Apparatus and method for minimally invasive total joint replacement

• US 7,604,637 B2
• Filed: 05/05/2003
• Issued: 10/20/2009
• Est. Priority Date: 06/14/2001
• Status: Expired due to Fees

• Current Assignee: Cayenne Medical Incorporated (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Alexandria Research Technologies, LLC
• Inventors: Engh, Gerard, Johnson, Wesley D.
• Primary Examiner(s): Philogene; Pedro
• Application Number:
  US10/429,435
• Publication Number:
  US 20030236523A1
• Time in Patent Office: 2,360 Days
• Field of Search: 606/79, 606/80, 606/81, 606/86, 606/88, 606/91, 606/99, 606/100, 606/39, 623/20.21, 623/20.14, 623/20.15, 623/20.31, 623/20.32, 623/20.35, 623/22.12, 623/22.15, 623/22.11, 173/17, 173/112, 173/206, 173/29, 173/91, 251/211, 251/318
• US Class Current: 606/81
• 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 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1628 Motors; Power supplies
• CPC Class Codes: A61B 17/1631 Special drive shafts, e.g. flexible shafts A61B17/1642, A61B17/164 take precedence
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 2017/00398 using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/00539 hydraulically
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0268 for the knee
• CPC Class Codes: A61B 2017/0275 for the hip
• CPC Class Codes: A61B 2017/1602 Mills
• CPC Class Codes: A61F 2/30724 Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity
• CPC Class Codes: A61F 2/30767 Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/30942 for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
• CPC Class Codes: A61F 2/34 Acetabular cups
• CPC Class Codes: A61F 2/3662 Femoral shafts
• CPC Class Codes: A61F 2/38 for elbows or knees
• CPC Class Codes: A61F 2/3859 : Femoral components
• CPC Class Codes: A61F 2/3872 : Meniscus for implantation between the natural bone surfaces
• CPC Class Codes: A61F 2/3877 : Patellae or trochleae
• CPC Class Codes: A61F 2/389 : Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2/4603 : for insertion or extraction of endoprosthetic joints or of accessories thereof
• CPC Class Codes: A61F 2/4609 : of acetabular cups
• CPC Class Codes: A61F 2/4684 : Trial or dummy prostheses
• CPC Class Codes: A61F 2002/30092 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2002/30616 : Sets comprising a plurality of prosthetic parts of different sizes or orientations
• CPC Class Codes: A61F 2002/30884 : Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
• CPC Class Codes: A61F 2002/30894 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/3895 : unicompartimental
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• 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: A61F 2002/4693 : hydraulic
• CPC Class Codes: A61F 2002/4694 : pneumatic
• CPC Class Codes: A61F 2210/0014 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00029 : Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
• CPC Class Codes: A61F 2310/00952 : Coating, pre-coating or prosthesis-covering structure made of bone cement, e.g. pre-applied PMMA cement mantle

Abstract

A method and apparatus for minimally invasive total joint replacement. The method involves sculpting the articular surface of a second bone that normally articulates with a first bone by attaching a bone sculpting tool directly or indirectly to the first bone with the tool in bone sculpting engagement with the articular surface of the second bone, and then sculpting the articular surface of the second bone with the joint reduced and moving one bone with respect to the other. An implant is placed to replace the articular surface of the second bone using an impaction device directly or indirectly attached to the first bone, wherein the force to place the implant is reacted by the second bone and the first bone.

Claims

1. A system for imparting force between adjacent first and second bones to seat an implant in the second bone, the system comprising:

a first bone mount including at least one receiving hole, said first bone mount receivable within a first bone;

an impaction device including an impaction mass housing having an attachment portion of a first side, the attachment portion slidably received by said first bone mount, and a mating prominence coupled to a second side for receiving an implant adaptor;

a spring-biased impaction mass including a receiving groove thereon, said impaction mass slidably received by said impaction mass housing, said impaction mass imparting impaction force to the implant to seat the implant in the second bone, the force being reacted with the second bone and the first bone;

a spring-biased retraction pin, said retraction pin structured to releasably engage said receiving groove;

wherein said first bone mount and said impaction device are structured to fit within the confines of a joint cavity.

2. The system of claim 1, further including an external alignment guide that orients and aligns the implant with the second bone.

3. The system of claim 1, further including a surgical navigation system for positioning and aligning the implant with respect to the second bone.

4. The system of claim 1, further including a surgical navigation system for positioning and aligning the impaction device with respect to the second bone.

5. The system of claim 1, wherein said first bone mount is adapted for attachment to the femur.

6. The system of claim 1, wherein the implant is an acetabular shell and the impaction device imparts force to seat the acetabular shell in the acetabulum.

7. The system of claim 5 wherein the impaction device is structured for direct attachment to the femur.

8. The system of claim 5 wherein the mount a femoral trial.

9. The system of claim 5 wherein the mount is a broach.

10. The system of claim 5, wherein the mount is a femoral stem.

11. The system of claim 1, wherein the impaction device is a pneumatic impaction hammer.

12. The system of claim 1, wherein the impaction device is a linear actuator.

13. The system of claim 1, wherein the impaction device is a hydraulic piston.

14. The system of claim 1, wherein the impaction device is spring activated.

15. The system of claim 1, wherein the impaction device activates for a single impaction cycle.

16. The system of claim 1, wherein the impaction device activates for multiple impaction cycles.

17. A method of securing an implant to a second bone that articulates with a first bone, the method comprising:

providing an impaction device, the impaction device including

an impaction mass housing having an attachment portion on a first side, the attachment portion slidably receivable by a mount, and a mating prominence coupled to a second side for receiving an implant;

an impaction mass positioned within said housing and including a receiving groove thereon;

a retraction pin for engaging said receiving groove; and

connecting means operably connecting said impaction mass and said retraction pin to a source of actuating power for actuating said impaction mass;

providing a first bone mount having at least one receiving hole;

slidably coupling said attachment portion into said at least one receiving hole of said first bone mount within the confines of the joint cavity;

placing an implant on the impaction device;

aligning the implant with a second bone; and

delivering said actuating power through said connecting means thereby charging said impaction mass and releasing said spring-biased retraction pin from said receiving groove wherein upon release the impaction mass imparts impaction force to the implant to seat the implant in the second bone, the force being reacted with the second bone and the first bone.

18. The method of claim 17, wherein impaction force is performed once per an activation cycle.

19. The method of claim 17, wherein impaction force is performed multiple times per an activation cycle.

20. The method of claim 17, further comprising positioning and aligning the acetabular shell with a surgical navigation system.

21. The method of claim 17, further comprising positioning and aligning the impaction device with a surgical navigation system.

22. The method of claim 17, wherein

attaching the impaction device to the first bone comprises attaching together the impaction device, the mount and a femur;

placing an implant on the impaction device and aligning the implant with the second bone comprises placing an acetabular shell on the impaction device and aligning the acetabular shell with an acetabulum; and

imparting force to the implant comprises imparting force to the acetabular shell, the force being reacted with the acetabulum and the femur.

23. The method of claim 22, wherein attaching the impaction device to the femur includes attaching the impaction device directly to the femur.

24. The method as in claim 22, wherein said mount is a femoral trial and placing the femoral trial in the femur.

25. The method of claim 22, wherein said mount is a broach.

26. The method of claim 22, wherein said mount is a femoral implant.

27. A system for imparting force between adjacent first and second bones to seat an implant in the second bone, the system structured to fit within the confines of the joint cavity, the system comprising:

an implant including at least one attachment portion;

an implant adaptor including at least first and second attachment portions, wherein the first attachment portion is releasably attached to said implant;

a first bone mount including at least one receiving hole, said first bone mount receivable with a first bone;

an impaction device including an attachment portion slidably receivable by a bone mount placed in the first bone, the impaction device including an impaction mass housing having an attachment portion on a first side, the attachment portion slidably received by said mount; and

a mating prominence coupled to a second side for receiving an implant adaptor;

an impaction mass releasably held in said impaction mass housing, said impaction mass powered to press fit the implant in the second bone by imparting force to the implant, said force reacted by said adjacent first and second bones.

28. The system of claim 27, further including an external alignment guide that orients and aligns the implant with the second bone.

29. The system of claim 27, further including a surgical navigation system for positioning and aligning the implant with respect to the second bone.

30. The system of claim 27, further including a surgical navigation system for positioning and aligning the impaction device with respect to the second bone.

31. The system of claim 27, wherein said mount is adapted for attachment to the first bone, the first bone being a femur.

32. The system of claim 27, wherein the implant is an acetabular shell and the impaction device imparts force to press fit the acetabular shell in the second bone, the second bone being an acetabulum.

33. The system of claim 31, wherein the impaction device is adapted for direct attachment to the femur.

34. The system of claim 31, wherein the impaction device is a femoral trial.

35. The system of claim 31, wherein the mount is a broach.

36. The system of claim 31, wherein the mount is a femoral stem.

37. The system of claim 27, wherein the impaction device is a pneumatic impaction hammer.

38. The system of claim 27, wherein the impaction device is a linear actuator.

39. The system of claim 27, wherein the impaction device is a hydraulic piston.

40. The system of claim 27, wherein the impaction device is spring activated.

41. The system of claim 27, wherein the impaction device activates for a single impaction cycle.

42. The system of claim 27, wherein the impaction device activates for multiple impaction cycles.

43. A method of securing an implant to a second bone that articulates with a first bone comprising:

providing an impaction device having an attachment portion on a first side;

said impaction device including an impaction mass housing having a mating prominence coupled to a second side for receiving the implant, a spring-biased impaction mass positioned within said housing and including a receiving groove thereon, and a spring-biased retraction pin for engaging said receiving groove;

providing a connecting means operably connecting said impaction mass and said retraction pin to a source of actuating power for actuating said impaction mass;

slidably coupling said attachment portion to the first bone;

placing the implant on the impaction device;

aligning the implant with the second bone;

imparting an impaction force to the implant by delivering said actuating power through said connecting means thereby charging said impaction mass and releasing said spring-biased retraction pin from said receiving groove wherein upon said release the impaction mass imparts impaction force to the implant to press fit the implant in the second bone, the impaction force being reacted with the second bone and the first bone; and

providing a surgical navigation system for positioning and aligning the impaction device.

44. The method of claim 43, wherein the step of imparting impaction force is performed once per an activation cycle.

45. The method of claim 43, wherein the step of imparting impaction force is performed multiple times per an activation cycle.

46. The method of claim 43, wherein:

attaching the impaction device to the first bone comprises attaching the impaction device to a femur;

placing an implant on the impaction device and aligning the implant with the second bone comprises placing an acetabular shell on the impaction device and positioning the acetabular shell with an acetabulum; and

imparting impaction force to the implant comprises imparting force to the acetabular shell, the impaction force being reacted with the acetabulum and the femur.

47. The method of claim 46, wherein attaching the impaction device to the femur includes attaching the impaction device indirectly to the femur.

48. The method of claim 47, wherein attaching the impaction device to the femur comprises attaching the impaction device to a femoral trial.

49. The method of claim 47, wherein attaching the impaction device to the femur comprises attaching the impaction device to a broach.

50. The method of claim 47, wherein attaching the impaction device to the femur comprises attaching the impaction device to a femoral implant.

51. An impaction device for imparting force between adjacent first and second bones to seat an implant in the second bone, the device comprising:

an impaction mass housing adapted for attachment to the first bone, said impaction mass housing having a mating prominence for receiving the implant and a cylinder for receiving an impaction mass;

a spring-biased impaction mass including a receiving groove thereon, said impaction mass releasably held in said cylinder;

a spring-biased retraction pin, said retraction pin structured to releasably engage said receiving groove;

wherein said impaction mass is powered to seat the implant in a second bone by imparting impaction force to the implant, said impaction force reacted by said adjacent first and second bones.

52. The impaction device of claim 51, wherein said impaction mass is a pneumatic impaction hammer.

53. The impaction device of claim 51, wherein said impaction mass is a hydraulic piston.

54. The impaction device of claim 51, wherein said impaction mass is a linear actuator.

55. The impaction device of claim 51, further including a mating prominence disposed on a top surface of impaction mass housing, said mating prominence configured to receive an implant adaptor.

56. A method of initiating an impaction cycle to seat an implant in a second bone that articulates with a first bone comprising:

providing an impaction device, said impaction device including

an impaction mass housing having an attachment portion on a first side, the attachment portion slidably receivable by a bone mount; and

a mating prominence coupled to a second side for receiving an implant adaptor;

a spring-biased impaction mass for biasing the impaction mass in a retracted position, said spring-biased impaction mass positioned within said housing and including a receiving groove thereon;

a spring-biased retraction pin for engaging said receiving groove; and

connecting means operably connecting said impaction mass and said retraction pin to a source of actuating power for actuating said impaction mass;

slidably coupling said attachment portion to the first bone;

placing an implant on the implant adaptor;

aligning the implant with a second bone;

delivering said actuating power through said connecting means thereby charging said impaction mass and releasing said spring-biased retraction pin from said receiving groove wherein upon said release the impaction mass imparts impaction force to the implant to seat the implant in the second bone, the force being reacted with the second bone and the first bone.

57. The method of claim 56 further comprising initiating a second impaction cycle until said implant is securely press fit in said second bone.