Electrosurgical system and method for treating hard body tissue

• US 9,131,597 B2
• Filed: 02/02/2011
• Issued: 09/08/2015
• Est. Priority Date: 02/02/2011
• Status: Active Grant

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Taft, Richard J., Seybold, Danielle
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US13/019,654
• Publication Number:
  US 20120197344A1
• Time in Patent Office: 1,679 Days
• Field of Search: 606/41, 606 45- 50, 606/79
• US Class Current: 1/1
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 2018/00565 Bone
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00583 Coblation, i.e. ablation using a cold plasma
• CPC Class Codes: A61B 2018/00589 Coagulation
• CPC Class Codes: A61B 2018/1407 Loop
• CPC Class Codes: A61B 2018/1425 Needle
• CPC Class Codes: A61B 2018/144 Wire
• CPC Class Codes: A61B 2018/1472 for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2218/007 Aspiration
• CPC Class Codes: A61N 1/326 for promoting growth of cells, e.g. bone cells
• CPC Class Codes: A61N 1/44 Applying ionised fluids ion generators H01J37/00
• CPC Class Codes: H05H 1/46 using applied electromagnetic fields, e.g. high frequency or microwave energy H05H1/26 takes precedence
• CPC Class Codes: H05H 1/466 using capacitive coupling means, e.g. electrodes
• CPC Class Codes: H05H 2245/34 Skin treatments, e.g. disinfection or wound treatment

Abstract

A method of preparing a target hard body tissue, such as osseous or dental tissue, to receive an implant component including; positioning an active electrode in proximity to a target tissue and proximate an electrically conductive fluid, followed by applying a high frequency voltage between the active electrode and a return electrode, the high frequency voltage sufficient to form a plasma. This plasma modifies at least a portion of the target tissue. An implant component may then be placed adjacent at least a portion of the modified target tissue.

Claims

1. A method of preparing a target tissue, including bone tissue and any surrounding tissue, to receive an implant component comprising:

resecting a portion of a bone body using a mechanical device, so as to define a resected bone surface prepared to fit with an implant;

followed by positioning an active electrode associated with an electrosurgical device in proximity to the resected bone surface and proximate an electrically conductive fluid;

applying a high frequency voltage between the active electrode and a return electrode, the high frequency voltage sufficient to form a plasma, wherein the plasma modifies at least a portion of the tissue on the resected bone surface prepared to fit with an implant; and

disposing an implant component adjacent at least a portion of the modified resected bone surface.

2. The method of claim 1, wherein modifying the tissue adjacent and on the resected bone surface removes unhealthy tissue or debris comprising at least one of the group consisting of:

necrotic tissue, damaged tissue, biofilm, bacteria and pathogens.

3. The method of claim 1, in which the bone body comprises at least one of the group consisting of:

a femur, a tibia, an acetabulum, a humerus, a scapula, a spine, a jaw bone, an area proximate a bone graft site, a bone graft and an area proximate a bone harvest site.

4. The method of claim 1, wherein the target tissue comprises an area proximate a bone fracture site.

5. The method of claim 1, wherein the target tissue further comprises an area proximate a bone being prepared to receive a bone plate system.

6. The method of claim 1, wherein the mechanical device resects at least one bone tunnel operable to receive a ligament anchor.

7. The method of claim 1 further comprising treating at least a portion of the target tissue with an osteoinductive compound.

8. The method of claim 1, wherein the target tissue is selected from the group consisting of cortical bone, cancellous bone and bi-cortical bone.

9. The method of claim 1, wherein applying the high frequency voltage modifies at least a portion of the tissue adjacent and on the resected bone surface according to at least one of the group consisting of:

inducing blood flow to the tissue, debriding the tissue, creating a more smooth and uniform resected bone surface geometry for enhanced implant bonding, sterilizing the tissue, invoking a gene expression in the target tissue, eliciting a change in the metabolic response of the tissue, eliciting a biochemical response in the tissue, and eliciting a physiological response in the tissue.

10. The method of claim 1 further comprising applying the high frequency voltage for a period sufficient to promote ingrowth of the resected bone surface into at least a portion of the implant component.

11. The method of claim 1, whereby positioning the active electrode comprises translating the active electrode axially and radially over tissue in the proximity of the target tissue.

12. The method of claim 1, wherein the plasma is generated within the electrically conductive fluid.

13. The method of claim 1, wherein the electrically conductive fluid comprises a conductive bridge disposed between the active and return electrodes.

14. The method of claim 1, wherein the electrically conductive fluid comprises a least one selected from the group consisting of:

a body fluid, a conductive gel, isotonic saline and Ringer'"'"'s lactate solution.

15. The method of claim 1, wherein the active electrode is selected from the group consisting of an electrode having a pointed tip, a wire electrode, a screen electrode, a loop electrode, and a suction electrode.

16. The method of claim 1, further comprising at least partially contacting the tissue adjacent and on the resected bone surface with the active electrode.

17. The method of claim 1, further comprising wetting the target tissue with the conductive fluid.

18. The method of claim 1, further comprising limiting the period of the application of high frequency voltage between the active electrode and the return electrode for about 0.05 seconds to 3 seconds on each instance.

19. The method of claim 1, further comprising limiting the period of the application of high frequency voltage between the active electrode and the return electrode for about 0.5 seconds on each instance.

20. The method of claim 1, wherein the plasma applies an electrical field to at least a portion of the target tissue to stimulate bone repair and growth.

21. The method of claim 1, wherein modifying the tissue comprises coagulating at least a portion of the tissue adjacent or on the resected bone surface.

22. The method of claim 1 wherein modifying the tissue comprises inducing at least a portion of resected bone surface to molecularly dissociate.

23. The method of claim 22, wherein inducing the resected bone surface to molecularly disassociate further comprises ablating resected bone surface to a controlled depth to form a modified tissue surface having a substantially non-necrotic surface.

24. The method of claim 1 wherein the step of positioning the active electrode is performed using a robot.

25. The method of claim 1 wherein the surrounding tissue comprises a hematoma.

26. The method of claim 1, wherein the mechanical device is selected from a group consisting of:

a reamer, a drill, a scraper, an expander, a rasper and a dremel.

27. The method of claim 1, wherein the step of modifying further comprises creating holes or divots only within at least some of the tissues surrounding the resected bone surface and creating a smooth and uniform resected bone surface smooth.

28. The method of claim 1, wherein the bone body comprises a femur and wherein the implant component comprises a hip implant system.

29. The method of claim 1, wherein the bone body comprises a femur and the wherein the implant component comprises a knee implant system.

30. An electrosurgical method of treating bone tissue and any proximate tissue comprising:

positioning an active electrode in proximity to a surface of a target bone tissue and an electrically conductive fluid; and

modifying the surface of the target bone tissue so as to create a uniform and smooth contoured bone tissue surface using a plasma formed by applying sufficiently high frequency voltage between the active electrode and a return electrode to the bone tissue surface; and

creating holes or divots in proximate tissues only, using the plasma so as to stimulate repair and growth of the bone tissue surface.

31. The method of claim 30, wherein the surface of the target bone tissue comprises an area of bone tissue exposed following a mechanical resection of a portion of a bone body, resected so as to fit with an implant component.

32. The method of claim 31, in which the bone body comprises at least one of the group consisting of:

a femur, a tibia, an acetabulum, a humerus, a scapula, a spine, a jaw bone, an area proximate a bone graft site, a bone graft and an area proximate a bone harvest site.

33. The method of claim 30, wherein the tissue comprises an area proximate a bone fracture site.

34. The method of claim 31, wherein the resected target bone tissue is mechanically resected using a non-electrosurgical instrument to be in the form of a bone tunnel operable to fit with an implant.

35. The method of claim 31 further comprising treating at least a portion of the bone tissue with an osteoinductive compound.

36. The method of claim 30, wherein the bone tissue is selected from the group consisting of cortical bone, cancellous bone and bi-cortical bone.

37. The method of claim 31 further comprising applying the high frequency voltage for a period sufficient to promote osseointegration between the bone tissue and at least a portion of the implant component.

38. The method of claim 30, wherein applying the high frequency voltage further modifies at least a portion of the surface of the bone and proximate tissue according to at least one of the group consisting of:

inducing blood flow to the tissue, sterilizing the tissue, debriding the tissue, creating a tissue surface geometry for enhanced implant bonding, invoking a gene expression in the tissue, eliciting a change in the metabolic response of the tissue, eliciting a biochemical response in the tissue, and eliciting a physiological response in the tissue.

39. The method of claim 30, whereby positioning the active electrode comprises translating the active electrode axially and radially over tissue in the proximity of the tissue.

40. The method of claim 30, wherein the plasma is generated within the electrically conductive fluid.

41. The method of claim 30, wherein the electrically conductive fluid comprises a conductive bridge disposed between the active and return electrodes.

42. The method of claim 30, wherein the electrically conductive fluid comprises a least one selected from the group consisting of:

a body fluid, a conductive gel, isotonic saline and Ringer'"'"'s lactate solution.

43. The method of claim 30, wherein the active electrode is selected from the group consisting of an electrode having a pointed tip, a wire electrode, a screen electrode, a loop electrode, and a suction electrode.

44. The method of claim 30, further comprising at least partially contacting the tissue with the active electrode.

45. The method of claim 30, further comprising wetting the tissue with the conductive fluid.

46. The method of claim 30, further comprising limiting the period of the application of high frequency voltage between the active electrode and the return electrode for about 0.05 seconds to 3 seconds on each instance.

47. The method of claim 30, further comprising limiting the period of the application of high frequency voltage between the active electrode and the return electrode for about 0.5 seconds on each instance.

48. The method of claim 30, wherein modifying the tissue comprises coagulating at least a portion of the tissue.

49. The method of claim 30, wherein the plasma further induces at least a portion of tissue to molecularly dissociate.

50. The method of claim 49, wherein inducing the tissue to molecularly disassociate further comprises ablating bone tissue to a controlled depth to form a modified tissue surface having a substantially non-necrotic surface.

51. The method of claim 30 wherein the step of positioning the active electrode is performed using a robot.

52. The method claim 30, further comprising the step of resecting a portion of the target bone tissue using a mechanical device, before the step of positioning so as to create the surface of target bone tissue.

53. The method of claim 52 wherein the mechanical device is not capable of supplying a high frequency voltage.

54. The electrosurgical method of claim 53, wherein the mechanical device is selected from a group consisting of:

a reamer, a drill, a scraper, an expander, a rasper and a dremel.

55. A method of treating bone tissue and some proximate tissue comprising:

resecting a portion of bone tissue using a non-electrosurgical device so as to prepare a resected bone surface to fit with an implant;

followed by positioning an electrosurgical device with an active electrode in proximity to the resected bone tissue surface; and

applying a high frequency voltage between the active electrode and a return electrode, the high frequency voltage sufficient to develop a high electric field intensity associated with a vapor layer proximate the active electrode, wherein the electric field intensity stimulates the secretion of at least one growth mediator associated with bone repair at the resected bone tissue surface.

56. The method of claim 55, wherein the non-electrosurgical device is selected from a group consisting of:

a reamer, a drill, a scraper, an expander, a rasper and a dremel.

57. The method of claim 55, in which the bone tissue comprises at least one of the group consisting of:

a femur, a tibia, an acetabulum, a humerus, a scapula, a spine, a jaw bone, an area proximate a bone graft site, a bone graft and an area proximate a bone harvest site. area proximate a bone fracture site.

58. The method of claim 55, wherein the bone tissue comprises an area proximate a bone fracture site.

59. The method of claim 55, wherein the bone tissue comprises an area proximate a bone being prepared to receive a bone plate.

60. The method of claim 55, wherein the resected bone surface is in the form of a bone tunnel operable to receive an anchor.

61. The method of claim 55, further comprising treating at least a portion of the bone tissue with an osteoinductive compound.

62. The method of claim 55, wherein a plasma is generated within the electrically conductive fluid.

63. The method of claim 55, wherein the electrically conductive fluid comprises a least one selected from the group consisting of:

a body fluid, a conductive gel, isotonic saline and Ringer'"'"'s lactate solution.

64. The method of claim 55, wherein the high frequency voltage induces the resected bone tissue surface to molecularly disassociate and ablates the resected bone tissue surface to a controlled depth to form a modified tissue surface having a substantially non-necrotic surface.

65. The method of claim 55, wherein the step of positioning the active electrode is performed using a robot.

66. A method of preparing a target bone tissue comprising:

positioning an active electrode in proximity to a surface of a target bone tissue and proximate an electrically conductive fluid, wherein the target tissue is being prepared to receive an implant component; and

applying a high frequency voltage between the active electrode and a return electrode, the high frequency voltage sufficient to form a plasma;

wherein the plasma applies an electrical field to at least a portion of the surface of the target bone tissue and some proximate tissues;

wherein the plasma removes necrotic and unhealthy tissue from within and adjacent the target bone tissue so as to create a uniform smooth and sterilized bone tissue surface and creates holes or divots in some proximate soft tissues to stimulate bone repair and growth.

67. The method of claim 66 further comprising mechanically resecting a surface of the target bone tissue so to prepare the surface to fit with an implant before the step of applying a high frequency voltage.

68. The method of claim 67 wherein the step of mechanically resecting is performed using a non-electrosurgical device.

69. A method of preparing a target tissue, including bone tissue and any surrounding wound, to receive an implant component comprising:

resecting a portion of a bone body, so as to define a resected bone surface prepared to fit with an implant;

positioning an active electrode in proximity to the resected bone surface and proximate an electrically conductive fluid;

applying a high frequency voltage between the active electrode and a return electrode, the high frequency voltage sufficient to form a plasma, wherein the plasma modifies at least a portion of the resected bone surface; and

disposing an implant component adjacent at least a portion of the modified resected bone surface;

wherein the resecting step and the applying step are performed using different devices.

70. The method of claim 69, wherein the resecting step is performed using at least one mechanical device and the step of positioning and applying are performed using at least one electrosurgical device.