Invention (Patent): Birmingham P. Method and device for joint replacement. US20160262897A1 (2016).
US20160262897A1 US
Inventor: Patrick Birmingham
Current Assignee: Zimmer Inc
Application US15/064,758 events:
2016-03-09 Application filed by Individual
2016-03-09 Priority to US15/064,758
2016-09-15 Publication of US20160262897A1
2018-09-04 Application granted
2018-09-04 Publication of US10064730B2
Status: Active
2036-03-21 Adjusted expiration
Method and device for joint
replacement
Patrick Birmingham
Abstract
A joint replacement device is
provided that includes an inner surface configured to accommodate at least one
of a portion of an outer surface of a femoral head of a femur and a prosthetic
secured to the femoral head, an outer surface configured to accommodate at
least one of a portion of an outer surface of an acetabulum socket and a
prosthetic secured to a pelvis, wherein the inner surface and outer surface
each have a circular curvilinear shape and together include an inner perimeter
and an outer perimeter, and wherein the inner perimeter is joined to the outer
perimeter to form a posterior limb and an anterior limb, and further including,
a posterior portion, an anterior portion, and a superior portion formed from
the inner surface and the outer surface; wherein the superior portion further
includes a posterior superior portion and an anterior superior portion.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
This application claims priority from U.S. Provisional
Patent Application Ser. No. 62/133,046 filed on Mar. 13, 2015, of which is
incorporated herein by reference in its entirety.
RELATED FIELD
The method and device for joint replacement relates to joint
repair and replacement.
BACKGROUND
Joints provide articulation of various body parts. These
joints can be damaged in numerous ways, such as exposure to trauma or
degeneration due to old age or disease. Joints, such as hip joints, typically
include a bone with a ball end and a bone with a socket opening. When damaged,
the interaction between the ball and socket can become problematic, preventing
proper articulation of a joint and/or pain in the joint. Such restriction
and/or discomfort are often due to a breakdown of the surfaces of one or both
of the ball and socket. In the case of a hip joint, the femur and pelvis are
involved. The femur includes the femoral head with a layer of articular
cartilage and the pelvic bone includes the acetabulum socket, also with a layer
of articular cartilage. Once the layer of articular cartilage is worn or
damaged to an advanced degree, the joint no longer functions as intended and
can require surgical intervention.
Currently, to address worn or damaged hip joints, an
invasive surgical procedure is performed to install a full or half prosthetic
joint. The installation of the prosthetic joint involves substantial
restructuring of the original joint, which requires the surgeon to inflict
substantial damage to the joint area to access and install the prosthetic joint,
thereby increasing the likelihood of permanent damage to surrounding nerves,
ligaments, etc. In addition, this invasive procedure can result in chronic
pain, poor articulation of the joint, failure of the prosthesis, etc., which
can substantially decrease the likelihood of a post-operative normally
functioning prosthetic joint. Often hip arthritis can cause significant
discomfort, but the trauma to a patient's hip and the lingering post-operative
issues can be unacceptable to a patient. In particular, if the patient is young
and/or very active.
Accordingly, it would be desirable to provide a minimally
invasive procedure that limits the damage to the joint area during installation
and provide a more reliable prosthetic repair/replacement.
BRIEF SUMMARY
In at least some embodiments, the method of joint
replacement relates to forming one or more arthroscopy portals adjacent a hip
joint that includes a femur and a pelvis; inserting a guide wire through a
portion of the femur to extend out of a femoral head of the femur; securing a
reamer blade to the guide wire; reaming a femoral head outer surface at the end
of the femoral head to at least one of access cancellous bone and remove
damaged cartilage; reaming an acetabulum outer surface of the acetabulum socket
of the pelvis to at least one of access cancellous bone and remove damaged
cartilage; unsecuring the reamer blade from the guide wire; and inserting a
hemiarthroplasty cup between the femoral head outer surface and the acetabulum
outer surface.
In at least some embodiments, the method of joint
replacement relates to forming one or more arthroscopy portals adjacent a hip
joint that includes a femur and a pelvis; inserting a guide wire through a
portion of the femur to extend out of a femoral head of the femur; securing a
reamer blade to the guide wire; reaming a femoral head outer surface at the end
of the femoral head to at least one of access cancellous bone and remove
damaged cartilage; reaming an acetabulum outer surface of the acetabulum socket
of the pelvis to at least one of access cancellous bone and remove damaged
cartilage; unsecuring the reamer blade from the guide wire; rotating a
cannulated drill around the guide wire and through the femur; inserting a
cannulated fastener in place of the cannulated drill; inserting a cup femoral
head prosthesis adjacent to the femoral head outer surface; securing the cup
femoral head prosthesis to the femoral head outer surface using the cannulated
fastener; and inserting a hemiarthroplasty cup between the femoral head outer
surface and the acetabulum outer surface.
In at least some embodiments, the method of joint
replacement relates to forming one or more arthroscopy portals adjacent a hip
joint that includes a femur and a pelvis; inserting a guide wire through a
portion of the femur to extend out of a femoral head of the femur; securing a
reamer blade to the guide wire; reaming a femoral head outer surface at the end
of the femoral head to at least one of access cancellous bone and remove
damaged cartilage; reaming an acetabulum outer surface of the acetabulum socket
of the pelvis to at least one of access cancellous bone and remove damaged
cartilage; unsecuring the reamer blade from the guide wire; rotating a
cannulated drill around the guide wire and through the femur; inserting a
cannulated fastener in place of the cannulated drill; inserting a cup femoral
head prosthesis adjacent to the femoral head outer surface; and securing the
cup femoral head prosthesis to the femoral head outer surface using the cannulated
fastener.
In at least some embodiments, a device for joint replacement
relates to a prosthesis including a hemiarthroplasty cup including an inner
surface and an outer surface, wherein the inner surface is shaped and sized to
accommodate a reamed or unreamed femoral head outer surface, and wherein the
outer surface is shaped and sized to accommodate a reamed or unreamed
acetabulum outer surface of an acetabulum socket.
In at least some embodiments, a device for joint replacement
relates to a prosthesis including an at least partially hemispherical-shaped
cup including an inner surface and an outer surface, wherein the inner surface
is shaped and sized to accommodate a reamed femoral head outer surface of a
femur, and wherein the outer surface is shaped and sized to accommodate at
least one of a reamed or unreamed acetabulum outer surface of an acetabulum
socket and an inner surface of a hemiarthroplasty cup; a fastener securable to
the femur for engagement with a portion of the hemispherical-shaped cup to provide
securement of the hemispherical-shaped cup to the femoral head outer surface.
In at least some embodiments, a device for joint replacement
relates to a prosthesis including a hemiarthroplasty cup including an inner
surface shaped and sized to accommodate a reamed or unreamed femoral head outer
surface, and an outer surface shaped and sized to accommodate a reamed or
unreamed acetabulum outer surface of an acetabulum socket, wherein the
hemiarthroplasty cup is configured to maintain allowance of articulation of the
femoral head outer surface and the acetabulum socket relative to the
hemiarthroplasty cup after implantation.
In at least some embodiments, a device for joint replacement
relates to a prosthesis including an at least partially hemispherical-shaped
cup including an inner surface and an outer surface, wherein the inner surface
is shaped and sized to accommodate at least one of a reamed femoral head outer
surface of a femur and a cup femoral head prosthesis, and wherein the outer
surface is shaped and sized to accommodate a reamed acetabulum outer surface of
an acetabulum socket.
In at least some embodiments, a device for joint replacement
relates to a prosthesis including a cup-shaped portion including an inner
surface and an outer surface, wherein the inner surface is shaped and sized to
accommodate at least one of a reamed femoral head outer surface of a femur and
a cup femoral head prosthesis, and wherein the outer surface is shaped and
sized to accommodate a reamed or unreamed acetabulum outer surface of an
acetabulum socket.
In at least some other embodiments, a joint replacement
device is provided that includes an inner surface configured to accommodate at
least one of a portion of an outer surface of a femoral head of a femur and a
prosthetic secured to the femoral head; an outer surface configured to
accommodate at least one of a portion of an outer surface of an acetabulum
socket and a prosthetic secured to a pelvis, wherein the inner surface and
outer surface each have a circular curvilinear shape and together include an
inner perimeter and an outer perimeter, and wherein the inner perimeter is
joined to the outer perimeter to form a posterior limb and an anterior limb; an
interior perimeter diameter that extends between opposite sides of the inner
perimeter; and a posterior portion, an anterior portion, and a superior portion
formed from the inner surface and the outer surface; wherein the superior
portion further includes a posterior superior portion and an anterior superior
portion.
Other embodiments, aspects, features, objectives, and
advantages will be understood and appreciated upon a full reading of the
detailed description and the claims that follow.
BRIEF DESCRIPTION OF THE DRAWINGS
Embodiments of the method and device for joint replacement
are disclosed with reference to the accompanying drawings and are for
illustrative purposes only. The method and device for joint replacement is not
limited in its application to the details of construction or the arrangement of
the components illustrated in the drawings. The method and device for joint
replacement is capable of other embodiments or of being practiced or carried
out in other various ways. In the drawings:
FIG. 1 illustrates a front view of a portion of an
example of a human body with an example of a hip joint;
FIG. 2 illustrates an example of a front skeletal view
of the hip joint of FIG. 1;
FIG. 3 illustrates a view of FIG. 2 with the
femur distracted from the pelvis;
FIG. 4 illustrates another view of the femur and pelvis
of FIG. 3;
FIG. 5 illustrates an example of a drill guide;
FIG. 6 illustrates an example of a guide wire and an
example of a reamer;
FIG. 7 illustrates a top view of the reamer
of FIG. 6;
FIG. 8 illustrates the femur and pelvis of FIG.
3 and an example of a hemiarthroplasty cup prosthesis;
FIG. 9 illustrates a bottom view of the
hemiarthroplasty cup prosthesis;
FIG. 10 illustrates a cross-sectional side view of the
hemiarthroplasty cup prosthesis taken at line 10-10;
FIG. 11A illustrates the femur of FIG. 3 with
the guide wire positioned therein;
FIG. 11B illustrates the femur of FIG. 3 with
an example of a cannulated drill positioned therein;
FIG. 11C illustrates the femur of FIG. 3 with
an example of a cup femoral head prosthesis and an example of a cannulated
fastener positioned therein;
FIG. 11D illustrates the femur of FIG. 3 with
the cup femoral head prosthesis secured to the femur;
FIG. 11E illustrates the femur of FIG. 3 with
a view of the cup femoral head prosthesis and cannulated fastener both inside
and outside the hip joint;
FIG. 12 illustrates a view of the hip joint
of FIG. 2, post-installation of the cup femoral head prosthesis and the
hemiarthroplasty cup prosthesis;
FIG. 13 illustrates the femur and pelvis of FIG.
3 and an exemplary joint spacer;
FIG. 14 illustrates the femur and pelvis of FIG.
3 with an attached ligamentum teres ligament and an exemplary joint
spacer;
FIG. 15 illustrates a front view of the exemplary joint
spacer;
FIG. 16 illustrates a back view of the exemplary joint
spacer of FIG. 15;
FIG. 17 illustrates a front perspective view of the
exemplary joint spacer of FIG. 15;
FIG. 18 illustrates a rear perspective view of the
exemplary joint spacer of FIG. 15;
FIG. 19 illustrates a top view of the exemplary joint
spacer of FIG. 15;
FIG. 20 illustrates a front view of the another
exemplary joint spacer;
FIG. 21 illustrates a back view of the exemplary joint
spacer of FIG. 20;
FIG. 22 illustrates a front perspective view of the
exemplary joint spacer of FIG. 20;
FIG. 23 illustrates a rear perspective view of the
exemplary joint spacer of FIG. 20; and
FIG. 24 illustrates a top view of the exemplary joint
spacer of FIG. 20;
DETAILED DESCRIPTION
Referring to FIG. 1, a front view of a portion of an
example of a human body 102 is illustrated. The body 102 is
shown with a plurality of hip arthroscopy portals 105 identified.
These hip arthroscopy portals 105 are provided to allow access
past skin 103, muscle, ligaments, etc., to the hip joint 104 and
are established as needed during a hip repair/replacement procedure. The
arthroscopy portals illustrated include an anterolateral portal 106,
a midanterior portal 108, and a distal anterolateral portal 110,
although one or more of various other types of arthroscopy portals can be
provided in place of or in addition to these portals.
Referring to FIG. 2, a front skeletal view of
the hip joint 104 is provided. The hip joint 104 includes
at least portions of a pelvis 120 and a femur 122.
The femur 122 includes a femoral head 124 connected
to the femur 122 by a femoral neck 126.
The pelvis 120 includes an acetabulum socket 128,
which is a socket formed in the pelvis 120. In FIG. 2,
the femoral head 124 is shown in its natural seated position in
the acetabulum socket 128. FIG. 3 illustrates a view of
the hip joint 104 of FIG. 2 with the femur 122 distracted
from the pelvis 120. The distraction exposes an acetabulum outer
surface 130 and a femoral head outer surface 132. The
acetabulum outer surface 130 and femoral head outer
surface 132 are at least partially comprised of a layer of articular
cartilage 141 (FIG. 4).
As a result of trauma, disease, and/or degeneration,
the articular cartilage 141 can become damaged resulting in a
rough or irregular surface. In some cases, at least portions of
the articular cartilage 141 can be substantially worn away.
These conditions reduce or eliminate the normally smooth engagement of
the femoral head 124 and the acetabulum socket 128. In
order to provide the smooth surfaces desired for proper joint function, one or
both of the acetabulum outer surface 130 and femoral
head outer surface 132 are at least one of, resurfaced for
engaging with a prosthesis or at least partially covered with a prosthesis.
This can be achieved through at least the use of the procedures and prosthesis
as described below.
Referring now to FIG. 4, another view of the hip
joint 104 of FIG. 3 is illustrated. It is not evident by
the illustrations, but it is to be understood that one or both of
the acetabulum socket 128 and femoral head 124 can
be damaged or otherwise in need of repair or replacement. The procedure
described below can include the use of one or more of various tools as
described below. FIG. 5 illustrates a drill guide 140 utilized
for inserting a guide wire 142 (FIG. 4) into the femur 122.
The drill guide 140 includes an aiming arm 144 and
a drill sleeve 146, both interconnected by a handle 148. In
addition, referring to FIGS. 6 and 7, a reamer 150 is
provided for resurfacing an end 151 of the femoral
head outer surface 132 and/or acetabulum outer
surface 130. The reamer 150 is shown as sickle-shaped,
although it is contemplated that the shape and size of the reamer 150 can
be modified as needed to accommodate various bone and prosthesis shapes and
sizes. A fastening portion, such as a locking aperture 152 can
be provided at a base portion 154 of the reamer 150.
The locking aperture 152 is configured to be securable to
the guide wire 142. The securement can be accomplished by one or more
of various methods, such as providing reverse threads 155 in the
locking aperture 152 for rotational engagement with reverse
threads 155 on a guide wire end portion 158. In addition,
the reamer 150 includes an engagement portion 162 having
a top edge 164 and bottom edge 166. The top
edge 164 includes a radius of curvature 167 shaped to
conform to a desired shape for the acetabulum outer surface 130.
The bottom edge 166 includes a radius of curvature 167 shaped
to conform to a desired shape for the end 151 of the femoral
head outer surface 132. Further, the engagement portion 162 can
be tapered as it extends away from the base portion 154. In at least
some embodiments, the top edge 164 and bottom edge 166 each
comprise a bladed edge, although other shapes and configurations can be
utilized to provide the desired resurfacing effect.
In at least some embodiments, to begin a hip joint repair or
replacement procedure, a patient is positioned on a hip arthroscopy traction
table, in a supine, lateral, or other position as desired. The hip is
distracted, as illustrated in FIG. 4, to provide the necessary access to
the femur 122 and acetabulum socket 128. The hip
arthroscopy portals 105 are formed as necessary, as shown
in FIG. 1. Upon entry into the body 102, the hip ligamentous
capsule (not shown) is cut to provide the necessary access, for example from a
10 o'clock to 2 o'clock position. The drill guide 140 is then
placed through the distal anterolateral portal 110 or others as
desired, and the drill sleeve 146 is pushed to
the skin 103. After a small incision is made, the guide
wire 142 is advanced through the femur 122 by a drill
(not shown) to its aimed location (determined by the positioning of the
aiming arm 144 and drill sleeve 146), which is
the center 170 of the femoral head 124. After
installation of the guide wire 142, the drill guide 140 is
removed and the midanterior portal 108 is enlarged to provide
greater access, such as to a diameter of about 4 centimeters, or other
necessary size. The guide wire 142 is now positioned to receive
the reamer 150. The reamer 150 is inserted through
the midanterior portal 108 and positioned so the reverse
threads 155 of the guide wire 142 rotationally engage
the reverse threads 155 of the locking aperture 152 to
allow the reamer 150 to be locked to the guide wire 142.
The drill is secured to the guide wire 142 and
energized to rotate the guide wire 142. As the guide wire 142 rotates,
the secured reamer 150 also rotates. Placing a pulling tension
on the guide wire 142, such that the bottom edge 166 of
the rotating reamer 150 engages the end 151 of
the femoral head outer surface 132, serves to ream down
the end 151 of the femoral head outer surface 132 at
least partially to cancellous bone and/or to remove damaged cartilage, thereby
partially, substantially, or completely removing the articular cartilage layer
from the femoral head 124. The radius of curvature 167 along
the bottom edge 166 of the engagement portion 162 can
be chosen to form the end 151 of the femoral head outer
surface 132 to a desired shape, such as a symmetrical hemispherical
shape. Similarly, advancing (pushing tension) the guide wire 142 during
rotation, such that the top edge 164 of the rotating
reamer 150 engages the acetabulum outer surface 130, serves
to ream down the acetabulum outer surface 130 at least partially
to cancellous bone and/or to remove damaged cartilage, thereby partially,
substantially, or completely removing the articular cartilage layer from
the acetabulum socket 128. The radius of curvature 167 along
the top edge 164 of the engagement portion 162 can
be chosen to form the acetabulum outer surface 130 to a desired
shape, such as a symmetrical hemispherical shape. Upon completion of the
reaming process, the reamer 150 is then secured and
the guide wire 142 is reversed in direction to disarticulate
the guide wire 142 from the reamer 150.
The reamer 150 is then removed from the body 102.
Therefore, use of the reamer 150 as described, can serve to
prepare the femoral head 124 and the acetabulum
socket 128 for receiving or otherwise engaging each other or a
prosthesis.
After completing the above procedure, various options exist
for repairing or replacing the hip joint 104. Referring to FIG.
8, in at least one embodiment, where a hemiarthroplasty (half joint
replacement) is desired, the guide wire 142 can be removed and
a hemiarthroplasty cup 172 is inserted through
the midanterior portal 108. The hemiarthroplasty cup 172,
as seen in FIGS. 8, 9, and 10, is in at least some embodiments, a
dual-sided hemispherical cup having a cup outer surface 174 and
a cup inner surface 176. The hemiarthroplasty cup 172 can
in at least some embodiments, be hemispherical, partially hemispherical, or
substantially hemispherical, or otherwise sized to accommodate a reamed or unreamed
joint bone. In addition, the hemiarthroplasty cup 172 can
include alternate shapes, for example, an oblong/oval hemisphere. The
cup outer surface 174 is shaped and sized to pivotably engage
the acetabulum outer surface 130 and can be installed without
the use of an assisting fixation method, such as cement, fasteners, bone growth
agents, etc. Similarly, the cup inner surface 176 is shaped and
sized to pivotably engage and articulate with the femoral head outer
surface 132 (or another prosthesis installed thereon) and can be
installed without the use of an assisting fixation method, such as cement,
fasteners, bone growth agents, etc.
As the cup outer surface 174 can be installed
without fixation, the femoral head 124 and the acetabulum
socket 128 are allowed to articulate with the respective inner and
outer cup surfaces 176, 174 of the hemiarthroplasty
cup 172. The need for assistive fixation methods are substantially reduced
or eliminated due to, at least in part due to, the minimal violation of the hip
joint area during installation. For example, the above procedure does not
require cutting the entire ligamentous hip capsule (not shown) or significant
cutting of the musculature of the hip, in order to prepare the hip
joint 104 and install the hemiarthroplasty cup 172. The
limited violation can maintain sufficient structure to support and secure
the hemiarthroplasty cup 172 as needed. In at least some
embodiments, the hemiarthroplasty cup 172 can be secured using
assistive fixation methods, such as repair or reconstruction of the ligamentous
capsule, or repair or reconstruction of the acetabular labrum, or another
method as desired or necessary for one or more reasons.
As discussed above, various options exist for repairing or
replacing the hip joint 104 after preparation of the hip
joint 104. Referring now to FIGS. 11A-11E, in at least some
embodiments, a cup femoral head prosthesis 180 can be installed
on the femoral head 124. This procedure includes securing the
cup femoral head prosthesis 180 to the femoral head 124.
As seen in FIG. 11A, the guide wire 142 is positioned
through the femur 122. In at least some embodiments, to fasten the
cup femoral head prosthesis 180, a cannulated drill 181 is
rotated over the guide wire 142, as seen in FIG. 11B, until it
passes out of the femoral head outer surface 132 at
the center 170 of the femoral head 124. The guide
wire 142 is secured and the cup femoral head prosthesis 180 is
brought into the hip joint 104 through the midanterior
portal 108. The guide wire 142 is then articulated with the
cup femoral head prosthesis 180, while a cannulated fastener, such as
a cannulated screw 184 with an anchoring head 185, is
inserted into the femur 122 over the guide wire 142,
as seen in FIG. 11C. Further, as seen in FIG. 11C, the
cup femoral head prosthesis 180 is illustrated. The
cup femoral head prosthesis 180 can include numerous shapes, for
example a shape similar to the hemiarthroplasty cup 172, such as a
hemispherical, partially hemispherical, or substantially hemispherical cup
shape. The cup femoral head prosthesis 180 includes a femoral
cup outer surface 186 and a femoral cup inner surface 188.
The cup femoral head prosthesis 180 can be
utilized with or without the hemiarthroplasty cup 172. As such, if
a hemiarthroplasty cup 172 is not to be installed, the femoral
cup outer surface 186 is shaped and sized to pivotably engage
the acetabulum outer surface 130 (as seen in FIG. 8) after it
has been reamed. If the hemiarthroplasty cup 172 is to be
installed, the femoral cup outer surface 186 is shaped and sized
to pivotably engage the cup inner surface 176 of
the hemiarthroplasty cup 172. The femoral cup inner
surface 188 is shaped and sized to fit the end 151 of
the femoral head outer surface 132, after it has been reamed. The
cup femoral head prosthesis 180 further includes a fastener
receiving aperture 190 (see FIG. 11E) for engaging the
cannulated screw 184. In at least some embodiments, the
receiving aperture 190 extends there through and
includes threads 194 for engaging a threaded end portion 196 of
the cannulated screw 184.
Referring to FIG. 11D, the cup femoral head
prosthesis 180 is positioned over the femoral head outer
surface 132 and the cannulated screw 184 is secured to
the cup femoral head prosthesis 180. In at least some embodiments,
this is accomplished by rotating the cannulated screw 184 to
engage the threaded end portion 196 with the
receiving aperture 190 and tightening of the
cannulated screw 184 until the anchoring head 185 is
secured against a lateral femoral cortex 191 of the femur 122,
and the cup femoral head prosthesis 180 is secured onto the
femoral head outer surface 132. Once installed, the cup femoral
head prosthesis 180 provides a smooth and secure pivoting surface.
After the fastening has begun or has been completed, the guide wire 142 can
be removed, as seen in FIG. 11E. In at least some embodiments, the
installation of the cup femoral head prosthesis 180 is followed
by the insertion of the hemiarthroplasty cup 172 into
the hip joint 104, where the hemiarthroplasty cup 172 can
be brought into the hip joint 104 through the midanterior
portal 108. Upon completion of the installation of the prosthesis, the
traction is taken off the hip joint 104 and the cup femoral
head prosthesis 180 is brought to articulate with
the hemiarthroplasty cup 172, as seen in FIG. 12.
The cup femoral head prosthesis 180 and
the hemiarthroplasty cup 172 can be utilized together, or in
isolation as a hemiarthroplasty. In addition, the cup femoral head
prosthesis 180 and the hemiarthroplasty cup 172 can be
utilized together, or in isolation, without performing a reaming procedure on a
joint. The cup femoral head prosthesis 180 is comprised of
materials suitable for insertion into the body 102, such as cobalt
chrome, steel, aluminum, and/or other alloys, metals, ceramics, polymer
composites, etc. The femoral cup inner surface 188 of the
cup femoral head prosthesis 180 can be comprised of a porous,
grit blasted, or otherwise oriented surface amenable to either ongrowth or
ingrowth of the bone from the femoral head outer surface 132. In
addition, the hemiarthroplasty cup 172 is comprised of materials
suitable for insertion into the body 102, such as polyethylene,
cobalt chrome, steel, aluminum, and/or other alloys, metals, ceramics, or
polymer composites. The aforementioned material lists are not exclusive and
therefore, other materials not listed or currently unknown can be used if
suitable for such a purpose. Although the aforementioned procedure is described
in relation to hip joint 104, the components and procedures can be
modified to accommodate repair and/or replacement of various other joints in
the human body, such as a shoulder joint. For example, the shape of
the reamer 150 could be modified to ream other ball and socket
joints. Further, the components and procedures can be modified to accommodate
repair and/or replacement of a hip joint or other joints in the body of an
animal as well.
Referring to FIG. 13, a view of the hip
joint 104 of FIG. 2 with the femur 122 distracted
from the pelvis 120 and an exemplary joint spacer 200 shown
there between is provided. The spacer 200 can be used as a joint
replacement or enhancement device, where the term “joint replacement” is to be
understood as including a wide variety of uses in arthroplasty procedures, some
which may include, among other things, partial or complete joint replacement.
As noted above, the hip joint 104 includes at least portions of
the pelvis 120 and the femur 122. The femur 122 includes
the femoral head 124 connected to the femur 122 by
the femoral neck 126. The pelvis 120 includes
the acetabulum socket 128. The distraction exposes the
acetabulum outer surface 130 and the femoral head outer
surface 132. The acetabulum outer surface 130 and femoral
head outer surface 132 are at least partially comprised of a
layer of articular cartilage 141. FIG. 14 also illustrates
a view of the hip joint 104, but with a ligamentum teres
ligament 210 attached to the acetabulum outer surface 130 and
femoral head outer surface 132.
In at least some embodiments, the spacer 200 is
configured for positioning between the acetabulum outer surface 130 and
the femoral head outer surface 132. As shown in FIG. 15,
the spacer 200 includes an inner surface 212 configured
to accommodate at least one of a portion of the femoral head outer
surface 132 and a prosthetic secured to the femoral head 124.
As shown in FIG. 16, the spacer 200 includes an outer
surface 214 configured to accommodate at least one of a portion of
the acetabulum outer surface 130 and a prosthetic secured to
the pelvis 120. In at least some embodiments, the inner
surface 212 and outer surface 214 have similar
contours providing a uniform thickness, while in other embodiments, they may
have dissimilar contours providing a varying thickness across
the spacer 200. The thickness between the inner surface 212 and outer
surface 214 can vary, although in at least some embodiment, the
thickness is about 2 millimeters to about 8 millimeters, while in other
embodiments the thickness is about 4 millimeters, while in further embodiment,
the thickness can be greater or less than 2-8 millimeters. In at least some
embodiments, the spacer 200 has a circular curvilinear shape
with an inner perimeter 216 and an outer perimeter 218.
The inner perimeter 216 and outer perimeter can be continuous to
form closed inner and outer circles, or in other embodiments, they can be
discontinuous, wherein the inner perimeter 216 is joined to
the outer perimeter 218 to form a posterior limb 220 and
an anterior limb 222. The inner perimeter 216 can be
smaller in length relative to the outer perimeter 218. In at least
some embodiments, the posterior limb 220 is wider than
the anterior limb 222, although in other embodiments, they can be the
same or otherwise different. The spacer 200 includes
an interior perimeter diameter 223 that extends between opposite
sides of the inner perimeter 216. In at least some embodiments,
the interior perimeter diameter 223 can range from about 40
millimeters to about 60 millimeters, while in other embodiments,
the interior perimeter diameter 223 can be greater or less than
40-60 millimeters, while in further embodiments, the interior perimeter
diameter 223 can range from about 30 millimeters to about 70
millimeters For descriptive purposes, the spacer 200 can be
identified as having at least three portions, a posterior portion 230,
an anterior portion 232, and a superior portion 234.
Additionally, the superior portion 234 can be further identified
as having a posterior superior portion 236 and an
anterior superior portion 238. In at least some embodiments,
the spacer 200 can include a lip 240 that extends
outwardly from the outer perimeter 218 along the superior
portion 234, although in other embodiments, the lip 240 can
extend along the entire outer perimeter or a smaller portion thereof, including
or excluding any portion of the superior portion 234.
The lip 240 includes an inner edge 242 that is
joined to the outer perimeter 218, wherein the lip 240 extends
radially from and along the outer perimeter 218 forming
a lip extension 246 that terminates along an outer
edge 244, a first side edge 248, and a second side
edge 250. The lip extension 246 further includes a top
surface 252 and a bottom surface 254, wherein in at least
some embodiments, the bottom surface 254 is configured to at
least partially abut a portion of the acetabulum socket 128. In some
embodiments, the lip 240 will be unsecured to the acetabulum
socket 128, while in other embodiment, the lip 240 can be
secured to the acetabulum socket 128 using a fastener, such as a
screw, adhesive, etc. The each of the dimensions of the lip 240 can
vary as desired to accommodate fitment to a particular joint or patient.
Although the lip 240 is illustrated as a rectangular arc with
generally flat surfaces, the lip 240 can vary in shape, for
example, circular, triangular, parabolic, sinusoidal, etc., and can have a
varied cross-section to include non-flat surfaces.
The lip 240 can provide numerous functions,
such as engaging a portion of the acetabulum outer surface 130 when
unsecured, and as a securement means to provide a securing point. To assist
with securement of the lip 240 to the acetabulum
socket 128, in at least some embodiment, the lip extension 246 can
be trefinated, so as to include one or more holes (not shown). The holes can
vary in size and spacing as desired, although in at least some embodiments, the
holes can be about 2-3 millimeters in diameter and about 8 millimeters apart.
The holes can then be utilized with a fastener, such as a screw, peg, staple,
or a suture anchor. The femoral head can articular with the spacer 200 and
the lip 240 would be included in the articulation.
FIGS. 15-19 illustrate an embodiment of
the spacer 200 that is asymmetric and configured for use in the
right side of a pelvis, and FIGS. 20-24 illustrate another
embodiment, spacer 300, that is asymmetric and configured for use in the
left side of a pelvis. It is to be understood, that either configuration can be
modified as desired to be used on either side of the pelvis as well as to
accommodate various other joints in the body of a mammal. Further it is to be
understood that the spacer 300 is, in at least some embodiments, a
mirror image of the spacer 200 and performs a similar function,
but for an opposite joint, and therefore the description and operations
provided for spacer 200 can be applied to the spacer 300 without
the need for repetition throughout the specification.
As discussed above, the inner perimeter 216 and outer
perimeter 218 can be discontinuous, thereby providing
a gap 260 between the first end 220 (e.g., posterior
limb 220) and the second end 222 (e.g., anterior limb 222).
The gap 260 provides an opening for passing a ligament, such as
the ligamentum teres ligament 210, therethrough. For example, as shown
in FIG. 14, the ligament 210 is secured at either end to the
acetabulum outer surface 130 and femoral head outer
surface 132, as it naturally occurs. The gap 260 allows
the spacer 200 to at least partially surround the ligament with
the inner perimeter 216. In this manner, the ligament 262 can
remain attached, thereby avoiding the trauma associated with the need to cut
off the ligament, which is required when installing a hemispherical cup or
other cup shaped prosthesis that lacks an opening to accommodate the existing
ligament. This represents a substantial improvement over the prior art,
allowing for procedures to repair a damaged joint without inflicting
substantial invasive trauma. This substantially improves healing time and
future mobility, as well as the strength of the repaired joint, as opposed to
procedures that require the removal or cutting of the ligament securing the
joint. In addition, as in at least some embodiments, the spacer 200 includes
an inner perimeter and is not a closed back cup type configuration,
the spacer 200 requires less material to be inserted into the
body and the removal of less bone material from the body, thereby mitigating
the need to modify the joint and add new matter to the body. The dimensions of
the spacer 200 can be varied to accommodate the shape of the
acetabulum and femoral head patient (or the shape of other joints if not the
hip joint) of a specific patient. In this manner, the overall size of
the spacer 200 can be limited so as to replace only the
necessary portions of the joint that are damaged, as opposed to a standard cup
shape found in the prior art, which generally requires a gross modification of
the joint to accommodate an extensive implant. This also contributed to
recovery and future mobility. The information for the desired dimensions can be
obtained using one or more of various diagnostic tools, such as a radiograph, a
CT scan, an MM, or an equivalent modality.
In at least some embodiments, the spacer 200 can
be installed where the ligament 210 has been removed. In such an
installation, the unique shape of the spacer allows for expanded articulation
of the joint. Further, where the ligament 210 is not attached, the
inner and outer diameters of the spacer 200 can be continuous to
provide an “O” shape, as opposed to a “U” shape.
The spacer 200 is comprised of materials
suitable for insertion into the body 102, such as polyethylene,
plastic, rubber, cobalt chrome, steel, aluminum, and/or other alloys, metals,
ceramics, polymer composites, cadaveric tissue, living tissue (e.g., dermis),
etc. The aforementioned material lists are not exclusive and therefore, other
materials not listed or currently unknown can be used if suitable for such a
purpose. Portions of the spacer 200 can be comprised of one or
more different materials. For example, the lip 240 can be
comprised of a material different than the outer surface 214 or inner
surface 212. In addition, the surfaces of the spacer 200, for
example, the outer surface 214 or inner surface 212 can
include one or more different topographical surfaces, such as ribbed, dimpled,
textured, grit blasted, etc. In at least some embodiments, the outer
surface 214 utilizes a material or texture that is advantageous to
biological securement to the acetabulum socket 128 via bone
growth, while the inner surface 212 includes a material and
texture that allows smooth articulation with the femoral head 124.
Further, the rigidity of the spacer 200 can vary, as a whole, as
well as among portions of the spacer 200. For example,
the lip 240 can be more flexible than the remaining portion of
the spacer 200. The outer surface 214 of
the spacer 200 can be comprised of a porous, grit blasted, or
otherwise oriented surface amenable to either ongrowth or ingrowth of the bone
from the acetabulum socket 128. Although the aforementioned procedure
is described in relation to hip joint 104, the components and
procedures can be modified to accommodate repair and/or replacement of various
other joints in the human body, such as a shoulder joint. Further, the
components and procedures can be modified to accommodate repair and/or
replacement of a hip joint or other joints in the body of an animal as well. In
at least some embodiments, the spacer 200 is configured to be
wetable. In at least some embodiments, the device is configured to be installed
to an unprepared joint, or a prepared or reamed joint. The spacer 200 can
also be utilized with various other prosthetics, such as, a hemi-arthroplasty
prosthetic femoral head.
It is specifically intended that the aforementioned
spacers 200 and 300 not be limited to the embodiments and
illustrations contained herein, but include modified forms of those embodiments
including portions of the embodiments and combinations of elements of different
embodiments as come within the scope of the following claims. Further, the
steps outlined above can be modified in various manners, such as performance in
one or more alternate orders. The addition or exclusion of any step(s)
discussed or not discussed, does not preclude a desired completion of the
procedure.
What is claimed is:
1. A joint replacement device comprising:
an asymmetric spacer configured for positioning within an
acetabulum socket, the spacer having
an inner surface configured to accommodate at least one of a
portion of an outer surface of a femoral head of a femur and a prosthetic
secured to the femoral head;
an outer surface configured to accommodate at least one of a
portion of an outer surface of an acetabulum socket and a prosthetic secured to
a pelvis, wherein the inner surface and outer surface each have a circular
curvilinear shape and together include an inner perimeter and an outer
perimeter, wherein the inner perimeter is joined to the outer perimeter to form
a posterior limb of the inner and outer surfaces and an anterior limb of the
inner and outer surfaces, and wherein the posterior limb of the inner and outer
surfaces has a greater width than the anterior limb of the inner and outer
surfaces;
an interior perimeter diameter that extends between opposite
sides of the inner perimeter; and
a posterior portion, an anterior portion, and a superior
portion formed from the inner surface and the outer surface; wherein the
superior portion further includes a posterior superior portion and an anterior
superior portion.
2. The device of claim 1, further comprising a lip that
extends outwardly from the outer perimeter along the superior portion.
3. The device of claim 2, wherein the lip includes an
inner edge that is joined to the outer perimeter, wherein the lip extends
radially from and along the outer perimeter forming a lip extension that
terminates along a lip outer edge, a lip first side edge, and a lip second side
edge.
4. The device of claim 3, wherein the lip extension
further includes a top surface and a bottom surface, and wherein the bottom
surface is configured to at least partially abut a portion of the acetabulum
socket when installed.
5. The device of claim 4, wherein the lip is configured
to be unsecured to the acetabulum socket.
6. The device of claim 4, wherein the lip is configured
to be secured to the acetabulum socket using a fastener.
7. The device of claim 1, wherein the interior
perimeter diameter ranges from about 30 millimeters to about 70 millimeters.
8. The device of claim 1, wherein the inner perimeter
is smaller in length relative to the outer perimeter.
9. The device of claim 1, wherein the inner perimeter
and the outer perimeter are discontinuous, thereby providing a gap configured
to allow the passage of a ligament there through.
10. The device of claim 1, wherein the inner surface
and the outer surface have similar contours providing a uniform thickness.
11. The device of claim 1, wherein the inner surface
and the outer surface have dissimilar contours providing a varying thickness.
12. The device of claim 1, wherein the thickness
between the inner surface and the outer surface is about 2 millimeters to about
8 millimeters.
13. The device of claim 1, wherein the interior
perimeter diameter ranges from about 40 millimeters to about 60 millimeters.
External links
Birmingham P. Method and device for joint replacement. US20160262897A1 March 09, 2016. 2016. patents.google
Publications
of invention
CA2960266 (A1)
DE202017101341 (U1)
US10064730 (B2)
US11395742 (B2)
US2016262897 (A1)
US2019060080 (A1)
2016BirminghamP
Authors & Affiliations
Patrick
Birmingham , Winnetka , IL (US)
Keywords
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, endoprosthesis, prosthesis, invention, unipolar, subtotal, 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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