Segmented joint distractor

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.

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's foot and a counterforce to the patient'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.

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 toFIGS. 1 and 2, there is shown a joint distractor20according to the teachings of the various embodiments. The joint distractor20is composed of a pair of generally planar non-elastic polymer members23and24. These polymer members23and24are coupled together along the inside19and outside edges26to form a hollow toroid. Formed on the toroid is the series of hollow fluidly coupled generally spheroid members21. Each of the fluid containing bodies21is joined by the tube regions22. Prior to inflation, the distractor20is flat and the planar members23and24lie in contact with each other.

The fluid in the fluid containing bodies21functions to apply pressure to the generally planar elastic or non-elastic members23and24. The members23and24then in turn apply forces to the articulating surfaces25of the joint to separate them. This force is in direct opposition to the forces generated by the ligaments of the joint.

The inside edge19of the distractor defines a generally circular area27that generates the exposed joint surface25. These exposed surfaces can then be accessed by the many orthopedic instruments which can enter the generally circular area27by passing adjacent the tube regions22.

As shown inFIG. 3, uninflated distractor20′ is positioned adjacent to the surfaces to be separated by insertion through a small incision. The femoral component28of the hip joint is partially distracted from the pelvis29only enough to position the uninflated distractor20′ between the joint surfaces25. After insertion between the joint surfaces25, sterile fluid is injected under pressure by a pressurized fluid source such as a syringe into the sealed distractor20, filling the generally spheroid members21.

Once the pressurized fluid fills the generally spheroid members21, access to the articular cartilage surfaces25of the joint is available in the circular region27, by passing the orthopedic instruments between the inflated spheroids21via an appropriate incision. As best seen inFIG. 3, orthopedic instruments37can access the articular surface25adjacent to the tube region22. Each fluid distractor20preferably includes a valve30that regulates the fluid in and out of the spheroids21. The valve30functions to allow fluid into the distractor20while it is being pressurized. The sterile fluid can be removed from the distractor20by puncturing the surface23of the distractor or by releasing fluid through the valve30.

FIGS. 4 and 5represent views of an alternative embodiment of the present disclosure. Shown is the toroidal joint distractor31which is formed by a pair of generally crescent shaped fluid filled spheroids32and33. Coupling the crescent shaped spheroids32and33are a pair of adjoining fluidly filled tube regions22. Although the toroidal distractor31has fewer tube regions22to insert orthopedic instruments37, the crescent shaped spheroids32and33provide a larger surface area which impart force on the articular surface25. The polymer members23and24forming the crescent shaped spheroids27and28can be coupled so as to form an angled wedge structure should a particular use call for one.

With reference toFIG. 6, there is shown a joint distractor20according to the teachings of a second alternative embodiment of the present disclosure. The joint distractor20is composed of two fluidly isolated chambers53and54. These chambers53and54are each formed by at least one generally spheroid member21. Each of the chambers53and54are capable of being filled by separate fluid sources through the tube regions22aand22b. Additionally, the separate regions are non-fluidly coupled at regions55and56. As is depicted inFIG. 6, any of the distractors of the present disclosure can have radio opaque materials57such as the wire shown inFIG. 6. These radio opaque materials57can take the form of particulate incorporated within the distractor devices20. When placed within a joint the joint distractor as depicted inFIG. 6can be used to vary the angle of the joint by increasing or decreasing the amount of fluids in the chambers53and54. By modifying the amount of fluid within the chamber, access to the joint can be obtained adjacent to tube regions22.

FIGS. 7 and 8show side views of the third and fourth alternative embodiments of the present disclosure. Shown inFIG. 7is the connected tube region22disposed on the top surface of the distractor. This allows for access of the joint area under the tube region22and the spaces defined.FIG. 8shows a plurality of generally spheroidal members21coupled by tube members22located on the top and bottom surface of the joint distractor. The tube members define openings58between the tube members and the generally spheroidal bodies21. Access to the joint surfaces by medical instruments can be obtained adjacent the tube regions22.

With reference toFIG. 9, a fifth alternative embodiment of the present disclosure is shown. Shown is a distractor36having a series of generally spherical elements38on a cord40having handle elements50. The string of spherical elements36, which is pulled through a joint region, functions to separate and hold the joint articular cartilage surfaces25apart. The joint is first distracted slightly to separate the surfaces enough to allow passage of the distractor's cord40. The cord40is then pulled through the region from smallest diameter spherical element42to a point along the distractor that there is sufficient access space created (seeFIG. 12). Access to the joint can be obtained by the use of instruments placed in regions between the spherical elements38. The spherical elements38can 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 elements38be solid or fluid filled.

The series of adjacent spheres38are mounted onto a cord or articulating member40, which is made of fibers or wire by being integrally molded thereon. The spherical elements38have an increasing diameter from about 2 mm to about 10 mm, each spherical element38increasing in size by about 0.2 mm. The spherical elements38can be adjacent one another or can be spaced apart, leaving room between for access by orthopedic instruments37.

In another embodiment of the present disclosure, shown inFIG. 10is a top view of a segmented distractor46according to the teachings of a sixth alternative embodiment of the present disclosure. As can be seen, the distractor46has a series of generally circular distractor components48, each having the same diameter. Also shown are the handle members50which are used to pull the through the joint.FIG. 11shows a side view of the distractor46as shown inFIG. 10. As can be seen, the circular distractor components48have varying thicknesses. The thickness of the distractor components48increases from about 2 mm to about 10 mm. Each of these segments has a pair of generally parallel planar regions51and52with each adjoining distractor component48defining 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.