Abstract:
A retractor system, kit and method of use includes a plurality of retractors for use in retracting a wound during a minimally-invasive hip replacement surgery to define an access space to a surgical site is discussed. Each of the retractors comprises a handle portion configured to be held by a user, a curved bend portion distal of the handle portion, and a wound contact portion attached to the curved bend portion. The wound contact portion is configured to contact tissue of the wound when at least a portion of the retractor is inserted through a skin incision that defines the wound. Each retractor also has a distal portion disposed distally of the wound contact portion, wherein the wound contact portion has a generally curved cross-sectional profile perpendicular to its length that is configured to prevent necrosis of the tissue during retraction. In addition, the cross-sectional profile provides an improved line of sight during the surgical procedure. Furthermore, the cross-sectional profile prevents the jamming of a cutting device, such as a reamer inserted through the incision, while the retractors retract the wound.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation of U.S. patent application Ser. No. 13/194,176, filed on Jul. 29, 2011, now abandoned, which claims priority from U.S. Pro. Pat. App. Ser. Nos. 61/368,754, filed Jul. 29, 2010; 61/368,761, filed Jul. 29, 2010; and 61/368,768 filed Jul. 29, 2010. 
     
    
     1. FIELD OF THE INVENTION 
       [0002]    The present invention is directed to minimally invasive surgery, and more particularly to retractor tools for use in minimally invasive hip replacement surgery. 
       2. PRIOR ART 
       [0003]    Approximately 200,000 hip replacements are performed each year in the United States and the number is expected to continue to grow as the population continues to age. The usual reasons for hip replacement are osteoarthritis, rheumatoid arthritis and traumatic arthritis, all of which can cause pain and stiffness that limit mobility and the ability to perform daily living activities. Hip replacement surgery is usually performed where other measures (e.g. physical therapy, medications, and walking aids) are unable to overcome the chronic pain and disability associated with these conditions. 
         [0004]    Various techniques are used by orthopedic surgeons to perform hip replacements. These include the following approaches: anterior, antero-lateral, lateral, postero-lateral and posterior. The posterior and postero-lateral approaches account for approximately 60%-70% of hip replacement surgeries. 
         [0005]    Traditional hip replacement surgery involves an open surgical procedure and extensive surgical dissection. However, such procedures require a longer recovery period and rehabilitation time for the patient. The average hospital stay for open hip replacement procedures is 4-5 days, followed in most cases by extensive rehabilitation. 
         [0006]    More recently, there has been considerable interest and research done in Minimally Invasive Surgery (MIS), including the use of MIS procedures in connection with hip replacement surgery. In comparison with the traditional open surgical approach, MIS hip replacement surgeries involve fewer traumas to the muscles surrounding the hip joint. Specifically, fewer muscles that help to stabilize the hip joint are cut in MIS hip replacement surgeries, reducing the risk of dislocation of the hip surgery and speeding recovery. Patients spend less time in the hospital and return to normal life activities more quickly. 
         [0007]    MIS approaches use smaller surgical openings, which require specialized instruments to perform hip replacement procedures. Some of these instruments are surgical retractors used to retract tissue. This allows visualization of the surgical site and insertion of surgical tools, such as reamers, broaches and ultimately surgical implants. However, the use of conventional retractors in MIS hip surgery has often resulted in necrosis of the tissue that borders the incision and against which the retractors are pressed to maintain the access path to the surgical site. This necrosis can necessitate the surgical excision of such tissue. Additionally, conventional hip surgery retractors have a flat and generally rectangular cross-sectional profile. This frequently results in impingement on the rotating reamer as the latter is inserted through the incision to ream the acetabulum. Accordingly, there is a need for an improved retractor tool for use in MIS orthopedic procedures (e.g., hip replacement surgery) that addresses some of the shortcomings in the existing surgical retractors noted above. 
       SUMMARY OF THE INVENTION 
       [0008]    In accordance with one embodiment, a retractor for use in minimally invasive hip replacement surgery is provided. The retractor comprises a handle portion configured to be held by a user and a curved bend portion distal to the handle portion. A wound contact portion is attached to the curved bend portion, the wound contact portion configured to contact tissue of a wound when at least a portion of the retractor is inserted through a skin incision that defines the wound. In addition, a distal portion disposed distally of the wound contact portion, contacts the bony anatomy, particularly of the acetabulum and proximal femur. The wound contact portion has a generally curved cross-sectional profile perpendicular to its length that is configured to prevent necrosis of wound tissue during retraction of the wound with the retractor. 
         [0009]    In accordance with another embodiment, a retractor with an alternate design for use in minimally invasive hip replacement surgery is provided. This alternate retractor embodiment comprises a handle portion, configured to be held by a user that is centrally located between two wound contact portions. Two distal wound contact portions extend distally from the centrally located handle portion. The wound contact portions are configured to contact tissue of a wound when at least a portion of the retractor is inserted through a skin incision that defines the wound. 
         [0010]    Both retractor embodiments comprise a shaft that connects the handle portion to the wound contact portion and distal portion of the retractor. In addition to reducing tissue necrosis, the curved cross-sectional profile of the shaft provides an improved line of site during surgical procedures. The curved cross-sectional profile of the shaft minimizes visual obstruction thereby resulting in improved control of the tool during the surgical procedure. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0011]      FIG. 1  is a schematic drawing illustrating an anatomical region of the hip area. 
           [0012]      FIG. 2  is a schematic drawing of an area of the pelvic region of a human. 
           [0013]      FIG. 3  is a schematic drawing of a pelvic girdle of a human. 
           [0014]      FIG. 4  is a perspective view illustrating an embodiment of a piriformis retractor. 
           [0015]      FIG. 4A  is a cross-sectional view of a shaft of the piriformis retractor embodiment shown in  FIG. 4 . 
           [0016]      FIG. 5  shows a top view of the piriformis retractor embodiment shown in  FIG. 4 . 
           [0017]      FIG. 6  illustrates a side view of the piriformis retractor embodiment shown in  FIG. 4 . 
           [0018]      FIG. 7  is a perspective view of an embodiment of a posterior acetabular retractor. 
           [0019]      FIG. 7A  is a cross-sectional view of a shaft of the posterior acetabular retractor embodiment shown in FIG. 
           [0020]      FIG. 8  shows a top view of the posterior acetabular retractor embodiment shown in  FIG. 7 . 
           [0021]      FIG. 9  shows a side view of the posterior acetabular retractor embodiment shown in  FIG. 7 . 
           [0022]      FIG. 10  illustrates a perspective view of an embodiment of an anterior retractor. 
           [0023]      FIG. 10A  shows a cross-sectional view of a shaft of the anterior retractor embodiment shown in  FIG. 10 . 
           [0024]      FIG. 10B  shows a perspective view of an alternate embodiment of an anterior retractor. 
           [0025]      FIG. 11  shows a top view of the anterior retractor embodiment. 
           [0026]      FIG. 11A  illustrates a top view of the alternate embodiment of the anterior retractor shown in  FIG. 10A . 
           [0027]      FIG. 12  shows a side view of the anterior retractor shown in  FIG. 10 . 
           [0028]      FIG. 13  illustrates a perspective view of an embodiment of a femoral neck retractor. 
           [0029]      FIG. 13A  shows a cross-sectional view of a shaft of the femoral neck retractor embodiment shown in  FIG. 13 . 
           [0030]      FIG. 14  illustrates a side view of the embodiment of the femoral neck retractor shown in  FIG. 13 . 
           [0031]      FIG. 15  shows a top view of the femoral neck retractor shown in  FIG. 13 . 
           [0032]      FIG. 16  illustrates a perspective view of an embodiment of a double ended retractor. 
           [0033]      FIG. 16A  shows a cross-sectional view of a shaft of the double ended retractor embodiment shown in  FIG. 16 . 
           [0034]      FIG. 17  shows a side view of the double ended retractor shown in  FIG. 16 . 
           [0035]      FIG. 18  shows a top view of the double ended retractor shown in  FIG. 16 . 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0036]    Now turning to the figures,  FIGS. 1-3  illustrate some features of the musculoskeletal anatomy, specifically the hip region  10  of a human.  FIGS. 4-18  illustrate embodiments of orthopedic retractor tools of the present invention. As shown in  FIGS. 1-3 , there are several muscles that act to stabilize the femoral head of a femur bone  12  in the acetabulum ( FIG. 2 ). These muscles include the short external rotator muscles (i.e., the piriformis  14 , the superior gemellus  16 , the obturator internus  18 , the inferior gemellus  20 , the obturator externus (not shown) and the quadratus femoris  22 ). The gluteus maximus (not shown) extends over these short external rotator muscles. The femoral head  26  is enclosed in a fibrous capsule  28 , which attaches to the hip bone outside the acetabular lip  30  and to the base of the neck of the femoral head  26 . 
         [0037]    The MIS posterior hip replacement approach has traditionally involved first a skin incision, followed by an incision in the fascia lata, and then detachment of the short external rotator muscles of the hip  10 . However, it has been found that through a modified MIS posterior hip replacement approach only the piriformis muscle  14 , and occasionally the superior gemellus  16 , requires detachment. Through this modified MIS approach, the obturator internus  18 , inferior gemellus  20 , the obturator externus (not shown) and the quadratus femoris  22  are always left intact. 
         [0038]    In a preferred embodiment, the surgeon begins by making an incision  32  in a posterior side of a patient&#39;s hip  10  (e.g., on the buttocks) on a side proximate the hip joint to be treated. The surgeon can then separate fibers in the gluteus maximus longitudinally (not cut transversely) using a trans-gluteus maximus approach to access the external rotators of the hip  10  and then the hip capsule  28 . The present approach does not involve an incision in the fascia lata, which is required in other posterior surgical approaches, as well as in the antero-lateral and lateral approaches to the hip  10 . The surgeon can then detach the pirifromis  14 , and sometimes the superior gemellus  16 , which, as discussed above, are the only short external rotator muscles that are detached with this approach. This approach preserves the obturator internus  18 , inferior gemellus  20 , obturator externus (not shown) and quadratus femoris  22 , which provides significant additional stability to the hip  10 , and contributes to a faster post operative recovery. 
         [0039]    Once access to the acetabulum  34  is achieved, the surgeon can advance a cutting tool  36  such as a reamer, through the wound defined by the incision  32  to the surgical site proximate the acetabulum  34  and prepare the bone for implantation of a prosthetic cup (not shown). In an embodiment, the femoral head.  26  is also removed and a prosthetic hip stem (not shown) is implanted into the femur  12 , the prosthetic hip stem comprises a modular femoral head that articulates with the acetabular cup prosthesis. Once the prosthesis is in place, the capsule  28  can be closed, followed by closure of the incision  32 . 
         [0040]      FIGS. 4 ,  4 A,  5  and  6  show a preferred embodiment of a retractor  100 , namely, a piriformis retractor which is also generally referred to as an inferior acetabular retractor. The retractor  100  has a handle portion  102 , a bend portion  104 , a wound contact portion  106  and a distal portion  108 . As shown, the distal portion  108  can have a generally rectangular cross-section. Although a rectangular cross-section is preferred, the distal portion  108  may have a curved cross-section. In a preferred embodiment, a length  112  of the retractor  100  extends from a proximal end  110  to the wound contact portion  106 . It is preferred that the length  112  ranges from about 200 mm to about 400 mm. Furthermore, a shaft  114  extends therebetween the wound contact portion  106  and the handle portion  102 . 
         [0041]    The shaft  114  preferably has a curved cross-sectional profile perpendicular to its length, and more preferably a round cross-sectional profile as shown in  FIG. 4A . In a preferred embodiment, the shaft  114  has a thickness  116  that ranges from about 5 mm to about 10 mm in diameter. However, it is contemplated that the thickness  116  of the shaft  114  may be larger than 10 mm or smaller than 5 mm. 
         [0042]    The bend portion  104  resides therebetween the handle portion  102  and the distal portion  108  of the retractor  100  as shown in  FIG. 5 . The bend portion  104  has a bend angle  118  that generally measures about 90°. The bend angle  118  is measured between horizontal axis A-A, co-axial to the handle portion  102 , and perpendicular axis E-B. Alternatively, bend portion  104  may have a bend angle  118  that ranges from about 70° to about 130°. 
         [0043]    The handle portion  102  resides at the proximal end  110  of the retractor  100 . In a preferred embodiment, the handle portion  102  has a rectangular cross-section with a generally planar top  120  and bottom surface  122 . Alternatively, the handle portion  102  may be constructed with a round or oval cross-section. The handle  102  can have a thickness  124  that may be larger or smaller than the thickness  116  of the shaft  114 . An opening  126  may extend through the handle portion  102  from the top surface  120  through the bottom surface  122 . 
         [0044]    The distal portion  108  of the retractor  100  preferably has a height  128  ranging from about 50 mm to about 100 mm, a thickness  130  of about 3 mm and a maximum width  134  of about 12 mm. Furthermore, a height  132  extends between the distal end  138  of the retractor  100  and a bottom surface  122  of the handle portion. It is preferred that this height  132  range from about 100 mm to about 200 mm. 
         [0045]    In a preferred embodiment, the distal portion  108  has a generally rectangular cross-section with a distal portion width  134  that may range from about 2 mm to about 20 mm. In a preferred embodiment, the width  134  of the distal portion  108  gradually decreases to a pointed end. As illustrated, a prong  136  extends to the distal end  138  of the retractor  100 . The prong  136  preferably bends in an upwardly and outwardly direction from perpendicular axis B-B as shown in  FIGS. 4 and 6 . In a preferred embodiment, prong  136  bends outwardly or inwardly about 1° to about 15° from perpendicular axis B-B. However, it is contemplated that the retractor  100  may be constructed with other dimensions that are larger or smaller than those given above. 
         [0046]      FIGS. 7 ,  7 A,  8  and  9  illustrate a preferred embodiment of a retractor  200  generally referred to as a “posterior acetabular retractor”. As illustrated, the retractor  200  generally comprises an “S” shaped curve portion  202  distal of its handle portion  204 . The MS″ shaped curve portion  202  comprises a first bend portion  206  and a second bend portion  208 . As illustrated, the retractor  200  further comprises a wound contact portion  210  and a distal portion  212 . A shaft  214  extends distally from the handle portion  204  to a distal end  216  of the retractor  200 . 
         [0047]    In an embodiment, a length  218  of the retractor  200  extends from the proximal end  220  to the wound contact portion  210 . In a preferred embodiment, the length  218  ranges from about 300 mm to about 400 mm. A thickness  222  of the shaft  214  has a diameter that ranges between about 5 mm to about 10 mm. 
         [0048]    Similar to retractor  100  as previously discussed, the handle portion  204  of retractor  200  resides at the proximal end  220  of the retractor  200 . Like retractor  100 , the handle portion  204  has a generally rectangular cross-section with a generally planar top  224  and bottom surface  226 . Alternatively, the handle portion  204  may be constructed with a round or oval cross-section. The handle portion  204  can have a handle thickness  228  that may be larger or smaller than the thickness  222  of the shaft  214 . An opening  230  may extend through the handle portion  204  extending from the top surface  224  through the bottom surface  226 . 
         [0049]    The first bend portion  206  has a first radius of curvature  232 . The first radius of curvature  232  is defined by the radius that resides along a surface  234  of the first bend portion  206  that extends from a horizontal axis CC of the handle portion  204  to an apex point  236 , positioned between the first and second bend portions  206 ,  208 . The first bend portion  206  generally has a curved cross sectional profile perpendicular to its length, and more preferably, a round cross-sectional profile. It is preferred that the first radius of curvature  232  ranges from about 5 mm to about 25 mm. 
         [0050]    The second bend portion  208  has a second radius of curvature  238 . The second radius of curvature  238  is defined by the curved radius that resides along a surface  240  of the bend portion  208  from the apex point  236  to the end of the distal portion  216 . It is preferred that the second bend portion  208  has a second radius of curative  238  that ranges from about 2 mm to about 10 mm. The second bend portion  208  generally has a curved cross sectional profile perpendicular to its length, and more preferably, a round cross-sectional profile. A prong  242  preferably extends outwardly and upwardly from an edge  244  of the distal portion  212 . As illustrated in  FIG. 7 , the width  250  of the prong  242  gradually decreases to a pointed end which corresponds to the distal end  216  of the retractor  200 . 
         [0051]    In a preferred embodiment, the distal portion  212  is of a generally rectangular shape with a distal portion width  246 , length  252  and thickness  254 . In a preferred embodiment, the width  246  of the distal portion  212  ranges from about 10 mm to about 20 mm, the distal portion length  252  ranges from about 15 mm to about 30 mm and the distal portion thickness  254  ranges from about 1 mm to about 5 mm. As shown in  FIG. 7 , the prong  242  extends distally from an edge  244  of the distal portion  212 . In a preferred embodiment, the prong  242  extends about 2 mm to about 10 mm from the edge  244  of the distal portion  212 . Furthermore, the prong  242  may extend upwardly or downwardly from the edge  244  of the distal portion  212 . Additionally, a height  248  between the distal end  216  of the retractor  200  to the bottom surface  226  of the handle portion  204  ranges from about 100 mm to about 200 mm. 
         [0052]    Alternatively, retractor  200  may be designed without the second bend portion  208 , comprising only the first bend portion  206 . In this alternative embodiment, the distal portion  212  extends downwardly from horizontal axis CC such that the distal portion is generally about perpendicular to the horizontal axis C-C. 
         [0053]      FIGS. 10 ,  10 A,  103 ,  11 ,  11 A and  12  illustrate embodiments of a retractor  300  generally referred to as an “anterior retractor”. As illustrated, retractor  300  has a generally curved shape with a distal portion  302  that extends from a handle portion  304  at a proximal end  308 . A wound contact portion  310  extends therebetween. 
         [0054]    In a preferred embodiment, the retractor  300  has a bend portion  312  that is defined by a curved surface  314  ( FIG. 12 ) that extends between the distal portion  302  and the handle portion  304 . The bend portion  312  further has a radius of curvature  316  that extends from an axis DD that is co-planar with the handle portion  304  to the distal portion  302 . In a preferred embodiment, the radius of curvature  316  ranges from about 10 mm to about 50 mm. 
         [0055]    In a preferred embodiment, the retractor  300  has a length  318  that extends between the proximal end  308  and the wound contact portion  310  in a preferred embodiment, the length  318  ranges from about 200 mm to about 300 mm. Residing between the handle portion  304  and the distal end portion  302  is a shaft  320 . The shaft  320  generally has a curved cross sectional profile perpendicular to its length, and more preferably, a round cross-sectional profile ( FIG. 10A ). In a preferred embodiment, a thickness  342  of the shaft  320  is of a diameter that ranges from about 5 mm to about 10 mm. 
         [0056]    Similarly to retractors  100  and  200  as previously discussed, the handle portion  304  of retractor  300  resides at the proximal end  308 . Like retractors  100  and  200 , the handle portion  308  has a generally rectangular cross-section with a generally planar to  322  and bottom surface  324 . Alternatively the handle portion  304  may be constructed with a round or oval cross-section. An alternate handle  306  design is shown in  FIGS. 103 and 11A . As illustrated, these alternative handle portion embodiments generally have a handle portion thickness  326  that is greater than shown in  FIGS. 10 and 12 . Furthermore, the alternative handle portion  306  embodiment features a generally frustro-conical handle nose  330 . Either handle portion embodiment  304  or  306  may have a handle thickness  326  that can be larger or smaller than the thickness of the shaft  320 . An opening  328  may extend through the handle portion  304  from the top surface  322  through the bottom surface  324 . The handle portion  304 ,  306  preferably has a thickness  326  ranging from about 3 mm to about 15 mm. Furthermore, a height  340  extends between the distal end  302  of the retractor  300  and the bottom surface  324  of the handle portion  304 . In a preferred embodiment, the height  340  ranges from about 100 mm to about 200 mm. 
         [0057]    The distal portion  302  of retractor  300  preferably has a rectangular cross-sectional profile. However, the distal portion  302  may have a curved or round cross-sectional profile. In a preferred embodiment, the distal portion has a generally planar surface  328  that extends from the wound contact portion  310  to a distal end  332  of the distal portion  302 . Preferably, the distal surface  328  has a width  334  that ranges from about 5 mm to about 20 mm. It is also preferred that the distal portion  302  may have a thickness  338  that ranges from about 1 mm to about 5 mm. 
         [0058]    In the embodiment illustrated in  FIGS. 10 and 11 , the width  334  of the distal portion  302  gradually narrows to a point at the end  332  of the distal portion  302 . This point as illustrated in  FIGS. 10 and 11 , generally curls upwardly and outwardly from the planar surface  328 . However, it is contemplated that this point  332  may also curl downwardly and way from the planar surface  328 . 
         [0059]    Alternatively, as illustrated in  FIGS. 103 and 11A , a prong  336  extends from an edge  339  of the distal portion  302  of the retractor  300 . In this alternative embodiment, the width of the prong  336  is substantially and abruptly smaller than the width of the edge  339  of the distal portion  302 . The end of the prong  336 , i.e., the end  332  of the distal portion  302 , may curve upwardly or downwardly away from the plane of the distal portion surface  328 . 
         [0060]      FIGS. 13 ,  13 A,  14  and  15  illustrate an embodiment of a retractor  400  generally referred to as a “femoral neck retractor”. The retractor  400  comprises a handle portion  402 , a bend portion  404 , a wound contact portion  406 , and a distal portion  408 . 
         [0061]    As illustrated, a shaft  410  extends therebetween the distal end portion  408  and the handle portion  402 . In a preferred embodiment, the shaft  410  generally has a curved cross-sectional profile perpendicular to its length, and more preferably, a round cross-sectional profile ( FIG. 13A ). The shaft  410  preferably has a thickness  412  with a diameter that ranges from about 2 mm to about 20 mm. A length  414  extends from a proximal end  434  to the end of the distal portion  408  of the retractor  400 . In a preferred embodiment, the length  414  ranges from about 200 mm to about 400 mm. 
         [0062]    Similarly to the retractors  100 ,  200  and  300  previously discussed, the handle portion  402  of retractor  400  resides at the proximal end  434  of the retractor  400 . Like retractors  100 ,  200  and  300 , the handle portion  402  generally embodies a rectangular cross-sectional profile with a generally planar top  436  and bottom surface  438 . Alternatively, the handle portion  402  may be constructed with a round or oval cross-section. The handle thickness  440  may be larger or smaller than the thickness of the shaft  410 . An opening may extend through the handle portion  402  from the top surface  436  through the bottom surface  438 . The handle portion  402  preferably has a thickness  440  ranging from about 3 mm to about 15 mm. Furthermore, a height  432  extends between the distal end portion  408  of the retractor  400  and the bottom surface  438  of the handle portion  402 . In a preferred embodiment, the height  432  ranges from about 100 mm to about 200 mm. 
         [0063]    In an embodiment illustrated in  FIGS. 13 ,  14  and  15 , the distal end portion  408  comprises a claw portion  416 . More preferably, the claw portion  416  comprises at least one prong  418 . These prongs  418  extend distally from a surface  420  of the claw  416 . An inlet  422  residing between the two prongs  418  provides a space that separates the prongs  418 . A claw radius of curvature  424  defines the opening of the inlet  422  between the prongs  418 . In a preferred embodiment, the radius of curvature  424  ranges from about 5 mm to about 25 mm. 
         [0064]    It is further preferred that the claw portion  416  is inclined about a bottom claw point  426 . An incline angle  442  is defined as the angle between a horizontal axis E-E that intersects and extends parallel to the bottom point  426  and imaginary line F-F that is tangent of a bottom surface  444  of the claw  416 . In a preferred embodiment, the claw  416  has an incline angle  442  ranging from about 5° to about 25°. 
         [0065]    It is additionally preferred that the claw surface  420  extends from an inlet apex  428  to a portion  430  between the proximal end of the claw portion  416  and the distal end of the shaft  410 . Furthermore, the curved surface  420  of the claw  416  is preferably depressed inwards towards the body of the claw  416 , thereby creating an inclined or “wedge like” surface  420  that resides between the end of the prongs  418  and a proximal end of the distal portion  408 . This inclined or “wedge like” surface  420  of the claw  416  assists and provides additional engagement of the femoral neck retractor  400 . The retractor  400  further has a shaft thickness  412  with a diameter ranging from about 5 mm to about 10 mm. 
         [0066]      FIGS. 16 ,  16 A,  17  and  18  illustrate embodiments of a retractor  530  generally referred to as a “double ended retractor”. The retractor  500  comprises a handle portion  502 , a first bend portion  504 , a second bend portion  506 , a first wound contact portion  508 , a second wound contact portion  510 , a first distal end portion  512 , and a second distal end portion  514 . A surgeon can therefore use one or both of the first and second distal end portions  512 ,  514  during an orthopedic surgical procedure. 
         [0067]    As illustrated, the handle portion  502  is located between the first and second distal end portions  512 ,  514 . A shaft  516  extends from a left side  518  and right side  520  of the handle portion  502 . The shaft  516  connects the handle portion  502  to the respective distal end portions  512 ,  514 . In a preferred embodiment, the shaft  516  generally has a curved cross-sectional profile perpendicular to its length, and more preferably, a round cross-sectional profile ( FIG. 16A ). The shaft  516  preferably has a thickness  522  with a diameter that ranges from about 5 mm to about 10 mm. Furthermore, the overall length  528  of retractor  500  extending from the first bend portion  504  to the second bend portion  506 , preferably ranges from about 200 mm to about 400 mm. 
         [0068]    Residing between the handle portion  502  and the first distal end portion  512  is the first bend portion  504 . The first wound contact portion  508  resides therebetween the first distal end portion  512  and the first bend portion  504 . 
         [0069]    The first bend portion  504  is defined by a first bend angle  524  that generally measures about 90°. The first bend angle  524  is measured between horizontal axis GG, co-axial to the handle portion  502 , and perpendicular axis H-H. Although a 90° first bend angle  524  is preferred, the angle  524  may range from about 70° to about 130°. 
         [0070]    Additionally, residing between the handle portion  502  and the second distal end portion  514  is a second bend portion  506 . A second wound contact portion  510  resides therebetween the second distal end portion  514  and the second bend portion  506 . 
         [0071]    The second bend portion  506  is defined by a second bend angle  526  that generally measures about 90°. The second bend angle  526  is measured between horizontal axis G-G, co-axial to the handle portion  502 , and perpendicular axis I-I. Although a 90° second bend angle  526  is preferred, the angle  526  may range from about 70° to about 130° Furthermore, the first and second angles  524 ,  526  may or may not be equal. 
         [0072]    The first distal end portion  512  extends from the distal end of the first wound portion  508  to a distal end  530  of the first distal end portion  512 . The first distal end portion  512  preferably has a generally rectangular cross-section. However, the distal portion  512  may have a curved or round cross-sectional profile. A first claw portion  532  preferably′ comprising at least one prong  534  extends to the end  530  of the first distal end portion  512 . The claw portion may or may not be positioned such that it curves inwardly and outwardly from perpendicular axis H-H as shown in  FIG. 17 . 
         [0073]    Additionally, it is preferred that the first distal end portion  512  comprises a planar first distal end portion surface  536 . Although this surface  536  may not necessarily be constructed such that it is planar. Instead, it may be designed with a curved surface. This surface  536  enables the user to place the end of the retractor  530  between muscles and/or tissue with increased precision and ease. In a preferred embodiment a length  538  of the first distal end portion surface  538  is from about 20 mm to about 60 mm. Furthermore, the first distal end portion  512  has a thickness  540  that ranges from about 2 mm to about 10 mm and a first distal end width  542  that ranges from about 5 mm to about 30 mm. A first distal end portion height  544  preferably extends from the distal end  530  of the first distal end portion  512  to the first bend portion  504 . In a preferred embodiment, the first distal end portion height  544  ranges from about 50 mm to about 150 mm. 
         [0074]    The second distal end portion  514  extends from the distal end of the second wound portion  510  to a distal end  546  of the second distal end portion  514 . The second distal end portion  514  preferably has a generally rectangular cross-section. However, the distal portion  514  may have a curved or round cross-sectional profile. A second claw portion  548  preferably comprising at least one prong  534  extends to the end  545  of the second distal end portion  514 . The second claw portion  548  may or may not be positioned such that it curves inwardly from perpendicular axis I-I as shown in  FIG. 17 . Alternatively, the second claw portion  548  may be positioned outwardly from perpendicular axis I-I. 
         [0075]    It is further preferred that the second distal end portion  514  comprise a planar second distal end portion surface  550 . However, this surface  550  may not necessarily be constructed such that it is planar. Instead, it may be designed with a curved surface. This surface  550  enables the user to place the end of the retractor  546  between muscles and/or tissue with increased precision and ease. 
         [0076]    In a preferred embodiment, the length  552  of the second distal end portion surface  550  ranges from about 10 mm to about 30 mm. Furthermore, the second distal end portion  514  has a thickness  554  from about 2 mm to about 10 mm and a second claw width  556  that preferably ranges from about 2 mm to about 20 mm. A second distal end portion height  558  extends from the distal end  546  of the second distal end portion  514  to the second bend portion  506 . In a preferred embodiment, the second distal end portion height  558  ranges from about 20 mm to about 80 mm. 
         [0077]    Advantageously, the curved cross-section of the retractors  100 ,  200 ,  300 ,  400  and  500  inhibit necrosis of the tissue of the incision, that contacts the wound contact portions  106 ,  210 ,  310 ,  406 ,  508 ,  510  thereby allowing a surgeon to perform the surgical procedure without traumatizing the tissue. This helps reduce the length of the surgical procedure and retain the tissue of the tissue generally intact. Additionally, the curved cross-sectional profile and reduced cross-sectional dimensions of the retractor  500  allows the retractor or multiple retractors to be placed in a variety of positions within the incision while allowing the insertion of other surgical tools (e.g. reamer) through the access space defined through the incision. 
         [0078]    Additionally, unlike conventional retractors, which have a generally flat and rectangular cross-sectional profile, the curved cross-sectional profile and reduced cross-sectional dimensions of the retractors  100 ,  200 ,  300 ,  400  and  500  helps prevent contact with the reamer when the latter is inserted through the access space defined by the incision and operated to ream the acetabulum. Though conventional retractors with smaller widths have been tried, the reduction in width generally resulted in a decreased retractor strength that can lead to damage of the retractor. In contrast, the retractors  100 ,  200 ,  300 ,  400  and  500  described above inhibit such jamming with the reamer while retaining sufficient strength to inhibit breaking of the retractors  100 ,  200 ,  300 ,  400  and  500  during the surgical procedure. 
         [0079]    In one embodiment, one or more of at least one of the retractors  100 ,  200 ,  300 ,  400  and  500  of  FIGS. 4-18  can be provided as part of a kit. However, in another embodiment, fewer or more retractors can be provided as part of the kit, each retractor having a different shape, with each retractor  100 ,  200 ,  300 ,  400  and  500  having a generally round cross-sectional profile or generally oval cross-sectional profile at the location where the retractor engages the tissue defined by the incision. The retractors  100 ,  200 ,  300 ,  400  and  500  can be made of any suitable known material for use in surgical procedures. Preferred examples of such materials include, but are not limited to, stainless steel, MP35N, aluminum, as well as polymeric and ceramic materials. 
         [0080]    Of course, the forgoing description is that of certain features, aspects and advantages of the present invention, to which various changes and modifications can be made without departing from the spirit and scope of the present invention. Moreover, the retractors need not feature all of the objects, advantages, features and aspects discussed above. Thus, for example, those of skill in the art will recognize that the invention can be embodied or carried out in a manner that achieves or optimizes one advantage or a group of advantages as taught herein without necessarily achieving other objects or advantages as may be taught or suggested herein. In addition, while a number of variations of the invention have been shown and described in detail, other modifications and methods of use, which are within the scope of this invention, will be readily apparent to those of skill in the art based upon this disclosure. It is contemplated that various combinations or sub-combinations of these specific features and aspects of embodiments may be made and still fall within the scope of the invention. Accordingly, it should be understood that various features and aspects of embodiments may be made and still fall within the scope of the invention. Accordingly, it should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the discussed retractor system and kit. Additionally, one of ordinary skill in the art will recognize that the retractor embodiments described herein are not limited for use in hip replacement surgeries, or for use in orthopedic surgical procedures, but can be used in other surgical procedures (e.g., abdominal or spinal).