Abstract:
A surgical assembly according to an exemplary aspect of the present disclosure includes, among other things, a housing, a first arm extending outside the housing and a linkage assembly housed by the housing and connected to the first arm. Movement of the linkage assembly inside the housing is linked to movement of the first arm outside of the housing.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This application claims priority to U.S. Provisional Application No. 61/865,329, which was filed on Aug. 13, 2013. 
     
    
     BACKGROUND 
       [0002]    This disclosure relates to orthopedic surgical instrumentation, and more particularly to a surgical impactor/extractor assembly and method of use for installing and/or removing a prosthetic device, such as a femoral implant or trial. 
         [0003]    Total or partial knee arthroplasty has been performed for many years to treat patients with diseased knee joints. Numerous cuts (i.e., resections) must be made in the femur to prepare the femur for receiving a prosthetic device. Surgical tools may be necessary for installing and/or removing prosthetic devices. Although impactor/extractor tools are known, additional advances in this field of technology are desired. 
       SUMMARY 
       [0004]    A surgical assembly according to an exemplary aspect of the present disclosure includes, among other things, a housing, a first arm extending outside the housing and a linkage assembly housed by the housing and connected to the first arm. Movement of a portion of the linkage assembly inside the housing is linked to movement of the first arm outside of the housing. 
         [0005]    In a further non-limiting embodiment of the foregoing assembly, the portion of the linkage assembly is movable in a vertical direction to move the first arm in a horizontal direction. 
         [0006]    In a further non-limiting embodiment of either of the foregoing assemblies, a second arm is mounted inside the housing. The first arm and the second arm move in opposite directions in response to movement of the portion of the linkage assembly. 
         [0007]    In a further non-limiting embodiment of any of the foregoing assemblies, the linkage assembly includes a first link and a second link. 
         [0008]    In a further non-limiting embodiment of any of the foregoing assemblies, the first link is connected between an adjustment bar or a glide sleeve and the second link, and the second link is connected between the first link and the first arm. 
         [0009]    In a further non-limiting embodiment of any of the foregoing assemblies, a dial is mounted inside the housing and is rotatable to move an adjustment block toward or away from the housing. 
         [0010]    In a further non-limiting embodiment of any of the foregoing assemblies, a dial is mounted outside the housing and is rotatable to move an adjustment block toward or away from the housing. 
         [0011]    In a further non-limiting embodiment of any of the foregoing assemblies, the linkage assembly includes at least one link that travels between opposing ends of a slot of the housing during movement of the first arm. 
         [0012]    In a further non-limiting embodiment of any of the foregoing assemblies, a portion of the first arm protrudes from the housing and is connectable to a prosthetic device. 
         [0013]    In a further non-limiting embodiment of any of the foregoing assemblies, a lever is movable to lock or unlock the first arm relative to the housing. 
         [0014]    A surgical assembly according to another exemplary aspect of the present disclosure includes, among other things, a housing, a first arm that protrudes from a first side of the housing, a second arm that protrudes from a second side of the housing, and a linkage assembly connected to the first arm and the second arm and configured to move the first arm and the second arm between a first position farther away from the housing and a second position closer to the housing. 
         [0015]    In a further non-limiting embodiment of any of the foregoing assemblies, the linkage assembly includes a central rod, a glide sleeve, a first link and a second link housed inside the housing. 
         [0016]    In a further non-limiting embodiment of any of the foregoing assemblies, the linkage assembly includes an adjustment bar, a first link, a second link, and a biasing member. 
         [0017]    In a further non-limiting embodiment of any of the foregoing assemblies, the linkage assembly includes an actuator movable in a vertical direction to move the first arm and the second arm in opposite horizontal directions. 
         [0018]    In a further non-limiting embodiment of any of the foregoing assemblies, a lever is movable to lock or unlock at least one of the first arm and the second arm relative to the housing. 
         [0019]    A surgical method according to another exemplary aspect of the present disclosure includes, among other things, moving a portion of a surgical assembly in a first direction and moving an arm of the surgical assembly in a second, different direction in response to the step of moving the portion to configure the surgical assembly for connection to a prosthetic device. 
         [0020]    In a further non-limiting embodiment of the foregoing method, the moving step includes either moving an actuator or moving a glide sleeve in the first direction. 
         [0021]    In a further non-limiting embodiment of either of the foregoing methods, the method includes positioning the surgical assembly relative to the prosthetic device and moving the arm from an expanded position to a collapsed position to connect the arm to the prosthetic device. 
         [0022]    In a further non-limiting embodiment of any of the foregoing methods, the method includes tightening or loosening an adjustment block of the surgical assembly relative to the prosthetic device. 
         [0023]    In a further non-limiting embodiment of any of the foregoing methods, the method includes using the surgical assembly to insert the prosthetic device into a joint or using the surgical assembly to remove the prosthetic device from the joint. 
         [0024]    The embodiments, examples and alternatives of the preceding paragraphs, the claims, or the following description and drawings, including any of their various aspects or respective individual features, may be taken independently or in any combination. Features described in connection with one embodiment are applicable to all embodiments, unless such features are incompatible. 
         [0025]    The various features and advantages of this disclosure will become apparent to those skilled in the art from the following detailed description. The drawings that accompany the detailed description can be briefly described as follows. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0026]      FIG. 1  schematically illustrates a knee joint that includes a prosthetic device. 
           [0027]      FIG. 2  illustrates a surgical impactor/extractor assembly. 
           [0028]      FIG. 3  illustrates a first positioning of arms of a surgical impactor/extractor assembly. 
           [0029]      FIG. 4  illustrates a second positioning of arms of a surgical impactor/extractor assembly. 
           [0030]      FIG. 5  illustrates a linkage assembly of a surgical impactor/extractor assembly. 
           [0031]      FIG. 6  illustrates a handle of a surgical impactor/extractor assembly. 
           [0032]      FIGS. 7 ,  8 ,  9 ,  10 ,  11 ,  12  and  13  schematically illustrate a method of using a surgical impactor/extractor assembly to either implant or extract a prosthetic device into/from a joint. 
           [0033]      FIG. 14  illustrates a second embodiment of a surgical impactor/extractor assembly. 
           [0034]      FIG. 15  illustrates a side view of the surgical impactor/extractor assembly of  FIG. 14 . 
           [0035]      FIGS. 16 and 17  illustrate a third embodiment of a surgical impactor/extractor assembly. 
           [0036]      FIGS. 18 and 19  illustrate additional features of the surgical impactor/extractor assembly of  FIGS. 16 and 17 . 
       
    
    
     DETAILED DESCRIPTION 
       [0037]      FIG. 1  illustrates a portion of a joint  10 , such as the knee joint of a human body. The joint  10  includes a femur  12 , but could include other or additional bones, including but not limited to, a tibia and a patella (not shown). Diseased portions of the femur  12  have been removed and replaced with a prosthetic device  14  that is positionable within the joint  10 . In one embodiment, the prosthetic device  14  is a femoral implant. In another embodiment, the prosthetic device  14  is a trial that may be used to confirm the appropriate size of a femoral implant. The prosthetic device  14  may be of any size, shape or configuration and is patient specific. 
         [0038]    This disclosure is directed to surgical impactor/extractor assemblies that can be used to insert and/or extract the prosthetic device  14  into/from the joint  10 . Although the embodiments of this disclosure are presented in the context of implanting/removing a femoral implant or trial into/from a knee joint, this disclosure could extend to other implants and to other surgeries. 
         [0039]      FIGS. 2 ,  3  and  4  illustrate a surgical impactor/extractor assembly  20  that may be used to either insert or extract a prosthetic device. The surgical impactor/extractor assembly  20  may include a housing  22 , one or more arms  24  (two arms are included in one non-limiting embodiment), and an actuator  26  for moving the arms  24  relative to the housing  22  in order to connect the surgical impactor/extractor assembly  20  to a prosthetic device. 
         [0040]    The housing  22  may embody any of a variety of shapes and can include either a unitary structure or multiple parts. The size and shape illustrated in these figures is not intended to limit this disclosure. The housing  22  may additionally include multiple openings, slots, formations, retaining features etc. for accommodating the other parts of the surgical impactor/extractor assembly  20 . In one embodiment, the housing  22  is made of a metallic material, such as stainless steel, although other materials are also contemplated. 
         [0041]    In one non-limiting embodiment, two arms  24  are mounted inside the housing  22 . The arms  24  may be generally L-shaped and include tabs  32  for connecting to pockets of a prosthetic device (see, for example,  FIGS. 9 ,  10  and  11 ). At least a portion of each arm  24  protrudes from the housing  22  in order to connect to a prosthetic device. 
         [0042]    In one embodiment, the arms  24  are moveable between a first position X (see  FIG. 3 ) and a second position X′ (see  FIG. 4 ) relative to the housing  22 . The first position of the arms  24  is a collapsed position and the second position is an expanded position. Of course, the arms  24  could also be moved to any position between the first position X and the second position X′. 
         [0043]    Movement of the arms  24  is guided by slots  48  that are formed in the housing  22 . For example, the slots  48  provide a track for guiding movement of a linkage assembly  38  that is connected between the arms  24  and the actuator  26 , as is further discussed below. In one embodiment, the slots  48  are curved slots. 
         [0044]    The actuator  26 , which may be part of the linkage assembly  38 , is moveable in a first direction D 1  in order to move the arms in a second direction D 2 . In other words, vertical movement of the actuator  26  may be transferred to horizontal movement of the arms  24 . In one embodiment, the direction D 2  is perpendicular to the direction D 1 . 
         [0045]    The actuator  26  is moveable within another slot  28  formed in the housing  22 . In one embodiment, the actuator  26  includes a cam lever  30  that is moveable between a locked position Y (see  FIGS. 3 and 4 ) and an unlocked position Y′ (see  FIG. 2 ). In the locked position Y, the cam lever  30  is pressed against the housing  22  and is parallel thereto. The cam lever  30  is moved away from the housing  22  to a non-parallel position in the unlocked position. The cam lever  30  may be rotated to the unlocked position Y′ in order to release the actuator  26  for movement within the slot  28 , or may be flipped to the locked position Y in order to lock the actuator  26  and maintain a positioning of the arms  24  relative to the housing  22 . 
         [0046]    A dial  34 , such as a threaded knob, may be rotatably mounted inside the housing  22 . The dial  34  partially protrudes from a window  68  of the housing  22  so that it can be accessed by a surgeon or other user. In one embodiment, the dial  34  is turned, either in a clockwise or counter-clockwise direction, in order to move an adjustment block  36  either toward or away from a prosthetic device. In other words, rotary movement of the dial  34  is transferred to linear movement of the adjustment block  36 , such as through a threaded pin (not shown), in order to loosen or tighten the grip of the surgical impactor/extractor assembly  20  on a prosthetic device. 
         [0047]    Referring to  FIG. 5 , with continued reference to  FIGS. 2 ,  3  and  4 , the linkage assembly  38  of the surgical impactor/extractor assembly  20  is housed within the housing  22  and connects between the actuator  26  and the arms  24  to link movement of the actuator  26  with movement of the arms  24 . For example, the linkage assembly  38  transfers movement of the actuator  26  in the first direction D 1  to the arms  24  in order to move the arms  24  in the second direction D 2 , or to any position between the first and second positions X, X′. 
         [0048]    In one embodiment, the linkage assembly  38  includes an adjustment bar  40 , links  42 , H-links  44 , and a biasing member  45 . The H-links  44  are connected at a first end to the arms  24  by one or more pins  46  and at a second end to the links  42  by additional pins  70 . The links  42  extend between the H-links  44  and the adjustment bar  40 . The links  42  may be received by a rod  76  that protrudes from the adjustment bar  40 . The cam lever  30  of the actuator  26  may be pinned to the rod  76  (see  FIG. 3 ). The biasing member  45 , which may be spring, biases the linkage assembly  38  toward either the first position X or the second position X′ of the arms  24 . 
         [0049]    In operation, movement of cam lever  30  of the actuator  26  is transferred through the adjustment bar  40 , then through the links  42 , and then through the H-links  44  in order to move the arms  24 . In one embodiment, the slots  48  of the housing  22  guide movement of the H-links  44  of the linkage assembly  38 . The pins  46 ,  70  travel between opposing ends  72 ,  74  of the slots  48  to guide the arms  24  between the first position X and the second position X′. The pins  70  may strike the end  72  to limit further travel of the arms  24  beyond the first position X. Similarly, the pins  46  may strike the end  74  to limit further travel of the arms  24  beyond the second position X′. The slots  48  can be designed to provide any amount of travel between the first position X and the second position X′. 
         [0050]      FIG. 6  illustrates a handle  50  that can be utilized with the surgical impactor/extractor assembly  20  of  FIGS. 2-5 . The handle  50  includes a grip  52  and a shaft  54  that extends from the grip  52 . A slot  56  may be formed at a distal end of the shaft  54  for connecting the handle  50  to the housing  22  of the surgical impactor/extractor assembly  20 . In one embodiment, the slot  56  is a T-slot that may be connected relative to a key seat feature  58  that extends from the housing  22 . 
         [0051]    The key seat feature  58  may extend from a portion of the housing  22  that is on an opposite side from the adjustment block  36  (see  FIG. 2 ). In one non-limiting embodiment, the handle  50  is attached to the housing  22  by inserting the key seat feature  58  into the slot  56  of the handle  50  and then rotating the handle  50  to lock it in position relative to the key seat feature  58 . 
         [0052]      FIGS. 7-13 , with continued reference to  FIGS. 1-6 , schematically illustrate a method for utilizing a surgical impactor/extractor assembly  20  to either insert or extract a prosthetic device  14  into/from a joint. In one non-limiting embodiment, the surgical impactor/extractor assembly  20  is used to insert or extract a femoral implant or trial during a total knee arthroplasty procedure. However, the surgical impactor/extractor assembly  20  could be used for other procedures within the scope of this disclosure. In addition, it should be understood that fewer or additional steps than are recited below could be performed and that the recited order of steps is not intended to limit this disclosure. 
         [0053]    As illustrated by  FIG. 7 , the cam lever  30  of the actuator  26  may be pivoted to the unlocked position Y′ to prepare to move the arms  24  into a position acceptable to connect to a prosthetic device  14 . Once unlocked, the actuator  26  can be moved in the first direction D 1  to move the arms  24  to an expanded position X′ (see  FIG. 8 ). The surgical impactor/extractor assembly  20  may then be positioned relative to the prosthetic device  14 . 
         [0054]    Referring to  FIG. 9 , the actuator  26  is next moved in a direction D 3  that is opposite of the first direction D 1  to collapse the arms  24  to the first position X such that the arms  24  connect to the prosthetic device  14 . As shown in  FIG. 10 , the prosthetic device  14  includes one or more pockets  60  on its underside  61  that can receive the tabs  32  of the arms  24 . Proper positioning of the tabs  32  relative to the pockets  60  is illustrated by  FIG. 11 . 
         [0055]    Once the arms  24  are properly positioned to hold the prosthetic device  14 , the dial  34  may be rotated in order to tighten or loosen the adjustment block  36  relative to the prosthetic device  14  (see  FIG. 12 ). Thereafter, as shown in  FIG. 13 , the surgical impactor/extractor assembly  20  may be used to either insert the prosthetic device  14  or remove it from a joint  10 , such as a knee joint. 
         [0056]      FIGS. 14 and 15  illustrate a second embodiment of a surgical impactor/extractor assembly  120 . In this disclosure, like reference numerals designate like elements where appropriate and reference numerals with the addition of 100 or multiples thereof designate modified elements that are understood to incorporate the same features and benefits of the corresponding original elements. 
         [0057]    The assembly  120  is similar to the assembly  20  but includes a different actuator  126 . In this embodiment, the actuator  126  includes a button  62  that may be moved within a slot  64  of a cover  66  in order to effectuate movement of the arms  124  to the expanded position illustrated by  FIG. 14 . The cover  66  may be attached to a housing  122  of the assembly  120 . A linkage assembly  138  transfers movement of the button  62  to the arms  124 . 
         [0058]    As best shown in  FIG. 15 , the cover  66  may include a plurality of teeth  90  for locking a positioning of the button  62  relative to the housing  122 . The button  62  can be moved in and out of engagement with the teeth  90  to lock and release the actuator  126  for controlling a positioning of the arms  124 . The assembly  120  can be used in a method that is similar to the one described with reference to  FIGS. 7-13  in order to implant/extract a prosthetic device. 
         [0059]      FIGS. 16 and 17  illustrate yet another impactor/extractor assembly  220  that can be used to insert or extract a prosthetic device  14 . The impactor/extractor assembly  220  may include a housing  222 , arms  224 , a dial  234  and a handle  250 . In one non-limiting embodiment, the arms  224  are generally L-shaped and at least partially protrude outside of the housing  222 . The arms  224  may include tabs  232  for engaging pockets of the prosthetic device  14 . In one embodiment, the arms  224  are moveable between the expanded position EP of  FIG. 16  and the collapsed position CP of  FIG. 17  relative to the housing  222  to disconnect/connect to the prosthetic device  14 . 
         [0060]    Movement of the arms  224  may be guided by slots  248  that are formed in the housing  222 . For example, the slots  248  provide a track for guiding movement of a linkage assembly  238  that is connected between the arms  224  and a central rod  299 , as is further discussed below. 
         [0061]    The dial  234  may be rotatably mounted to the housing  222 . In one embodiment, the dial  234  is turned, either in a clockwise or counter-clockwise direction, in order to move an adjustment block  236  either toward or away from the prosthetic device  14 . In other words, rotary movement of the dial  234  may be transferred to linear movement of the adjustment block  236  through the central rod  299  in order to loosen or tighten the grip of the surgical impactor/extractor assembly  220  on the prosthetic device  14 . In one embodiment, rotary movement of the dial  234  advances a threaded portion  297  of the central rod  299  in a direction V 1  (see  FIG. 19 ), which is generally toward the prosthetic device  14 . 
         [0062]    The handle  250  may include a grip  252  and a shaft  254  that extends from the grip  252 . The shaft  254  may engage the dial  234  to connect the handle  250  to the housing  222  of the surgical impactor/extractor assembly  220 . In one embodiment, the shaft  254  is welded to the dial  234 . However, the handle  250  could be connected to the dial  234 , or to another portion of the housing  222 , in any known manner. 
         [0063]    The impactor/extractor assembly  220  may additionally include one or more levers  275  that are connected to the housing  222 . The levers  275  can engage the arms  224  in a variety of positions to lock movement of the arms  224  relative to the housing  222 . 
         [0064]    Additional details concerning the linkage assembly  238  and the levers  275  of the impactor/extractor assembly  220  are illustrated in the cross-sectional views of  FIGS. 18 and 19 . In one embodiment, the linkage assembly  238  includes the central rod  299 , a glide sleeve  235 , links  242 , and H-links  244 . The H-links  244  are connected at a first end to the arms  224  by one or more pins  246  and at a second end to the links  242  by additional pins  270 . The links  242  extend between the H-links  244  and the glide sleeve  235 . The links  42  may include openings  247  for receiving pins  245  of the glide sleeve  235 . The glide sleeve  235  is received over the central rod  299  and may travel vertically along the length of the central rod  299  to move the linkage assembly  238 . 
         [0065]    For example, movement of the glide sleeve  235  in a first direction D 1  moves the arms  224  in a second direction D 2 . In other words, vertical movement of the glide sleeve  235  may be transferred to horizontal movement of the arms  224 . In one embodiment, the direction D 2  is perpendicular to the direction D 1 . The slots  248  of the housing  222  (see  FIGS. 16 and 17 ) guide the movement of the H-links  244  of the linkage assembly  238  to guide the arms  224  between the expanded and collapsed positions. 
         [0066]    In one embodiment, the levers  275  are mounted to the housing  222  via pins  277 . The levers  275  may be biased, with a spring  279 , toward the arms  224  such that teeth  281  of the levers  275  engage corresponding teeth  283  of the arms  224 . In the engaged or biased position, the levers  275  lock the positioning of the arms  224  by engaging the teeth  281 ,  283  together. In another embodiment, the levers  275  may be actuated or tripped to release the teeth  281 ,  283  from one another and allow movement of the arms  224 . For example, legs  285  of the levers  275  may be pressed inwardly toward the housing  222  to overcome the biasing force of the springs  279 , thereby releasing the teeth  281 ,  283  from one another to allow the arms  224  to move horizontally to a desired position. 
         [0067]    Although the different non-limiting embodiments are illustrated as having specific components, the embodiments of this disclosure are not limited to those particular combinations. It is possible to use some of the components or features from any of the non-limiting embodiments in combination with features or components from any of the other non-limiting embodiments. 
         [0068]    It should be understood that like reference numerals identify corresponding or similar elements throughout the several drawings. It should also be understood that although a particular component arrangement is disclosed and illustrated in these exemplary embodiments, other arrangements could also benefit from the teachings of this disclosure. 
         [0069]    The foregoing description shall be interpreted as illustrative and not in any limiting sense. A worker of ordinary skill in the art would understand that certain modifications could come within the scope of this disclosure. For these reasons, the following claims should be studied to determine the true scope and content of this disclosure.