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WO2013052584A1 - Dispositif et procédé d'arthroscopie de la hanche - Google Patents

Dispositif et procédé d'arthroscopie de la hanche Download PDF

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Publication number
WO2013052584A1
WO2013052584A1 PCT/US2012/058623 US2012058623W WO2013052584A1 WO 2013052584 A1 WO2013052584 A1 WO 2013052584A1 US 2012058623 W US2012058623 W US 2012058623W WO 2013052584 A1 WO2013052584 A1 WO 2013052584A1
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WO
WIPO (PCT)
Prior art keywords
lesion
mis
port
template
cutting tool
Prior art date
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Ceased
Application number
PCT/US2012/058623
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English (en)
Inventor
Shane NHO
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Individual
Original Assignee
Individual
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Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of WO2013052584A1 publication Critical patent/WO2013052584A1/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
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
    • A61B1/317—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for bones or joints, e.g. osteoscopes, arthroscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/32—Devices for opening or enlarging the visual field, e.g. of a tube of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/1662—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1664—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body for the hip
    • A61B17/1668—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body for the hip for the upper femur
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A61B17/175—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip for preparing the femur for hip prosthesis insertion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/564—Methods for bone or joint treatment

Definitions

  • the present invention relates generally to hip surgery and, more specifically, to a system, method, and apparatus for performing arthroscopic hip surgery.
  • Arthroscopic surgery is generally well known in the art, and is regularly employed by orthopedic surgeons to treat a wide variety of conditions on human joints. Arthroscopic surgery on some joints, such as the knee, is relatively straightforward and is thus widely performed. However, arthroscopic surgery on thi hip presents some unique challenges, and therefore is not performed with as much frequency.
  • a system for arthroscopically treating a lesion at a desired location adjacent a hip joint includes an MIS port, the MIS port sized to permit access to the hip joint at the desired location, with the MIS port further sized to permit visualization of the lesion at the desired location.
  • a cutting tool is included, the cutting tool having a cutting head and adapted for placement into the MIS port to position the cutting head adjacent the lesion at the desired location.
  • a template is provided, with the template sized for placement through the MIS port to a position adjacent the lesion, the template further sized an shaped to allow the cutting head to reach at least a portion of the lesion, such that the portion of the lesion can be removed.
  • a method of arthroscopically treating a lesion at a desired location adjacent a hip joint may comprise the steps of locating a lesion adjacent a junction of a femoral head and a femoral neck within the hip joint, placing an MIS port into a joint capsule at the desired location adjacent the lesion, placing a template through the MIS port to a position adjacent the lesion, providing a cutting tool having a cutting head, positioning the cutting head through the MIS port and adjacent the template and adjacent the lesion, and removing at least a portion of the lesion using the cutting head while using the template to limit a range of motion of the cutting head relative to the lesion.
  • a system and/or method for arthroscopically treating a lesion at a desired location of a hip joint may further include any one or more of the following preferred forms.
  • the template may comprise an edge guide to limit access of the cutting head to a desired area of the lesion, and/or may comprise a depth guide to limit access to a desired depth of the lesion.
  • the cutting head may include a rotatable end portion, and may include a motor operatively coupled to the rotatable end portion.
  • the rotatable end portion may comprise a number of arrangements, such as a discshaped portion, a conical portion, a rotating burr, a conical portion oriented coaxial with an axis of the cutting tool, or a conical portion oriented transversely relative to an axis of the cutting tool.
  • the method may include providing the template with an edge guide to limit access of the cutting head to a desired area of the lesion, and/or providing the template with a depth guide to limit access to a desired depth of the lesion.
  • the method may include removing a first portion of the lesion with the template in place, and then removing a second portion of the lesion with the template removed.
  • the MIS port is sized to permit visualization of the lesion through the MIS port.
  • the cutting head may be provided with a rotatable end portion, and may be operatively coupled a motor.
  • the cutting tool may be arranged to receive a selected one of a plurality of rotatable end portions, including a disc-shaped portion, a conical portion, or a transversely oriented portion.
  • the method may include positioning the femoral head relative to the acetabulum to permit access to the labrum, and repairing a condition of the labrum.
  • the method may include providing a distal end of the MIS port with flanges, incising the joint capsule, and placing the flanges beneath the joint capsule.
  • the method may include using a dilator to dilate an opening after locating the lesion, and then placing the MIS port through the dilated opening.
  • the method may include visualizing the joint by placing an arthroscope into the MIS port, and may include using the cutting tool while the arthroscope is in place.
  • Figure 1 is a schematic cross-sectional view of the hip joint and illustrating a system for treating a lesion assembled in accordance with an exemplary
  • Figure 2 is a schematic view of the example of Figure 1 taken from outside the joint looking through an MIS port and showing the template in the form of a shaped plate, and further illustrating the cutting tool positioned to treat the lesion.
  • Figure 3 is a schematic cross-sectional view of the hip joint and illustrating another exemplary template arrangement formed from a cylindrical guide.
  • Figure 4 is a schematic view of the embodiment of Figure 3 taken from outside the joint looking through the MIS port and the cylindrical guide.
  • Figure 5 is a schematic diagram of the hip joint including the acetabulum, the femoral head, and the femoral neck, with a lesion disposed adjacent the junction between the femoral head and the femoral neck, and illustrating a needle being used to localize the lesion.
  • Figure 6 through Figure 8 are schematic diagrams similar to Figure 5 and showing progressively widening dilators inserted adjacent the lesion in order to provide an access opening.
  • Figure 9 is another schematic diagram similar to Figures 5 through 8 and illustrating a minimally invasive surgery (MIS) port through the opening created by the dilators adjacent the lesion.
  • MIS minimally invasive surgery
  • Figure 10 is another schematic diagram illustrating the MIS port in place adjacent the lesion, such that a surgeon can incise the joint capsule through the access opening provided by the MIS port.
  • Figure 1 1 is another schematic diagram illustrating the MIS port positioned with the port flange is disposed under the capsular flaps such that the opening provides access to the lesion at the head-neck junction.
  • Figure 12 is a schematic diagram illustrating a cutting tool inserted through the opening of the MIS port to position a cutting head adjacent the lesion.
  • Figure 13 is another schematic diagram illustrating the cutting head of the cutting tool penetrating into the articular cartilage of the femoral head a distance approximately equal to the depth of the cutting head.
  • Figure 14 is a schematic diagram illustrating the template placed over the CAM lesion, and showing a portion of the lesion extending beyond the lesion.
  • Figure 15 is a schematic diagram illustrating the joint after removal of a portion of the lesion.
  • Figure 16 is a still further schematic diagram illustrating the cutting tool being used to remove additional portions of the lesion after removal of the template.
  • Figure 17 is another schematic diagram illustrating the joint ready for capsular closure.
  • Figures 18a through 18d are enlarged fragmentary views illustrating four exemplary embodiments for the cutting head of the cutting tool.
  • Figure 19 is a plan view of an exemplary template, shown to greater advantage than in Figure 2.
  • Figures 1 -18d illustrate a device and method for arthroscopically treating a lesion in the hip joint and assembled in accordance with the teachings of a disclosed example or examples of the present invention.
  • an exemplary system 10 includes an MIS port 12 forming an access passage or opening 13, a cutting tool 14, and a template 16 (the template 16 is also visible in Figure 19).
  • the system 1 0 is shown in place adjacent a hip joint 18 which includes a femoral head 20, a femoral neck 22, and an acetabulum 24.
  • a lesion L is disposed adjacent a junction 26 between the femoral head 20 and the femoral neck 22.
  • the location of the lesion L constitutes a desired location for performing the arthroscopic procedure.
  • the cutting tool 14 includes a cutting head 28 which is positioned so as to extend through the MIS port 12 to place the cutting head 28 adjacent to the lesion L. in the example shown, an upper or outward portion 30 of the lesion L extends above or outwardly from the template 16.
  • the cutting tool 14 includes a motor M or is otherwise operatively coupled to a suitable motor to cause rotation of the cutting head 28.
  • the template 16 includes a pair of edge guides 16a and 16b, which define, at least in part, an exposed area of the lesion L when viewing the lesion through the MIS port 12 as shown in Figure 2.
  • the edge guides 16a and 16b limit the access of the cutting head 28 to a selected or desired area 32 of the lesion L, with the desired area 32 being disposed between the edge guides 16a and 16b (oriented toward the top and the bottom, respectively, when viewing Figure 2), and edge guides 16c and 16d (oriented toward the left and right, respectively, when viewing Figure 2). Consequently, in accordance with the disclosed example, the cutting head 28th of cutting tool 14 cannot access any additional area while the template 16 is in place.
  • the system 10 may also include a depth guide 34.
  • the depth guide 34 may be formed by a portion 36 of the template 16, which cooperates with a corresponding stop 38 carried by the cutting tool 14, thus limiting the penetration of the cutting head 28 of the cutting tool 14 into the lesion L.
  • a stop 40 may be formed on or otherwise carried by the cutting tool 14, and a cooperating stop 42 may be formed on or otherwise carried by the MIS port 12. thus limiting the penetration of the cutting head 28 of the cutting tool 14 into the lesion L.
  • the stops 40 and 42 cooperate to limit the
  • the cutting head 28 includes a rotatable end 44, and thus four exemplary embodiments illustrated for the rotatable and 44 of the cutting head 28.
  • the rotatable end 44 is a disc 46 having a cutting edge 46a and a cutting face 46b.
  • the rotatable end 44 is a cutting tool 48 which is oriented transversely relative to an axis A of the cutting tool 14 so as to rotate about an axis B.
  • the rotatable end 44 is a cone-shaped or truncated cone-shaped cutting tool 50, which rotates about the axis A.
  • the rotatable end 44 is again a cone-shaped or truncated cone-shaped cutting tool 50, but this time oriented so as to rotate about the axis B. Still other shapes, orientations, cutting surfaces, and other arrangements may prove suitable for the cutting tool.
  • the template 16 takes the form of a cylindrical guide 52, which is inserted through the opening of the MIS port 12.
  • portion of the lesion extends into the cylinder go area circumscribed by the cylindrical guide 52, such that the cutting tool 14 can access the protruding portion of the lesion L for removal.
  • the inner circumference of the cylindrical guide 52 forms an edge guide 53.
  • Figure 1 illustrates localization of the lesion L using a needle 54 such as a spinal needle.
  • a dilator 56 is inserted at the location determined by the needle 54 as shown in Figure 6.
  • the dilator or dilators 56 are used to progressively increase the size of an opening 58 through the surrounding tissue in order to access the hip joint 18.
  • the MIS port 12 can be inserted, and dilator or dilators 56 can be removed to permit incision of the joint capsule.
  • the MIS port 12 may include flanges 60, and preferably the flanges 60 are placed under the capsule or flaps, such that the MIS port is positioned over the junction 26 between the femoral head 20 and the femoral neck 22.
  • the cutting tool 14 is used to make an initial line at the medial aspect of the cam lesion, roughly 5 mm from the labrum, and from the twelve o'clock position to the six o'clock position when viewing the lesion through the MIS port 12.
  • the cutting head 24 will preferably take the form of a cutting burr 62.
  • the cutting head 24 may be any one of the examples shown in Figures 18a through 18d.
  • the cutting head 28 of the cutting tool 14 is used to penetrate the cartilage a depth
  • the next step is to place the template 16 in place over the cam lesion L (the template 16 is illustrated only schematically in Figure 14), such that any portion of the lesion L extending outside of or otherwise accessible through the template 16 can be removed using the appropriate cutting tool, with the result shown in Figure 15.
  • the MIS port 12 maybe sized to permit the surgeon to visualize sufficient portions of the hip joint and/or the lesion L without the use of any additional imaging equipment.
  • the surgeon may also insert relevant portions of an arthroscope 64 into the MIS port 12.
  • the arthroscope 64 is preferably operatively coupled to a display 66 via any suitable link 68, such that the surgeon can visualize relevant aspects of the hip joint and/or the lesion L.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • Molecular Biology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Biophysics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Physics & Mathematics (AREA)
  • Pathology (AREA)
  • Optics & Photonics (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Prostheses (AREA)

Abstract

La présente invention concerne un système de traitement de manière arthoscopique d'une lésion à un emplacement souhaité adjacent à une articulation de hanche, ledit système comprenant un orifice de chirurgie à effraction minimale (MIS), l'orifice MIS ayant une taille permettant l'accès à l'articulation de la hanche à l'emplacement souhaité, la taille de l'orifice MIS étant en outre telle qu'elle permet de visualiser la lésion à l'emplacement souhaité. Le système selon l'invention comprend également un outil de coupe, l'outil de coupe ayant une tête de coupe et étant conçu pour être placé à l'intérieur de l'orifice MIS pour positionner la tête de coupe de manière adjacente à la lésion à l'emplacement souhaité. L'invention concerne en outre une matrice, la matrice ayant une taille telle qu'elle peut être placée à travers l'orifice MIS dans une position adjacente à la lésion, la taille et la forme de la matrice étant en outre telles qu'elles permettent à la tête de coupe d'atteindre au moins une partie de la lésion, de sorte que la partie de la lésion puisse être éliminée.
PCT/US2012/058623 2011-10-04 2012-10-04 Dispositif et procédé d'arthroscopie de la hanche Ceased WO2013052584A1 (fr)

Applications Claiming Priority (2)

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US201161543209P 2011-10-04 2011-10-04
US61/543,209 2011-10-04

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WO2013052584A1 true WO2013052584A1 (fr) 2013-04-11

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5345927A (en) * 1990-03-02 1994-09-13 Bonutti Peter M Arthroscopic retractors
EP0807415A2 (fr) * 1996-05-09 1997-11-19 Olympus Optical Co., Ltd. Outillage pour retenir une cavité en chirurgie osseuse, outillage pour retenir une cavité en chirurgie generale, système d'endoscopie chirurgical utilisant un outillage pour retenir une cavité, et une procédure de chirurgie
US20070038034A1 (en) * 2005-08-15 2007-02-15 Sweeney Thomas M Ii Systems and methods for performing percutaneous surgery
WO2008035198A2 (fr) * 2006-09-21 2008-03-27 Comeg Tecnologie S.R.L gabarit, outil et appareil pour le façonnage d'implants prothétiques
WO2011103370A1 (fr) * 2010-02-17 2011-08-25 Reprise Technologies, Llc Système et procédé d'arthroscopie guidée par imagerie

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5345927A (en) * 1990-03-02 1994-09-13 Bonutti Peter M Arthroscopic retractors
EP0807415A2 (fr) * 1996-05-09 1997-11-19 Olympus Optical Co., Ltd. Outillage pour retenir une cavité en chirurgie osseuse, outillage pour retenir une cavité en chirurgie generale, système d'endoscopie chirurgical utilisant un outillage pour retenir une cavité, et une procédure de chirurgie
US20070038034A1 (en) * 2005-08-15 2007-02-15 Sweeney Thomas M Ii Systems and methods for performing percutaneous surgery
WO2008035198A2 (fr) * 2006-09-21 2008-03-27 Comeg Tecnologie S.R.L gabarit, outil et appareil pour le façonnage d'implants prothétiques
WO2011103370A1 (fr) * 2010-02-17 2011-08-25 Reprise Technologies, Llc Système et procédé d'arthroscopie guidée par imagerie

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