阅读说明：本技术 用于植入髋关节置换假体的手术托盘、器械及方法 (Surgical tray, instruments and method for implanting a hip replacement prosthesis ) 是由 扎菲尔·特曼尼尼 史蒂文·麦克唐纳 布莱恩·万黑尔 泰勒·戴维斯 于 2016-08-15 设计创作，主要内容包括：在髋关节置换手术中使用的手术托盘、工具及方法,其中,髋关节置换假体是逆向髋关节假体。本发明的试验部件、专用工具及方法使外科医生能够基于最适合于病人骨骼的尺寸和角度来确定用于植入病人体内的逆向髋关节假体的最佳部件。(Surgical trays, tools and methods for use in hip replacement surgery, wherein the hip replacement prosthesis is a reverse hip prosthesis. The trial components, specialized tools, and methods of the present invention enable a surgeon to determine the best components for a reverse hip prosthesis to be implanted in a patient based on the dimensions and angles that are best suited for the patient's anatomy.)

1. A trial acetabular cup for a reverse hip prosthesis comprising:

a cup having an outer surface adapted to fit a treated surface of an acetabular bone; and

an inner concave surface;

the outer surface and the inner surface having optional through openings; and

the inner concave surface has a shank extending from a bottom of the inner concave surface, the shank being internally threaded.

2. The trial acetabular cup of claim 1, wherein the outer surface is convex.

3. A trial acetabular ball for use in a reverse hip prosthesis comprising:

a hemispherical ball portion having a shank extending therefrom and a flat portion on a surface of the ball opposite the shank.

4. The trial acetabular ball of claim 3, wherein the stem is externally threaded.

5. The trial acetabular ball of claim 3, wherein the stem includes an opening sized to receive a stem of an acetabular cup.

6. The trial acetabular ball of claim 4, further comprising:

an opening in the center of the flat portion, the opening sized and shaped to receive a tool for tightening and loosening the trial acetabular ball when the threaded portion is screwed into the internally threaded stem of the trial acetabular cup.

7. A trial femoral cup for a reverse hip prosthesis comprising:

a cup having a concave surface adapted to form a joint on an acetabular ball; and

a stem extending from an outer surface of the cup portion opposite the concave surface, the stem adapted to attach to a proximal end of a broach or a proximal end of a femoral implant.

8. The trial femoral cup of claim 7, wherein the stem is adapted to receive a proximal end of a broach or a proximal end of a femoral implant.

9. The trial femoral cup of claim 7, wherein the stem is adapted to be received within a proximal end of a femoral implant.

10. A compression element for compressing a polymeric liner into a femoral cup for a reverse hip prosthesis, comprising:

a base having attached thereto a bracket adapted to receive a shaft having a press bar at a proximal end of the shaft and a cylindrical body piece at a distal end of the shaft, the cylindrical body piece adapted to press on a plunger;

a femoral cup locator positioned on the base opposite the cylindrical member;

wherein a femoral cup has a concave surface positioned in the femoral cup locator with the concave surface in an upwardly directed position and a polymeric liner has a concave portion positioned on the plunger and a convex portion positioned over the concave portion of the femoral cup such that when the plunger is pushed down using the press bar causing the cylindrical member to contact and press down on the plunger, the liner snaps into place in the femoral cup.

11. A trial acetabular ball having a circumferential groove therein to provide a gripping surface for insertion or removal of the trial acetabular ball into or from an acetabular cup.

12. A tool for inserting or removing the trial acetabular ball of claim 11, the tool comprising:

a handle at a proximal end of the tool, proximate to the ratchet portion,

a holder at a distal end of the tool, an

An articulating member disposed between the proximal end and the distal end;

the clamping member is adapted to clamp a circumferential groove of the trial acetabular ball.

Technical Field

The present invention relates to surgical instruments and methods for use in connection with reverse hip prostheses. More particularly, the present invention relates to instrument trays, surgical tools and trial implants for use in hip replacement surgery.

Background

Retrograde hip prostheses are described in us patents 8313531B2 and 8540779B 2. The prosthesis and revision surgery method are also described in U.S. patent No. 8992627B 2. The disclosures of these three patents are incorporated herein by reference in their entirety.

Disclosure of Invention

As described in the above-referenced patents, reverse hip prostheses typically include an acetabular ball attached to a stem in the acetabular cup and a femoral cup attached to the femoral stem, with the femoral cup forming a joint over the acetabular ball. The surgical tray, tools and methods of the invention enable surgeons to determine the best components for a reverse hip prosthesis to be implanted in a patient based on size and angle using trial implants and special surgical tools. In the present disclosure, applicants sometimes use the term "tool" to refer to a surgical tool.

Drawings

Fig. 1A and 1B illustrate a set of trays including tools for preparing a femur for implantation surgery.

Fig. 2A, 2B and 2C illustrate a set of trays including tools for preparing the acetabulum for implantation surgery.

Figures 3A, 3B and 3C illustrate a set of trays including trial implants and tools for sizing and implanting an acetabular cup and an acetabular ball.

Fig. 4A, 4B and 4C illustrate a set of trays including trial implants and tools for screening sized and implanting femoral cups.

Fig. 5A, 5B, 5C, 5D, and 5E include front, cross-sectional, and perspective views of a trial acetabular cup.

Fig. 6A, 6B, 6C and 6D include front, cross-sectional and perspective views of a first trial acetabular ball for use with a trial acetabular cup.

Figures 7A, 7B, 7C, 7D, 7E and 7F include front, cross-sectional, detail and perspective views of a second trial acetabular ball for use with an implanted acetabular cup.

Figures 8A, 8B, 8C, 8D and 8E show various views of a second trial acetabular ball of the type shown in figures 7A to 7F, and front and cross-sectional views of the ball placed on the stem of the acetabular cup.

Fig. 9A, 9B, and 9C illustrate in perspective and elevation views a handle for installing and removing a trial acetabular cup and a cross-sectional view of the handle threaded into the trial acetabular cup, the trial acetabular cup being located in a representative portion of the acetabulum.

Fig. 10A, 10B, 10C, 10D, 10E, and 10F include front, cross-sectional, detail, and perspective views of a first trial femoral cup.

Fig. 11A, 11B, 11C, 11D, 11E and 11F include additional views of a first trial femoral cup of the type shown in fig. 10A-10F, as well as perspective and elevation views of the cup in a first femoral implant.

Fig. 12A, 12B, 12C, 12D, 12E, and 12F show front, cross-sectional, detail, and perspective views of a second trial femoral cup.

Figures 13A, 13B, 13C, 13D, 13E, 13F and 13G show additional views of a second trial femoral cup of the type shown in figures 12A to 12F, together with perspective, elevation and cross-sectional views of the cup in a second femoral implant.

Figure 14 is a cross-sectional view showing a first trial acetabular ball in a trial acetabular cup and a tool for attaching and removing the ball from the cup.

Figure 15 is a cross-sectional view showing a first trial femoral cup in an articulated position on a first trial acetabular ball.

Fig. 16A, 16B, 16C, 16D, 16E, 16F, 16G and 16H show various views of a compression assembly for compressing a liner in a femoral cup and its components.

Fig. 17 is a front view of the compression assembly of fig. 16A-16H with a femoral cup in the compression assembly.

Fig. 18 is a cross-sectional view of fig. 17.

Fig. 19 is a perspective view of the insertion-removal tool.

Fig. 20 is a front view of the tool of fig. 19.

Fig. 21 is an elevation view of another embodiment of a trial acetabular ball suitable for use with the insertion-removal tool.

Figure 22 is a perspective view showing the position of the tool of figures 19 and 20 when the tool is in contact with the trial acetabular ball of figure 21 to facilitate removal of the ball from the acetabular cup.

Figure 23 is an elevational view of a conventional power drill used in surgery.

Detailed Description

Tools for preparing the femur for hip implantation surgery are included in the first set of steel trays 1 and 2 of fig. 1A and 1B, respectively. The tray 1 comprises a reamer (diameter) 3, a right hand handle 4 and a left hand handle 5. Also included in the tray 1 is a T-handle 6 and a box bone knife (box osteotome) 7. After the femur has been prepared for surgery by resecting the femoral head, the cartridge broach 7 is used as a center punch (center punch) to create an initial opening in the femur that serves as a guide for proper positioning of the reamer 3. Then, a T-shaped handle 6 adapted to be connected to the proximal end 3a of the reamer 3 is attached to the reamer, and the surgeon places the distal end 3b of the reamer 3 into the initial opening and rotates the handle while applying pressure to form a pocket-like pocket (pocket) in the femur. The right hand handle 4 and the left hand handle 5 are each adapted for attachment to the proximal end 3a of the reamer for rotating the reamer to form a deep pocket in the femur in preparation for use of a broach (broach)8, the broach 8 being described below together with the tray 2. A right-handed surgeon uses a right-handed handle 4 and a left-handed surgeon uses a left-handed handle 5.

The tray 2 includes a set of two or more broaches 8 of different sizes. The broach has a size in the range from 9mm (on the left-hand side of fig. 1B) to 21mm (on the right-hand side of fig. 1B). In the drawing, each broach 8 from left to right is 1mm larger than the broach to its left. As can be seen in the figures, the broaches are tapered and the size of each broach refers to the maximum diameter at the top (proximal end 8a) of the broach. A broach 8 (also known as a rasp) is inserted into the deep pocket and the broach 8 is stroked into the femur at the proximal end 8a using a hammer 9. The handle 10 is threaded into a threaded recess 75a at or near the proximal end of the femoral implant 75 (see fig. 13) and is used to implant the femoral implant into the femur.

Tools for preparing the acetabulum for hip joint implantation surgery are included in the second set of steel trays 11, 12 and 13 of figures 2A, 2B and 2C, respectively. Tray 11 and tray 12 collectively include two or more (25 are shown in fig. 2A and 2B) different sized acetabular bone cutters 14, which acetabular bone cutters 14 are used to cut the acetabular bone to the appropriate size to accommodate a correspondingly sized acetabular cup. The drive shaft and drive shaft handle are used to connect the drilling tool 140 (see fig. 23) to the acetabular osteotomy 14. The tray 13 shows two drive shafts 15 of different sizes and two drive shaft handles 16. The drive shaft has a distal end 15b adapted to be connected to a osteotome and a proximal end 15a adapted to be connected to a distal end 16b of a drive shaft handle 16. The proximal end 16a of the drive shaft handle 16 is adapted to be connected to a collet (chuck)141 of a drill 140.

Trial implants and tools for implanting acetabular cups and acetabular balls are included in the third set of steel trays 21, 22 and 23 of figures 3A, 3B and 3C, respectively.

Tray 21 includes a pilot drill handle 24, two or more drill bits 25, two or more pilot drills 26, two or more second trial acetabular balls 27, and a trial acetabular ball insertion-removal tool 28. Each drill bit 25 has a corresponding size of pilot drill.

Tray 22 includes two or more first trial acetabular balls 29, two or more trial acetabular cups 30, and a universal handle 31.

The tray 23 includes elements of an acetabular cup impactor assembly. The tray 23 includes another universal handle 31, an acetabular cup handle 32, an internal shaft 33 with a protruding handle 34 at its proximal end, two anteversion guide rods 35, at least one (and preferably three) collet pieces 38, and at least one (and preferably three) acetabular ball impactor 37. The tilt and anteversion guide 36 has thumb screws (not shown) for maintaining the guide 36 in position on the acetabular cup handle 32. This is described in detail in the co-pending international application No. PCT/US 16/42441 filed on 15.7.2016 by the applicant.

Trial implants and tools for implanting the femoral cup are included in the fourth set of steel trays 41, 42 and 43 of fig. 4A, 4B and 4C, respectively.

The tray 41 and tray 42 include only two or more first trial femoral cups 44. These first trial femoral cups 44 may differ in size, neck length, and offset angle. Preferably, the first trial femoral cup 44 is adapted to be temporarily attached to the proximal end of the broach 8 from tray 2 before the broach is removed from the femur. Alternatively, the first trial femoral cup 44 may be temporarily attached to the proximal end of the femoral implant 49 as shown in fig. 11E and 11F.

The tray 43 includes two or more second trial femoral cups 45 adapted to be temporarily attached to a femoral implant 49 (see fig. 11E and 11F). The tray also includes a press 46 for pressing the polymeric liner into the femoral cup, a femoral cup locator 47, and plungers 48 and 48a (see also fig. 16C, 16D, 16E, and 16F).

More specifically, fig. 5A-5E illustrate various views of the trial acetabular cup 30 for the various components included in the tray discussed above. Figure 5E is a perspective view of a trial acetabular cup. Fig. 5A is a side view, and fig. 5D is a sectional view of fig. 5A. Fig. 5B is a top view, and fig. 5C is a bottom view.

The trial acetabular cup 30 has an outer surface and an inner concave surface, wherein the outer surface is adapted to fit the treated surface of the acetabular bone. Preferably, the outer surface is a convex surface. A shank 50 having an internally threaded opening 51 extends from the bottom of the concave surface and the cup features a plurality of optional through openings 52. The threaded opening 51 receives threads of a universal handle 31, the universal handle 31 being used to install the cup 30 and remove the cup 30 from the acetabulum (see fig. 9C). The threads of opening 51 also receive the first trial acetabular ball 29 shown in figures 6A to 6D. The trial acetabular balls of the invention are hemispherical and may include flat portions and inclined surfaces as described below. Fig. 6D is a perspective view of the trial acetabular ball 29, fig. 6A is a side view, fig. 6B is a top view, and fig. 6C is a cross-sectional view. The threaded portion 60 is screwed into the opening 51. A hexagonal opening 61 is shown in the flat portion 62a and receives the tool 28 for screwing the ball 29 into and out of the cup 30 (see fig. 3A). Optional beveled portion 62b is adjacent threaded portion 60 and creates a beveled edge around the base of ball 29.

Figures 7 and 8 relate to a second trial acetabular ball 27.

Fig. 7A to 7F show various views of the ball 27. The ball 27 may be temporarily attached to an implanted acetabular cup 70 (see fig. 8D and 8E) to determine the optimal size of the ball for the prosthesis. Fig. 8A to 8C show a second trial acetabular ball 27 in different views.

Fig. 7F and 8C are perspective views of the ball 27, fig. 7A and 8A are side views of the ball 27, and fig. 7B and 8B are plan views. Fig. 7C is a bottom view of the ball 27, and fig. 7D is a sectional view taken along a section line 7D of fig. 7A. A detailed view of the encircled portion 7E of figure 7D is shown in figure 7E.

The second trial acetabular ball 27 includes a flat top portion 62 for imprinting identifying dimensional information. The ball 27 has an opening 63, the opening 63 being sized to fit the stem 71 of the acetabular cup 70. Slot 64 is provided on one side of tab 65 to make it easier to place and remove a ball on and from stem 71.

Fig. 9B shows the common handle 31 in a side view, and fig. 9A shows the common handle 31 in a perspective view. Fig. 9C is a cross-sectional view of the universal handle 31 threaded into a trial acetabular cup 30, the trial acetabular cup 30 being in a representative portion of an acetabular bone 80. The handle 31 is used to place the trial cup 30 into the acetabular bone 80.

A number of views of the first trial femoral cup 44 are shown in fig. 10. Fig. 11 shows further views of the cup 44 and a view of the cup 44 in a femoral implant 49.

Three different perspective views of the first trial femoral cup 44 are shown in fig. 10F, 11A and 11C. Fig. 10A, 11B and 11D show side views of the cup 44 taken from different angles. Fig. 10B is a top view, fig. 10C is a bottom view, and fig. 10D is a sectional view taken along a section line 10D of fig. 10A. Fig. 10E is a detail view of the encircled portion 10E taken from fig. 10D. Fig. 11F is a side view of cup 44 attached to implant 49, and fig. 11E is a perspective view of cup 44 attached to implant 49.

The first trial femoral cup 44 has a base portion 90 in the form of a stem that extends away from the first concave portion 91 (i.e., opposite the first concave portion 91). An opening 92 is included in base portion 90 that receives the proximal end of broach 8 or the shank of implant 49. The provision of slots 93 and 93a makes it easier to place the cup on the broach or handle and facilitates subsequent removal of the cup.

A second trial femoral cup 45 is shown in multiple views in fig. 12A-12F. Fig. 13A-13G show further views of the cup 45 and views of the cup 45 positioned in the femoral implant 75. A perspective view of the cup 45 is shown in fig. 12F and 13D, a side view is shown in fig. 12A and 13A, a top view is shown in fig. 12B and 13C, and a bottom view is shown in fig. 12C and 13B. Fig. 12D is a cross-sectional view taken along section line 12D of fig. 12A, and fig. 12E is a detail view of encircled portion 12E taken from fig. 12D. Fig. 13E is a perspective view of cup 45 positioned in implant 75, fig. 13G is a side view of cup 45 positioned in implant 75, and fig. 13F is a cross-sectional view of fig. 13G.

The second trial femoral cup 45 has a stem 95 extending away from the second concave portion 96 and adapted to be received within the femoral implant 75. The opening 97 in the stem 95 cooperates with the slot 98 to facilitate attachment of the cup 45 to the femoral implant 75 and removal of the cup 45 from the femoral implant 75.

Fig. 14 shows, in cross-section, a trial acetabular ball insertion-removal tool 28, which trial acetabular ball insertion-removal tool 28 is inserted into a hexagonal opening of a trial acetabular ball 29. This is the position of the tool associated with the ball for screwing the ball into or out of the trial acetabular cup 30, the cup 30 being shown in a representative portion of the acetabular bone 80.

The trial femoral cup 44 is shown in position on the trial acetabular ball 29 in figure 15. The femoral cup 44 is attached to the implant 49 and the trial acetabular cup 30 is shown in the acetabular bone 80.

Fig. 16 shows elements of a compression member 46 for compressing a polymeric liner into a femoral cup. A perspective view of the pressing piece 46 is shown in fig. 16A. Referring to fig. 16A to 16F and fig. 17 and 18, the pressing piece includes a base 101 to which a holder 102 is attached. The press rod 103 is disposed on a shaft 104, and a cylindrical body piece 105 is disposed at the distal end of the shaft 104. The cylindrical member 105 contacts and presses against the appropriately sized plunger 48. A femoral cup locator 47 having a femoral cup 110 therein is positioned on the base 101. As shown in cross-section in fig. 18, the female portion of the polymeric liner 111 is positioned on the plunger 106 and the male portion of the liner 111 is positioned on the female portion of the femoral cup 110. The plunger 48 is then pushed downward using the press bar 103 so that the cylindrical body piece 105 contacts and presses downward on the plunger while also stabilizing the handle 108 until the liner 111 snaps into place in the concave portion of the femoral cup 110.

The insertion-removal tool 120 is shown in fig. 19 and 20. The tool is similar in size and structure to a hemostat. The tool includes a handle 121 and a ratchet portion 122 at its proximal end. Hinge 123 is positioned to provide leverage and clamp 124 is disposed at the distal end. The portion of the tool located between hinge 123 and clamp 124 may be selectively angled (e.g., at about 20 ° (not shown)).

In the present application, the preferred use of the tool 120 is to remove the trial acetabular ball 27a from the acetabular cup 70. To this end, fig. 22 shows a tool 120 positioned on the ball 27 a. The ball 27a has all the same features as the ball 27 described above, with the additional feature of an indentation 130 in the form of a circumferential groove arranged to allow gripping of the ball and pulling it away from the stem 71 of the acetabular cup 70 (see fig. 8E).