WO2013052584A1

WO2013052584A1 - Hip arthroscopy device and method

Info

Publication number: WO2013052584A1
Application number: PCT/US2012/058623
Authority: WO
Inventors: Shane NHO
Original assignee: Nho Shane
Priority date: 2011-10-04
Filing date: 2012-10-04
Publication date: 2013-04-11

Abstract

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 and 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.

Description

HIP ARTHROSCOPY DEVICE AND METHOD

FIELD OF THE INVENTION

[0001] The present invention relates generally to hip surgery and, more specifically, to a system, method, and apparatus for performing arthroscopic hip surgery.

BACKGROUND

[0002] 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.

[0003] When treating hip conditions, surgeons have access to a number of well- accepted treatment methods, such as pelvic oesteotomy or open surgical dislocation. Such methods are more invasive than arthroscopic surgery, and thus require longer recovery and rehabilitation. Although some hip conditions, such as rim lesions or CAM lesions, seem to be well-suited for arthroscopic treatment, the unique challenges of the hip joint make performing hip arthroscopy very challenginc and greatly complicate the learning curve for surgeons learning a new technique. Therefore, there appears to be a need in the art for a method and apparatus which may, in some embodiments, shorten the learning curve for hip arthroscopy.

SUMMARY

[0004] In accordance with one exemplary aspect, 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. [0005] In accordance with another exemplary aspect, 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.

[0006] In further accordance with any one or more of the foregoing first or second aspects, 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.

[0007] In one preferred form, 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.

[0008] In another preferred form, 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.

[0009] In another preferred form, 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.

[0010] In another preferred from, 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. Preferably, 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.

[0011] In accordance with another preferred form, 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.

[0012] In accordance with another preferred form, 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.

[0013] In accordance with another preferred form, 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.

[0014] In accordance with another preferred from, 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.

BRIEF DESCRIPTION OF THE DRAWINGS

[0015] 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

embodiment of the present invention, including an exemplary template arrangement formed from a shaped plate.

[0016] 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.

[0017] Figure 3 is a schematic cross-sectional view of the hip joint and illustrating another exemplary template arrangement formed from a cylindrical guide.

[0018] 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.

[0019] 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. [0020] 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.

[0021] 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.

[0022] 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.

[0023] 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.

[0024] 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.

[0025] 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.

[0026] 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.

[0027] Figure 15 is a schematic diagram illustrating the joint after removal of a portion of the lesion.

[0028] 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.

[0029] Figure 17 is another schematic diagram illustrating the joint ready for capsular closure.

[0030] Figures 18a through 18d are enlarged fragmentary views illustrating four exemplary embodiments for the cutting head of the cutting tool.

[0031] Figure 19 is a plan view of an exemplary template, shown to greater advantage than in Figure 2. DETAILED DESCRIPTION

[0032] Referring now to the drawings, 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. As shown in Figure 1 , 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. In the exemplary hip joint 18 shown, a lesion L is disposed adjacent a junction 26 between the femoral head 20 and the femoral neck 22. It will be understood that the location of the lesion L constitutes a desired location for performing the arthroscopic procedure. Further, 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. It will be understood that 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.

[0033] Referring to Figure 2, 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.

[0034] Referring again to Figure 1 , the system 10 may also include a depth guide 34. In the example shown, 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. Alternatively, 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. Again, the stops 40 and 42 cooperate to limit the

penetration of the cutting head 28 of the cutting tool 14 into the lesion L.

[0035] Referring now to Figures 18a through 18d, 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. In the example of Figure 18a, the rotatable end 44 is a disc 46 having a cutting edge 46a and a cutting face 46b. In the example of Figure 18b, 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. In the example of Figure 18c, the rotatable end 44 is a cone-shaped or truncated cone-shaped cutting tool 50, which rotates about the axis A. In the example of Figure 18d, 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.

[0036] Referring now to Figures 3 and 4, an alternative arrangement for the cutting guide or template 16 is shown. In the arrangement shown, the template 16 takes the form of a cylindrical guide 52, which is inserted through the opening of the MIS port 12. In the example shown, 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.

[0037] Referring now to Figures 5 through 17, an exemplary method of performing arthroscopic removal of the lesion L is shown. Figure 1 illustrates localization of the lesion L using a needle 54 such as a spinal needle. After suitable location of the lesion L, a dilator 56 is inserted at the location determined by the needle 54 as shown in Figure 6. As shown in Figures 7 through 9, 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. As shown in Figure 10, when the size of the opening 58 is large enough, the MIS port 12 can be inserted, and dilator or dilators 56 can be removed to permit incision of the joint capsule. As shown in Figure 1 1 , 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. [0038] Referring now to Figure 12, 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. For this stuff, the cutting head 24 will preferably take the form of a cutting burr 62. Alternatively, for this step the cutting head 24 may be any one of the examples shown in Figures 18a through 18d. As shown in Figure 13, the cutting head 28 of the cutting tool 14 is used to penetrate the cartilage a depth

approximately equal to the depth of the cutting tool. As shown in Figure 14, 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.

Thereafter, as illustrated in Figure 16, upon removal of the template any remaining portions of the lesion L can be removed, such that the joint is ready for capsule or closure as illustrated schematically in Figure 17.

[0039] Preferably, one assembled in accordance with the teachings of the disclosed examples, 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. However, as illustrated schematically in Figure 12, 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.

Claims

1 . A system for arthroscopically treating a lesion at a desired location adjacent a hip joint, the system comprising: an MIS port, the MIS port sized to permit access to the hip joint at the desired location, the MIS port further sized to permit visualization of the lesion at the desired location; a cutting tool, the cutting tool having a cutting head, the cutting tool adapted for placement into the MIS port to position the cutting head adjacent the lesion at the desired location; and a template, the template sized for placement through the MIS port to a position adjacent the lesion, the template further sized and 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.

2. The system of claim 1 , wherein the template comprises an edge guide to limit access of the cutting head to a desired area of the lesion.

3. The system of claim 1 or 2, wherein the template comprises a depth guide to limit access to a desired depth of the lesion.

4. The system of any of the preceding claims, wherein the cutting head includes a rotatable end portion, and wherein the cutting tool comprises a motor operatively coupled to the rotatable end portion.

5. The system of claim 4, wherein the rotatable end portion comprises a disc-shaped portion.

6. The system of claim 4, wherein the rotatable end portion comprises a conical portion.

7. The system of claim 6, wherein the conical portion is oriented coaxial with an axis of the cutting tool.

8. The system of claim 6, wherein the conical portion is oriented transversely relative to an axis of the cutting tool.

9. The system of claim 4, wherein the rotatable end portion is oriented transversely relative to an axis of the cutting tool.

10. A method of arthroscopically treating a lesion at a desired location adjacent a hip joint, the method comprising 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, and positioning the cutting head through the MIS port and adjacent the template and adjacent the lesion; 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.

1 1 . The method of claim 10, including providing the template with an edge guide to limit access of the cutting head to a desired area of the lesion.

12. The method of claim 10 or 1 1 , including providing the template with a depth guide to limit access to a desired depth of the lesion.

13. The method of any of the preceding claims, including 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.

14. The method of claim 10, including sizing the MIS port to permit visualization of the lesion through the MIS port.

15. The method of claim 10, further comprising providing the cutting head with a rotatable end portion, and operatively coupling a motor to the rotatable end portion.

16. The method of claim 15, including arranging the cutting tool to receive a selected one of a plurality of rotatable end portions, the plurality including a discshaped portion, a conical portion, or a transversely oriented portion.

17. The method of claim 10, including positioning the femoral head relative to the acetabulum to permit access to the labrum, and repairing a condition of the labrum.

18. The method of claim 10, including providing a distal end of the MIS port with flanges, incising the joint capsule, and placing the flanges beneath the joint capsule.

19. The method of claim 10, including using a dilator to dilate an opening after locating the lesion, and then placing the MIS port through the dilated opening.

20. The method according to any of the preceding claims, including visualizing the joint by placing an arthroscope into the MIS port.

21 . The method according to claim 20, including using the cutting tool while the arthroscope is in place.