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WO2008003962A1 - procédé et appareil pour le compactage d'une greffe d'os - Google Patents

procédé et appareil pour le compactage d'une greffe d'os Download PDF

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Publication number
WO2008003962A1
WO2008003962A1 PCT/GB2007/002494 GB2007002494W WO2008003962A1 WO 2008003962 A1 WO2008003962 A1 WO 2008003962A1 GB 2007002494 W GB2007002494 W GB 2007002494W WO 2008003962 A1 WO2008003962 A1 WO 2008003962A1
Authority
WO
WIPO (PCT)
Prior art keywords
bone graft
bone
compacting
compacting tool
compaction
Prior art date
Application number
PCT/GB2007/002494
Other languages
English (en)
Inventor
Andrew Michael Raymond New
Douglas Graham Dunlop
Benjamin John Redman Fearne Bolland
Santana Phani Gopal Madabhushi
Original Assignee
University Of Southampton
Southampton University Hospitals Nhs Trust
Cambridge Enterprise Limited
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 University Of Southampton, Southampton University Hospitals Nhs Trust, Cambridge Enterprise Limited filed Critical University Of Southampton
Publication of WO2008003962A1 publication Critical patent/WO2008003962A1/fr

Links

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
    • A61F2/4601—Special tools for implanting artificial joints for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
    • 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
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary devices, e.g. pins or nails
    • 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
    • A61F2/32—Joints for the hip
    • 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
    • A61F2/28—Bones
    • A61F2002/2835—Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
    • 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
    • A61F2002/4677—Special tools for implanting artificial joints using a guide wire

Definitions

  • the present invention relates to a method and apparatus for bone graft compaction. It is particularly to be applied in methods of impaction bone grafting, for example in joint replacement surgery, particularly revision joint replacement surgery.
  • Revision joint replacement surgery (surgery to replace failed joint replacement prostheses, usually with new prostheses) accounted for approximately 15% of all joint replacement surgery carried out in the UK in 2005. This equates to approximately 7,500 revision hip replacements and a similar number of revision knee replacements per annum. The aging population and the trend for performing joint replacement operations in younger patients mean that the number of revision operations is likely to increase for the foreseeable future. Revision operations are costly and often their outcome is less successful than the primary operation.
  • Impaction bone grafting is a technique for replacing this lost bone (described in patents WO0108569, US5470336, WO9740785 and WO9301773).
  • the restoration of anatomy differentiates impaction bone grafting from other techniques such as bulk cementation or use of oversized or extra-long prostheses to bypass the defective site.
  • the solid foundation of bone produced by the impaction bone grafting technique enables the new prosthesis to function properly, giving pain relief and improved mobility for the patient, and, unlike alternative techniques, the probability of success of any subsequent revisions to be improved.
  • small chips of bone which may be obtained from a donor, and/or synthetic bone substitute materials (to reduce the volume of donor material required), are used to fill the defect caused by the loosening of the existing prosthesis.
  • the current surgical technique involves filling the bone defect that exists once the existing prosthesis has been removed with bone chips and then compacting the bone chips by repeated hammer blows to a "tamp" which is placed on top of the bone chips. The tamp serves to transmit the energy of the hammer blows to the bone chips to compact them together and to maintain an appropriately sized cavity within the graft formed by the bone chips to receive the new prosthesis.
  • This process may be repeated several times until the defect is adequately filled and a graft of sufficient compactness is achieved.
  • Sufficient compactness is judged at the time of surgery by the surgeon's experience and simple test methods, for example when the delivery of 10 controlled hammer blows does not cause any further progression of the tamp.
  • An objective of the present invention is to improve the compaction of the bone chips used to produce the graft in the impaction bone grafting procedure with respect to the standard impaction grafting technique which uses hammer blows applied to the tamp.
  • a further objective of the present invention is to reduce stresses and strains and subsequent risk of fracture during the graft compaction process, with respect to the standard impaction grafting technique.
  • the present inventors have realised that the bone graft produced by the impaction bone grafting procedure shares many characteristics with aggregate materials used in civil engineering applications such as soils, sands and ballasts used in the construction of railway beds and the sub-layers of roads.
  • aggregate materials used in civil engineering applications such as soils, sands and ballasts used in the construction of railway beds and the sub-layers of roads.
  • the behaviour of aggregates under load has been studied extensively by civil engineers and this knowledge ean be utilised to improve the mechanical characteristics of other aggregates such as bone graft.
  • the aggregate should have a well graded particle size distribution (a mixture of bone chips of different sizes in appropriate proportions)
  • the aggregate should be well compacted using an appropriate quantity of applied compaction effort, preferably by sequential compaction of layers of aggregate
  • Vibration applied to the aggregate is also commonly used in civil engineering applications in order to improve the compaction (packing together) of the aggregate particles and hence to increase aggregate compressive and shear strengths. Vibration applied to the aggregate, either on its own, in which case gravitational and surface energy forces cause compaction of the graft particles, or in conjunction with a additional applied loads, causes the aggregate particles to pack more efficiently.
  • the particles forming the aggregate are moved into a denser packing, which improves its shear strength.
  • the interstitial fluid needs to be drained out as it becomes more densely packed.
  • the increase in fluid pressure generated by the vibration can lead to an increase in pressure in the fluid phase that will be exerted on the solid particles forming the aggregate.
  • the fluid pressure can become large enough to push the solid particles apart, causing loss of contact. This phenomenon is known as liquefaction. Liquefaction can be avoided if adequate pressure relief is provided for the fluid phase.
  • the present inventors has realised that vibration techniques can be applied to the compaction of bone graft material. Further, pressure relief is required for a fluid phase in the bone graft material during compaction, to prevent liquefaction of the graft material.
  • the present invention provides a bone graft compaction apparatus comprising a compacting tool for contacting and compacting bone graft material, a vibrator for vibrating the compacting tool and means for relieving pressure in the bone graft material during compaction.
  • the present invention further provides a method of bone graft compaction, comprising contacting and compacting bone graft material with a compacting tool, vibrating the compacting tool and relieving pressure in fluid in the bone graft material during compaction.
  • the bone graft material used in the method of the invention or compacted with the apparatus of the present invention may comprise any conventional bone graft material, for example morsellised allograft material.
  • the person skilled in the art will be aware of methods for preparing such material, for example by milling bone material such as femoral heads.
  • the compacting tool may comprise any suitable compacting tool.
  • it comprises a compacting surface for contacting bone graft material and a driving surface for contacting the vibrator.
  • Suitable compacting tools as known to the person skilled in the art for conventional impaction bone grafting may be used, for an example the type known as a tamp or phantom.
  • a model available under the mark "X-change” (from Stryker UK Limited) may be used.
  • the compacting tool may be made of any suitable material, for example metal such as stainless steel.
  • the compacting tool may be provided with a longitudinally extending bore to allow it to be guided along a guide wire, in a manner known from the art of impaction bone grafting.
  • the frequency and amplitude should be selected to reduce the danger of fracture of the environment in which the bone graft material is being compacted.
  • a vibration device available under the mark "Woodpecker” (Minnesota Bramstedt Surgical Inc) may be used. Such a device is controllable by controlling the pressure of operating fluid supplied. Preferably, the device is operated at a pressure in the range 1.2-5.0 bar, more preferably 2.0-3.0 bar.
  • the compacting tool and the vibrator may be rigidly coupled to transfer vibrations. There may be a fluid coupling or the vibrator may comprise an oscillating hammer which repeatedly impacts a drive surface of the compacting tool.
  • compaction may be carried out for a period of time necessary for satisfactory compaction to occur. This may be assessed, for example, by determining the point at which no further movement of the compacting tool with respect to a fixed reference occurs.
  • the pressure relief means may be formed on a surface of or integral with the compacting tool.
  • channels may be formed in the surface of the compacting tool or holes may be formed in the surface of the compacting tool, communicating with a passage in the interior of the compacting tool.
  • a pump may be provided for removing fluid from the bone graft material.
  • Pressure relief holes preferably communicate with a longitudinally extending bore provided to allow the tool to be guided along a guide wire. This allows the holes to be provided in a simple manner and allows existing designs of tool to be adapted for the present invention.
  • the vibrator is contacted with the compacting tool such that when vibration of the vibrator ceases, substantially no load is applied to the compacting tool.
  • the only load applied may be the weight of the vibrator, which may be in the range 1- 5kg. In this way, the only load applied to the bone graft material is during the vibration. This has the advantage of being very controllable.
  • Figure 1 is a sketch view of a vibration assisted impaction bone grafting device according to the present invention for a femur.
  • Figure 2 is a sketch of a vibration assisted impaction bone grafting device for the acetabulum.
  • the invention is described here with respect to revision of the acetabular and femoral components of a failed hip replacement procedure, although the techniques could equally be applied to the tibial, femoral or patella components of a knee replacement or any component of any other joint replacement.
  • the vibrator or vibration device (1) is coupled to the compacting tool or tamp (2) such that vibration generated by the vibrator (1) is transmitted to the tamp (2) and hence into the bone chips which will form the bone graft (5).
  • the tamp (2) has a longitudinal hole which enables it to run over a guide wire (4).
  • the tamp (2) incorporates a series of holes (3) which communicate with the longitudinal hole to allow pressure pulses in the fluid component of the bone graft (5) that accompany the vibration to be relieved.
  • FIG. 2 shows a similar device designed for use in revision of the acetabular component of a hip replacement.
  • the vibration device (6) is coupled to the tamp (7) such that vibration generated by (6) is transmitted to (7) and hence into the bone chips which will form the bone graft (9).
  • the tamp (7) incorporates a series of holes (8) which communicate with the atmosphere to allow pressure pulses in the fluid component of the bone graft (9) that accompany the vibration to be relieved.

Landscapes

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

Abstract

La présente invention concerne un procédé et un appareil pour le compactage d'une greffe d'os, ledit appareil comprenant un outil de compactage (2) qui entre en contact avec un matériau de greffe d'os (5) et le compacte, un vibreur (1) qui fait vibrer l'outil de compactage (2) et des moyens pour diminuer la pression dans le matériau de greffe d'os (5).
PCT/GB2007/002494 2006-07-04 2007-07-04 procédé et appareil pour le compactage d'une greffe d'os WO2008003962A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GBGB0613274.0A GB0613274D0 (en) 2006-07-04 2006-07-04 A system for vibration-assisted bone graft compaction in impaction bone grafting
GB0613274.0 2006-07-04

Publications (1)

Publication Number Publication Date
WO2008003962A1 true WO2008003962A1 (fr) 2008-01-10

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/GB2007/002494 WO2008003962A1 (fr) 2006-07-04 2007-07-04 procédé et appareil pour le compactage d'une greffe d'os

Country Status (2)

Country Link
GB (1) GB0613274D0 (fr)
WO (1) WO2008003962A1 (fr)

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9168154B2 (en) 2013-12-29 2015-10-27 Kambiz Behzadi Prosthesis installation systems and methods
US9220612B2 (en) 2013-12-29 2015-12-29 Kambiz Behzadi Prosthesis positioning systems and methods
US10172722B2 (en) 2013-12-29 2019-01-08 Kambiz Behzadi Prosthesis installation systems and methods
US10245162B2 (en) 2013-12-29 2019-04-02 Kambiz Behzadi Prosthesis installation systems and methods
US10245160B2 (en) 2013-12-29 2019-04-02 Kambiz Behzadi Prosthesis installation systems and methods
US10456271B2 (en) 2013-12-29 2019-10-29 Kambiz Behzadi Prosthesis revision systems and methods
US10478318B2 (en) 2013-12-29 2019-11-19 Kambiz Behzadi Prosthesis installation systems and methods
US10610379B2 (en) 2013-12-29 2020-04-07 Kambiz Behzadi Prosthesis installation systems and methods

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1997040785A1 (fr) * 1996-04-26 1997-11-06 Mikhail Michael W E Systeme pour la chirurgie de revision des protheses de la hanche
EP1060731A1 (fr) * 1999-06-18 2000-12-20 Bone & Joint Research S.A. Matériau de comblement bio-actif, procédé d'utilisation de ce matériau et appareil pour la mise en oeuvre du procédé
WO2001008569A1 (fr) * 1999-07-29 2001-02-08 Mikhail Michael W E Systeme permettant de realiser une chirurgie prothetique de la hanche
WO2003007854A1 (fr) * 2001-07-20 2003-01-30 The Spineology Group, Llc Dispositif d'insertion de particules de matieres de remplissage dans des cavites du corps

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1997040785A1 (fr) * 1996-04-26 1997-11-06 Mikhail Michael W E Systeme pour la chirurgie de revision des protheses de la hanche
EP1060731A1 (fr) * 1999-06-18 2000-12-20 Bone & Joint Research S.A. Matériau de comblement bio-actif, procédé d'utilisation de ce matériau et appareil pour la mise en oeuvre du procédé
WO2001008569A1 (fr) * 1999-07-29 2001-02-08 Mikhail Michael W E Systeme permettant de realiser une chirurgie prothetique de la hanche
WO2003007854A1 (fr) * 2001-07-20 2003-01-30 The Spineology Group, Llc Dispositif d'insertion de particules de matieres de remplissage dans des cavites du corps

Cited By (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9168154B2 (en) 2013-12-29 2015-10-27 Kambiz Behzadi Prosthesis installation systems and methods
US9220612B2 (en) 2013-12-29 2015-12-29 Kambiz Behzadi Prosthesis positioning systems and methods
US9649202B2 (en) 2013-12-29 2017-05-16 Kambiz Behzadi Prosthesis positioning systems and methods
US10172722B2 (en) 2013-12-29 2019-01-08 Kambiz Behzadi Prosthesis installation systems and methods
US10245162B2 (en) 2013-12-29 2019-04-02 Kambiz Behzadi Prosthesis installation systems and methods
US10245160B2 (en) 2013-12-29 2019-04-02 Kambiz Behzadi Prosthesis installation systems and methods
US10456271B2 (en) 2013-12-29 2019-10-29 Kambiz Behzadi Prosthesis revision systems and methods
US10470897B2 (en) 2013-12-29 2019-11-12 Kambiz Behzadi Prosthesis revision systems and methods
US10478318B2 (en) 2013-12-29 2019-11-19 Kambiz Behzadi Prosthesis installation systems and methods
US10610379B2 (en) 2013-12-29 2020-04-07 Kambiz Behzadi Prosthesis installation systems and methods
US10729559B2 (en) 2013-12-29 2020-08-04 Kambiz Behzadi Prosthesis installation systems and methods
US11229530B2 (en) 2013-12-29 2022-01-25 Kambiz Behzadi Prosthesis revision systems and methods
US11337827B2 (en) 2013-12-29 2022-05-24 Kambiz Behzadi Prosthesis revision systems and methods
US11399962B2 (en) 2013-12-29 2022-08-02 Kambiz Behzadi Prosthesis installation systems and methods
US11576790B2 (en) 2013-12-29 2023-02-14 Kambiz Behzadi Prosthesis installation systems and methods

Also Published As

Publication number Publication date
GB0613274D0 (en) 2006-08-16

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