Invention (Patent): Frederick P, Belew K, Jasper L, Gatewood J, Gibson L, Masonis J, Cooper M, Kelman DC. Methods and apparatus for FAI surgeries. US20120283840A1 (2012).
US20120283840A1 US
Inventors: Phillip Frederick, Kevin Belew, Lauren Jasper, James Gatewood, Luke Gibson, John Masonis, Michael Cooper, David C. Kelman
Current Assignee: Smith and Nephew Inc
Worldwide applications 2010 KR JP RU BR CA US CN EP CN WO AU 2014 US 2016 AU 2017 AU
Application US13/202,612 events:
2010-02-25 Заявка подана Smith and Nephew Inc
2010-02-25 Приоритет US13/202,612
2012-11-08 Публикация US20120283840A1
2014-12-02 Заявка удовлетворена
2014-12-02 Публикация US8900320B2
Статус: Активный
2031-06-08 Измененный срок действия
Methods and apparatus for FAI surgeries
Phillip Frederick, Kevin
Belew, Lauren Jasper, James Gatewood, Luke Gibson, John Masonis, Michael Cooper,
David C. Kelman
Abstract
A partial rim implant for an
acetabulum in a pelvic bone comprises a ridge, a bearing surface, and a
fixation surface. The ridge is oriented to replace a labrum. The bearing
surface is configured to align with the articulating surface of the acetabulum.
The bearing surface extends from the ridge toward the apex of the acetabulum.
The fixation surface is configured to fix the implant to a prepared bone
surface of the pelvic bone.
Description
CROSS-REFERENCE
TO RELATED APPLICATIONS
This application is
the U.S. national phase of International Application No. PCT/US2010/025292,
filed Feb. 25, 2010 and published in English on Sep. 2, 2010 as International
Publication No. WO 2010/099247 A2, which application claims the benefit of U.S.
Provisional Application No. 61/155,060, filed Feb. 24, 2009, the contents of
both of which are incorporated herein by reference.
BACKGROUND
1. Field
This invention
relates generally to hip surgeries and, more particularly, relates to surgical
methods, tools and implants for treating femoral acetabular impingement.
2. Related Art
Femoroacetabular
impingement or FAI is a condition of the hip joint where the femoral head and
acetabulum rub abnormally creating damage to the hip joint. The damage can
occur to the articular cartilage of the head or acetabulum or to the labral
cartilage on and around the acetabular rim.
Specifically, FAI
may take one of two forms: cam or pincer. The difference between the two forms
is determined by the abnormality of the hip joint that is the cause of the
damage. The cam form of FAI occurs when the femoral head and neck relationship
is aspherical, or not perfectly round. This loss of roundness contributes to
abnormal contact between the head and socket. The pincer form occurs when the the
acetabulum has too much coverage of the femoral head. This over-coverage
typically exists along the front-top rim of the acetabulum and results in the
labral cartilage being “pinched” between the rim of the socket and the anterior
femoral head-neck junction. In most cases, the cam and pincer forms exist
together (thus creating a compound form of FAI).
Treatment of FAI
may be accomplished by surgical intervention. Arthroscopically, the hip may be
scoped to assess the hip joint and treat damage that is found through two to
four 1 cm incisions. Often, all of the components of FAI such as the labral
tear, damaged cartilage, and friction between the ball and socket can be
treated through the arthroscope. Repair may include debridement, microfracture
techniques, labral repair, and bony decompression. Care must be taken to avoid
damage to the hip's blood supply during the osteoplasty procedure.
An open surgical
technique requires hip dislocation through an incision (approximately 6 to 10
inches). An upper thigh bone osteotomy allows for dislocation of the femoral
head from the socket exposing all parts of the joint. This exposure allows
treatment of labral tears and abnormal contact between the ball and socket
while protecting the blood supply to the hip. In both of these types of
treatment, bone removal and repair are employed to address FAI.
SUMMARY OF
THE INVENTION
It is in view of
the above that the present invention was developed. In one embodiment of the
invention, a partial rim implant for an acetabulum in a pelvic bone comprises a
ridge, a bearing surface, and a fixation surface. The ridge is oriented to
replace a labrum. The bearing surface is configured to align with the
articulating surface of the acetabulum. The bearing surface extends from the
ridge toward the apex of the acetabulum. The fixation surface is configured to
fix the implant to a prepared bone surface of the pelvic bone.
In another aspect
of the invention, the fixation surface is generally perpendicular to the
articulating surface of the acetabulum.
In yet another
aspect of the invention, the apex of the acetabulum has a central axis
extending toward a plane defined by the rim of the acetabulum, further
comprising a rim portion extending from the fixation portion to the ridge, the
rim portion orienting the ridge.
Another embodiment
provides an implant made of a first compliant material and a second stiffer
material.
In another
embodiment, the ridge of the implant is made of the first compliant material.
In yet another
embodiment, the fixation surface is made of the first compliant material.
Another embodiment
comprises an insertion portion extending generally perpendicularly from the
bearing surface and a fixation flange extending from a rim portion of the
implant. The insertion portion and the flange portion converge toward one
another as the flange and insertion portion extend away from the acetabulum.
In another
embodiment, the apex of the acetabulum has a central axis extending toward a
plane defined by the rim of the acetabulum, the implant further comprising a
transition portion located between the bearing portion and the rim portion, the
transition portion extends the rim portion toward the central axis of the
acetabulum.
In yet another
embodiment, the implant is rolled onto the rim of the acetabulum.
Another embodiment
provides a fixation surface which is a post extending into the pelvic bone.
In another
embodiment, the implant is fixed to the bone with sutures.
Another aspect of
the invention provides a spacer for spacing a femur from an acetabulum. The
spacer comprises a spoon and a plenum. The spoon portion is configured to wrap
around the head of the femur. The plenum is attached to the spoon and
configured to inflate the spoon. The spoon, when inflated, separates the
acetabulum from the femur.
In another
embodiment, the spoon further comprises a cutout portion configured to extend
around the ligamentum teres.
In yet another
embodiment, the spacer further comprises a stiff portion extending through the
spoon, such that the spoon may be pushed into the hip joint.
Another embodiment
provides for the stiff portion to extend around the periphery of the spoon.
Another aspect of
the invention provides a cutting guide for cutting a portion of a rim of an
acetabulum. The guide comprises a generally planar rectangular member and an
axis. The generally rectangular planar member has an opening in the central
portion. Edges of the opening form a cutting surface. The opening has a width
and a height. The axis extends across the planar member. The axis forms a fold
line upon which the planar member may be folded such that when the planar
member is folded over an acetabular rim, the edges of the opening extend over
the rim and are configured to direct a cutting member to remove bone to a depth
defined by the height of the opening.
In another
embodiment, the width of the opening is set to the width of the implant.
In yet another embodiment,
the fold line is curved.
Another embodiment
provides the curved fold line is curved relative to the radius of the
acetabulum.
Further features,
aspects, and advantages of the present invention, as well as the structure and
operation of various embodiments of the present invention, are described in
detail below with reference to the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
The accompanying drawings, which are incorporated in and form a part of
the specification, illustrate embodiments of the present invention and together
with the description, serve to explain the principles of the invention. In the
drawings:
FIG. 1 is a view of an embodiment of an acetabular implant for treating
FAI;
FIG. 2 is another view of the embodiment of FIG. 1;
FIG. 3 is another view of the embodiment of FIG. 1;
FIGS. 4A through 4F are views of embodiments of an acetabular implant
similar to the embodiment of FIG. 1;
FIGS. 5A and 5B are views of the implant of FIG. 1 on an acetabulum;
FIG. 6 is a cut away view of the implant and acetabulum of FIG. 5;
FIG. 7A is a view of another embodiment of an acetabular implant for
treating FAI;
FIGS. 7B and 7C are views of the embodiment of FIG. 7A attached to an
acetabulum;
FIGS. 8A and 8B are views of another embodiment of an acetabular implant
for treating FAI implanted on an acetabulum;
FIG. 9A is a view of another embodiment of an acetabular implant for
treating FAI implanted on an acetabulum;
FIG. 9B is an exploded view of the acetabulum and implant of FIG. 9A;
FIG. 10A is a view of another embodiment of an acetabular implant for
treating FAI implanted on an acetabulum;
FIG. 10B is an exploded view of the acetabulum and implant of FIG. 10A;
FIG. 11 is a view of another embodiment of an acetabular implant for
treating FAI implanted on an acetabulum;
FIG. 12 is an exploded view of the acetabulum and implant of FIG. 11;
FIG. 13 is a view of a femur showing the affected area for cam type FAI;
FIGS. 14A through 14D are views of embodiments of femoral implants for
treating FAI on the femur;
FIG. 15 is a view of another embodiment of an acetabular implant for
treating FAI implanted on an acetabulum;
FIG. 16 is a cutaway view of the embodiment of FIG. 15;
FIG. 17 is a view of another embodiment of an acetabular implant for
treating FAI;
FIG. 18 is a view of the embodiment of FIG. 17 with sutures;
FIG. 19 is a view of the embodiment of FIG. 17 with sutures attached to
an acetabulum;
FIG. 20 is a view of another embodiment of an acetabular implant for
treating FAI;
FIG. 21 is a view of another embodiment of an acetabular implant for
treating FAI;
FIG. 22 is a view of another embodiment of an acetabular implant for
treating FAI implanted on an acetabulum;
FIG. 23 is a view of another embodiment of an acetabular implant for
treating FAI implanted on an acetabulum;
FIG. 24 is a view of another embodiment of an acetabular implant for
treating FAI implanted on an acetabulum;
FIG. 25 is a view of another embodiment of an acetabular implant for
treating FAI;
FIG. 26 is an exploded view of the implant of FIG. 25 bent into the
proper shape for implantation and fixation screws;
FIG. 27 is a cutaway view of the implant and screws of FIG. 26;
FIG. 28 is an exploded view of an embodiment of an acetabular implant
and fixation screws;
FIG. 29 is a view of an acetabulum with an implant;
FIG. 30A is a view of an embodiment of an implant that may be implanted
as shown in FIG. 29;
FIG. 30B is another view of an embodiment of an implant that may be
implanted as shown in FIG. 29;
FIG. 30C is another view of an embodiment of an implant that may be
implanted as shown in FIG. 29;
FIG. 31 is a view of a guide marker for an acetabular implant;
FIG. 32 is another view of the guide marker of FIG. 31;
FIG. 33 is a view of the guide marker of FIG. 31 placed on the surface
of an acetabulum;
FIG. 34 is a view of a bone cutting guide;
FIG. 35 is a view of a cutter and the bone cutting guide of FIG. 34
folded into a proper orientation to be received on an acetabulum;
FIG. 36 is a view of a measuring instrument oriented in the acetabulum;
FIG. 37 is another view of the measuring instrument of FIG. 36 oriented
in the acetabulum;
FIG. 38 is a view of another embodiment of a measuring instrument;
FIG. 39 is a view of a spacer instrument for separating the femur from
the acetabulum;
FIG. 40 is a partial view of the spacer instrument of FIG. 39 inserted
into the hip joint around the ligamentum teres;
FIG. 41 is a view of an acetabulum showing pathways from the iliac crest
to labral or acetabular defects;
FIG. 42 is another view of the acetabulum of FIG. 41 showing pathways
from the iliac crest to labral or acetabular defects;
FIGS. 43A to 43F are views of different embodiments of acetabular
implants to insert into the pathways shown in FIG. 41 and FIG. 42; and
FIG. 44 is a view of a plurality of bone mating surfaces of acetabular
implants having various radii.
DETAILED
DESCRIPTION OF THE EMBODIMENTS
Referring to the accompanying
drawings in which like reference numbers indicate like elements, FIG.
1 is a view of an embodiment of an acetabular implant 10 for
treating FAI. The implant 10 has an insertion portion 12,
a flange portion 14, a ridge 15, a rim portion 16,
a rim curvature 17, a bearing surface 18 and a
rim-bearing transition 19. For additional views of this
embodiment, FIG. 2 is another view of the embodiment of FIG.
1 and FIG. 3 is yet another view of the embodiment of FIG.
1. In FIG. 3, mounting holes 11 are positioned on
the flange portion 14. The insertion portion 12 may be
configured to insert into the acetabulum generally perpendicular to the bearing
surface of the acetabulum. The bearing surface 19, then, would lie
generally flush with the bearing surface of the acetabulum. The
rim-bearing transition 19 may generally be a curved portion of
the bearing surface 19 that transitions the
bearing surface 19 into the rim portion 16.
The rim portion 16 extends inward toward a central axis of the
acetabulum from the bearing surface 19. This rim portion 16 may
then be used to help capture the head of the femur (which was the function of
the surface that was removed, albeit the removed surface was damaged
necessitating its removal. Thus, the implant may restore the function of the
damaged surfaces that were removed without causing the negative pathological
response that was generated from the damaged tissue, bone or cartilage.
The rim portion 16 has
a ridge that transitions the rim portion 16 from the bearing surface
side of the implant 10 to a fixation side (through the flange
portion 14). The flange portion 14 may be fixed to the
acetabulum by screws or pins through screw holes 11 (as shown in this
embodiment) or by other means as discussed with respect to other embodiments.
The rim curvature 17 of the implant 10 is sized
to fit the acetabulum. Thus, varying diameters of different acetabulums may
require various rim curvatures 17 of the implant. Additionally,
depending on the size of the damaged region, the thickness of
the implant 10, the width of the implant 10 and the
depth of the rim portion 16 may be changed to fit the specific
anatomy of the patient.
The embodiments generally
share some common features, namely, a bearing portion, a rim portion for
replacing the labrum, and a fixation portion. It is contemplated within the
scope of this disclosure that different variations as described herein may
achieve a desired implant embodiment by providing these features as described
and then combined.
FIGS. 4A through 4F are
views of embodiments of acetabular implant 10 similar to the
embodiment of FIG. 1. These embodiments allow for different materials to
be used for different regions of the implant 10. A first stiffer
material portion 20 (e.g. metal, porous material, or PEEK) may be
used for portions of the bearing surface while a more flexible, compliant
material portion 22 (e.g., polyurethane) may be used for the flanges
and bone interfacing surfaces. Such embodiments may give the structure
necessary to perform the functions of the implant 10 while
allowing for a more conforming contact surface between the implant and the
acetabulum. The amount of one type of material vrealtive to the other may be
determined by the dynamics of the particular joint. For example, in FIG.
4B, the majority of the implant is made from the stiffer material 20.
In such an embodiment, the dynamics may produce larger loads across the implant
than an implant such as the one shown in FIG. 4E, where only the rim portion
is made of the stiffer material 20. A continuum between exerted
loads, implant stiffness, and conformity may all contribute to the material
composition of the implant 10 such that an implant may be made
from a stiffer material 20 (shown in FIG. 4A) or entirely from
the more compliant material (as shown in FIG. 4F).
FIGS. 5A and 5B are
views of the implant 10 of FIG. 1 on
an acetabular rim 1004 in the acetabulum 1002 of
a pelvic bone 1000. As previously described, the implant 10 extends
over the rim of the acetabulum 1004. The rim portion 16 of
the implant 10 is positioned to generally extend toward a
central axis of the acetabulum (or at least to not continue to extend the
spherical features of the acetabulum more.) As shown in this embodiment, there
are no screw holes extending through the flange portion of
the implant 10. Fixation means, if necessary, may be accomplished
through a bone ingrowth surface on the implant 10, or by other
mechanical means.
FIG. 6 is a cut away
view of the implant and acetabulum of FIG. 5. The implant 10 is
fixed to the acetabulum by a mechanical interference fit.
The portions 12 and 14 converge toward one another in
the pelvic bone. Thus, once the implant is put on the bone, the implant will
not dislodge as the converging surfaces grip the bone in between
the insertion portion 12 and the flange 14. Such an
interference fit may be achieved by rolling the implant 10 from
inside the acetabulum 1002 over the rim. Such a method requires
the insertion portion 12 to first engage the bone, then rolling
the flange 14 over the top of the bone.
FIG. 7A is a view of
another embodiment of an acetabular implant for treating FAI.
This bi-material implant 30 also has stiffer portions 20 and
more flexible portions 22. The more flexible portions, however,
comprise the fixation portions of the implant 30, which in this
example is the insertion portion 32 and the flange
portion 34. The implant 30, then may be wrapped around the rim
of the acetabulum. As shown in FIGS. 7A and 7B, FIGS. 7B and
7C are views of the embodiment of FIG. 7A attached to
an acetabulum 1000. The insertion portion 32 may be
put into a prepared recess portion 1006 of the acetabulum.
The flexible portion 22 may then be wrapped around the rim and
fixed to the acetabulum (for example through a mounting hole 31) to
the acetabulum 1000. A more flexible bearing portion 38 and rim
portion 36 may then be positioned to adjust to the proper depth to
keep the bearing surface 38 of the implant 30 in
line with the natural bearing surface of the acetabulum and may also position
a ridge 35 of the rim portion 36 to be properly
oriented to provide the capture features that are replaced with
the implant 30.
FIGS. 8A and 8B are
views of another embodiment of an acetabular implant 40 for
treating FAI implanted on an acetabulum 1002. This embodiment may be
a hard bearing material (such as Oxinium) that may be press fit into the bone.
Such an embodiment may require very precise bone preparation and a specifically
sized match for the shape of the preparation accounting for the natural
characteristics of the acetabulum 1002. The
bearing surface 48 of the implant 40 may then be
a hard bearing just as the whole implant 40 is a hard material.
The bone for receiving such an implant may be prepared with an instrument
having the shape desired for the bone contacting surface of
the implant 40 so that the preparation may occur at one time,
instead of a more fitted procedure where different portions of bone may be
prepared based upon earlier preparation of other bone portions.
The implant 40 may be under constant compressive load so that
there is little risk of dislodging of the implant 40 from the
acetabulum.
FIG. 9A is a view of another
embodiment of an acetabular implant 50 for treating FAI
implanted on an acetabulum. FIG. 9B is an exploded view of the
acetabulum and implant 50 of FIG. 9A.
Mounting holes 51 may be positioned on flanges 54 a and 54 b to
mount the implant 50 to the bone. A ridge 55 on a rim
portion of the implant 50 provides the constraining feature of
the implant 50. A bearing surface 58 extends into the
acetabulum to mate with the natural bearing surface of the acetabulum. In the
cutaway view of FIG. 9B, bone preparation surfaces 1010, 1012 a and 1012 b are
prepared to receive the implant 50.
FIG. 10A is a view of
another embodiment of an acetabular implant 60 for treating FAI
implanted on an acetabulum. FIG. 10B is an exploded view of the
acetabulum and implant 60 of FIG. 10A.
Mounting holes 61 may be positioned on flange 64 to
mount the implant 60 to the bone. A ridge 65 on a
rim portion of the implant 60 provides the constraining feature
of the implant 60. A bearing surface 68 extends into
the acetabulum to mate with the natural bearing surface of the acetabulum. In
the cutaway view of FIG. 9B, bone preparation surfaces 1010, 1012 c are
prepared to receive the implant 60.
FIG. 11 is a view of
another embodiment of an acetabular implant 70 for treating FAI
implanted on an acetabulum. FIG. 12 is an exploded view of the
acetabulum and implant 70 of FIG. 11. Mounting holes 71 may
be positioned on the implant 70 to mount the implant 70 to
the bone. A ridge 75 on a rim portion of the implant 70 provides
the labrum replacement feature of the implant 70. A
bearing surface 78 extends into the acetabulum to mate with the
natural bearing surface of the acetabulum. In the cutaway view of FIG. 9B,
bone preparation surfaces 1010 are prepared to receive
the implant 70.
In the embodiments
of FIG. 9A through FIG. 12, the bone preparation matches the
implant surfaces without a compliant material in use. Thus the bone preparation
would likely be from guided stamps or cutting surfaces, and not from free hand
cutting using burrs or the like. As the prepared surfaces direct the position
of the entire implant, the prepared surfaces must take into account not only
the underlying bone but also the rim characteristics and bearing surface
characteristics of the implant.
FIG. 13 is a view of a femur 2000 showing an
affected area РИС. for cam type
FAI. An a spherical femoral head 2002 may create the affected
area РИС.. It may be necessary to treat the affected area first
with debridement and then with an implant designed to limit osseus overgrowth
(as would occur from continued stress from contact with the acetabulum.
FIGS. 14A through 14D are views of embodiments of femoral
implants 80 a, 80 b, 80 c, and 80 d for
treating FAI on the femur. Mounting holes 81 a, 81 b, 81 c,
and 81 d may be used to mount the implant onto the femur.
Alternatively, the implant shape may be molded intraoperatively or from
radiographic scans of the femur prior to surgery. The implants may be made of a
rigid or flexible material and mounted with any of the mounting means discussed
herein.
FIG. 15 is a view of
another embodiment of an acetabular implant 90 for treating FAI
implanted on an acetabulum. FIG. 16 is a cutaway view of the
embodiment of FIG. 15. The implant 90 is made from a
flexible material that may bend at a transition 97 so that
a screw 300 having a head 302 greater in diameter
than a hole 91 through a flange portion 94 of
the implant 90 may fix the implant to the bone.
A ridge 95 of a rim portion 96 replaces the
labrum. A bearing surface 98 contacts the femoral head.
The transition 97 also transitions the bearing surface between
the acetabulum 1002 and the bearing surface 98 of
the implant 90.
The bone preparation may
include a single planar surface cutting a portion of the rim of the acetabulum
away. The screw 300, then, may compress the flange 94 against
a bone surface 1014 to fix the implant 90 to the
bone through fixation elements 306 on a shaft 304 of
the screw 300. The rim portion 96 of
the implant 90 may then be moved into position over
the screw head 302. The rim portion 96 may also be
fixed to the flange 94 with sutures or other fixation elements
so that the rim portion 96 is stiffened relative to
the flange 94.
FIG. 17 is a view of
another embodiment of an acetabular implant 100 for treating
FAI. This wedge type implant (similar to the implant of FIG. 15) may be
implanted after having made a single planar cut of the acetabular rim.
The implant 100 of FIG. 17, as well as FIGS. 18 and
19, may be fixed to the acetabulum with sutures or wire. FIG. 18 is a
view of the embodiment of FIG. 17 with sutures 310. FIG.
19 is a view of the embodiment of FIG.
17 with sutures 310 attached to an acetabulum 1002.
The sutures 310 may extend through suture guides 101 through
the implant 100 and into suture guides 1016 in
the bone. A bone mating surface 104, a rim portion 106,
terminating in a ridge 105 extends along a
bearing surface 108. Thus there is labrum replacement in a rim
portion, a bearing surface transitioning to the natural cartilage in the
acetabulum, and fixation means in the implant 100.
FIGS. 20 and 21 are
views of other embodiments of an acetabular implant for treating FAI. Similar
to previous embodiments, this embodiment is a wedge type design with a
bi-material structure. A more rigid portion 20 and a
more flexible portion 22. As previously described, such features may
give the implant some compliance when implanted. As shown in FIG.
22, FIG. 22 is a view of another embodiment of an acetabular implant
for treating FAI implanted on an acetabulum where the compliant
material 22 is a bone interface surface. FIGS. 23 and
24 similarly show bi-material combinations where the more compliant and
more rigid portions of the implant comprise different portions of the implants.
FIG. 25 is a view of
another embodiment of an acetabular implant 160 for treating
FAI. The implant includes more rigid material 20 and
more flexible material 22. Mounting means 161 may fix the
implant to the bone. A notch 166 may allow the implant to be
bent. A relief 163 may be positioned opposite
the notch 166 to relieve stress in the implant when it is bent.
Opposing surfaces 168 and 169 may contact each other
when the implant is bent. In an alternative embodiment, a chanmfer 167 may
transition the bearing surface of the implant to the bone.
FIG. 26 is an exploded
view of the implant of FIG. 25 bent into the proper shape for
implantation and fixation screws. FIG. 27 is a cutaway view of the
implant and screws of FIG. 26. The implant may form bone interfacing
surfaces 1024 and 1026 to contact the bone. Screws 300 may
then pass through the mounting means 161 to fix the impant 160 to
the acetabulum 1002. A ridge 165 is formed when the
implant is bent onto the acetabulum 1002.
FIG. 28 is an exploded
view of an embodiment of an acetabular implant 170 and fixation
screws 300. The implant may be made of a bi-material of more rigid
material 20 and more flexible material 22.
The screws 300 may be countersunk 171 b with
mounting holes 171 a. A ridge 175 may replace the
labrum when the implant is fixed to bone.
FIG. 29 is a view of
an acetabulum 1002 with an implant 180.
The implant 180 may include a chamfer 187 between
the bearing surface of the implant 180 and the articulating
surface of the acetabulum. The implant may have a bone interfacing surface that
runs more generally parallel to the articulating surface of the acetabulum. Two
cuts that are generally perpendicular to each other form a generally
rectangular recess in the bone. The load on the bone surface may be preferable
in some instances with an implant design like this (as opposed to a wedge
embodiment or a layover embodiment.) The general portions are still intact in
such a design, namely, a bone contacting surface, a bearing surface and a constraining
portion that replaces the labrurn.
FIGS. 30A through
30C are views of embodiments of implants 180, 190,
and 200 that may be implanted as shown in FIG. 29. In the
implants a chamfer 187, 197 and 207 relieves the
implant near the acetabular articulating surface and a gap 1030 a, 1030 b,
and 1030 c is formed between the implant and the acetabulum. A
bearing surface 188, 198 and 208 aligns with the
acetabular articulating surface. A rim portion 186, 196,
and 206 extends into the acetabular cavity and terminates in
a ridge 185, 195 and 205 that replaces the
labrum.
FIG. 31 is a view of
a guide marker 400 for an acetabular implant.
A handle 402 extends along a shaft 404 to
a guide 406. Depth indicia 412 on the guide 406 may
set the depth of the implant while radii (r1, r2, r3, and r4) by markings 408 a-d (shown
in FIG. 32). Widths (w1, w2) may be determined through markings 410.
Based upon the necessary bone removal, the markings may determine the size of
the implant, the depth to which the bone must be removed in order for the
implant to fit properly, and the correct radius of the implant.
FIG. 33 is a view of the
guide marker of FIG. 31 placed on the surface of an acetabulum. The
guide uses the radius markings to make sure the proper radius of the acetabulum
is determined. By aligning an edge of the guide on one end of the damaged site,
the width markings may be used to measure the width of the implant. The depth
may be determined from the markings 112 which may show the depth of
removal necessary for the implant to sit flush with the articulating surface of
the acetabulum.
FIG. 34 is a view of
a bone cutting guide 500. An opening 502 in
the guide 500 creates guide surfaces 504 for the depth
of cutting. The guide 500 may be bent so that a lower
portion 508 and an upper portion 506 overlie the rim
of the acetabulum. As shown in FIG. 35, FIG. 35 is a view of
a cutter 522 on a surgical tool 520 and the bone
cutting guide of FIG. 34 folded into a proper orientation to be received
on an acetabulum.
FIG. 36 is a view of a
measuring instrument 600 oriented in the acetabulum 1002.
The instrument 600 includes a shaft 604 attached
to a hemispherical head 606. Depth marks 608 are located on
the shaft 604. A stylus 610 slides along
the shaft 604 in a shaft guide 612.
The head 606 may be positioned within the acetabulum to orient
the version and adduction of the shaft. The stylus may then measure the depth
to the lesion 1004 by using the markings 608. Radius
markings on the stylus may measure the radius of the acetabular rim. FIG.
37 is another view of the measuring instrument of FIG.
36 oriented in the acetabulum.
FIG. 38 is a view of
another embodiment of a measuring instrument 600.
The stylus 610′ may be reversible. Additionally a lesion depth
paddle 611 may be placed on the end of the stylus.
The stylus 610′ may measure the depth from the shaft, and
the paddle 611 may measure the depth of the lesion.
FIG. 39 is a view of
a spacer instrument 700 for separating the femur from the acetabulum.
The spacer instrument 700 includes a plenum 702 attached
to a forked inflatable spoon 703 through a tube 704.
The spoon 703 includes a first finger 705 and
a second finger 707 separated by a cutout portion 706.
A stiffening member 709 may stiffen the spoon 703 for
insertion. A control module 710 includes a one way
valve 712, a pressure release knob 714 and a
pop-off valve 716. The plenum 702 may inflate
the spoon 703 to inflate the finger portions 705 and 707.
The finger portions 705 and 707 (as shown in FIG.
40) may avoid the ligamentum teres. When inflated, the spoon may separate the
femur from the acetabulum without tearing the ligamentum teres. Stiffening
means 709 may be placed along the edge of the spoon 703 so
that the spoon may be pushed into the hip joint.
FIG. 41 is a view of
an acetabulum showing pathways 1060 from the iliac crest
to labral or acetabular
defects. FIG. 42 is another view of the acetabulum of FIG.
41 showing pathways from the iliac crest to labral or acetabular defects.
The pathways 1060 allow for distal to proximal orientation of an
implant or a proximal to distal orientation of an implant. By using these
different pathways through the iliac crest, the implant orientation at the
labrum may be controlled. The implants inserted through these pathways are
shown in FIGS. 43A to 43F.
FIGS. 43A to 43F are
views of different embodiments of acetabular implants to insert into the
pathways shown in FIG. 41 and FIG. 42. Each implant 210, 220, 230, 240, 250,
and 260 have a post that extends along the pathway. Each implant has
a ridge (like 215 in 43A), a bearing portion (e.g., 228 in FIG.
43B), and a rim portion (like 236 in FIG. 43C). The posts may be
made of a compliant material 22, press fit into an implant, or
threaded. Threaded designs may have rotational members 242 or 252 depending
on proximal or distal direction of the implantation. The posts provide fixation
for the implant in the bone 1000.
FIG. 44 is a view of a
plurality of bone mating surfaces 278 a, 278 b, and 278 c of
acetabular implants having various radii R1, R2, R3. With the varying radii and
the varying directions, as well as the ability to control the depth of the
implants in the bone, the proper orientation may be accomplished with good
fixation, proper bearing placement and proper labrum replacement.
In view of the foregoing, it
will be seen that the several advantages of the invention are achieved and
attained.
The embodiments were chosen
and described in order to best explain the principles of the invention and its
practical application to thereby enable others skilled in the art to best
utilize the invention in various embodiments and with various modifications as
are suited to the particular use contemplated.
As various modifications
could be made in the constructions and methods herein described and illustrated
without departing from the scope of the invention, it is intended that all
matter contained in the foregoing description or shown in the accompanying
drawings shall be interpreted as illustrative rather than limiting. Thus, the
breadth and scope of the present invention should not be limited by any of the
above-described exemplary embodiments, but should be defined only in accordance
with the following claims appended hereto and their equivalents.
Claims:
What is claimed is:
1. A partial rim implant for an acetabulum in a pelvic bone, wherein the
acetabulum comprises an articulating surface, a rim, and an apex, the implant
comprising:
a. a ridge oriented to replace a labrum;
b. a bearing surface configured to align with the articulating surface
of the acetabulum, wherein the bearing surface extends from the ridge toward
the apex of the acetabulum;
c. an insertion portion extending at an angle away from the bearing
surface, wherein the insertion portion is adapted to engage a bone recess in
the pelvic bone; and
d. at least one flange portion extending from the ridge and away from
the bearing surface; and
wherein the bearing surface extends between the ridge and the insertion
portion; and wherein the insertion portion and the at least one flange portion
are angled toward one another as the insertion portion and the at least one
flange portion extend away from the bearing surface.
2. The implant of claim 1, wherein the implant is fixed to the
acetabulum with sutures.
3. The implant of claim 1, wherein the insertion portion and the
flange portion each extend away from the bearing surface in the same general
direction and define a space therebetween sized and configured for receipt of a
portion of the pelvic bone therein.
4. The implant of claim 3, wherein the at least one flange portion
comprises at least one screw hole.
5. The implant of claim 3, wherein the at least one flange portion
comprises at least two fixation flanges.
6. The implant of claim 1, further comprising a substantially
planar fixation surface adapted to adjoin a substantially planar prepared
surface of the acetabulum.
7. The implant of claim 6, wherein the flange portion the
substantially planar fixation surface and a screw hole.
8. The implant of claim 7, further comprising a rim portion
defining the ridge and the bearing surface.
9. The implant of claim 1, wherein the bearing surface is curved
between the ridge and the insertion portion.
10. The implant of claim 9, wherein the bearing surface comprises a
concave curvature extending between the ridge and the insertion portion.
11. The implant of claim 1, wherein the at least one flange portion
comprises at least one fastener opening.
12. The implant of claim 1, wherein the implant comprises a first
material and a different second material each having a rigidity, wherein the
rigidity of the first material is greater than the rigidity of the second
material.
13. The implant of claim 12, wherein at least a portion of the
bearing surface comprises the first material and at least one of the insertion
portion and the flange portion comprises the second material.
14. The implant of claim 13, wherein the insertion portion and the
flange portion each comprise the second material.
15. The implant of claim 12, wherein the first material comprises a
metallic material and the second material comprises a polymeric material.
16. The implant of claim 12, wherein the second material comprises
a polymeric material.
17. A partial rim implant for an acetabulum in a pelvic bone, wherein
the acetabulum comprises an articulating surface, a rim, and an apex, the
implant comprising:
a. a ridge oriented to replace a labrum; and
b. a bearing surface configured to align with the articulating surface
of the acetabulum, wherein the bearing surface extends from the ridge toward
the apex of the acetabulum;
c. an insertion portion extending at an angle away from the bearing
surface, wherein the insertion portion is adapted to engage a bone recess in
the pelvic bone; and
d. at least one flange portion extending from the ridge and away from
the bearing surface; and
wherein the at least one flange portion comprises at least one screw
hole; and
wherein the insertion portion and the at least one flange portion are
angled toward one another as the insertion portion and the at least one flange
portion extend away from the bearing surface.
18. The implant of claim 17, wherein the at least one flange
portion is adapted to lie substantially flush with a portion of the pelvic
bone.
19. The implant of claim 17, wherein the bearing surface comprises
a concave curvature extending between the ridge and the insertion portion.
20. The implant of claim 17, wherein the insertion portion and the
flange portion each extend away from the bearing surface in the same general
direction and define a space therebetween sized and configured for receipt of a
portion of the pelvic bone therein.
21. A partial rim implant for an acetabulum in a pelvic bone, wherein
the acetabulum comprises an articulating surface, a rim, and an apex, the
implant comprising:
a. a ridge oriented to replace a labrum;
b. a bearing surface configured to align with the articulating surface
of the acetabulum, wherein the bearing surface extends from the ridge toward
the apex of the acetabulum;
c. an insertion portion extending at an angle away from the bearing
surface, wherein the insertion portion is adapted to engage a bone recess in
the pelvic bone; and
d. at least one flange portion extending from the ridge and away from
the bearing surface; and
wherein the insertion portion and the at least one flange portion
converge toward one another as the insertion portion and the at least one
flange portion extend away from the bearing surface.
22. The implant of claim 21, wherein the implant is rolled onto the
rim of the acetabulum.
23. The implant of claim 21, wherein the bearing surface comprises
a concave curvature extending between the ridge and the insertion portion.
24. The implant of claim 21, wherein the insertion portion and the
flange portion each extend away from the bearing surface in the same general
direction and define a space therebetween sized and configured for receipt of a
portion of the pelvic bone therein.
25. The implant of claim 21, wherein the implant comprises a first
material and a different second material each having a rigidity, wherein the
rigidity of the first material is greater than the rigidity of the second
material; and
wherein at least a portion of the bearing surface comprises the first
material and at least one of the insertion portion and the flange portion
comprises the second material.
26. The implant of claim 25, wherein the first material comprises a
metallic material and the second material comprises a polymeric material.
27. A partial rim implant for an acetabulum in a pelvic bone, wherein
the acetabulum comprises an articulating surface, a rim, and an apex, the
implant comprising:
a. a ridge oriented to replace a labrum;
b. a bearing surface configured to align with the articulating surface
of the acetabulum wherein the bearing surface extends from the ridge toward the
apex of the acetabulum;
c. an insertion portion extending at an angle away from the bearing
surface, wherein the insertion portion is adapted to engage a bone recess in
the pelvic bone; and
d. at least one flange portion extending from the ridge and away from
the bearing surface; and
wherein the implant comprises a first material and a second material
each having a rigidity, wherein the rigidity of the first material is greater
than the rigidity of the second material; and
wherein at least a portion of the bearing surface comprises the first
material and at least one of the insertion portion and the flange portion
comprises the second material.
28. The implant of claim 27, wherein the ridge of the implant
comprises the second material.
29. The implant of claim 27, wherein the ridge of the implant
comprises the first material.
30. The implant of claim 27, wherein the insertion portion and the
flange portion each comprise the second material.
31. The implant of claim 27, wherein the second material comprises
a polymeric material.
32. The implant of claim 27, wherein the first material comprises a
metallic material and the second material comprises a polymeric material.
33. The implant of claim 27, wherein the insertion portion and the
at least one flange portion are angled toward one another as the insertion
portion and the at least one flange portion extend away from the bearing
surface.
External links
Frederick P, Belew K, Jasper L, Gatewood J, Gibson L, Masonis J, Cooper M, Kelman DC. Methods and apparatus for FAI surgeries. US20120283840A1 February, 25 2010. 2012. patents.google
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2012FrederickP_KelmanDC
Authors & Affiliations
Phillip
Frederick, Memphis, TN (US)
Kevin Belew,
Hernando, MS (US)
Lauren Jasper,
Memphis, TN (US)
James Gatewood,
Memphis, TN (US)
Luke Gibson,
Southhaven, MS (US)
John Masonis,
Charlotte, NC (US)
Michael Cooper,
Nesbit, MS (US)
David C. Kelman,
Collierville, TN (US)
Keywords
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, endoprosthesis, prosthesis, invention, spacer
NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7
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