking adjustable flexible member construct around an outer surface of the trochanter; and

tensioning free ends of the self-locking adjustable flexible member construct to draw the trochanter into secure engagement with the femoral prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot;

wherein coupling the first portion of the self-locking adjustable flexible member construct to the first attachment region includes coupling a fixed length portion of the self-locking adjustable flexible member construct extending from a pair of passage portions of the self-locking adjustable flexible member construct to a discrete area of the first attachment region of the femoral prosthesis; and

wherein coupling the second portion of the self-locking adjustable flexible member construct to the second attachment region includes coupling a pair of adjustable loops extending from the pair of passage portions to a discrete area of the second attachment region of the femoral prosthesis.

10. A method for trochanteric reattachment, comprising:

positioning a femoral prosthesis relative to a proximal portion of a femur;

coupling a first portion of a self-locking adjustable flexible member construct to a first attachment region of the femoral prosthesis;

coupling a second portion of the self-locking adjustable flexible member construct to a second attachment region of the femoral prosthesis, the second portion being opposite the first portion;

positioning a trochanter relative to the femur and a trochanteric engaging region of the femoral prosthesis;

positioning the self-locking adjustable flexible member construct around an outer surface of the trochanter; and

tensioning free ends of the self-locking adjustable flexible member construct to draw the trochanter into secure engagement with the femoral prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot;

forming a first bore through a portion of the trochanter so as to align with the first attachment region of the femoral prosthesis;

positioning a first portion of a second self-locking adjustable flexible member construct through the first bore and retaining the first portion relative to a discrete attachment member of the first attachment region, wherein the first portion includes a flexible anchor slidably coupled thereto; and

tensioning free ends of the second self-locking adjustable flexible member construct to position a second flexible anchor coupled to a second portion of the second self-locking adjustable flexible member construct relative to an opening of the first bore on the outer surface of the trochanter and draw the trochanter into secure engagement with the femoral prosthesis and femur in an absence of a knot.

11. The method of claim 10, further comprising:

forming a second bore through another portion of the trochanter so as to align with the second attachment region of the femoral prosthesis;

positioning a first portion of a third self-locking adjustable flexible member construct through the second bore and retaining the first portion relative to a discrete attachment member of the second attachment region, wherein the first portion of the third flexible member construct includes a flexible anchor slidably coupled thereto; and

tensioning free ends of the third self-locking adjustable flexible member construct to position a second flexible anchor coupled to a second portion of the third self-locking adjustable flexible member construct relative to an opening of the second bore on the outer surface of the trochanter and draw the trochanter into secure engagement with the femoral prosthesis and femur in an absence of a knot.

12. A method for trochanteric reattachment, comprising:

positioning a femoral prosthesis relative to a proximal portion of a femur;

forming first and second bores spaced apart from each other and through a greater trochanter that has been at least partially separated from the femur;

passing a first portion of a self-locking adjustable flexible member construct through the first bore;

coupling the first portion to a first attachment region of the femoral prosthesis;

passing a second portion of the self-locking flexible member construct through the second bore;

coupling the second portion to a second attachment region of the femoral prosthesis opposite of the first attachment region;

positioning the self-locking adjustable flexible member construct around an outer surface of the greater trochanter; and

tensioning free ends of the self-locking adjustable flexible member construct to draw the greater trochanter into secure engagement with the femoral prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot.

13. The method of claim 12, wherein coupling the first portion to the first attachment region of the femoral prosthesis includes positioning a first flexible anchor slidably coupled to a first adjustable loop of the self-locking adjustable flexible member construct through a first aperture defined by the first attachment region and retaining the first adjustable loop relative to the first aperture via the first flexible anchor;

and

wherein coupling the second portion to the second attachment region of the femoral prosthesis includes positioning a second flexible anchor slidably coupled to second adjustable loop of the self-locking adjustable flexible member construct through a second aperture defined by the second attachment region and retaining the second adjustable loop relative to the second aperture via the second flexible anchor.

14. The method of claim 13, wherein tensioning free ends of the self-locking adjustable flexible member construct to draw the greater trochanter into secure engagement with the femoral prosthesis and the femur includes sliding the first and second adjustable loops relative to the respective first and second anchors being retained relative to the respective first and second apertures.

15. The method of claim 13, further comprising coupling the first flexible anchor and the second flexible anchor to both the first and second adjustable loops of the self-locking adjustable flexible member construct.

16. The method of claim 12, wherein coupling the first portion to the first attachment region of the femoral prosthesis includes removably coupling a first adjustable loop of the self-locking adjustable flexible member construct to a first tab extending from the first attachment region;

and

wherein coupling the second portion to the second attachment region of the femoral prosthesis includes removably coupling a second adjustable loop of the self-locking adjustable flexible member construct to a second tab extending from the second attachment region.

17. The method of claim 16, wherein the first and second adjustable loops extend from opposite sides of a passage portion of the self-locking adjustable flexible member construct.

18. The method of claim 16, further comprising coupling the first and second adjustable loops to the first tab and the second tab.

19. The method of claim 12, further comprising:

coupling a first adjustable loop of a second self-locking adjustable flexible member construct to the first attachment region of the femoral prosthesis at a location different than the first portion;

coupling a second adjustable loop of the second self-locking adjustable flexible member construct to the second attachment region of the femoral prosthesis at a location different than the second portion;

positioning the second self-locking adjustable flexible member construct around the outer surface of the greater trochanter; and

tensioning free ends of the second self-locking adjustable flexible member construct to draw the greater trochanter into secure engagement with the femoral prosthesis and the femur in an absence of a knot.

20. A method for trochanteric reattachment, comprising:

positioning a femoral prosthesis relative to a proximal portion of a femur, the femoral prosthesis including first and second attachment regions each having a plurality of attachment members spaced apart from each other and arranged at increasing distances from a proximal end of the prosthesis toward a distal end, the first and second attachment regions being on opposite sides of the femoral prosthesis;

coupling a first portion of a first self-locking adjustable flexible member construct to a first attachment member of the first attachment region;

coupling a second portion of the first self-locking adjustable flexible member construct to a second attachment member of the second attachment region;

coupling a first portion of a second self-locking adjustable flexible member construct to a third attachment member of the first attachment region;

coupling a second portion of the second self-locking adjustable flexible member construct to a fourth attachment member of the second attachment region;

positioning the first and second self-locking adjustable flexible member constructs around an outer surface of a greater trochanter such that the first and second self-locking adjustable flexible member constructs overlap each other; and

tensioning free ends of the first and second self-locking adjustable flexible member constructs to draw the greater trochanter into secure engagement with the femoral prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot.

21. The method of claim 20, wherein coupling the first and second portions of the first self-locking adjustable flexible member construct to the respective first and second attachment members includes coupling first and second flexible anchors slidable coupled to adjustable loops of the first self-locking adjustable flexible member construct to the respective first and second attachment members;

and

wherein coupling the first and second portions of the second self-locking adjustable flexible member construct to the respective third and fourth attachment members includes coupling third and fourth flexible anchors slidable coupled to adjustable loops of the second self-locking adjustable flexible member construct to the respective third and fourth attachment members.

22. The method of claim 20, wherein positioning the first and second self-locking adjustable flexible member constructs around the outer surface of the greater trochanter includes positioning the first and second self-locking adjustable flexible member constructs around the outer surface of the greater trochanter such that the first and second self-locking adjustable flexible member constructs overlap each other in an X-shaped pattern.

23. The method of claim 20, further comprising:

positioning the first and second portions of the first self-locking adjustable flexible member construct through respective first and second bores formed through the greater trochanter in alignment with the respective first and second attachment members; and

positioning the first and second portions of the second self-locking adjustable flexible member construct through respective third and fourth bores formed through the greater trochanter in alignment with the respective third and fourth attachment members.

24. A method for reattachment of a bone, comprising:

positioning a prosthesis relative to a proximal portion of a first bone;

coupling a first portion of a self-locking adjustable flexible member construct to a first attachment region of the prosthesis;

positioning a second bone portion relative to the first bone proximal portion and a second bone engaging region of the prosthesis;

coupling a second portion of the self-locking adjustable flexible member construct to the second bone portion, the second portion being opposite the first portion;

tensioning free ends of the self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone via the self-locking adjustable flexible member construct in an absence of a knot; and

forming a bore through the second bone portion that has been at least partially separated from the first bone; and

wherein coupling the first portion of the self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes coupling the first portion of the self-locking adjustable flexible member construct to a plug member, wherein the plug is coupled to the prosthesis.

25. The method of claim 24, wherein coupling the first portion of the self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes passing the first portion through the bbre formed in the second bone portion and through a through bore in the prosthesis, the plug configured to be at least partially received in the through bore of the prosthesis.

26. The method of claim 25, wherein coupling a second portion of the self-locking adjustable flexible member construct to the second bone portion includes positioning a flexible anchor slidably coupled to the flexible member construct on an outer surface of the second bone portion adjacent the bore;

and

wherein tensioning free ends of the self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone includes tensioning the free ends to draw the plug into fixed engagement with a side of the through bore opposite a side facing the second bone.

27. The method of claim 24, wherein the first bone includes a femur and the second bone portion includes a greater trochanter of the femur.

28. A method for reattachment of a bone comprising:

positioning a prosthesis relative to a proximal portion of a first bone;

coupling a first portion of a self-locking adjustable flexible member construct to a first attachment region of the prosthesis;

positioning a second bone portion relative to the first bone proximal portion and a second bone engaging region of the prosthesis;

coupling a second portion of the self-locking adjustable flexible member construct to the second bone portion, the second portion being opposite the first portion; and

tensioning free ends of the self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone via the self-locking adjustable flexible member construct in an absence of a knot;

wherein the first bone includes a humerus and the second bone portion includes a greater trochanter of the humerus.