阅读说明：本技术 用于治疗髋关节发育不良的装置及方法 (Device and method for treating hip joint dysplasia ) 是由 内田宗志 李康乔 梅森·贝滕加 杰弗里·怀曼 保罗·亚历山大·托里 于 2018-03-30 设计创作，主要内容包括：用于标准化和简化架髋臼成形术的手术技术及器械。本公开的方法包括：1)使用标准化的移植物分级器制备骨移植物；2)使用偏置平行引导件和插管凿形装置(如骨凿或改进的钻孔引导件)定位和形成插入部位；以及3)使用推动器固定骨移植物。任选地,缝合锚定件可用于将骨移植物进一步固定到骨。还公开了用于分级骨移植物的移植物分级器的实例。(Surgical techniques and instruments for standardizing and simplifying acetabular arthroplasty. The method of the present disclosure comprises: 1) preparing a bone graft using a standardized graft sizer; 2) positioning and forming an insertion site using an offset parallel guide and an intubation chisel device (e.g., an osteotome or modified drill guide); and 3) securing the bone graft using a pusher. Optionally, suture anchors may be used to further secure the bone graft to the bone. Examples of graft sizers for sizing bone grafts are also disclosed.)

1. A method for acetabular reconstruction, comprising:

trimming the bone graft to a preselected length using a first side of the graft sizer;

trimming the bone graft to a preselected width and angle using a second side of the graft sizer, the second side being opposite the first side;

creating at least two openings through the bone graft;

inserting a first end of a first pin member and a first end of a second pin member into the acetabulum;

forming an insertion site in the acetabulum;

advancing the bone graft toward the insertion site by passing the second end of the first pin member and the second end of the second pin member through separate ones of the at least two apertures in the bone graft; and

securing the bone graft to an insertion site of the acetabulum.

2. The method of claim 1, wherein the cross-section of the graded bone graft is substantially rectangular.

3. The method of claim 1, wherein inserting a first end of a first pin member and a first end of a second pin member into the acetabulum comprises passing the first pin member and the second pin member through first and second apertures in a guide, respectively, the guide for ensuring accurate placement of the first and second pin members.

4. The method of claim 1, wherein forming an insertion site comprises excavating the insertion site with an osteotome to a preselected depth.

5. The method of claim 4, wherein the preselected depth is about 20 mm.

6. The method of claim 4, wherein the excavating the insertion site with the osteotome comprises advancing the osteotome toward the acetabulum by passing the osteotome through the second end of the first pin member and the second end of the second pin member.

7. The method of claim 1, wherein advancing the bone graft toward the acetabulum comprises advancing the bone graft toward the acetabulum using a pusher configured to pass through the second ends of the first and second pin members.

8. The method of claim 1, wherein the preselected length of the sized bone graft is about 30mm and the preselected width of the sized bone graft is about 25 mm.

9. The method of claim 1, wherein the preselected height of the first side of the bone graft is between about 7mm to about 8mm and the preselected height of the second side of the bone graft is between about 2mm to about 3 mm.

10. The method of claim 1, wherein securing the bone graft to the insertion site comprises securing the bone graft with a suture anchor.

11. A method for acetabular reconstruction, comprising:

trimming the bone graft to a preselected length and width using a graft sizer;

inserting a first pin member and a second pin member through the bone graft;

forming an insertion site in the acetabulum;

inserting the bone graft, the first pin member, and the second pin member into the insertion site;

advancing the bone graft toward the acetabulum; and

securing the bone graft to an insertion site of the acetabulum.

12. The method of claim 11, wherein the cross-section of the graded bone graft is substantially trapezoidal.

13. The method of claim 11, further comprising inserting a third pin member within the acetabulum.

14. The method of claim 13, wherein inserting a third pin member into the acetabulum comprises passing the third pin member through an aperture in a guide for ensuring accurate placement of the third pin member.

15. The method of claim 13, wherein forming the insertion site within the acetabulum comprises:

passing a cannula drill guide through the third pin member;

removing the third pin member from the acetabulum and the drill guide;

inserting a drill through the drill guide; and

the insertion site is drilled to a first preselected depth.

16. The method of claim 15, wherein the first preselected depth is about 10 mm.

17. The method of claim 11, further comprising excavating the insertion site to a second preselected depth with a slot expander.

18. The method of claim 17, wherein the second preselected depth is about 20 mm.

19. The method of claim 11, wherein advancing the bone graft toward the acetabulum comprises advancing the bone graft toward the acetabulum with a pusher configured to pass over the first and second pin members.

20. The method of claim 11, wherein the preselected length of the sized bone graft is between about 25mm to about 30 mm.

21. The method of claim 11, wherein the preselected width of the first end of the bone graft is between about 16mm and about 17mm and the preselected width of the second end of the bone graft is between about 25mm and about 28 mm.

22. The method of claim 11, wherein the height of the first side of the bone graft is between about 7mm to about 8mm and the height of the second side of the bone graft is between about 2mm to about 3 mm.

23. A bone graft sizer for surgical repair, the sizer comprising:

a generally rectangular body having a top surface and a bottom surface opposite the top surface;

a first substantially square opening extending from an approximate midpoint of the top surface through a first side surface of the body;

a second generally triangular opening in the bottom surface extending through the front surface of the body; and

at least two through holes extending through a second side surface of the body opposite the first side surface, the at least two through holes in communication with the second opening;

wherein the first opening is configured to step the length of the bone graft; and is

Wherein the second opening is configured to grade a width and an angle of the bone graft.

24. A bone graft sizer for surgical repair, the sizer comprising:

a generally rectangular body having a top surface;

an opening in the top surface extending through the front and rear surfaces of the body, the opening defined between first and second block portions of the body;

the first block portion includes a groove extending therethrough in communication with an exterior of the body; and

two angled slots extending through portions of the first block member and the opening, the two angled slots terminating in and communicating with a transverse slot in the opening, the two angled slots and the transverse slot configured for passage of a cutting device;

wherein the transverse grooves are configured to grade a length of bone graft with the cutting device; and is

Wherein the two angled slots are configured to grade a width of the bone graft with the cutting device.

Technical Field

The present disclosure relates generally to hip surgery and, more particularly, to implants, surgical methods and instruments for treating hip dysplasia.

Background

Hip dysplasia (DDH) is a dislocation of the hip that occurs mainly in infants. In some patients, the acetabulum (the hip socket into which the femoral head fits) is too shallow, and the femoral head may slip out of the socket, either partially or completely. In some cases, ligaments that help hold the joint in place may also stretch. Although children with DDH have varying degrees of hip joint laxity or instability, DDH can cause decreased hip joint mobility, arthritis, and pain. In severe cases, surgical acetabular reconstruction may be required.

Acetabular cage arthroplasty or "cage acetabular arthroplasty" is one example of an endoscopic technique for treating acetabular reconstruction of DDH. This technique provides a wider weight bearing surface for the hip joint by placing cortical cancellous bone graft over the acetabulum. Current stenting acetabular arthroplasty involves trimming and drilling holes in the bone graft, positioning the acetabulum with two pins through, using osteotomes at the top of the pins to form the insertion site, and sliding the graft along the pins through for graft fixation. However, these steps are typically performed in a free manner, which can lead to inconsistencies in graft preparation, pin placement, insertion site preparation, and graft fixation.

Disclosure of Invention

Described herein are novel surgical techniques and instruments for standardizing and simplifying acetabular arthroplasty. The method of the present disclosure comprises: 1) preparing a bone graft using a standardized graft sizer; 2) positioning and forming an insertion site using an offset parallel guide and an intubation chisel device (e.g., an osteotome or modified drill guide); and 3) securing the bone graft using a pusher. Optionally, suture anchors may be used to further secure the bone graft to the bone. All aspects of the methods of the present disclosure are designed to reproduce consistent surgical results in a controlled manner. Advantageously, the additional anchor fixation provides improved graft fixation strength and prevents the graft from pouring into the joint space and thus damaging surrounding tissue.

Other examples of the apparatus and methods of the present disclosure may include one or more of the following in any suitable combination.

In an example, a method of the present disclosure for acetabular reconstruction includes: 1) trimming the bone graft to a preselected length using a first side of the graft sizer; 2) trimming the bone graft to a preselected width and angle using a second side of the graft sizer, the second side being opposite the first side; 3) creating at least two openings through the bone graft; 4) inserting a first end of a first pin member and a first end of a second pin member into the acetabulum; 5) forming an insertion site in the acetabulum; 6) advancing the bone graft toward the insertion site by passing the second end of the first pin member and the second end of the second pin member through respective ones of the at least two openings in the bone graft; and 7) securing the bone graft to the insertion site of the acetabulum. In an example, the cross-section of the graded bone graft is substantially rectangular. The preselected length of the graded bone graft is about 30mm and the preselected width of the graded bone graft is about 25 mm. The preselected height of the first side of the bone graft is between about 7mm and about 8mm and the preselected height of the second side of the bone graft is between about 2mm and about 3 mm.

In other examples of the method, inserting the first end of the first pin member and the first end of the second pin member into the acetabulum includes passing the first pin member and the second pin member through first and second apertures in a guide, respectively, the guide for ensuring precise placement of the first and second pin members. Forming the insertion site includes digging the insertion site with an osteotome to a preselected depth, which in the example is about 20 mm. Excavating the insertion site with the osteotome includes advancing the osteotome toward the acetabulum by passing the osteotome through the second end of the first pin member and the second end of the second pin member. Advancing the bone graft toward the acetabulum includes advancing the bone graft toward the acetabulum with a pusher configured for passage through the second ends of the first and second pin members. Securing the bone graft to the insertion site includes securing the bone graft with a suture anchor.

Examples of another method for acetabular reconstruction of the present disclosure include: 1) trimming the bone graft to a preselected length and width using a graft sizer; 2) inserting a first pin member and a second pin member through the bone graft; 3) forming an insertion site in the acetabulum; 4) inserting the bone graft, the first pin member, and the second pin member into the insertion site; 5) pushing the bone graft towards the acetabulum; and 6) securing the bone graft to the insertion site of the acetabulum. In an example, the cross-section of the graded bone graft is substantially trapezoidal. The preselected length of the graded bone graft is between about 25mm to about 30 mm. The preselected width of the first end of the bone graft is between about 16mm and about 17mm and the preselected width of the second end of the bone graft is between about 25mm and about 28 mm. The first side of the bone graft is between about 7mm and about 8mm in height, and the second side of the bone graft is between about 2mm and about 3mm in height.

Additional examples of the method include inserting a third pin member into the acetabulum. Inserting the third pin member into the acetabulum includes passing the third pin member through an aperture in a guide for ensuring accurate placement of the third pin member. Forming an insertion site in an acetabulum comprises: a) passing the drill guide through a third pin member; b) removing the third pin member from the acetabulum and the drill guide; c) inserting a bore through a bore guide; and d) drilling the insertion site to a first preselected depth. In an example, the first preselected depth is about 10 mm. The method further includes excavating the insertion site to a second preselected depth with the slot expander. In an example, the second preselected depth is about 20 mm. Advancing the bone graft toward the acetabulum comprises advancing the bone graft toward the acetabulum with a pusher configured for passage through the first pin member and the second pin member.

An example of a bone graft sizer of the present disclosure includes a generally rectangular body having a top surface and a bottom surface opposite the top surface. A first generally square opening extends from an approximate midpoint of the top surface through the first side surface of the body. A second generally triangular opening in the bottom surface extends through the front surface of the body. At least two through holes extend through a second side surface of the body opposite the first side surface and communicate with the second opening. The first opening is configured to grade a length of the bone graft and the second opening is configured to grade a width and angle of the bone graft.

Another example bone graft sizer of the present disclosure includes a generally rectangular body having a top surface. An opening in the top surface extends through the front and rear surfaces of the body and is defined between the first and second block portions of the body. The first block portion has a groove extending therethrough in communication with an exterior of the body. Two angled slots extend through portions of the first block member and the opening. The two angled slots terminate in and communicate with the transverse slots in the opening. The two angled slots and the transverse slot are configured for passage of a cutting device. The transverse slot is configured to determine a length of the bone graft with a cutting device, and the two angled slots are configured to determine a width of the bone graft with the cutting device.

These and other features and advantages will be apparent from a reading of the following detailed description and a review of the associated drawings. It is to be understood that both the foregoing general description and the following detailed description are explanatory only and are not restrictive of aspects as claimed.

Drawings

The present disclosure will become more fully understood from the detailed description and the accompanying drawings, wherein:

1A-M illustrate a first method of preparing a bone graft using an exemplary graft sizer of the present disclosure;

FIG. 2 illustrates a first exemplary offset guide of the present disclosure;

figures 3A-F illustrate a first method for treating DDH using the staged bone graft of figure 1M and the offset guide of figure 2;

4A-H illustrate a second method of preparing a bone graft using an exemplary graft sizer of the present disclosure;

fig. 5A and 5B illustrate a second exemplary offset guide of the present disclosure;

6A-C illustrate an exemplary improved drill guide of the present disclosure;

figures 7A-J illustrate a second method of treating DDH using the graded bone graft of figure 4F, the offset guide of figure 5A, and the modified drill guide of figure 6A; and

fig. 8A-C illustrate a method of securing a staged bone graft to an acetabulum using a suture anchor.

Detailed Description

In the following description, similar components have been given the same reference numerals regardless of whether they are shown in different examples. In order to show examples in a clear and concise manner, the drawings may not necessarily be to scale and certain features may be shown in somewhat schematic form. Features that are described and/or illustrated with respect to one example may be used in the same way or in a similar way in one or more other examples and/or in combination with or instead of the features of the other examples.

As used in the specification and claims, the terms "about" and "approximately" are used for the purposes of describing and defining the present invention to represent the inherent degree of uncertainty that may be attributed to any quantitative comparison, value, measurement, or other representation. The terms "about" and "approximately" are also utilized herein to represent the degree by which a quantitative representation may vary from a stated reference without resulting in a change in the basic function of the subject matter at issue. The various forms of "including," "comprising," and/or each are open-ended and include listed components and may include additional components not listed. "and/or" is open-ended and includes one or more of the listed components and combinations of the listed components.

Referring now to fig. 1A-M, a first method of forming a bone graft 112 using an exemplary graft sizer 100 of the present disclosure is illustrated. As shown, the graft sizer 100 of the present disclosure provides controlled trimming and preparation of bone grafts for use in stented acetabular arthroplasty. However, the present disclosure contemplates that implant sizer 100 can be used for other types of surgical repair, such as glenohumeral joint instability repair. The graft sizer 100 of the present disclosure can be made of polymer, metal, or other suitable material and is intended to be reusable.

Turning now to fig. 1A and 1B, an exemplary graft sizer 100 of the present disclosure is shown in the form of a generally rectangular block having a top surface 114 (fig. 1A) and a bottom surface 116 (fig. 1B). The top surface 114 includes a first generally square opening 118 extending from an approximate midpoint of the top surface 114 through a first side surface 120. The bottom surface 116 includes a second generally triangular opening 122 extending through the front surface 110. At least two through holes 124a, 124b extend through a second side surface 126 of the graft sizer 100 and communicate with the second opening 122.

As shown in fig. 1C, to shape the bone graft 112, a length of bone, typically obtained from the iliac crest of a patient, is placed within the first opening 118 of the graft sizer 100 and trimmed to a desired length L (fig. 1D), for example with a sagittal saw (not shown). As shown in fig. 1E, the trimmed bone graft 112 is now sized to fit within the second opening 122 of the graft sizer 100. The bone graft 112 is secured to the second opening 122 by drilling at least two drill pins 128a, 128b, which may be 2.4mm drill pins, through the bone graft 112 (fig. 1F). Once secured, the bone graft 112 may be trimmed to the desired width W (fig. 1H) and angle a (fig. 1I), as shown in fig. 1G. The at least two drill pins 128a, 128b may then be removed from the bone graft 112, for example, using a pin remover (not shown).

FIGS. 1J and 1K illustrate bone migration before (FIG. 1J) and after (FIG. 1K) stagingAnd (4) plants 112. As can be seen in fig. 1K, the graded bone graft is substantially rectangular in cross-section. For a stented acetabular arthroplasty, the size and shape of the graded bone graft 112 is selected to cover the femoral head of the hip joint, as described further below. For example, the length L of the graded bone graft may be about 30mm and the width W may be about 25 mm. Height H of the higher end¹May be about 7-8mm and the height H of the shorter end²And may be about 2-3 mm. However, the size and shape of the bone graft 112 may vary and depend on the application for which it is used. Notably, the graded bone graft 112 now includes at least two apertures 130a, 130b extending through the bone graft 112. In other examples, as shown in fig. 1L and 1M, using an implant sizer 100 having three through holes 124a, 124b, 124c results in a sized bone implant 112 including three openings 130a, 130b, 130c that correspond to the through holes 124, 124b, 124c of the implant sizer 100.

An exemplary offset guide 150 of the present disclosure will now be discussed with reference to fig. 2. In the example shown in fig. 2, the offset guide 150 generally includes a rectangular head portion 152 and an elongated tubular shank portion 156. The handle 156 may include surface features for assisting a user in firmly gripping the handle 156. The head portion 152 includes a plurality of apertures 154a, 154b, 154c, 154d, and 154e extending through the head portion 152. Although fig. 2 shows five apertures, three or more apertures are contemplated by the present disclosure. The central aperture 154c is configured to receive a proximal end of a hollow aimer shaft 158. As described further below, the aimer shaft 158 is sized for passage of drill pins. First, the aimer shaft 158 is disposed within the central bore 154c of the head portion 152 such that the aimer shaft 158 is along the first longitudinal axis L¹And (4) extending. The distal end of the aimer shaft 158 includes a chamfered opening 160 and a protruding member 162. The projecting member 160 further includes a distally extending finger 164 along the second longitudinal axis L²And (4) extending. In fig. 2, it can be seen that the longitudinal axis L of the finger 162²To the longitudinal axis L of the aimer shaft 156¹Offset by an offset distance D. In an example, the offset distance D may be about 7 mm. However, other suitable offset distances D are contemplated by the present disclosure. As described further below, offset guides are usedThe guide 150 ensures consistent and accurate placement of the bone graft on the acetabulum.

The use of a staged bone graft 112 (such as the three hole bone graft 112 of fig. 1M) and the offset guide 150 of fig. 2 during a stented acetabular procedure will now be discussed with reference to fig. 3A-G. In fig. 3A, a general detail of a human hip joint 10 is shown. For simplicity, only the major areas of the hip joint anatomy are shown, including the pelvis 12 and the femur 14, including the femoral head 14 a. As noted above, in a healthy anatomy, the femoral head 14a is in close engagement with the acetabulum 16, and more specifically, with the inner concave surface 16a of the acetabulum 16. The location where the femoral head 14a meets the acetabulum 16 is generally referred to as the hip joint 10.

Turning now to fig. 3B, to begin the repair, the aimer shaft 156 of the offset guide 150 is advanced through the portal into the hip joint 10 toward the acetabulum 16. The lateral edges of the fingers 164 of the aimer shaft 156 press slightly against the inner rim of the acetabulum 16 to position the aimer shaft 156. A first drill pin 174, which may be a 2.4mm bore, is then inserted through the aimer shaft 156 such that the drill pin 174 exits the chamfer opening 160 and is inserted into the acetabulum 16. Next, as shown in fig. 3C, the second and third drill pins 180, 182, which may be 2.4mm drill pins, enter the acetabulum 16 through two of the remaining apertures 154a, 154b, 154d, 154e of the offset guide 150 (fig. 2) such that each of the second and third drill pins 180, 182 are disposed on either side of the first drill pin 174. The offset guide 150, including the aimer shaft 156, is then removed from the hip joint 10, leaving the first, second, and third drill pins 174, 180, 182 in place in the acetabulum 16. Each of first, second, and third drill pins 174, 180, 182 are then over-drilled to a preselected depth within acetabulum 16 with a core drill (not shown), which may be a 7mm drill. The preselected depth may be about 20mm from the surface of the acetabulum 16. First peg 174 is then removed from hip joint 10, leaving second and third pegs 180, 182 in place in acetabulum 16.

Turning now to fig. 3D, an cannulated chisel device, such as osteotome 132, is next passed through second drill pin 180 and third drill pin 182 such that second drill pin 180 and third drill pin 182 extend through osteotome 132. Osteotome 132 includes an obturator 134 extending through central passage 140 for preventing debris from entering passage 140 during insertion of osteotome 132 into hip joint 10. The osteotome 132 is then advanced, such as with a mallet (not shown), to a depth within the acetabulum 16 that corresponds to the preselected burr depth described above. In an example, the depth may be about 20 mm. Osteotome 132 may include a serrated edge 144 or other surface marking feature for indicating the depth of insertion of osteotome 132. Thus, as described further below, the osteotome 132 is used to gouge the insertion slot 142 in the acetabulum 16 to an insertion depth sufficient to allow insertion of a pre-staged bone graft. The obturator 134 is then removed from the passage 140 of the osteotome 132. Optionally, an anchor attached to a suture (not shown) may then be delivered through the passage 140 of the osteotome 134 into the acetabulum 16 such that the anchor is fully seated within the acetabulum 16 and the free ends of the attached suture are extruded into the insertion slot 142. Osteotome 134 is then removed from hip joint 10.

Turning now to fig. 3E, the staged bone graft 112 is now ready to be secured to the acetabulum 16. The bone graft 112 and the cannula pusher 144 pass over the second and third pegs 180, 182 such that the second and third pegs 180, 182 extend through the side apertures 130a, 130c, respectively, in the bone graft 112 and through the pusher 144. The free end of suture 138 (when present) may pass through central opening 130b of bone graft 112. The bone graft 112 is advanced toward the acetabulum 16, for example, by applying a tapping force to the end of the pusher 144 until the bone graft 112 is fully wedged into the insertion slot 142. The pusher 144, second pin 180 and third pin 182 are then removed from the hip joint 10, leaving the bone graft 112 in place. The bone graft 112 now covers the femoral head 14a (fig. 3F), thus providing a wider weight bearing surface for the hip joint 10. The free end of the suture 138 (if present) may then be tensioned and passed through a secondary anchor, such as a button (not shown). A surgical knot may be tied over the suture 138 to the button to further secure the bone graft 112 to the acetabulum 16. The free ends of the sutures 138 may then be trimmed and the repair completed.

Referring now to fig. 4A-E, a second method of forming a bone graft 212 using the exemplary graft sizer 200 of the present disclosure is illustrated. As shown, the graft sizer 200 of the present disclosure provides controlled trimming and preparation of bone grafts for use in stented acetabular arthroplasty. However, the present disclosure contemplates that graft sizer 200 can be used for other types of surgical repair, such as a glenohumeral joint instability repair. The graft sizer 200 of the present disclosure can be made of polymer, metal, or other suitable material and is intended to be reusable.

Turning now to fig. 4A, an exemplary graft sizer 200 of the present disclosure is shown in the form of a generally rectangular block having a top surface 214. Top surface 214 includes a first generally square opening 218 extending through anterior surface 210 and posterior surface 216 of implant sizer 200 and defined between first block 206 and second block 208. The first block 206 further includes grooves 204a, 204b that extend through the first block 206 and communicate with the exterior of the graft sizer 200. In an example, the grooves 204a, 204b are spaced apart by about 10 mm. The second block 208 further includes vias 224a, 224b, the purpose of which will be described below. Extending through the first block 206 and the portion of the opening 218 are two angled slots 220 sized for the passage of a cutting device, such as a sagittal saw. Two angled slots 220 terminate in and communicate with a transverse slot 222, also configured for passage of a cutting device. The use of the slots 220, 222 will be described in more detail below.

Fig. 4B shows the bone graft 212 positioned within the opening 218 of the graft sizer 200 in the space defined between the angled slot 220 and the transverse slot 222. The bone graft 212 may be harvested from the iliac crest of the patient, and may be pre-angled during harvesting. The bone graft 212 is manually pressed onto the graft sizer 200 such that the upper end is aligned with the first block 206. The bone graft 212 is then trimmed to the desired length by extending the cutting device 230 through the transverse slot 222. Next, as shown in fig. 4C, two drill pins 228a, 228b (which may be 1.2mm drill pins) are drilled through the respective grooves 204a, 204b of the first block 206, bone graft 212, and second block 208 such that the drill pins 228a, 228b exit the through holes 224a, 224b in the second block 208 and the bone graft 212 is secured to the graft sizer 200. The bone graft 212 may then be trimmed to the desired width by extending the cutting device 230 through the angled slot 220 (fig. 4D). Due to the angle of the angled slot 220, the cross-section of the staged bone graft 212 is substantially trapezoidal. In fig. 4E, the drill pins 228a, 228b are retracted from the second block 208 such that the sized bone graft 212 can be freely lifted from the graft sizer 200 by lifting the drill pins 228a, 228b through the grooves 204a, 204 b. The staged bone graft 212 and drill pins 228a, 228b are now ready for insertion into the repair site (fig. 4F).

As shown in fig. 4G and 4H, the present disclosure contemplates that two different graft graders 200 can be used to form two different sizes of bone graft 212. In an example, the length L of a "medium" sized bone graft 212 (as viewed from the top surface) may be about 25 mm. Width W of narrow end¹May be about 16mm and the width W of the wide end²May be about 25 mm. In an example, the length L of the "large" sized bone graft 212 may be about 30 mm. Width W of narrow end¹May be about 17mm and the width W of the wide end²May be about 28 mm. In both examples, the height H of the narrow end²May be about 2mm (as viewed from the side surface) and the height H of the wider end¹And may be about 7-8 mm.

A second example of the offset guide 250 of the present disclosure will now be shown with reference to fig. 5A and 5B. In the example of fig. 5A, the offset guide 250 generally includes a cannula head portion 252 and an elongate handle 256. The handle 256 may include finger notches (as shown) or other surface features to assist a user in securely gripping the handle 256. The head portion 252 is configured to receive a proximal end of a hollow aimer shaft 258. The sight shaft 258 is sized for the passage of a drill pin 274, which may be a 2.4mm bore hole, the purpose of which will be described in more detail below. First, the aimer shaft 258 is disposed within the head portion 252 such that the aimer shaft 258 is along the first longitudinal axis L¹And (4) extending. The distal end of the aimer shaft 258 includes a chamfered opening 260 and a protruding member 262. The projecting member 260 further includes a distally extending finger 264 along the second longitudinal axis L²And (4) extending. In fig. 2, it can be seen that the longitudinal axis L of the finger 262²To the longitudinal axis L of the sight shaft 256¹Offset by an offset distance D. In an example, the offset distance D may be about 7 mm. However, this disclosureOther suitable offset distances D are contemplated. As described further below, the use of the offset guide 250 ensures consistent and accurate placement of the bone graft on the acetabulum. In fig. 5B, it can also be seen that the surface of the drill pin 274 is provided with a number of markings 254 to indicate the length of the drill pin 274 extending distally from the offset guide 250.

An example of the improved drill guide 232 of the present disclosure will now be shown with respect to fig. 6A-C. As shown in fig. 6A, drill guide 232 includes a generally elongated, flattened body 236 having a proximal end 268 and a distal end 270, with an open cannula 226 (fig. 6B) extending from proximal end 268 to distal end 270. The obturator 234 is configured to be slidably disposed within the cannula 226 such that it extends slightly away from the distal end 270 of the drill guide 232, but cannot slide past the distal end 270. The packer 234 further includes an internal passage 240 for passage of a drill pin 274, as described further below.

Fig. 6B is a detailed view of the distal end 270 of the drill guide 232 with the obturator 234 removed from the cannula 226. In fig. 6B, it can be seen that distal end 270 of drill guide 232 includes at least one sharp point 272, which may be two points, as shown, for biting into bone. Drill guide 232 and point 272 are further illustrated from the top view in fig. 6C. As shown in fig. 6C, when the obturator 234 is removed from the cannula 226, the drill guide 232 is configured for passage of a drilling tool 280, which may be a 4.5mm drilling tool. The drill 280 includes a proximal annular rim 276 having a diameter selected such that it cannot enter the drill guide 232. When the drill 280 is fully seated within the drill guide 232, the annular rim 276 abuts the proximal end 268 of the drill guide 232 and the drill bit 278 extends about 10mm from the distal end 270 of the drill guide 232. The purpose of this construction will be described in more detail below.

The use of the staged bone graft 212 of fig. 4F, the offset guide 250 of fig. 5A, and the improved drill guide 232 of fig. 6A during a stented acetabular procedure will now be discussed with reference to fig. 7A-J. The method described below is similar in many respects to the method described above with respect to fig. 3A-G, except that the second and third drill pins 180, 182 initially passing through the offset guide 150 are now pre-assembled with the staged bone graft 212. As described in more detail below, a modified drill guide 232 and slot expander are used in place of osteotome 132 to core insertion slot 142 to a preselected depth. In both cases, all aspects of the method are designed to reproduce consistent surgical results in a controlled manner.

Turning now to fig. 7A, to begin the repair, the aimer shaft 256 of the offset guide 250 is advanced through the portal into the hip joint 10 toward the acetabulum 16. The lateral edges of the fingers 264 (fig. 5A) of the aimer shaft 256 press slightly against the inner rim of the acetabulum 16 to position the aimer shaft 256. The drill pin 274 is then inserted through the aimer shaft 256 and used to drill a hole into the acetabulum 16, which may be about 15mm deep. The offset guide 250, including the aimer shaft 256, is then removed from the hip joint 10, leaving the drill pin 274 in place in the acetabulum 16 (fig. 7B).

Next, as shown in FIG. 7C, the modified driller 232, including the packer 234, passes over the drill pin 274 such that the drill pin 274 extends through the packer 234. The drill guide 232 is then stroked into the acetabulum 16, for example, with a mallet (not shown), such that the drill guide 232 is advanced into the acetabulum 16. Advancing the drill guide 232 into the acetabulum 16 causes a point 272 of the drill guide 232 to engage the bone and the obturator 234 to protrude from the distal end 270 of the drill guide 232 (fig. 7D). The obturator 234 and drill pin 274 are then removed from the hip joint 10, leaving the drill guide 232 extending from the acetabulum 16. As shown in fig. 7E, the drilling tool 280 then passes through the drill guide 232 and drills to a hard stop, i.e., about 10mm deep within the acetabulum 16. As shown in fig. 7F, the drilling tool 280 is swept laterally from within the drill guide 232 until all bone material within the drilling tool 280 is removed to form the insertion slot 242. The drill 280 and drill guide 232 are then removed from the hip joint 10.

Turning now to fig. 7G, a slot expander 282 is then introduced into the insertion slot 242. As shown in greater detail in fig. 7H, the slot dilator 282 can include a serrated edge 244 or other surface marking feature for indicating the insertion depth of the slot dilator 282. The slot expander 282 is advanced into the insertion slot 242, for example, using a mallet (not shown), until a 20mm mark (not shown) on the slot expander 282 reaches below the acetabulum 16. The slot dilator 282 is then removed from the hip joint 10.

Turning now to fig. 7I, the staged bone graft 212 is now ready for fixation to the acetabulum 16. The bone graft 212 is advanced into the insertion slot 242 using the drill pins 228a, 228 b. The cannula pusher 244 then passes over the pegs 228a, 228b such that the pegs 228a, 228b extend through the pusher 244. The bone graft 212 is advanced toward the acetabulum 16, for example, applying a tapping force to the end of the pusher 244 until the bone graft 212 is fully wedged into the acetabulum 16. The pusher 244 and drill pins 228a, 228b are then removed from the hip joint 10, leaving the bone graft 212 in place. The bone graft 212 now covers the femoral head 14a (fig. 7J), thus providing a wider weight bearing surface for the hip joint 10.

Additional fixation of the bone graft 212 to the acetabulum 16 can optionally be achieved by deploying one or more anchors (not shown) attached to sutures into the insertion slot 242 through holes in the bone graft 212 formed by the drill pins 228a, 228 b. Any suitable anchor known in the art may be used for this purpose. In an example, the anchor can be a bioabsorbable anchor. As shown in fig. 8A, the suture 238 may be pulled through the bone graft 212 by a suture passer 290 or other device. The free ends of the suture 238 are then tensioned and passed through a secondary anchor, such as button 246 (fig. 8B). A surgical knot 248 is then tied in the suture 238 on the button 246 to further secure the bone graft 212 to the acetabulum 16 (fig. 8C). The free ends of the suture 238 may then be trimmed and the repair completed.

While the present disclosure has been particularly shown and described with reference to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the spirit and scope of the present application as defined by the appended claims. Such variations are intended to be covered by the scope of the present application. Accordingly, the foregoing description of examples of the present application is not intended to be limiting, but is to be accorded the full scope as conveyed by the appended claims.