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WO2012020460A1 - Distracteur de genou en temps réel - Google Patents

Distracteur de genou en temps réel Download PDF

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Publication number
WO2012020460A1
WO2012020460A1 PCT/JP2010/005062 JP2010005062W WO2012020460A1 WO 2012020460 A1 WO2012020460 A1 WO 2012020460A1 JP 2010005062 W JP2010005062 W JP 2010005062W WO 2012020460 A1 WO2012020460 A1 WO 2012020460A1
Authority
WO
WIPO (PCT)
Prior art keywords
base plate
top plate
plate
slider
balancer
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2010/005062
Other languages
English (en)
Inventor
Masahisa Tanimoto
Yoshihiro Aoki
Tetsuya Kiyono
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Johnson and Johnson KK
Original Assignee
Johnson and Johnson KK
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Johnson and Johnson KK filed Critical Johnson and Johnson KK
Priority to PCT/JP2010/005062 priority Critical patent/WO2012020460A1/fr
Priority to JP2013523702A priority patent/JP5642878B2/ja
Publication of WO2012020460A1 publication Critical patent/WO2012020460A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools for implanting artificial joints
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/025—Joint distractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0268—Joint distractors for the knee
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/067—Measuring instruments not otherwise provided for for measuring angles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools for implanting artificial joints
    • A61F2/4684—Trial or dummy prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools for implanting artificial joints
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4658—Measuring instruments used for implanting artificial joints for measuring dimensions, e.g. length
    • A61F2002/4661—Measuring instruments used for implanting artificial joints for measuring dimensions, e.g. length for measuring thickness
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools for implanting artificial joints
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4666—Measuring instruments used for implanting artificial joints for measuring force, pressure or mechanical tension
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools for implanting artificial joints
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4668—Measuring instruments used for implanting artificial joints for measuring angles

Definitions

  • the present invention relates to an apparatus capable of measuring the gap and the balance between the femur and the tibia in execution of a total knee replacement, and more particularly, to an apparatus capable of measuring with ease and in real time the gap and the balance under load.
  • Patent Citation 1 discloses an apparatus that has a ratchet type screw jack made up of a jack base portion and a jack movable portion, and fixes an engaging plate extending long from the jack base portion at the tibia by nails while placing a swingable supporting plate similarly extending long from the jack movable portion below the femur, uses a torque wrench to lift the supporting plate with the jack function and push up the lower surface of the femur.
  • the jack is opened with the torque wrench until the torque reaches a predetermined value, and after lifting up the supporting plate (i.e., the lower surface of the femur) to a certain height position, the amount of swing of an arm extended towards the jack from the supporting plate is read from an angle scale provided on the jack, giving the balance between the femur and the tibia.
  • Patent Citation 2 discloses an apparatus including a lower member, a swingable upper member, a coil spring disposed between the upper and lower members, and an eccentric shaft for locking the upper and lower members at the closest position to each other, a scale serving both as a gap indicator and an angular indicator being provided on the lower member and a pointer for pointing at the scale being provided on the upper member.
  • adjustment and checking of the ligament balance can be achieved by setting the upper and lower members locked at the closest position to each other between the femur and the tibia, and vertically expanding the upper and lower members by unlocking them, and reading the scale (the lower member) pointed at by the pointer (the upper member).
  • Patent Citation 1 sets the gap and reads the angle at that point rather than measuring the gap, due to the construction employing the jack, and differs in the required application and function.
  • the left-right asymmetry requires left and right apparatuses to be separately prepared, generating concerns about cost.
  • the construction in which the scale is read at the jack remote from the measuring target makes accurate measurements fairly difficult.
  • the construction which is difficult to make compact and lightweight, generates concerns about burden on the operator (the surgeon or the like) and the subject (the patient).
  • measurements may be performed sequentially at various desired angles within the range from flexion to extension of the knee joint, and in such a case, the problems arises of having to repeat a cycle of opening the jack, measuring, and closing the jack for every measurement, which is a cumbersome procedure.
  • the Ligament Tensor may be the same as the present invention in that it is inserted between the femur and the tibia to move apart the two, but, it does not have its own measuring functions and is used in combination with a navigation system.
  • the present invention can be described as a creation of a very unique idea on an extension of this technology.
  • an object of the present invention is to provide an apparatus capable of measuring in real time and accurately the gap and the balance between the femur and the tibia without the use of a navigation system.
  • a first aspect of the invention is characterized by a balancer insertable between a femur and a tibia, including: a base plate having a gap scale, a slider having a gap pointer and an angular scale and being movable translationally and vertically with respect to the base plate, a top plate having an angular pointer, being swingable with respect to the slider, and vertically movable together with the slider, and a resilient member biasing the top plate upwards with respect to the base plate, wherein, when a biasing force of the resilient member causes the base plate to engage the tibia and the top plate to engage the femur, cooperation of the gap scale of the base plate and the gap pointer of the slider indicates a vertical position of the top plate with respect to the base plate, and at the same time, cooperation of the angular scale of the slider and the angular pointer of the top plate indicates an inclination of the top plate with respect to the base plate.
  • a second aspect of the invention is characterized in that, in the first aspect, the top plate is connected to the slider via a shaft and is swingable around the shaft.
  • a third aspect of the invention is characterized in that, in the first aspect, the resilient member is arranged between the base plate and the top plate.
  • a fourth aspect of the invention is characterized by a balancer insertable between a femur and a tibia, including: a base plate having a gap scale on each of the left and right sides, a slider having a gap pointer and an angular scale on each of the left and right sides, the slider being translationally and vertically movable with respect to the base plate, a top plate having an angular pointer on each of the left and right sides, the top plate being swingable with respect to the slider and vertically movable together with the slider, and a resilient member arranged in each of the left and right sides of the balancer to bias the top plate upwards with respect to the base plate, wherein, when a biasing force of the resilient member causes the base plate to engage the tibia and the top plate to engage the femur, cooperation of the gap scale of the base plate and the gap pointer of the slider indicates a vertical position of the top plate with respect to the base plate, and at the same time, cooperation of the angular scale of the slider and
  • a fifth aspect of the invention is characterized in that, in the fourth aspect, the top plate is connected to the slider via a shaft and is swingable around the shaft.
  • a sixth aspect of the invention is characterized in that, in the fourth aspect, the resilient member is arranged between the base plate and the top plate.
  • a seventh aspect of the invention is characterized by a handle for vertically pinching a balancer according to any one of the first to sixth aspects, including: a pair of bar members, one of the bar members having a first end portion for depressing the top plate from above, the other of the bar members having a second end portion insertable into an opening formed in the base plate.
  • An eighth aspect of the invention is characterized in that, in the seventh aspect, the first end portion is bifurcated and has a rounded contacting portion for contacting the top plate, and the second end portion is formed into a straight flat plate having a cross-section complementary to a cross-section of the opening.
  • a ninth aspect of the invention is characterized by a shim to be attached to a balancer according to any one of the first to sixth aspects, the shim having a predetermined thickness.
  • a tenth aspect of the invention is characterized in that, in the ninth aspect, a top surface of the shim is attached to an under surface of the base plate through a male-female type fitting portion.
  • An eleventh aspect of the invention is characterized in that, in the ninth aspect, an under surface of the shim is attached to a top surface of a tilt plate through a male-female type fitting portion.
  • a twelfth aspect of the invention is characterized in that, in the ninth aspect, a top surface of the shim is provided with a protrusion for preventing the shim from falling off.
  • a thirteenth aspect of the invention is characterized by a tilt plate to be attached to a balancer according to any one of the first to sixth aspects, the tilt plate including a thinner side and a thicker side to form a predetermined inclination angle.
  • a fourteenth aspect of the invention is characterized in that, in the thirteenth aspect, a top surface of the tilt plate is provided with a male-female type fitting portion for attachment to an under surface of the base plate and/or the shim.
  • the gap and balance between the femur and the tibia can be simply and accurately measured in real time without using a navigation system.
  • FIG. 1 is an exploded perspective view of a balancer according to an embodiment of the present invention as seen from diagonally forward right.
  • FIG. 2 is an exploded perspective view of the balancer according to the present embodiment as seen from diagonally backward left.
  • FIG. 3 is a plan view of a base plate.
  • FIG. 4 is a front view of the base plate.
  • FIG. 5 is a side view of the base plate.
  • FIG. 6 is a perspective view of the base plate as seen from diagonally forward right.
  • FIG. 7 is a perspective view of the base upside down.
  • FIG. 8 is a plan view of a top plate.
  • FIG. 9 is a front view of the top plate.
  • FIG. 10 is a cross-sectional view of the top plate taken along line X-X and seen in the direction of the arrows in FIG. 9.
  • FIG. 11 is a bottom view of the top plate.
  • FIG. 12 is a perspective view of the top plate as seen from diagonally forward right.
  • FIG. 13 is a perspective view of the top plate upside down.
  • FIG. 14 is a front view of a slider.
  • FIG. 15 is a cross-sectional view of the slider taken along line XV-XV and seen in the direction of the arrows in FIG. 14.
  • FIG. 16 is a perspective view of a handle.
  • FIG. 17 is a perspective view of one of the bar members constructing the handle.
  • FIG. 18 is a perspective view of the other one of the bar members constructing the handle.
  • FIG. 17 is a perspective view of one of the bar members constructing the handle.
  • FIG. 19 is a front view of a shim.
  • FIG. 20 is a side view of the shim.
  • FIG. 21 is a perspective view of the shim as seen diagonally forward right.
  • FIG. 22 is a perspective view of the shim upside down.
  • FIG. 23 is an exploded view of an assembly of the balancer, the shim and the tilt plate as seen from the front.
  • FIG. 24 is an exploded view of the assembly of the balancer, the shim and the tilt plate as seen from the side.
  • FIG. 25 is an exploded perspective view of the assembly of the balancer, the shim and the tilt plate as seen from diagonally forward right.
  • FIG. 26 is an exploded perspective view of the assembly of the balancer, the shim and the tilt plate as seen from diagonally backward left.
  • FIG. 27 is a view of the balancer set between the femur and the tibia as seen from the front.
  • FIG. 1 is an exploded perspective view of a balancer 1 according to an embodiment of the invention as seen from diagonally forward right
  • FIG. 2 is an exploded perspective view of the balancer 1 of the present embodiment as seen from diagonally backward left.
  • the arrow X in FIG. 1 indicates a width direction (left-right direction)of the balancer, the arrow Y the depth direction (front-back direction) of the balancer, and the arrow Z the height direction (thickness direction) of the balancer.
  • the balancer 1 is, for example, a measuring apparatus to be inserted between the femur and the tibia in a total knee replacement operation and essentially includes a base plate 3 that is to be located on the tibia side, a top plate 5 that is to be located on the femur side, a slider 7 coupled to the top plate 5, and a pair of coil springs (resilient members) 9 disposed between the base plate 3 and the top plate 5 to bias them to move apart from each other.
  • a measuring apparatus to be inserted between the femur and the tibia in a total knee replacement operation and essentially includes a base plate 3 that is to be located on the tibia side, a top plate 5 that is to be located on the femur side, a slider 7 coupled to the top plate 5, and a pair of coil springs (resilient members) 9 disposed between the base plate 3 and the top plate 5 to bias them to move apart from each other.
  • the balancer 1 of the present embodiment is also accompanied by a handle 11 (FIG. 16) for reliably grasping the balancer 1 for the above-mentioned insertion, a shim 13 (FIG. 19) for making it possible to deal with small and large sizes of the gap between the femur and the tibia, and a tilt plate 15 (FIG. 23) for making it possible to deal with the inclination in the anterior posterior direction of the above-mentioned gaps.
  • These components may be made of, for example, suitably heat-treated, precipitation hardened stainless steel (concretely, e.g., SUS 630) which has an excellent balance of hardness and corrosion resistance.
  • the base plate 3 has a substantially kidney shape or a substantially broad-bean shape when viewed from above and preferably has a size nearly the same as that of the proximal end surface of the tibia.
  • each of the left and right sides of the top surface of the base plate 3 is provided with a cylindrical raised portion 21 for holding the coil spring 9.
  • a pair of upstanding portions 23 is provided to stand symmetrically a predetermined distance spaced apart in the horizontal direction.
  • each upstanding portion 23 is provided, along the vertically extending outer edge, with a gap scale 25 (25a, 25b) (in the drawings, scale marks or nicks at 1 mm intervals) and numerical characters for the scale (in the drawings, 8, 10, and 12).
  • a substantially rectangular parallelepiped guide post 29 for guiding the translational movement of the top plate 5 in the Z direction is vertically provided on substantially the center of the top surface of the base plate 3.
  • the front surface of the guide post 29 is formed with a vertically elongated opening 31 that penetrates the guide post 29 in the Y direction.
  • a shaft 47 of the top plate 5 fits into the vertically elongated opening 31, and as the top plate 5 translationally moves in the vertical direction (Z direction, back and forth), the shaft 47 hits the upper and lower inner ends of the vertically elongated opening 31 to limit the movement in the vertical direction (Z direction) to a certain distance.
  • the length of the vertically elongated opening 31 determines the maximum stroke length of the translational movement (Z direction) of the top plate 5.
  • a horizontally elongated opening 33 which penetrates the guide post 29 in the Y direction in the same manner, is formed.
  • the horizontally elongated opening 33 receives one of the two ends of the handle 11, which will be described later, for grasping the balancer 1.
  • a wall surface 26 of the guide post 29 and a wall surface 44 of the top plate 5 engage to guide the translational movement and, at the same time, a wall surface 27 of the guide post 29 and a wall surface 45 of the top plate 5 engage to guide the translational movement, thereby restraining rotation of the top plate 5 within the Y-Z plane. This allows more stable measurement.
  • the bottom surface (under surface) of the base plate 3 is provided with a plurality of protrusions 35 (four in the illustrated configuration) for positioning and connecting the shim 13 and the tilt plate 15, which will be described later. These protrusions are stuck into the end surface of the tibia for fixation of the base plate.
  • the top plate 5 is of substantially kidney shape or broad-bean shape when viewed from above.
  • each of the left and right sides of the under surface (bottom surface) of the top plate 5 is provided with a raised portion 41 having a circular cylindrical form with a diagonally cut top for holding the coil spring 9.
  • Substantially the center of the top surface of the top plate 5 is provided with a rectangular opening 43 that penetrates the top plate 5 in the Z direction (vertical direction). This rectangular opening 43 fittingly receives the guide post 29 of the base plate 3.
  • the center of the rear inner face in the Y direction of the rectangular opening 43 is provided with a holding hole that receives and holds the rear end of the shaft 47 extending in the Y direction, and the corresponding front inner face in the Y direction is provided with a through hole that holds the front of the shaft 47.
  • the shaft 47 is fixedly supported by the top plate 5 via these two holes and the shaft end located on the front side forwardly protrudes a certain length from the front end surface of the top plate 5.
  • the slider 7 is mounted on the thus-protruding shaft portion.
  • the coil springs 9 are set on the base plate 3, the guide post 29 is passed through the rectangular opening 43, and the top plate 5 is moved closer to the base plate 3 against the biasing force of the coil springs 9, and when the front through hole and the rear holding hole of the top plate 5 and the vertically elongated opening 31 of the guide post 29 (and a central opening 57 of the slider 7) are aligned as seen from the front side, the shaft 47 is fitted to the top plate 5.
  • the left and right sides of the front surface of the top plate 5 are each provided with a single pointing mark or nick 51 (51a , 51b) (hereinafter referred to as an angular pointer) for pointing at an angular scale (which will be described later) on the slider 7.
  • a single pointing mark or nick 51 51a , 51b
  • an angular pointer for pointing at an angular scale (which will be described later) on the slider 7.
  • the slider 7 includes a rectangular thick plate portion 59, which has at its center the central opening 57 that penetrates in the anterior posterior direction (Y direction), and thin plate portions 61 at both left and right sides, which extend horizontally outwards from both sides of the thick plate portion 59 and have edges (outer boundary) formed by an arc whose center is the central opening 57.
  • the central opening 57 of the slider 7 is, as described previously, fitted rotatably relative to the shaft 43 that projects from the front end surface of the top plate 5.
  • the thick plate portion 59 has opposing vertical surfaces on both sides in the horizontal direction, and each vertical surface slidably engages, as described above, with the corresponding vertical surface of the upstanding portions 23a and 23b of the base plate 3.
  • each thin plate portion 61 is provided, along its outer edge, with an angular scale 65 (in the drawing, scale marks or nicks at 1 degree intervals) and numerical characters for the scale (in the drawing, +5 and -5).
  • the vertically center (horizontal position) scale mark 65n in each of the left and right angular scales 65a and 65b is formed thicker and longer than others.
  • This scale mark 65n forms a gap pointer (65n) for pointing at the gap scale 25 on the upstanding portion 23 of the base plate 3.
  • the coil springs 9 are used. However, springs, rubbers, or the like of other forms may be used provided that they can bias the base plate 3 and the top plate 5 to move apart (to be spaced apart) relative to each other.
  • the handle 11 is a tool for grasping the balancer 1 to insert it between the femur and the tibia, and pinches the base plate 3 and the top plate 5 against the biasing force of the coil springs 9, reducing the overall thickness to achieve easy insertion.
  • the handle 11 has a construction such that two substantially S-like shape bar members 71, 73 are crossed and connected at a crossed section by means of a pin 75.
  • the front side of one of the bar members 71 is bifurcated so that the left and right can be pressed in a well-balanced manner when depressing the top surface of the top plate 5 downwards, and the front end portion 71a (pressing portion or contacting portion) is rounded to be able to make point or line contact for minimizing the generation of unnecessary component forces during the pressing.
  • the front end side of the other bar member 73 is provided with a straight flat plate portion 73a having a complementary and similar cross-section.
  • the illustrated shim 13 has a thickness of 2.5 mm.
  • shim having other thickness e.g. thickness of 5.0 mm and 7.5 mm, are provided.
  • the top surface of the shim 13 is provided, for attachment of the shim 13 to the base plate 3, with four fitting holes 81 that receive the four protrusions 35 provided on the under surface of the base plate 3.
  • the under surface of the shim 13 is provided with three protrusions 85 for attachment of the tilt plate 15.
  • the top surface of the shim 13 is provided with a C-like shape protruding portion 89.
  • This protruding portion 89 is constructed to enter within the base plate, when the shim 13 is attached to the under surface of the base plate 3, through an opening 37 (FIG. 7) formed in the base plate under surface so as to communicate with the horizontally elongated hole 33 and substantially align with the horizontally elongated hole 33.
  • the illustrated tilt plate 15 has a top surface forming an attachment surface for the base plate 3 or the shim 13 (the illustrated shim has a thickness of 5 mm), and has a thinner front side, a thicker rear side, and an inclination of 5 degrees.
  • the tilt plate may have a different inclination angle (e.g., 10 degrees, 15 degrees or the like).
  • the top surface (attachment surface) of the tilt plate is provided with four fitting holes 91, into which the four protrusions 35 protruding from the base plate under surface can fit for the connection with the base plate 3, and also provided with three fitting holes 93 into which the three protrusions 85 projecting from the shim under surface can fit for the connection with the shim 13.
  • these seven protrusions 35, 85 may have the same outer diameter
  • the seven fitting holes 91, 93 may have the same inner diameter.
  • the flat plate portion 73a of the handle 11 Prior to insertion of the balancer 1 between the femur and the tibia, the flat plate portion 73a of the handle 11 is first inserted into the horizontally elongated opening 33 of the guide post 29 of the base plate 3 and the top surface of the top plate 5 is depressed by the other front end portions 71a of the handle 11 to minimize the overall thickness of the balancer.
  • the base plate 3 and the top plate 5 are located to be closest to each other.
  • the construction which enables the balancer 1 to be grasped in such a reduced thickness, allows for very easy insertion of the balancer 1 into the gap between the femur and the tibia.
  • the novel interconnecting structure of the protruding portion 89 of the shim 13, the horizontally elongated opening 33 of the base plate 3, and the flat plate portion 73a of the handle 11 can reliably prevent the falling of the shim 13.
  • the handle 11 can grasp the balancer 1 with the usual opening angle, which may considerably improve work efficiency and performance.
  • the slider 7 and the shaft 47 move translationally upwards with respect to the base plate 3 while the top plate 5 moves upwards together with the slider 7 and the shaft, but swingably around the shaft 47.
  • the gap (dimension or distance) between the tibia and the femur can be visually confirmed (measured) with ease from the gap scale 25 (25a, 25b) of the base plate 3 (the upstanding portion 23) and the gap pointer 65n of the slider 7 pointing at the gap scale.
  • the inclination or balance of the femur against the tibia can be visually confirmed (measured) with ease from the angular scale 65 (65a, 65b) of the slider 7 and the angular pointer (pointing mark) 51 (51a, 51b) of the top plate 5 pointing at the angular pointer.
  • an apparatus configuration corresponding to the opening and inclining conditions between the tibia and the femur can be achieved instantly, and the balancer can be set very simply and easily between the tibia and the femur and, in addition, real time measurement of the dimension and inclination (balance) between the two bones can be performed at the moment the balancer is set.
  • the whole balancer can be constructed very compact and lightweight, allowing considerably improved operability and keeping damage to the subject to a minimum.
  • the balancer is made up of a left-right symmetrical structure, and hence, when it is set between the femur and the tibia, measurements can be made from the combination of the scale and pointer on one side even if the combination of the scale and pointer on the other side cannot be visually confirmed due to an obstacle on that side. That is, suitable measuring operation can be realized. This allows measurements with the patella returned to its original position, resulting in reproduction of a situation closer to that of an actual knee joint.
  • FIG. 27 shows the balancer 1 of the present embodiment actually set between the femur F and the tibia T.
  • the femur F and the tibia T are in an extended condition, and the (unillustrated) patella is in its original location (non-everted position).
  • the balancer 1 of the present embodiment proper and quick measurement is possible for the knee (the femur and the tibia) that has no patella eversion and is functionally and physiologically in its natural conditions.
  • a similar measurement is possible for a knee (the femur and the tibia) in a flexed condition.
  • the present invention itself, however, is not limited to constructing balancers in a left-right symmetrical structure.
  • the balancer may be constructed in a left-right asymmetrical structure.
  • the required measurements are possible provided that the scale and pointer combination is provided on either of left and right sides of the balancer.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Transplantation (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Biophysics (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Cardiology (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un distracteur comportant une plaque servant de socle (3) équipée d'un pendule d'écartement (25), un coulisseau (7) comprenant un pointeur d'écartement (65n) et un pendule angulaire (65), ledit coulisseau étant translationnellement et verticalement mobile par rapport à la plaque servant de socle (3), une plaque supérieure (5) comportant un pointeur angulaire (51), ladite plaque pouvant basculer par rapport au coulisseau (7) et étant verticalement mobile en association avec le coulisseau (7), et un élément élastique (9) capable de solliciter la plaque supérieure (5) vers le haut par rapport à la plaque servant de socle (3). Lorsqu'une force de sollicitation en provenance de l'élément élastique (9) fait que la plaque servant de socle (3) vient prendre appui sur le tibia et que la plaque supérieure (5) vient prendre appui sur le fémur, la coopération du pendule d'écartement (25) de la plaque servant de socle (3) et du pointeur d'écartement (65n) du coulisseau (7) indique une position verticale de la plaque supérieure (5) par rapport à la plaque servant de socle (3), tandis que la coopération du pendule angulaire (65) du coulisseau (7) et du pointeur angulaire (51) de la plaque supérieure (5) indique une inclinaison de la plaque supérieure (5) par rapport à la plaque servant de socle (3).
PCT/JP2010/005062 2010-08-13 2010-08-13 Distracteur de genou en temps réel Ceased WO2012020460A1 (fr)

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WO2013148954A1 (fr) * 2012-03-30 2013-10-03 Jody Claypool Systèmes de prothèse tibiale, trousses et procédés
US8603101B2 (en) 2010-12-17 2013-12-10 Zimmer, Inc. Provisional tibial prosthesis system
GB2516674A (en) * 2013-07-29 2015-02-04 Ramesh Chandra Orthopaedic Apparatus
GB2526724A (en) * 2013-05-23 2015-12-02 Kirti Moholkar Improvements in or relating to assemblies for use in knee replacement surgery
US20160278944A1 (en) * 2015-03-24 2016-09-29 XpandOrtho, Inc. Balancing device for arthroplasty and methods for use
US9592133B2 (en) 2013-09-23 2017-03-14 Zimmer, Inc. Spacer block
US9597090B2 (en) 2010-12-17 2017-03-21 Zimmer, Inc. Cut guide attachment for use in tibial prosthesis systems
WO2017181216A1 (fr) * 2016-04-22 2017-10-26 Cabot Jonathan Peter Agencement et procédé utilisés dans la préparation de la surface proximale du tibia pour l'élément tibial d'une articulation prothétique du genou
US10154836B2 (en) 2013-10-15 2018-12-18 XpandOrtho, Inc. Actuated positioning device for arthroplasty and methods of use
US10195041B2 (en) 2010-07-24 2019-02-05 Zimmer, Inc. Asymmetric tibial components for a knee prosthesis
US10265181B2 (en) 2011-11-21 2019-04-23 Zimmer, Inc. Tibial baseplate with asymmetric placement of fixation structures
US10278827B2 (en) 2015-09-21 2019-05-07 Zimmer, Inc. Prosthesis system including tibial bearing component
US10413415B2 (en) 2010-09-10 2019-09-17 Zimmer, Inc. Motion facilitating tibial components for a knee prosthesis
US10470889B2 (en) 2010-07-24 2019-11-12 Zimmer, Inc. Asymmetric tibial components for a knee prosthesis
US10543099B2 (en) 2010-07-24 2020-01-28 Zimmer, Inc. Tibial prosthesis
US10582918B2 (en) 2013-05-23 2020-03-10 Kirti MOHOLKAR Assemblies for use in knee replacement surgery
US10675153B2 (en) 2017-03-10 2020-06-09 Zimmer, Inc. Tibial prosthesis with tibial bearing component securing feature
US20200305943A1 (en) * 2019-03-29 2020-10-01 Depuy Ireland Unlimited Company Methods of operating a surgical instrument and performing a surgical procedure to balance a patient's knee
US10835380B2 (en) 2018-04-30 2020-11-17 Zimmer, Inc. Posterior stabilized prosthesis system
US10898337B2 (en) 2011-11-18 2021-01-26 Zimmer, Inc. Tibial bearing component for a knee prosthesis with improved articular characteristics
US11317954B2 (en) 2017-07-28 2022-05-03 Wright Medical Technology, Inc. Joint osteotomy system and method
US11324598B2 (en) 2013-08-30 2022-05-10 Zimmer, Inc. Method for optimizing implant designs
US11324599B2 (en) 2017-05-12 2022-05-10 Zimmer, Inc. Femoral prostheses with upsizing and downsizing capabilities
US11426282B2 (en) 2017-11-16 2022-08-30 Zimmer, Inc. Implants for adding joint inclination to a knee arthroplasty
EP3880121A4 (fr) * 2018-11-15 2023-06-07 Little Engine, LLC Appareil et procédé de tension et de mesure d'écartement de flexion et d'extension des genoux
US11678894B2 (en) 2017-12-15 2023-06-20 Jonathan P. Cabot Knee balancing instrument
US12433656B2 (en) 2019-03-29 2025-10-07 Depuy Ireland Unlimited Company Methods, surgical instruments, and associated systems for performing a surgical procedure to balance a patient's knee

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Cited By (63)

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US10195041B2 (en) 2010-07-24 2019-02-05 Zimmer, Inc. Asymmetric tibial components for a knee prosthesis
US12239540B2 (en) 2010-07-24 2025-03-04 Zimmer, Inc. Asymmetric tibial components for a knee prosthesis
US11224519B2 (en) 2010-07-24 2022-01-18 Zimmer, Inc. Asymmetric tibial components for a knee prosthesis
US10543099B2 (en) 2010-07-24 2020-01-28 Zimmer, Inc. Tibial prosthesis
US10470889B2 (en) 2010-07-24 2019-11-12 Zimmer, Inc. Asymmetric tibial components for a knee prosthesis
US11471288B2 (en) 2010-09-10 2022-10-18 Zimmer, Inc. Motion facilitating tibial components for a knee prosthesis
US10413415B2 (en) 2010-09-10 2019-09-17 Zimmer, Inc. Motion facilitating tibial components for a knee prosthesis
US9597090B2 (en) 2010-12-17 2017-03-21 Zimmer, Inc. Cut guide attachment for use in tibial prosthesis systems
US9763807B2 (en) 2010-12-17 2017-09-19 Zimmer, Inc. Provisional tibial prosthesis system
US9011459B2 (en) 2010-12-17 2015-04-21 Zimmer, Inc. Provisional tibial prosthesis system
US9427337B2 (en) 2010-12-17 2016-08-30 Zimmer, Inc. Provisional tibial prosthesis system
US10188530B2 (en) 2010-12-17 2019-01-29 Zimmer, Inc. Provisional tibial prosthesis system
US8603101B2 (en) 2010-12-17 2013-12-10 Zimmer, Inc. Provisional tibial prosthesis system
US10010330B2 (en) 2010-12-17 2018-07-03 Zimmer, Inc. Cut guide attachment for use in tibial prosthesis systems
US9539116B2 (en) 2010-12-17 2017-01-10 Zimmer, Inc. User interface related to a surgical provisional
US10898337B2 (en) 2011-11-18 2021-01-26 Zimmer, Inc. Tibial bearing component for a knee prosthesis with improved articular characteristics
US12383407B2 (en) 2011-11-18 2025-08-12 Zimmer, Inc. Tibial bearing component for a knee prosthesis with improved articular characteristics
US10265181B2 (en) 2011-11-21 2019-04-23 Zimmer, Inc. Tibial baseplate with asymmetric placement of fixation structures
CN104379094B (zh) * 2012-03-30 2016-06-01 捷迈有限公司 胫骨假体系统、配套组件和方法
US9149206B2 (en) 2012-03-30 2015-10-06 Zimmer, Inc. Tibial prosthesis systems, kits, and methods
CN104379094A (zh) * 2012-03-30 2015-02-25 捷迈有限公司 胫骨假体系统、配套组件和方法
US9492290B2 (en) 2012-03-30 2016-11-15 Zimmer, Inc. Tibial prosthesis systems, kits, and methods
WO2013148954A1 (fr) * 2012-03-30 2013-10-03 Jody Claypool Systèmes de prothèse tibiale, trousses et procédés
AU2013238046B2 (en) * 2012-03-30 2016-03-03 Zimmer, Inc. Tibial prosthesis systems, kits, and methods
GB2526724A (en) * 2013-05-23 2015-12-02 Kirti Moholkar Improvements in or relating to assemblies for use in knee replacement surgery
GB2526724B (en) * 2013-05-23 2016-06-01 Moholkar Kirti Instrument for use in knee replacement surgery
US10582918B2 (en) 2013-05-23 2020-03-10 Kirti MOHOLKAR Assemblies for use in knee replacement surgery
GB2516674A (en) * 2013-07-29 2015-02-04 Ramesh Chandra Orthopaedic Apparatus
US11324598B2 (en) 2013-08-30 2022-05-10 Zimmer, Inc. Method for optimizing implant designs
US9901331B2 (en) 2013-09-23 2018-02-27 Zimmer, Inc. Spacer block
US9592133B2 (en) 2013-09-23 2017-03-14 Zimmer, Inc. Spacer block
US10154836B2 (en) 2013-10-15 2018-12-18 XpandOrtho, Inc. Actuated positioning device for arthroplasty and methods of use
KR20170130545A (ko) * 2015-03-24 2017-11-28 스팬도르소, 인코퍼레이티드 관절 성형을 위한 균형 유지 디바이스 및 사용 방법
WO2016154489A1 (fr) * 2015-03-24 2016-09-29 XpandOrtho, Inc. Dispositif d'équilibrage pour arthroplastie et procédés d'utilisation
US20160278944A1 (en) * 2015-03-24 2016-09-29 XpandOrtho, Inc. Balancing device for arthroplasty and methods for use
US20220175552A1 (en) * 2015-03-24 2022-06-09 XpandOrtho, Inc. Balancing device for arthroplasty and methods for use
US10206791B2 (en) 2015-03-24 2019-02-19 XpandOrtho, Inc. Balancing device for arthroplasty and methods for use
KR102531926B1 (ko) 2015-03-24 2023-05-11 스팬도르소, 인코퍼레이티드 관절 성형을 위한 균형 유지 디바이스 및 사용 방법
AU2016238323B2 (en) * 2015-03-24 2021-04-01 Advita Ortho, LLC. Balancing device for arthroplasty and methods of use
US11173049B2 (en) 2015-03-24 2021-11-16 XpandOrtho, Inc. Balancing device for arthroplasty and methods for use
US11160659B2 (en) 2015-09-21 2021-11-02 Zimmer, Inc. Prosthesis system including tibial bearing component
US10278827B2 (en) 2015-09-21 2019-05-07 Zimmer, Inc. Prosthesis system including tibial bearing component
US10973659B2 (en) 2016-04-22 2021-04-13 Jonathan Peter Cabot Arrangement and method used in the preparation of the proximal surface of the tibia for the tibia component of a prosthetic knee joint
AU2017253941B2 (en) * 2016-04-22 2018-11-15 Knee Balancer IP Pty Ltd An arrangement and method used in the preparation of the proximal surface of the tibia for the tibia component of a prosthetic knee joint
WO2017181216A1 (fr) * 2016-04-22 2017-10-26 Cabot Jonathan Peter Agencement et procédé utilisés dans la préparation de la surface proximale du tibia pour l'élément tibial d'une articulation prothétique du genou
US12458502B2 (en) 2017-03-10 2025-11-04 Zimmer, Inc. Tibial prosthesis with tibial bearing component securing feature
US11547571B2 (en) 2017-03-10 2023-01-10 Zimmer, Inc. Tibial prosthesis with tibial bearing component securing feature
US10675153B2 (en) 2017-03-10 2020-06-09 Zimmer, Inc. Tibial prosthesis with tibial bearing component securing feature
US11324599B2 (en) 2017-05-12 2022-05-10 Zimmer, Inc. Femoral prostheses with upsizing and downsizing capabilities
US11653960B2 (en) 2017-07-28 2023-05-23 Wright Medical Technology, Inc. Joint osteotomy system and method
US11471202B2 (en) 2017-07-28 2022-10-18 Wright Medical Technology, Inc. Joint osteotomy system and method
US11490936B2 (en) 2017-07-28 2022-11-08 Wright Medical Technology, Inc. Joint osteotomy system and method
US11317954B2 (en) 2017-07-28 2022-05-03 Wright Medical Technology, Inc. Joint osteotomy system and method
US11628003B2 (en) 2017-07-28 2023-04-18 Wright Medical Technology, Inc. Joint osteotomy system and method
US11426282B2 (en) 2017-11-16 2022-08-30 Zimmer, Inc. Implants for adding joint inclination to a knee arthroplasty
US11678894B2 (en) 2017-12-15 2023-06-20 Jonathan P. Cabot Knee balancing instrument
US11911279B2 (en) 2018-04-30 2024-02-27 Zimmer, Inc. Posterior stabilized prosthesis system
US10835380B2 (en) 2018-04-30 2020-11-17 Zimmer, Inc. Posterior stabilized prosthesis system
EP3880121A4 (fr) * 2018-11-15 2023-06-07 Little Engine, LLC Appareil et procédé de tension et de mesure d'écartement de flexion et d'extension des genoux
US11344352B2 (en) 2019-03-29 2022-05-31 Depuy Ireland Unlimited Company Methods of operating a surgical instrument and performing a surgical procedure to balance a patient's knee
US10945777B2 (en) 2019-03-29 2021-03-16 Depuy Ireland Unlimited Company Surgical instrument and method for performing an orthopaedic surgical procedure
US12433656B2 (en) 2019-03-29 2025-10-07 Depuy Ireland Unlimited Company Methods, surgical instruments, and associated systems for performing a surgical procedure to balance a patient's knee
US20200305943A1 (en) * 2019-03-29 2020-10-01 Depuy Ireland Unlimited Company Methods of operating a surgical instrument and performing a surgical procedure to balance a patient's knee

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