Abstract:
A method of separating two articulating surfaces of a joint is provided. The method includes providing a distractor having a series of generally spheroidal members. The method also includes inserting the distractor into the joint, and moving the distractor to separate the two articulating surfaces.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a divisional of U.S. patent application Ser. No. 10/614,657, filed on Jul. 7, 2003, which is a divisional of U.S. patent application Ser. No. 09/838,456, filed on Apr. 19, 2001 which issued on Sep. 9, 2003 as U.S. Pat. No. 6,616,673. The disclosures of the above referenced applications are incorporated herein by reference. The disclosures of the above referenced applications are incorporated herein by reference. 
    
    
     BACKGROUND 
     The present disclosure generally relates to an orthopedic instrument used to distract a joint, and more particularly, to a segmented joint distractor which allows for access into a distracted joint. 
     Joint arthroscopy is a relatively young treatment modality for treating painful joints. Its primary function is to diagnose joint pathology. Additionally, debridement, joint flushing and smoothing of the joint surfaces has led to reduced pain and a return to more normal activities. 
     An important step in arthroscopy is to assure that not only are the bones of the joint properly aligned, but also that both joint surfaces are accessible. Failure of both joint surfaces being accessible can lead to significant trauma to the surrounding joint soft tissue, which leads to significant recovery time. 
     The joint surfaces are spanned by muscles, ligaments or other soft tissue. For example, in the knee joint, the collateral ligaments are both equally tight in the joint. This tension in the collateral ligaments prevents sideways toggle of the appendage. The ACL and PCL limit the amount of anterior and posterior motion in the knee joint. These ligaments limit the amount the joint can be separated to create access to the joint surfaces. 
     The knee is a superficial joint because there is little soft tissue between the skin and the joint as compared to the hip. Access is achieved by a combination of flexion and extension to give the clinician direct view of the various anatomic structures. At times, hand distraction and rotation can be used to increase exposure. 
     While the current disclosure has more application in total joint surgery where ligament balancing is key, it has uses in other surgical procedures. In another example, gaining access to the bearing surfaces of a hip joint with minimal tissue disruption is often complex and relatively ineffective. Current methods, for example, to perform hip arthroscopy utilize elongated arthroscopy instruments to obtain access to the joint which lies under many thick layers of muscle and soft tissue. Distraction normally is applied to the leg to create approximately 5 to 7 millimeters of joint displacement. Access to limited portions of the intra-articular area can then be achieved. 
     This distraction of the joint applies force to the patient&#39;s foot and a counterforce to the patient&#39;s groin area. This mode of distraction is only marginally effective. Possible side effects to this surgery include numbness, nerve damage, and impotence. Additionally, the immobilized leg is not free to be manipulated to allow visualization of the articular cartilage areas. 
     Other apparatus attempt to separate various inner body regions by use of a fluid operated regulator. Typically, a balloon is positioned at the desired location within the body for developing an atomic space at the desired location. The apparatus typically includes a tunneling member and an inflatable balloon. The tunneling member has a substantially rigid tubular shaft with proximal and distal ends and a passage extending through the ends, and having an opening in the proximal end to receive an inflatable balloon. The balloon generally comprises a substantially flexible, and preferably non-elastic, material having an inflatable space therein, defining a predetermined shape capable of assuming collapsed and inflated conditions. 
     Inherent with these types of balloon distractors, is that the surface which needs to be observed or worked on is often covered by the balloon material. Inherent in arthroscopic surgeries is a need to access joint surfaces. As such, what is needed then is a joint distractor that does not suffer from the above-mentioned disadvantages. This, in turn, will provide a substantially conforming joint distractor between the articular cartilage areas, allow for visualization of the articular cartilage areas, and allow for debridement, joint flushing, and smoothing of the joint surfaces. 
     SUMMARY 
     In accordance with the teachings of the present disclosure, a method of separating two articulating surfaces of a joint is provided. The method includes providing a distractor having a series of members. The method also includes inserting the distractor into the joint, and moving the distractor to separate the two articulating surfaces. 
     In one of various embodiments, a method of separating two articulating surfaces of a joint is provided. The method includes providing a distractor having a series of members. The method also includes inserting the distractor into the joint. The method further includes pulling the distractor through the joint to separate the two articulating surfaces. 
     The present disclosure further provides a method of separating two articulating surfaces of a joint. The method includes providing first handle operably interconnected to a series of members, and coupling the series of members together. The method also includes passing the first handle into the joint. The method includes moving the first handle to separate the two articulating surfaces, and inserting at least one instrument into a space defined by the members. 
    
    
     
       DRAWINGS 
       Still other advantages of the present disclosure will become apparent to those skilled in the art after reading the following specification and by reference to the drawings in which: 
         FIG. 1  discloses a top view of the compartmentalized joint distractor according to the teachings of an embodiment of the present disclosure; 
         FIG. 2  is a side view of the compartmentalized joint distractor as shown in  FIG. 1 ; 
         FIG. 3  is a view of the compartmentalized joint distractor of  FIGS. 1 and 2  shown disposed within a hip joint; 
         FIG. 4  is a view of an alternative embodiment of the present disclosure; 
         FIG. 5  is a side view of the alternative embodiment of  FIG. 4 ; 
         FIG. 6  is a view of a second alternative embodiment of the present disclosure; 
         FIG. 7  is a view of a third alternative embodiment of the present disclosure; 
         FIG. 8  is a view of a fourth alternative embodiment of the present disclosure; 
         FIG. 9  is a view of a fifth alternative embodiment of the present disclosure; 
         FIG. 10  is a view of a sixth alternative embodiment of the present disclosure; 
         FIG. 11  is a side view of the embodiment shown in  FIG. 10 ; and 
         FIG. 12  is a view of the compartmentalized joint distractor of  FIG. 10  distracting a joint. 
     
    
    
     DETAILED DESCRIPTION 
     The following description of the various embodiments concerning a joint distraction apparatus are merely exemplary in nature and not intended to limit the present disclosure, its application, or uses. Moreover, while the present disclosure is described in detail with respect to a hip joint, it will be appreciated by those skilled in the art that the present disclosure is clearly not limited to use in distracting a hip joint and may be applied to various other types of joints or body structures, as further discussed herein. 
     Referring to  FIGS. 1 and 2 , there is shown a joint distractor  20  according to the teachings of the various embodiments. The joint distractor  20  is composed of a pair of generally planar non-elastic polymer members  23  and  24 . These polymer members  23  and  24  are coupled together along the inside  19  and outside edges  26  to form a hollow toroid. Formed on the toroid is the series of hollow fluidly coupled generally spheroid members  21 . Each of the fluid containing bodies  21  is joined by the tube regions  22 . Prior to inflation, the distractor  20  is flat and the planar members  23  and  24  lie in contact with each other. 
     The fluid in the fluid containing bodies  21  functions to apply pressure to the generally planar elastic or non-elastic members  23  and  24 . The members  23  and  24  then in turn apply forces to the articulating surfaces  25  of the joint to separate them. This force is in direct opposition to the forces generated by the ligaments of the joint. 
     The inside edge  19  of the distractor defines a generally circular area  27  that generates the exposed joint surface  25 . These exposed surfaces can then be accessed by the many orthopedic instruments which can enter the generally circular area  27  by passing adjacent the tube regions  22 . 
     As shown in  FIG. 3 , uninflated distractor  20 ′ is positioned adjacent to the surfaces to be separated by insertion through a small incision. The femoral component  28  of the hip joint is partially distracted from the pelvis  29  only enough to position the uninflated distractor  20 ′ between the joint surfaces  25 . After insertion between the joint surfaces  25 , sterile fluid is injected under pressure by a pressurized fluid source such as a syringe into the sealed distractor  20 , filling the generally spheroid members  21 . 
     Once the pressurized fluid fills the generally spheroid members  21 , access to the articular cartilage surfaces  25  of the joint is available in the circular region  27 , by passing the orthopedic instruments between the inflated spheroids  21  via an appropriate incision. As best seen in  FIG. 3 , orthopedic instruments  37  can access the articular surface  25  adjacent to the tube region  22 . Each fluid distractor  20  preferably includes a valve  30  that regulates the fluid in and out of the spheroids  21 . The valve  30  functions to allow fluid into the distractor  20  while it is being pressurized. The sterile fluid can be removed from the distractor  20  by puncturing the surface  23  of the distractor or by releasing fluid through the valve  30 . 
       FIGS. 4 and 5  represent views of an alternative embodiment of the present disclosure. Shown is the toroidal joint distractor  31  which is formed by a pair of generally crescent shaped fluid filled spheroids  32  and  33 . Coupling the crescent shaped spheroids  32  and  33  are a pair of adjoining fluidly filled tube regions  22 . Although the toroidal distractor  31  has fewer tube regions  22  to insert orthopedic instruments  37 , the crescent shaped spheroids  32  and  33  provide a larger surface area which impart force on the articular surface  25 . The polymer members  23  and  24  forming the crescent shaped spheroids  27  and  28  can be coupled so as to form an angled wedge structure should a particular use call for one. 
     With reference to  FIG. 6 , there is shown a joint distractor  20  according to the teachings of a second alternative embodiment of the present disclosure. The joint distractor  20  is composed of two fluidly isolated chambers  53  and  54 . These chambers  53  and  54  are each formed by at least one generally spheroid member  21 . Each of the chambers  53  and  54  are capable of being filled by separate fluid sources through the tube regions  22   a  and  22   b  . Additionally, the separate regions are non-fluidly coupled at regions  55  and  56 . As is depicted in  FIG. 6 , any of the distractors of the present disclosure can have radio opaque materials  57  such as the wire shown in  FIG. 6 . These radio opaque materials  57  can take the form of particulate incorporated within the distractor devices  20 . When placed within a joint the joint distractor as depicted in  FIG. 6  can be used to vary the angle of the joint by increasing or decreasing the amount of fluids in the chambers  53  and  54 . By modifying the amount of fluid within the chamber, access to the joint can be obtained adjacent to tube regions  22 . 
       FIGS. 7 and 8  show side views of the third and fourth alternative embodiments of the present disclosure. Shown in  FIG. 7  is the connected tube region  22  disposed on the top surface of the distractor. This allows for access of the joint area under the tube region  22  and the spaces defined.  FIG. 8  shows a plurality of generally spheroidal members  21  coupled by tube members  22  located on the top and bottom surface of the joint distractor. The tube members define openings  58  between the tube members and the generally spheroidal bodies  21 . Access to the joint surfaces by medical instruments can be obtained adjacent the tube regions  22 . 
     With reference to  FIG. 9 , a fifth alternative embodiment of the present disclosure is shown. Shown is a distractor  36  having a series of generally spherical elements  38  on a cord  40  having handle elements  50 . The string of spherical elements  36 , which is pulled through a joint region, functions to separate and hold the joint articular cartilage surfaces  25  apart. The joint is first distracted slightly to separate the surfaces enough to allow passage of the distractor&#39;s cord  40 . The cord  40  is then pulled through the region from smallest diameter spherical element  42  to a point along the distractor that there is sufficient access space created (see  FIG. 12 ). Access to the joint can be obtained by the use of instruments placed in regions between the spherical elements  38 . The spherical elements  38  can be used to hold the surfaces apart after the joint has been distracted by applying forces to separate the members. It is envisioned that the spherical elements  38  be solid or fluid filled. 
     The series of adjacent spheres  38  are mounted onto a cord or articulating member  40 , which is made of fibers or wire by being integrally molded thereon. The spherical elements  38  have an increasing diameter from about 2 mm to about 10 mm, each spherical element  38  increasing in size by about 0.2 mm. The spherical elements  38  can be adjacent one another or can be spaced apart, leaving room between for access by orthopedic instruments  37 . 
     In another embodiment of the present disclosure, shown in  FIG. 10  is a top view of a segmented distractor  46  according to the teachings of a sixth alternative embodiment of the present disclosure. As can be seen, the distractor  46  has a series of generally circular distractor components  48 , each having the same diameter. Also shown are the handle members  50  which are used to pull the through the joint.  FIG. 11  shows a side view of the distractor  46  as shown in  FIG. 10 . As can be seen, the circular distractor components  48  have varying thicknesses. The thickness of the distractor components  48  increases from about 2 mm to about 10 mm. Each of these segments has a pair of generally parallel planar regions  51  and  52  with each adjoining distractor component  48  defining a slightly larger thickness. The planar regions optionally can have a slightly angled surface to assist in the facilitation of the separation of the joint. 
     A wide variety of features can be utilized in the various material disclosed and described above. The foregoing discussion discloses and describes the various embodiments of the present disclosure. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings that various changes, modifications, and variations can be made therein without departing from the true spirit and fair scope of the present disclosure.