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WO1999038464A1 - Appareil orthopedique - Google Patents

Appareil orthopedique Download PDF

Info

Publication number
WO1999038464A1
WO1999038464A1 PCT/US1999/001882 US9901882W WO9938464A1 WO 1999038464 A1 WO1999038464 A1 WO 1999038464A1 US 9901882 W US9901882 W US 9901882W WO 9938464 A1 WO9938464 A1 WO 9938464A1
Authority
WO
WIPO (PCT)
Prior art keywords
bearing member
femur
elongate member
bearing
orthopaedic
Prior art date
Application number
PCT/US1999/001882
Other languages
English (en)
Inventor
Paul Firer
Original Assignee
Handelman, Joseph, H.
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 Handelman, Joseph, H. filed Critical Handelman, Joseph, H.
Priority to AU24800/99A priority Critical patent/AU2480099A/en
Publication of WO1999038464A1 publication Critical patent/WO1999038464A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/14—Surgical saws
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • 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

Definitions

  • THIS INVENTION relates to an orthopaedic apparatus and to
  • reference numeral 1 0 generally indicates
  • Figures 1 and 2 are used to illustrate the background to the invention.
  • weight bearing iine 1 8 is a line extending from the centre of the hip joint 20 to the centre of the ankle 21 .
  • a distal end portion 22 of the femur 24 is cut to define a substantially planar distal femoral surface 26, which is at
  • the cuts to the tibia 14 and the femur 24 should thus be made so that both the tibial surface 1 6 and the femoral surface 26 are at an angle to the horizontal, taken from the front (known as the valgus angle, and hereinafter referred to as ⁇ °) .
  • the angle a° is determined pre-operatively by X-ray.
  • the cuts should also be made so that the tibial and femoral surfaces are at an angle to the horizontal, when the knee is in extension and when viewed from the side, which may be from 0° upwards, depending on the prosthesis selected (hereinafter referred to as ⁇ °) .
  • anterior cut shown in dotted lines as 30, and the posterior cut, shown in dotted lines as 32 and define anterior and posterior surfaces.
  • the anterior and posterior surfaces should be parallel to each other.
  • Jigs are used to make the anterior and posterior cuts 30, 32.
  • the jigs must be placed in the correct degree of rotation on the end portion 22 of the femur 24 so that, once the anterior and posterior cuts are made and when the knee 1 0 is in flexion, and the soft tissues around
  • the posterior surface is parallel to the proximal tibial surface 1 6. This is to ensure that the prosthesis fits correctly when the knee 1 0 is in flexion.
  • the soft tissues around the joint must also be balanced for both the extended and flexed positions. Generally, the soft tissues are first balanced when the knee is in extension. The balancing of the soft tissue should take into account the prosthesis which is to be positioned between the tibial and femoral surfaces 1 6, 26, when the knee is in extension or between the posterior surface 32 and the tibial surface 1 6 when the knee is in flexion.
  • the anterior and posterior cuts 30, 32 are made when the knee is in flexion.
  • the jigs to make the anterior and posterior cuts 30, 32 are engaged with the distal end of the femur 24 and are rotated to keep the soft tissue balanced once the anterior and posterior cuts 30, 32 have
  • the device acts on the tibial and femoral surfaces 1 6, 26 to achieve balancing of the soft tissue. This is possible since the tibial and femoral surfaces 1 6, 26 are oriented as set out in principles (a) and (b) above. It is clear that the device would be substantially ineffective where one of the tibial and femoral surfaces is unprepared.
  • an orthopaedic apparatus which includes an elongate member, which is insertable into a medullary canal of
  • a bearing member which is arranged on a first end of the elongate member to bear against a prepared surface of the tibia, the bearing member being positioned in a plane which is oriented at predetermined
  • the elongate member may be in the form of a fluted rod having a tapered second end.
  • a locating member may be mounted on the first end of the elongate member, to locate the bearing member relative to the elongate member.
  • the locating member and the bearing member may define complementary mounting formations which are configured so that the bearing member is positioned in said plane.
  • the complementary mounting formations may be in the form of tongue and slot formations defined on the locating member and the
  • the bearing member may define a substantially planar
  • a handle may be fast with the bearing member and may extend from the bearing member.
  • the handle may be in the form of a straight bar, which is positioned parallel to the plane in which the bearing member is positioned.
  • the handle may include alignment check rod engaging means.
  • a method of balancing ligament tension in orthopaedic surgery including the steps of: cutting a tibia to obtain a planar tibial surface which is substantially at right angles to a weight bearing line; positioning an elongate member of an orthopaedic apparatus in the medullary canal of the femur so that a bearing member on an end of the elongate member is positioned between the tibial surface and the femur; and
  • Figure 1 shows a schematic side view of a knee joint in flexion
  • Figure 2 shows a schematic front view of a knee joint in extension
  • Figure 3 shows a side view of a rod and locating member of an orthopaedic apparatus, in accordance with the invention
  • Figure 4 shows a front view of the rod and locating member of the orthopaedic apparatus
  • Figure 5 shows a schematic front view of the knee joint with the orthopaedic apparatus in an operative position
  • Figure 6 shows a three dimensional view of the rod and locating member of the orthopaedic apparatus
  • Figure 7 shows a side view of a bearing member and handle of the orthopaedic apparatus
  • Figure 8 shows a front view of the bearing member and handle of the orthopaedic apparatus.
  • Figure 9 shows an end view of the bearing member and handle of the orthopaedic apparatus.
  • reference numeral 1 0 generally indicates a knee joint prior to knee replacement surgery.
  • the relevant parts of the knee joint 1 0 and their role in knee replacement surgery have been described under "Background to the Invention" above.
  • the rod 40 and the locator 42 are of surgical steel.
  • a first or proximal end 44 of the rod 40 is tapered or rounded to facilitate insertion of the rod 40 into the medullary canal of the femur 24. Further, the rod 40 has flutes 46 defined therein to reduce compressive forces exerted by the rod 40 when the rod 40 is inserted into the medullary canal of the femur 24.
  • the locator 42 has a rectangular body 48 with two opposed
  • the major faces 50 One of the major faces 50.1 is fast with the rod 40.
  • the major face 50.1 is oriented at 90° - ⁇ °, taken from the front, relative to the rod 40 and at 90° - ⁇ °, taken from the side, relative to the rod 40. 9
  • the angles a° and ⁇ ° are described earlier in the specification.
  • a tongue 52 extends from each of a pair of opposed minor
  • reference numeral 60 generally indicates a bearing member in the form of a plate for positioning between the proximal tibial surface 1 6 and the distal end 22 of the femur 24.
  • the plate 60 is roughly pear shaped, having a narrow side
  • the plate 60 also has a pair of opposed, planar major faces 62.
  • the plate 60 is of a predetermined thickness and has a pair of openings 78 defined therein. The openings 78 permit shims to be attached to the plate 60 to vary an effective thickness of the plate 60.
  • the plate 60 is marked on one of the faces 62 at 80 to indicate to a user whether that side 62 is to face the femur 24 or the tibia 14.
  • a rectangular slot 68 is defined in the plate 60 to open at the broad side 66.
  • a groove 70 is defined in each of a pair of opposed, inner surfaces 72 defining the slot 68. 10 Relative dimensions of the body 48 and the slot 68 are such that the body 48 is a sliding fit in the slot 68, with the faces 50 of the locator 42 flush with the faces 62 of the plate 60 ( Figure 6) . Similarly, relative dimensions of the tongues 52 and the grooves 70 are such that
  • the tongues 52 are a sliding fit in the grooves 70.
  • a handle 74 is fixed to the narrow side 64 of the plate 60.
  • the handle 74 is elongate and is circular cylindrical in cross section.
  • the handle 74 is in a parallel orientation with respect to the plate 60.
  • a pair of spaced guide passages 76 are defined in the handle 74.
  • the guide passages 76 are parallel to each other and are oriented at ⁇ ° relative to the handle 74.
  • An alignment check rod (not shown) is received through each guide passage 76 to permit a surgeon to confirm
  • ⁇ ° of a particular patient is determined prior to carrying out the knee replacement surgery.
  • the angle ⁇ ° is dependent on the prosthesis being used in the surgery and is usually 0° or 7 ° .
  • a range of locators having different ⁇ ° , for the left and right knee, are provided. 11
  • the rod 40 is then inserted into the medullary canal of the femur 24, through a tunnel prepared for later use by the distal femoral cutting jig, which is an
  • the plate 60 is engaged with the locator 42 in the manner described above so that the major face 62.1 of the plate 60 bears against the femoral condyles 82. It will be appreciated that, as a result of the orientation of the locator 42, the faces 62 of the plate 60 are at 90° to the weight bearing line 1 8.
  • vaigus alignment can be checked by external alignment techniques common to knee replacement surgery, by using the alignment check rods positioned in the passages 76.
  • the soft tissue sleeves 28 can now be balanced with normal surgical techniques, without the necessity of preparing the femoral surface 26.
  • the reason for this is that, as a result of the orientation of the plate 60, the femur is oriented as if the femoral surface 26 had already been prepared.
  • the Applicant believes that the orthopaedic apparatus 12 described above provides a simple and convenient means for accurately balancing a tension in the soft tissue 28 prior to making the femoral cut in knee replacement surgery.

Landscapes

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

Abstract

L'invention se rapporte à un appareil orthopédique comportant un élément oblong (74) qui est conçu pour être inséré dans le canal médullaire d'un fémur (24) et d'un tibia (14). Un élément porteur (60) est disposé au niveau d'une première extrémité (74) de l'élément oblong (74) de façon à s'appuyer contre une surface préparée du fémur et du tibia. Cet élément porteur (60) est positionné dans un plan qui est orienté par rapport à l'élément oblong (74) de façon à former un angle préétabli d'une part avec une partie avant dudit élément porteur (60) et d'autre part avec une partie latérale de ce même élément. L'invention se rapporte en outre à un procédé visant à équilibrer la tension des ligaments en chirurgie orthopédique.
PCT/US1999/001882 1998-01-28 1999-01-27 Appareil orthopedique WO1999038464A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU24800/99A AU2480099A (en) 1998-01-28 1999-01-27 An orthopaedic apparatus

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ZA98699 1998-01-28
ZA98/0699 1998-01-28

Publications (1)

Publication Number Publication Date
WO1999038464A1 true WO1999038464A1 (fr) 1999-08-05

Family

ID=25586836

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1999/001882 WO1999038464A1 (fr) 1998-01-28 1999-01-27 Appareil orthopedique

Country Status (2)

Country Link
AU (1) AU2480099A (fr)
WO (1) WO1999038464A1 (fr)

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5387216A (en) * 1993-02-18 1995-02-07 Thornhill; Thomas S. Intramedullary based instrument systems for total knee revision
US5437676A (en) * 1994-01-27 1995-08-01 Developpement D'implants Orthopediques Et Medicaux Kneecap cutting device for the fitting of a total knee replacement

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5387216A (en) * 1993-02-18 1995-02-07 Thornhill; Thomas S. Intramedullary based instrument systems for total knee revision
US5437676A (en) * 1994-01-27 1995-08-01 Developpement D'implants Orthopediques Et Medicaux Kneecap cutting device for the fitting of a total knee replacement

Also Published As

Publication number Publication date
AU2480099A (en) 1999-08-16

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