Surgery – Instruments – Orthopedic instrumentation
Reexamination Certificate
2002-10-15
2004-06-01
Philogene, Pedro (Department: 3732)
Surgery
Instruments
Orthopedic instrumentation
C606S102000
Reexamination Certificate
active
06743235
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention is related to hip joint replacement surgery and in particular for correct positioning and implantation of an acetabular prosthetic socket. The present invention provides a simple modular surgical instrument to position an acetabular prosthesis into correct position, which rely upon specific parameters and specific mechanisms incorporated into the modular instrument in order to reduce the likelihood of malpositioning an acetabular prosthetic socket into a reamed acetabulum of pelvic bone.
A malpositioned acetabular prosthetic socket can lead to several complications such as, dislocation of the hip joint, impingement of the prosthetic elements, impingement of soft tissues, decreased joint motion, painful joint, limping, increased wear and tear of the prosthetic elements, and eventual loosening and failure of the implant.
Correct anatomical placement and implantation of acetabular prosthetic socket can be surgically demanding and challenging task for orthopaedic surgeons. Correct alignment and implantation is hampered by a deep wound, bleeding from the reamed bony acetabulum, few clear reference landmarks, major neurovascular structures, close to the operating field.
To prevent malpositioning of acetabular prosthetic socket, several surgical instruments and methods have been devoloped in the art, but many such instruments are limited in application at the time of a major surgical procedure.
Hip joint replacement surgery requires knowledge of topographical and surgical anatomy of patients and clinical pathology of the hip joint. Many currently available acetabular prosthetic socket alignment apparatus and methods, merely rely upon reference landmarks external to the pelvis of a patient, the reliance placed on such external landmarks on pelvis tend to introduce inadvertent misjudgements arising from the variations in patient's external landmarks associated with obesity, patient's position on the operating table, previous surgeries on the hip or pelvis, and surgeon's proprioceptive skills, and the results can vary widely, wherein reliable and consistant results are not assured.
Instruments incorporating electronics, computer tomographic scans, intraoperative radiological monitoring, have been used to position an acetabular prosthetic socketc correctly, but then these instruments and methods can be expensive, complicated, invasive, again some of them can be misleading and are not widely practical, and are not widely popular.
2. Description of the Related Art
The following patents are related for positioning and implanting an acetabular prosthetic cup into acetabulum of a pelvic bone.
U.S. Pat. No. 4,305,394 to Bertuch Jr. (1981)
U.S. Pat. No. 4,475,549 to Oh (1984)
U.S. Pat. No. 4,994,064 to Aboczsky (1991)
U.S. Pat. No. 5,037,424 to Aboczsky (1991)
U.S. Pat. No. 4,141,512 to Farmer et al (1992)
U.S. Pat. No. 5,284,483 to Johnson (1994)
U.S. Pat. No. 5,320,625 to Bertin (1994)
U.S. Pat. No. 5,364,403 to Petersen (1994)
U.S. Pat. No. 5,540,697 to Rehmann (1996)
U.S. Pat. No. 4,716,894 to Lazzari (1998)
U.S. Pat. No. 6,214,014 BI to McGann (2001)
U.S. Pat. No. 6,395,005 BI to Lovell (2002)
For example U.S Pat. No. 4,305,394 to Bertuch Jr. discloses an acetabular prosthetic socket positioning instrument that has an interchangeable ball and a flange and a drive mechanism operatively connected through a drive coupling rod, flexible drive cable and drive member and carrying such ball. The instrument also discloses a left hand handle, a stabilising rod, a right hand handle and a L shaped hollow drive housing. Similarly, U.S. Pat. No. 475,549 to Indong Oh discloses an acetabular cup positioner, comprising a head having an axis which is receivable in the acetabular cup, a first arm coupled to the head and extending from the head at an acute angle, and a second arm coupled to the first arm at a location spaced from the head and the arms and the axis are coupled the first arm such that the antiversion angle can be established for the right and left hips by aligning the first and second hands, respectively with the patient axis.
U.S. Pat. No. 4,716,894 to Lazzeri et al; discloses an acetabular cup inserting instrument comprising a first handle and a second handle extending therefrom, the second handle is selectively locable in a desired position with respect to the first handle.
Instruments that address the orientation, inserting and impacting problems for acetabular prosthetic sockets are known in the art. For example U.S. Pat. No. 4,994,064 and U.S. Pat. No. 5,037,424 to Robert Aboczky discloses an instrument comprising an impaction rod, coupling rod, pivoting rod and supporting rod. Acetabular prosthetic cup is aligned and inserted in accordance with a plane normal to line between the right and left anterior iliac spines. The alignment arrangement includes a bar which is rotatably adjustable about the axis of coupling rod, and which is aligned normal to a line which crosses from posterior superior iliac to the anterior iliac spine. U.S. Pat. No. 5,141,512 to Malcom Fraser et al; discloses a modular apparatus for proper alignment of an acetabular prosthetic socket, includes a frame having feet which are placed against anterior iliac spines and symphysis pubis. The invention includes a light beam directed from a source through an aperture to a mirror mounted on an inserter. The light beam is reflected back from the mirror to a target region. When the incident and reflected beam are coincident the cup is aligned for correct placement. The target region is rotatably and pivotably mounted for precise adjustments of the angle of abduction and antiversion respectively. The instrument appear bulky, complicated and occupy considerable space at the time of surgery, and also appear not suitable for patients placed in lateral position.
U.S. Pat. No. 5,284,483 to Erin Johnson discloses an instrument comprising a first elongated handle, a second elongated handle extending therefrom. The second handle is capable of ratcheting about the longitudinal axis of the first elongated handle. The second handle may be selectively locked in a desired position with respect to the first handle by means of a control on the ratchet mechanism to aid proper positioning an acetabular prosthetic cup. Similarly U.S. Pat. No. 5,320,625 to Kim Bertin discloses an apparatus that includes a orientation bar and an alignment arm, laterally displaced from the longitudinal axis of the apparatus and selectively fixed or rotatably connected in order to implant the acetabular prosthetic cup in desired orientation.
Similarly U.S. Pat. No. 5,364,403 to Thomas Petersen discloses an instrument, provides a resilient collar at one end connecting the acetabular cup, a sighting guide and an A-shaped alignment guide to check the alignment of the acetabular cup with anatomical check points on the patient. Similarly apparatus U.S. Pat. No. 5,540,697 to Mark Rehmann discloses both axial and angular alignment references to fecilitate correct alignment of an acetabular prosthetic cup, the alignment includes an abduction indicating member and antiversion indicating member connected to an elongated tool body to provide an axial alignment guide.
U.S. Pat. No. 6,214,014 BI to William McGann discloses an alignment system for hip replacement surgery, the acetabular guide comprises of three components, the laser pointer, goniometer, and a swing arm. The swing arm includes a window with an alignment guide, the laser light is directed towards a wall in the operating room and a mark is made on the wall where the laser light points. The goniometer and the laser pointer are removed after appropriate mark is imdicated on the operating room wall. The acetabular cup is inserted with the aid of a handle and the handle is appropriately aligned by inserting the laser pointer into the bore and moving the handle until the laser light of the pointer is aligned with the previously indicated mark on the wall, and once this has occured the acetabular cup is finally inserted into the p
Bonderer David A
Philogene Pedro
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