Patent Publication Number: US-2015073420-A1

Title: Femoral elevator

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to orthopaedic devices, and, more particularly, to femoral elevators. 
     2. Description of the Related Art 
     Hip surgery can require using a support for a femur. Such a support is known which connects to a specialized surgical table. 
     What is needed in the art is a femoral elevator which is simple in design and that does not require a specialized surgical table. 
     SUMMARY OF THE INVENTION 
     The present invention provides a femoral elevator that is simple in design and that does not require a specialized surgical table. 
     The invention in one form is directed to a bone elevator system which includes: a bone hook; a first coupling device; an elevator arm member including a substantially straight first elongate arm and a substantially straight second elongate arm which is offset from and fixedly coupled with the first elongate arm, the first coupling device coupling the first elongate arm with the bone hook, the second elongate arm configured for being coupled, by way of a second coupling device, with an anchoring post. 
     The invention in another form is directed to a method for using a bone elevator system, the method including: providing a bone hook, a first coupling device, and an elevator arm member including a substantially straight first elongate arm and a substantially straight second elongate arm which is offset from and fixedly coupled with the first elongate arm; coupling, using the first coupling device, the first elongate arm with the bone hook; coupling, using the second coupling device, the second elongate arm with an anchoring post. 
     An advantage of the present invention is that it provides a surgical instrument to be used in minimally invasive surgery hip arthroplasty procedure. 
     Another advantage of the present invention is that it provides a device for hip joint reconstruction that can optionally be used with an anterior surgical approach. The device is a hip femoral elevator which optionally can be used as an anterior approach hip femoral elevator. Advantages of the anterior approach include little detachment of muscle from bone (thereby decreasing recovering time and improving post-operative mobility) and a smaller incision. Disadvantages of the anterior approach include difficulty in exposing the proximal femur and a specialized surgical table is thereby recommended. Such a specialized surgical table can be the HANA® table. However, the present invention provides a device that facilitates exposure of the proximal femur without using a specialized surgical table, such as the HANA® table. The present invention can thus optionally be used with a standard surgical bed or table. Application of the present invention is not limited to the anterior surgical approach. 
     Yet another advantage of the present invention is that the L-shaped elevator arm member, together with the post coupling device, facilitate movement in all six degrees of freedom and provide an additional seven and one-half inches of extension above the table (the table on which the surgical patient lies). 
     Yet another advantage is that the bone hook coupling device and the bone hook of the bone elevator system of the present invention together have an “open” design so as to facilitate movement of the bone hook coupling device and the bone hook about and/or along the elevator arm member. The bone hook coupling device can be hooked onto the elevator arm member after the construct (including the post rail, the post coupling device, and the elevator arm member) is in position. Similarly, the bone hook can be attached to the bone hook coupling device after this construct is in position. 
     Yet another advantage is the bone elevator system of the present invention can be a femoral elevator. As such, the femoral elevator of the present invention is a reusable device that can be used to facilitate exposure of the femur during a surgical procedure. The femoral elevator can be attached to the rail of an operating room surgical bed/table. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The above-mentioned and other features and advantages of this invention, and the manner of attaining them, will become more apparent and the invention will be better understood by reference to the following description of embodiments of the invention taken in conjunction with the accompanying drawings, wherein: 
         FIG. 1  is a perspective view of the bone elevator system of the present invention; 
         FIG. 2  is a partially exploded, perspective view of the rail post of the bone elevator system of  FIG. 1 ; 
         FIG. 3  is a cross-sectional view of the rail post of  FIG. 1  taken along line  3 - 3  of  FIG. 1 ; 
         FIG. 4  is an exploded, perspective view of the post coupling device of the bone elevator system of  FIG. 1 ; 
         FIG. 5  is a side view of a passageway of the post coupling device of  FIG. 4 , with portions broken away; 
         FIG. 6  is an exploded, perspective view of the elevator bar member of the bone elevator system of the  FIG. 1 ; 
         FIG. 7  is an exploded, perspective view of the bone hook coupling device of the bone elevator system of  FIG. 1 ; 
         FIG. 8  is an exploded, perspective view of the bone hook coupling device of the bone elevator system of  FIG. 1 ; 
         FIG. 9  is a cross-sectional, perspective view of the ratchet mechanism of the bone elevator system of  FIG. 1  taken along line  9 - 9  of  FIG. 7 ; and 
         FIG. 10  is an exploded, perspective view of the lateral retention ring assembly of the bone elevator system of  FIG. 1 . 
     
    
    
     Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate one embodiment of the invention, and such exemplifications are not to be construed as limiting the scope of the invention in any manner. 
     DETAILED DESCRIPTION OF THE INVENTION 
     Referring now to the drawings, and more particularly to  FIG. 1 , there is shown a bone elevator system  10  which generally includes an anchoring post  12 , a post coupling device  14 , an elevator arm member  16 , a lateral retention ring assembly  18 , a bone hook coupling device  20 , and a bone hook  22 . 
       FIGS. 1-3  show anchoring post  12 . Anchoring post  12  serves to anchor and thereby support post coupling device  14 , elevator arm member  16 , lateral retention ring assembly  18 , bone hook coupling device  20 , and bone hook  22  to a support mechanism, such as a surgical bed or surgical table. According to one embodiment of the present invention, anchoring post  12  is a vertical rail post  12 , as shown in the figures. Rail post  12  stands substantially vertically and is mounted to a rail  24 , which can be a bed rail or a table rail. This bed or table is not shown in the drawings, but it is understood that rail  24  can extend substantially horizontally along the side of the table or bed on which a medical patient lies during a surgical procedure. Thus, rail post  12  is configured for coupling with rail  24 . Rail post  12  is configured for sliding substantially horizontally along rail in either direction (as shown by double-arrow  26 ) and can be selectively positioned in a plurality of positions along rail. As shown in  FIGS. 2 and 3 , rail post  12  can be a rail post assembly. As an assembly, rail post  12  can include a post rod  28 , handle assembly  30 , a clamp housing  32 , a clamp  34 , a locking nut  36 , an adjustment nut  38 , clamp cover  40 , and a bar  42 . Certain components (not necessarily all) of rail post  12  are known. 
     Post rod  28  is an elongate rod and has a top portion and a bottom portion. The top portion of post rod  28  includes an elongate blind hole  44 , which can have a cone-shaped terminating end. The top portion further includes two opposing threaded holes each of which threadably receives a ball plunger  46 . Ball plunger  46  can include a ball (which is biased outwardly) and a nylon locking insert (Nylok), and, in general, the ball plunger  46  can be made of 303 series stainless steel (such as part no. SSB-46P from Vlier Eng. Corp.); this is provided by way of example and not by way of limitation. Ball plungers  46  compress onto post rod  28  and thus provide some resistance to handle assembly  30  coming out of blind hole  44  of post rod  28 , although a surgeon, for example, can readily move post rod  28  to overcome the compressive force of ball plungers  46 . Ball plungers  46  can also provide a tactile sensation to the user, to include when the distal end of handle  56  (which forms a stepped portion of handle  56  and thus has a greater radius than other portions of handle  56 ) passes adjacent to or by ball plungers  46  during use of handle assembly  30 ). The top portion further includes two opposing holes each of which receives a pin  48  which serves as a handle stop (to stop handle  56 ). Thus, during use when a surgeon pulls cap assembly  30  up from hole  44 , the stepped distal end of handle  56  is prevented from being fully withdrawn from post rod  28  by pins  48 . Each pin  48  can be made of DIN 1.4301 or 1.4305 German stainless steel; this is provided by way of example and not by way of limitation. Pins  48  can be welded to post rod  28 . Pins  48  can protrude (for example, approximately 0.25 mm) into the elongate blind bore  44  in two places and must clear the inside diameter of post rod  28  so as to serve as a handle stop. Thus, pins  48  captures handle  56  in the vertical direction relative to post rod  28 . Communicating with the centrally located elongate blind hole  44  are opposing holes  50 ,  52  in post rod  28 , hole  50  being elliptical, hole  52  also being elliptical but being open on top and not extending down as far as hole  50 . The bottom portion of post rod  28  is threaded. Post rod  28  can be made of DIN 1.4305 German; this is provided by way of example and not by way of limitation. 
     Handle assembly  30  mounts to the upper portion of post rod  28  but can be detached therefrom. Handle assembly  30  includes a cap  54  and a handle  56 . Cap  54  includes a hole  58  in which one end of handle  56  is attached and welded thereto; that is, at this end, there is a weld all around this end and hole  58  (and assembly of cap  54  and handle  56  includes grinding and polishing smooth to match radius of cap  54 ). Cap  54  can be made of DIN 1.4301 German stainless steel; this is provided by way of example and not by way of limitation. Handle  56  is an elongate rod. Handle  56  can be made of DIN 1.4301 German stainless steel; this is provided by way of example and not by way of limitation. During use, handle assembly  30  can be pulled partially out of blind hole  44 , pins  48  preventing handle assembly from being pulled all of the way out from post rod  28 . Further, holes  50  and  52  cooperate with handle  56  so that handle assembly  30  can be used as a turning mechanism to turn post rod  28 , this turning of post rod  28  causing clamp  34  to clamp down onto rail  24  or to be released from rail  24  (depending upon the direction of turning).  FIG. 3  shows schematically that handle assembly  30  can be pulled partially out of hole  44  (the schematic depiction of handle assembly  30  extending to the left of the primary drawing in  FIG. 3 . Then, handle assembly  30  can be rotated approximately ninety degrees in holes  50  and  52  so that handle assembly  30  can be used as a turning mechanism (as indicated by the schematic depiction of handle assembly  30  in  FIG. 3  that is perpendicular to rail post  28 ). More specifically, the larger hole  50  provides clearance to allow the distal end of handle  56  to rotate clear of post rod  28 , while the smaller hole  52  allows the portion of handle nearer to cap  54  to rest within hole  52  upon rotation of handle assembly  30  ninety degrees. These holes  50  and  52  thus capture handle  56  in a horizontal position with appropriate pressure by the user. 
     Clamp housing  32  includes a space that houses clamp  34 , adjusting nut  38 , and locking nut  36 . Clamp housing  32  includes a threaded through-hole  60  which is threadably connected to the bottom of bar  42  (which can be referred to as a grooved support cover  42 ). Through-hole  60  also receives the bottom portion of post rod  28  therethrough. Clamp  34  can be made of AlMgSi 0.5 or AlMgSi 1 German Aluminum and can have a blue anodized finish; this is provided by way of example and not by way of limitation. Holes  65 , provided in clamp housing  32 , are 180° apart from one another. Additional holes (which are also 180° apart from one another and are comparable in diameter to holes  65 ) are provided in clamp housing  32  at ninety degrees to holes  65 ; these two additional holes are not shown in the figures. Thus, these four holes are spaced ninety degrees apart from one another about clamp housing  32 . Four corresponding holes can also be drilled into bar  42  and threaded (these holes in clamp housing  32  can be drilled at the same time as the corresponding holes in bar  42 , or they can be drilled separately). These four holes in clamp housing  32  and these four holes in bar  42  receive set screws (not shown in the figures) therein; that is, hole  65  which aligns with a single hole in bar  42  together threadably receive one set screw, the other aligned holes each receiving a single set screw as well. These four set screws can be made of M4 DIN 916 V2A, which is provided by way of example and not by way of limitation. These four set screws can be secured within these corresponding holes by Loctite epoxy (by applying the epoxy before and/or after threading the screws in the holes). These set screws serve to resist torque applied to bar  42  and thus provide a mechanical fixation of clamp housing  32  to bar  42 . 
     Locking nut  36  is fixedly secured to a bottom portion of post rod  28  by way of a pin  62  (by way of example and not by way of limitation, this pin  62  can be made of DIN 1.4301 or 1.4305 German stainless steel). During assembly, using a pilot hole extending radially on locking nut (this pilot hole may be formed in only one wall of locking nut), a hole can be drilled through locking nut  36  and post rod  38 , and pin  62  can be attached in this hole. Locking nut  36  can rotate within the space of clamp housing  32  and serves to keep the bottom portion of post rod  28  within the space of clamp housing  32  and can serve to prevent clamp  34  from moving too far up post rod  28  during rotation of post rod  28 . Locking nut  36  can be made of CuSn6 or CuSn8 German bronze, and the finish can be chrome plated; this is provided by way of example and not by way of limitation. Adjustment nut  38  is positioned within a side-facing through-hole of clamp  34  and is threaded onto the bottom portion of post rod  28  below locking nut  36  (post rod  28  also extending through a top hole in clamp  34 , this top hole and the side-facing through-hole of clamp  34  being in communication with one another). As post rod  28  is rotated by a user, adjustment nut  38  is caused to translate up and down (depending upon the direction of rotation of post rod  28 ) on the threaded portion of post rod  28 . As adjustment nut  38  moves up and down on post rod  28 , clamp  34  correspondingly moves up and down on post rod  28  and thereby can tighten onto or loosen from the horizontal rail  24 , thereby selectively securing clamp  34  to rail  24  or releasing clamp  34  from rail  24 . Adjustment nut  38  can be made of CuSn6 or CuSn8 German bronze; this is provided by way of example and not by way of limitation. 
     Clamp  34  moves up and down on post rod  28  by way of adjustment nut  38 . Clamp  34 , when in an engagement position, can contact a bed or table rail  24  and clamp the rail post  12  in position on the rail  24 . Clamp  34  can be released from rail  24  so that rail post  12  can be moved to another position on rail  24 . Clamp  34  can be made of 1.4305 German stainless steel and have a satin finish; this is provided by way of example and not by way of limitation. 
     Clamp cover  40  can be screwed to clamp housing  32  with two flathead screws  64  (by way of example and not by way of limitation, flathead screws  64  can be made of DIN 1.4301 or 1.4305 German stainless steel). Clamp cover  40  can be made of 1.4301 German stainless steel and can have a satin finish; this is provided by way of example and not by way of limitation. Clamp cover  64  can include a through-hole  66  which can be used to insert a lubricant. 
     Bar  42  can also be referred to as a grooved support cover or a sleeve. Bar  42  has a longitudinally extending passageway  68  therethrough and can thus be deemed to be hollow. Post rod  28  is positioned within this passageway  68 . Bar  42  has an externally threaded section  70  on the bottom portion of bar  42 . This threaded section  70  of bar  42  is threaded into the through-hole  60  of clamp housing  32  and is thereby affixed thereto. Bar  42  does not rotate with post rod  28 . Bar  42  further includes a radially outwardly facing peripheral surface which has a plurality of grooves  72  running longitudinally (that is, axially) on bar  42 . Each groove  72  can be spaced apart from an adjacent groove  72  by eight degrees (this is provided by way of example and not by way of limitation). Grooves  72  can be formed by a milling operation (where tool is moving and bar  42  remains constant). Grooves  72  provide positive engagement with post coupling device  14  while still allowing for adjustment at eight degree increments. A top portion of bar  42  can be positioned over a bushing  74 . Bushing  74  can be formed generally as an annular ring. Bushing  74  can surround post rod  28 . Bushing  74  can rotate with post rod  28 , at least intermittently. Bar  42  can be made of DIN 1.4301 or 1.4305 German stainless steel; this is provided by way of example and not by way of limitation. Bushing  74  can be made of bronze, for example (but not by way of limitation), CuSn6 or CuSn8 German bronze. Bushing  74  can have a finish which is a nickel plate. This material and finish is provided by way of example and not by way of limitation. 
     Notwithstanding the disclosure above, the finish of rail post  12  (for example, individual parts) can optionally be glass bead or satin, and individual parts can be finished and passivated before assembly. The finish of clamp housing  32  can be blue anodized. The finish of locking nut  36  can be nickel plated. The pertinent components of rail post  12  can be lubricated before each use by way of hole  66  in cover plate  40 . Lubrication and/or flushing can occur by hole  66  and/or hole  67 . Cracks, pits, and visible imperfections are not permissible, and all burrs and sharp edges are to be removed, with respect to rail post  12 . The rail post  12  shall pass test TM-120 boil test and STM-04 autoclave test. Further, it is noted that  FIG. 3  shows additional structures not included or shown in  FIGS. 1 and 2 . 
       FIGS. 4 and 5  show post coupling device  14 . Post coupling device  14  couples rail post  12  with elevator arm member  16 . Post coupling device  14  includes a first coupling half  76 , a second coupling half  78 , a center post  80 , a pin  82 , and a T-handle tightener  84 . First coupling half  76  can be referred to as a lateral coupling half, considering that it is positioned to the lateral side of the surgical table or bed (and also to the patient). First coupling half  76  includes two passageways  86 ,  88  (first passageway  86  and second passageway  88 ) which are substantially perpendicular to one another. The first passageway  86  is formed by a split ring such that the two portions adjacent the split  90  can be brought closer together when post coupling device  14  is tightened or spread apart when post coupling device  14  is loosened (by way of tightener  84 ). An inner surface of first passageway  86  also includes a plurality of ridges  92  (such as two ridges  92  on each side of the split  90 , but more or less ridges  92  can be provided); these ridges  92  are spaced apart so as to engage grooves  72  on the external surface of bar  42  and thereby prevent bar  42  and first coupling half  76  from rotating relative to one another when first coupling half  76  is tightened about bar  42 . The second passageway  88  receives center post  80  therethrough. Further, on an outer axial end of second passageway  88  (the end facing second coupling half  78 ), the second passageway  88  includes a plurality of teeth  100 , which are configured to engage grooves between a plurality of teeth  100  on second coupling half  78 ; this engagement relative to teeth  100  of both coupling halves  76 ,  78  helps to prevent first coupling half  76  and second coupling half  78  from rotating relative to one another when tightener  84  is tightened. 
     Second coupling half  78  includes two passageways  86 ,  88  (first passageway  86  and second passageway  88 ) which are substantially perpendicular to one another. The first passageway  86  is formed by a split ring such that the two portions adjacent the split  90  can be brought closer together when post coupling device  14  is tightened or spread apart when post coupling device  14  is loosened (by way of tightener  84 ). An inner surface of first passageway  86  also includes a plurality of ridges  92  (such as two ridges  92  on each side of the split  90 , but more or less ridges  92  can be provided); these ridges  92  are spaced apart so as to engage grooves  126  on an external surface of short bar  122  and thereby prevent short bar  122  and second coupling half  78  from rotating relative to one another when second coupling half  78  is tightened about short bar  122 . The second passageway  88  receives center post  80  therethrough. Pin  82  is inserted through opposing holes in second coupling half  78  (one of these holes is shown in  FIG. 6 , but it is understood that these holes can be smoothed over during manufacture) and also through the through-hole  104  near one longitudinal end of center post  80 ; in so doing, center post  80  cannot rotate relative to second coupling half  78  because pin  82  is welded on both sides of pin  82  to second coupling half  78 . Further, on an outer axial end of second passageway  88  (the end facing laterally and thus towards first coupling half  76 ), the second passageway  88  includes a plurality of teeth  100 , which are configured to engage grooves between the plurality of teeth  100  on first coupling half  76  so as to prevent first coupling half  76  and second coupling half  78  from rotating relative to one another when tightener  84  is turned so as to tighten post coupling device  14 . First and second coupling halves  76 ,  78  can be made of 304 stainless steel adhering to ASTM F899, have a satin finish (excluding teeth side walls), and can be passivated (per ASTM A967); this is provided by way of example and not by way of limitation. 
       FIG. 5  shows a detail view of first passageway  86  of first coupling half  76 , the detail view being taken generally in the direction of arrow  91  in  FIG. 4 .  FIG. 5  focuses on showing the inner surface of first passageway  86 . Arrows A, B, and C in  FIG. 5  are associated with five arrows, these arrows pointing to different regions on the inner surface. Arrows A, B, and C are each associated with a region having a specific radius on the inner surface, arrow A being in a region having a radius A, arrow B being in a region having a radius B, and arrow C being in a region having a radius C. Radii A, B, and C are different from one another (the arrows with radius A have the same radius). The relative dimensions are as follows: A&lt;B&lt;C. Thus, these radii do not share a common center point. Regions with arrows A and B can be mirrored on the other side of the inner surface. More specifically, arrows A and B are shown in the portion of first passageway  86  ranging from 6 o&#39;clock to 12 o&#39;clock in  FIG. 5 ; if the page of  FIG. 5  were folded from 12 o&#39;clock to 6 o&#39;clock in  FIG. 5 , then the portion ranging from 12 o&#39;clock to 6 o&#39;clock would mirror the portion ranging from 6 o&#39;clock to 12 o&#39;clock. When first passageway  86  is in a relaxed position, first passageway  86  is thus not a circle. However, when first passageway  86  is compressed so as to substantially close split  90 , first passageway  86  virtually forms a perfect circle, for purposes of gripping. First passageway  86  of second coupling half  78  is substantially similar to what is shown in  FIG. 5 . 
     Center post  80  is a longitudinally extending rod and includes a transverse through-hole  104  on one longitudinal end and a threaded portion  106  on the opposing longitudinal end. Center post  80  is inserted through each second passageway  88  of first coupling half  76  and second coupling half  78  and is positioned therein. The through-hole  104  receives pin  82  therethrough when pin  82  is inserted in corresponding through-holes in second coupling half  78 . Center post can be made of 420 stainless steel adhering to ASTM F899, have a satin finish, can be passivated (per ASTM A967), and can be heat treated to Rc 49-54; this is provided by way of example and not by way of limitation. Cross pin  82  can be made of 416 stainless steel and can be passivated (per ASTM A967); this is provided by way of example and not by way of limitation. 
     Tightener  84  includes a threaded body  108  and a bar  110  (which can be referred to as a T-bar  110 ). Threaded body  108  includes a longitudinally extending blind hole  112 , which can terminate in a coned section inside threaded body  108 . Threaded body  108  includes threads and corresponding transverse through-holes  114  in the cylindrical wall of threaded body  108 . Threaded body  108  is threadably secured to the threads  106  of center post  80 . Threaded body  108  can be made of NITRONIC® 60 stainless steel adhering to ASTM A276 or ASTM F899, have a satin finish (excluding internal features), and can be passivated (per ASTM A967); this is provided by way of example and not by way of limitation. T-bar  110  can be made of 17-4 PH stainless steel adhering to ASTM A564 or ASTM F899, have a satin finish, can be passivated (per ASTM A967), and can be heat treated to condition H900, Rc 40 min (“minimum”); this is provided by way of example and not by way of limitation. Tightener  84  can be passivated per ASTM A967. An endcap  116  can be welded to T-bar  110  (such as, for example, by way of gas tungsten arc welding 308 or 308 L, with filler, and polished smooth). Endcap  116  can be made of 17-4 PH stainless steel adhering to ASTM A564 or ASTM F899, have a satin finish, can be passivated (per ASTM A967), and can be heat treated to condition H900, Rc 40 min; this is provided by way of example and not by way of limitation. Tightener  84  can be formed by milling and machining (such as wire electrical discharge machining (wire EDM)), holes  114  being formed by wire EDM; these manufacturing processes are provided by way of example and not by way of limitation. T-bar  110  is received in transverse through-holes  114  in threaded body  108  and is able to slide within holes  114 . By turning T-bar  110 , threaded body  108  is caused to move further onto center post  80  or, conversely, to move further off of center post  80  depending upon the direction of turning (while still being threaded onto center post  80 )(double-arrow  111  shows that T-bar  110  can be turned in either direction). In moving threaded body  108  further onto center post  80 , threaded body  108  pushes on one end of first coupling half  76 , which causes first coupling half  76  to push on second coupling half  78 . Because center post  80  is secured to second coupling half  78  by way of pin  82 , this pushing action causes the splits  90  of first and second coupling halves  76 ,  78  to close and thus causes first and second coupling halves  76 ,  78  to tighten their grip on bar  42  and short arm  122 , respectively. Conversely, turning T-bar  110  in the opposite direction causes first and second coupling halves  76 ,  78  to loosen their grip on bar  42  and short arm  122 , respectively. Pin  82  can be welded to second coupling half  78  (on both sides of pin  82 ), such as by way of gas tungsten arc welding, 308 or 308L SST, with a filler as needed. This weld area (or the entire post coupling device  14  after assembly) can be passivated per ATSM A967. Post coupling device  14  is configured for selectively rotating relative to rail post  12  between a plurality of positions, as indicated by double-arrow  118  (a double-arrow, herein, signifying that movement can occur in either direction). That is, when tightener  84  is loosened, post coupling device  14  can be rotated and thus repositioned from one position on bar  42  to another position on bar  42 , ridges  92  of post coupling device  14  fitting within grooves  72  of bar  42  when post coupling device  14  is tightened onto bar  42 . Further, when tightener  84  is loosened, post coupling device  14  can be raised or lowered on bar  42  (as indicated by double-arrow  117 ) and then tightened onto bar  42  at a selected elevation on bar  42 . Further, first and second coupling halves  76 ,  78  can be repositioned (for example, by rotation) relative to one another and then brought back together by way of tightener  84  and further prevented from rotating from one another by way of teeth  100 ; more specifically, when tightener  84  is loosened, second coupling half  78  can be rotated (as indicated by double-arrow  119 ) relative to first coupling half  76  (this may need to be done in conjunction with T-bar  110  and threaded body  108  so that turning second coupling half  78  does not tighten or loosen post coupling device  14  to an undesired degree), and tightener  84  can be tightened (using T-bar  110 ) when the desired orientation of second coupling half  78  to first coupling half  76  is achieved. Certain components (not necessarily all) of post coupling device are known. 
       FIG. 6  shows elevator arm member  16 , as well as post coupling device  14  being detached therefrom. Elevator arm member  16 , according to one embodiment of the present invention, can include a substantially straight first elongate arm  120  and a substantially straight second elongate arm  122  which is offset from and fixedly coupled with first elongate arm  120 . First elongate arm  120  can be longer than second elongate arm  122 . Thus, second elongate arm  122  can be referred to as short arm  122 , and first elongate arm  120  can be referred to as long arm  120 . Elevator arm member  16  can further include an elbow  124 . Short arm  122  and long arm  120  can be joined by elbow  124 . As shown in  FIG. 6 , elevator arm member  16  can have an L-shaped configuration formed by short arm  122  and long arm  120 . According to one embodiment of the present invention, elevator arm member  16  does not have any other elongate arm other than long and short arms  120 ,  122 ; that is, elevator arm member  16  has an absence of an elongate arm in addition to long and short arms  120 ,  122 . 
     Short arm  122  is configured for being coupled, by way of a post coupling device  14 , with rail post  12 .  FIG. 1  shows that short arm  122  is coupled to rail post  12  by way of post coupling device  14 ; that is, post coupling device  14  couples short arm  122  with rail post  12 . Short arm  122  can be a hollow structure that is substantially cylindrical. Short arm  122  further includes a radially outwardly facing peripheral surface which has a plurality of grooves  126  running longitudinally (that is, axially) on short arm  122 . Each groove  126  can be spaced apart from an adjacent groove  126  by eight degrees (this is provided by way of example and not by way of limitation). Each groove  126  is configured to mate with ridges  92  of second coupling half  78  of post coupling device  14  so that short arm  122  is prevented from rotating within first passageway  86  of second coupling half  78  of post coupling device  14 . Grooves  126  provide positive engagement while still allowing for adjustment at eight degree increments (thus, grooves  126  can be spaced apart at every eight degrees). Grooves  126  can be formed by a lathe operation, the tool remaining constant while short arm  122  is moving, including rotating every eight degrees so that grooves  126  can be formed). Thus, second coupling half  78  is captured on short arm  122 . Short arm  122  can be made of 17-4 PH stainless steel adhering to ASTM A564 or ASTM F899 and can be passivated (per ASTM A967); this is provided by way of example and not by way of limitation. Short arm  122  can include one longitudinal end (that is, the end opposite elbow  124 ) which is internally threaded which can be predrilled. A stopcap  128  can be externally threaded and can be threadably received by this internally threaded longitudinal end of short arm  122 , as indicated by  FIG. 6 . Stopcap  128  can also be welded to short arm  122  after short arm  122  threadably receives stopcap  128  (and after post coupling device  14  is mounted to short arm  122 ); this weld can be performed by gas tungsten arc welding, with 17-4 filler, and polished smooth (this is provided by way of example and not by way of limitation). This stopcap  128  (which can have a head, for instance, which is larger in diameter than the threads of endcap  128 ) can be made of 17-4 PH stainless steel adhering to ASTM A564 or ASTM F899, can be passivated (per ASTM A967), and can be heat treated to condition H900, Rc 40 min; this is provided by way of example and not by way of limitation. 
     Short arm  122  is configured for selectively rotating relative to post coupling device  14  between a plurality of predetermined positions (determined by the location of grooves  126  of short arm  122 ) and is configured for selectively moving axially relative to post coupling device  14  between a plurality of positions. Thus, when post coupling device  14  is loosened, short arm  122  can rotate within second coupling half  78  of post coupling device  14  from one position to another position as indicated by double-arrow  130 , ridges  92  of second coupling half  78  fitting in grooves  126  of short arm  122  when post coupling device  14  is tightened onto short arm  122 . Further, when post coupling device  14  is loosened, short arm  122  can also be moved axially within second coupling half  78  to a desired position, as indicated by double-arrow  132 , and post coupling device  14  can be tightened to secure short arm  122  in this other position. 
     Long arm  120  in general can extend transversely across the bed (not shown) to which rail post  12  is attached. According to one embodiment of the present invention, long arm  120  can be longer than short arm  122 . Long arm  120  can be made of 17-4 PH stainless steel adhering to ASTM A564 or ASTM F899 and can be passivated (per ASTM A967); this is provided by way of example and not by way of limitation. Long arm  120  can have one longitudinal end (that is, the free end) which is internally threaded which can be predrilled. An endcap  134  can be externally threaded and thus threadably received by this internally threaded longitudinal end of long arm  120  and also welded to long arm  120 . This endcap  134  can be made of 17-4 PH stainless steel adhering to ASTM A564 or ASTM F899 and can be passivated (per ASTM A967); this is provided by way of example and not by way of limitation. The end of long arm  120  to which endcap  134  attaches can have a radiused end feature so that this end of long arm  120  and endcap  134  flow together smoothly with no step. Long arm  120  is attached to short arm  122  (by way of elbow  124 ) on one longitudinal end of long arm  120 , the other longitudinal end of long arm  120  being a free end. Long arm  120  can be a hollow structure or a solid structure. Long arm  120  is coupled to bone hook  22  by way of bone hook coupling device  20 ; that is, bone hook coupling device  20  couples long arm  120  with bone hook  22 . Further, a gun drilling operation, for example, can be used to manufacture the bore through long arm  120 . Because of the length of long arm  120 , the drill may not be able to drill the entire length of this bore; thus, the bore can be drilled from both sides of long arm  120  and a through-hole mismatch is allowable (a step, to some degree, can be acceptable in this bore through-hole). 
     Elbow  124  generally has a right angle shape. Elbow  124  includes a shaft  136  projecting in one direction and a blind hole  138  (which can have a flat terminating end) projecting in another direction which is substantially perpendicular to the direction of the shaft  136 . Elbow  124  can be made of 17-4 PH stainless steel adhering to ASTM A564 or ASTM F899 and can be passivated (per ASTM A967); this is provided by way of example and not by way of limitation. 
     During assembly of elevator arm member  16 , long arm  120  can be attached to elbow  124 , and short arm  122  can be attached to elbow  124 . To attach short arm  122  to elbow  124 , the following steps can be followed: (1) press fit one longitudinal end (the end which is not threaded) of short arm  122  into blind hole  138  of elbow  124 ; (2) drill a through-hole through the portion of elbow  124  forming blind hole  138  (on both sides of blind hole  138 ) and also through the longitudinal end of short arm  122  which has been press fit into blind hole  138  (this drilling can occur after short arm  122  is inserted into elbow  124  and can occur using a milling operation, for example); (3) countersink for weld filler; (4) insert a dowel pin  140  into the drilled hole referenced in step (2) (dowel pin  140  can be made of 416 stainless steel and can be passivated (per ASTM A967); this is provided by way of example and not by way of limitation); and (5) weld both sides of pin  140  to the adjacent sides of elbow  124  (this welding can be performed by gas tungsten arc welding, with 308 or 308L filler as needed, and polished flush). To attach long arm  120  to elbow  124 , the following steps can be followed: (1) insert one longitudinal end (the end which is not threaded) of long arm  120  onto shaft  136  of elbow  124 ; (2) drill a through-hole through this longitudinal end of long arm  120 , through shaft  136 , and through the other side of this longitudinal end of long arm  120  (this drilling can occur after long arm  120  is inserted onto shaft  136  of elbow  124  and can occur using a milling operation, for example); (3) countersink for weld filler; (4) insert a dowel pin  142  into the drilled hole referenced in step (2)(dowel pin  142  can be made of 416 stainless steel and can be passivated (per ASTM A967); this is provided by way of example and not by way of limitation), dowel pin  142  of long arm  120  being shorter than dowel pin  140  of short arm  122 ; and (5) weld both sides of pin  142  to the adjacent sides of long arm  120  (this welding can be performed by gas tungsten arc welding, with 17-4 filler as needed, and polished smooth). No shavings or large debris is to be present in either shaft (that is, in long arm  120  and short arm  122 ). Endcap  134  (associated with long arm  120 ) is threaded into the threaded longitudinal end of long arm  120 ; endcap  134  can be welded to long arm  120 , such as by laser beam welding, with 17-4 filler as needed, and polished smooth). Stopcap  128  is threaded into the threaded longitudinal end of short arm  122 ; stopcap  128  can be welded to short arm  122 . Short arm  122  and long arm  120  can be respectively welded to elbow  124 . For example, the longitudinal edge (adjacent elbow  124 ) of long arm  120  can be welded to shaft  136  of elbow  124  and/or to the body (which forms blind hole  138 ) of elbow  124 ; short arm  122 , at about the portion of short arm  122  that is adjacent to the opening of blind hole  138  in elbow  124 , can be welded to elbow  124 . This welding of short arm  122  and long arm  120  respectively to elbow  124  can be performed by gas tungsten arc welding, with 17-4 filler as needed, and polished smooth (any welding operation described herein is provided by way of example and not by way of limitation). The individual parts of elevator arm member  16 , and/or elevator arm member  16  as a whole (as an assembly), can have a satin finish, can be passivated complete per ASTM A967, and can be heat treated to condition H900, Rc 40 min; this is provided by way of example and not by way of limitation. 
     Further, during assembly of elevator arm member  16  to post coupling device  14 , post coupling device  14  is slid onto short arm  122  by way of second coupling half  78  (post coupling device  14  must be oriented as shown in  FIG. 6  during this mounting step). Stopcap  128  is threaded into short arm  122  to capture post coupling device  14 . Slide post coupling device  14  onto short arm  122  the furthest it can be slid from stopcap  128 , and then weld stopcap  128  to short arm  122  (as described above). A function check can be performed such that post coupling device  14  must rotate freely on short arm  122  when the halves  76 ,  78  of post coupling device  14  are in a relaxed (untightened) position. This weld area (welding stopcap  128  to short arm  122 ) can be passivated per ASTM A967. According to the embodiment shown in the figures, elevator arm member  16  does not have any other elongate arm other than long and short arms  120 ,  122 . 
       FIGS. 7 ,  8 , and  9  show bone hook coupling device  20 . Bone hook coupling device  20  couples elevator arm member  16  with bone hook  22 . Bone hook coupling device  20  includes an arm hook  144  and a ratchet mechanism  146 . Arm hook  144  is pivotally connected to ratchet mechanism  146 . When arm hook  144  is placed on long arm  120 , arm hook  144  at least partially overlies long arm  120 . More specifically, arm hook  144  has an arcuate portion  148  that at least partially overlies long arm  120 . Arm hook  144  can be readily placed on long arm  120 , readily taken off of long arm  120 , and readily moved to different positions transversely along long arm  120 . Thus, as shown in  FIG. 1 , arm hook  144  is not necessarily attached to long arm  120  by any fasteners or anything else other than simply overlying part of the circumference of long arm  120 . Arm hook  144  is configured for selectively translating along long arm  120  in a plurality of positions, these positions being chosen by the user (such as the surgeon). That is, a user (such as a surgeon) can slide arm hook  144  in either direction on long arm  120 , as indicated by double-arrow  150  in  FIG. 1 . Thus, arm hook  144  at least partially overlies long arm  120  and is configured for selectively translating along long arm  120  in a plurality of positions. 
     Arm hook  144  also includes a window section  152  which includes two opposing flat surfaces and a window  154  forming a through-opening extending from one flat face to the other flat face in window section  152 . The lateral sides of window can be formed by walls  156  that slope inwardly from each opposing flat face of the window section  152  (that is, these walls  156  slope inwardly from each flat face of window section  152  and can be joined by a substantially flat wall section, the inwardly sloping walls  156  along with the adjoining flat wall section forming a triangular projection inside the window  154  with a generally flat top rather than a pointed top of the triangle). Further, window section  152  of arm hook  144  includes a pivot pin  158  which is positioned in window  154 . A bottom portion of window section  152  can include a through-hole, and a top portion of window section  152  can include a corresponding blind hole (which can terminate in a cone-shaped end). During assembly, pivot pin  158  can be inserted through this bottom through-hole and then into blind hole, thereby also traversing window  154 . To secure pivot pin  158  to this through-hole and this blind hole, a press fit and/or a weld can be used (or any other suitable connection). Pivot pin  158  can be made of NITRONIC® 60 stainless steel adhering to ASTM A276 or ASTM F899, have a machine finish; this is provided by way of example and not by way of limitation. The remaining portions of arm hook  144  can be made of 17-4 PH stainless steel, ASTM A564, and/or ASTM F899, can have a satin finish, can be passivated (per ASTM A967), and can be heat treated to condition H900, Rc 40 min; this is provided by way of example and not by way of limitation. 
     Ratchet mechanism  146  is configured for selectively holding bone hook  22  in a plurality of positions. Ratchet mechanism  146  includes a carrier  160 , a retaining cap  162 , a release trigger  164 , a spring  166 , and a toothed wheel  168 . Carrier  160  of ratchet mechanism  146  includes a projection  170  with a through-hole  172 . This through-hole  172  receives pivot pin  158 ; this reception can be accomplished by inserting projection  170  in window  154 , aligning through-hole  172  with the through-hole in the bottom of window section  152  and the blind hole in the top of window section  152  (this through-hole and blind hole of window section communicating with window  154 ), and inserting pivot pin  158  first through the through-hole in the bottom of window section  152 , then through through-hole  172 , and then into the blind hole of the top of window section  152  (pivot pin  158  can be welded to window  154 ). Thus, pivot pin  158  extends through through-hole  172 . Projection  170  is thereby configured for pivoting about pivot pin  158 . Window  154  forms a pivot boundary relative to projection  170 . That is, projection  170  can pivot about pivot pin  158  only so far as the lateral sides (specifically, walls  156 , which thus form the pivot boundary) of window  154 . Thus, bone hook  22  can pivot twenty-five degrees in each direction from center to allow for femoral shift during elevation or to compensate for an error in initial construct (generally, bone elevator system  10 ) positioning. The sloped walls  156  of these lateral sides of window  154  allow essentially for a mating contact with the walls  156  of projection  170  as projection  170  swings to either side of window  154 . Double-arrow  171  shows that projection  170  can rotate, as bounded by window  154 , about pivot pin  158 . 
     Carrier  160  of ratchet mechanism  146  further includes a through-hole in a side wall of carrier  160 , this through-hole communicating with a pocket  174  (which can be referred to as a boss) formed on one side of this sidewall; this through-hole helps in flushing pocket  174  and thereby aids in the cleanability of carrier  160 . Spring  166  is positioned in pocket  174  on one end of spring  166  and in pocket  198  of release trigger  164  and is thereby captured and held in pocket  174  and pocket  198  by compression on spring  166  provided by carrier  160  and release trigger  164 . Spring  166  biases a handle  176  of release trigger  164  away from carrier  160 . Carrier  160  includes a pivot bar  178  which fits within a through-hole of an upper portion of release trigger  164  and also in corresponding through-holes in wing projections of carrier  160 , release trigger  164  thereby being able to pivot about pivot bar  178 . When release trigger  164  is in an engaged position with bone hook  22 , handle  176  of release trigger  164  can be either substantially parallel with the side wall (having pocket  174 ) of carrier or can form an angle with this side wall such that handle is pushed farther away from this sidewall than handle  176  would be if handle  176  were parallel with this side wall of carrier  160 . Pivot bar  178  can be welded to carrier in any suitable manner and can be made of, for example, 416 stainless steel; this is provided by way of example and not by way of limitation. Carrier  160  includes a central passageway  180  defined at least in part by the interior of carrier  160 . Central passageway  180  receives bone hook  22  therethrough, bone hook  22  being able to move selectively in either direction (shown by double-arrow  182 ) in passageway  180 . Along the open longitudinal side of carrier  160 , carrier  160  includes half of a through-hole  184  and half of a pocket  186  opposing the carrier half of the through-hole  184 . Carrier  160  can be made of 17-4 PH stainless steel adhering to ASTM A564 or ASTM F899, can have a satin finish (internal surfaces of carrier  160  can be bead blasted), can be passivated (per ASTM A967), and can be heat treated to condition H900, Rc 40 min; this is provided by way of example and not by way of limitation. 
     Retaining cap  162  is attached to carrier  160 , such as by welding. Retaining cap  162  includes an upper projection  188  and a lower projection  190 . Retaining cap  162  also includes two opposing sides  192 , one side  192  including half of through-hole  184 , the other side  192  including half of pocket  186 . Retaining cap  162  also includes a chamber  194 . Upper and lower projections  188 ,  190  fit within the open portion of a longitudinal side of carrier  160  so that retaining cap  162  can be joined with carrier  160 . Upon bringing retaining cap  162  to carrier  160 , the halves of through-hole  184  of carrier  160  and retaining cap  162  mate with one another to form a single through-hole  184 . Similarly, the halves of pocket  186  of carrier  160  and retaining cap  162  mate with one another to form a single pocket  186 . Retaining cap  162  can be attached to carrier  160  by welding, as described below. Toothed wheel  168  seats within hole  184  and in pocket  186 , toothed wheel  168  being captured by carrier  160  and retaining cap  162  and being permitted to rotate within hole  184  and pocket  186 . When retaining cap  162  is attached to carrier  160 , chamber  194  forms a side chamber to the side of, and communicating with, passageway  180 . Retaining cap  162  can be made of 17-4 PH stainless steel adhering to ASTM A564 or ASTM F899, can have a satin finish, can be passivated (per ASTM A967), and can be heat treated to condition H900, Rc 40 min, and internal surfaces of carrier  160  can be bead blasted; this is provided by way of example and not by way of limitation. 
     Release trigger  164  can also be referred to as a lever. Release trigger  164  includes handle  176  and a tooth  196  on an upper portion of release trigger  164 . An exterior surface of handle  176  of release trigger  164  can include a plurality of ridges (as shown) to facilitate the gripping or frictional engagement of handle by the thumb or finger of a surgeon; these ridges can have grooves therebetween which have a radius or which individually come to a sharp point. An inner surface of handle can include a shallow pocket  198  which receives one end of spring  166 , spring  166  thereby being held by this pocket  198  on one end of spring  166  and being held by pocket  174  of carrier  160  on the other end of spring  166  and biasing handle  176  away from carrier  160  and thereby biasing tooth  196  of release trigger  164  towards bone hook  22 . Release trigger  164  pivots about pivot bar  178  of carrier  168  by way of a through-hole through the top portion of release trigger  164 . When handle  176  is in a first position pushed away from carrier  160  by spring  166 , tooth  196  is in an engagement position so as to engage with a groove between teeth  200  of bone hook  22 . When handle  176  is in a second position pressed towards carrier  160  by a surgeon, tooth  196  is in a disengagement position so as not to engage bone hook  22 . Thus, when handle  176  is released by a surgeon, release trigger  164  returns to a home position, that being the engagement position. Release trigger  164  can be made of 455 stainless steel adhering to ASTM F899 and can be heat treated to Rc 48-52; this is provided by way of example and not by way of limitation. All surfaces except the carrier facing surface of release trigger  164  (this carrier facing surface being opposing the thumb gripping ridges of release trigger  164 , this carrier facing surface extending from the inwardly facing bottom corner of release trigger  164 , past pocket  198 , and up to the tip of tooth  196 ) release trigger  164  can have a high sheen finish (near buff), and this carrier facing surface of release trigger  164  can have a satin finish. Release trigger  164  can be passivated (per ASTM A967). Release trigger  164  can be gold plated using Electro-spec. That is, release trigger  164  can be plated with gold using an electrical adhesion process. A base coat with a non-nickel alloyed Technic acid gold strike can be used. An outer coat with orosene 990 HS per ASTM B488-01 code C can be used. The width of release trigger  164  (this width being taken above the curved portion defining the thumb/finger-depressing portion of release trigger  164  and running parallel to the ridges of the thumb/finger-depressing portion of release trigger  164 ) and the diameter of the through-hole in release trigger  164  which receives pivot bar  178  can be maintained after coating. 
     Toothed wheel  168  includes a shaft  202 , a plurality of teeth  204 , and a tab  206 . Shaft  202  (which can be referred to as a pinion shaft) can include a groove on one end that receives tab  206  and is welded to tab  206  (which can be referred to as a thumb piece  206 ). In one embodiment, tab  206  can have be a generally flat structure having an oval or elliptical cross-section. Tab  206  can have a groove formed in a side edge of the flat structure of tab  206 , the groove having a generally straight side and seating within the groove of shaft  202 , the groove of tab  206  optionally having a female dovetail in the inner corners. Tab  206  is used to turn toothed wheel  168  by a surgeon. Tab  206  can be made of 304 stainless steel adhering to ASTM F899 and can have a satin finish; this is provided by way of example and not by way of limitation. Further, in one embodiment, shaft  202  and teeth  204  can be formed integral with one another (that is, they can be formed from the same piece). Alternatively, shaft  202  and teeth  204  can be formed separately and joined together to form a unitary assembly. According to either alternative, shaft  202  can be positioned in through-hole  184 , in side chamber  194 , and in pocket  186 . Further, the plurality of teeth  204  can have a hub from which the teeth  204  extend. Shaft  202  can extend through this hub (shaft  202  and this hub thus being connected by welding) or, alternatively, can be formed in one piece with this hub. Each tooth  204  can be flat at its crest (at the distal end of the tooth  204 ). Shaft  202  and teeth  204  can be made of 455 stainless steel adhering to ASTM F899 and can have a satin finish; this is provided by way of example and not by way of limitation. Tab  206  can be fully seated in the groove of shaft  202 . Tab  206  can be welded to shaft  202  using laser beam welding (such as 308 or 308 L, with filler as needed, and polished smooth) such as where the tab groove contacts the groove of shaft  202 , such as (but not limited to) the base of the shaft groove. Further, the toothed wheel  168  (the assembly) can be heat treated (to Rc 48-52) to achieve the specified hardness for the structure formed of shaft  202  and teeth  204 . Further, toothed wheel  168  (the assembly) can be passivated complete (per ASTM A967) after welding and heat treating; this is provided by way of example and not by way of limitation. 
     During assembly, toothed wheel  168  is captured with carrier  160  and retaining cap  162 . That is, shaft  202  can be positioned against carrier  160  by half portions of through-hole  184  and pocket  186 , and then retaining cap  162  can be attached to carrier  160  to form the other half of through-hole  184  and pocket  186 , shaft  202  and teeth  204  being held thereby and being able to pivot within through-hole  184  and pocket  186 . Toothed wheel  168  is supported in side chamber  194  by through-hole  184  and pocket  186 , shaft  202  of toothed wheel  168  being supported in through-hole  184 , and distal end of shaft  202  being supported in pocket  186 .  FIG. 7  shows that the toothed portion  204  of toothed wheel  168  is positioned at least partially in side chamber  194 , a portion of one or more teeth  204  projecting in central passageway  180  so as to engage with the teeth  200  of bone hook  22 . Retaining cap  162  is welded to carrier  160  (after capturing toothed wheel  168  with carrier  160  and retaining cap  162 ), such as by way of micro-TIG (tungsten inert gas welding), with 17-4 filler, relative to the entire seam, and polished smooth. This includes that the bottom of carrier  160  and the bottom of retaining cap  162  (the bottom being opposite the top of carrier  160  which is closer to the arcuate section  148  of the arm hook  144 ) are welded to one another using micro-TIG, with 17-4 filler as needed, and polished smooth. A function check can be performed with LMC and MMC gauge, checking to ensure, for example, geometry has been maintained. Further, the bottom of carrier walls of carrier  160  can be welded to the bottom of retaining cap  162  and to the bottom of lower projection  190  of retaining cap  162 , such as by way of micro-TIG, with 17-4 filler as needed, and polished flush. The internal geometry must be maintained while welding the end seam (for example, the bottom of carrier walls of carrier  160  that weld to the bottom of retaining cap  162  and to the bottom of lower projection  190  of retaining cap  162 ), and a function check can be done with LMC and MMC gauges. Spring  166  is captured with release trigger  164  and carrier  160 . Release trigger  164  is cross-pinned to carrier  160  with pin  178 , and both sides of pin  178  are welded, such as by way of laser beam welding, 17-4 filler, and polished flush. Arm hook  144  is captured with pin  158  and carrier  160 ; arm hook  144  is cross-pinned to carrier  160  with pin  158 , and both sides of pin  158  (or just the bottom of pin  158  to the bottom of window section  152  opposite the arcuate section  148 ) can be welded to arm hook  144 , such as by way of gas tungsten arc welding, with 17-4 filler, and polished flush. Further, the weld areas of bone hook coupling device  20  can be passivated per ASTM A967. A Weck lube (lubricant) or an equivalent can be applied to the bone hook coupling device  20  (the assembly). Toothed wheel  168  must rotate freely. A function check of the bone hook coupling device  20  (the assembly) can be performed with LMC and MMC gauge, for example, to ensure proper dimensions associated with each of the welding operations. 
       FIG. 1  shows bone hook  22 . Bone hook  22  can be a substantially rigid structure. Bone hook  22  includes a hook  208  and a longitudinally extending shaft  210  with a plurality of teeth  200  thereon. Bone hook  22  can further include a stop  212  which prevents bone hook  22  from being inserted too far into carrier of ratchet mechanism  146 ; that is, stop  212  provides a positive stop on bone hook  22  to prevent ratcheting too far. Hook  208  can be selectively provided with a certain radius in the curve of hook  208 , this curve being shown in  FIG. 1 .  FIG. 1  shows the curve of hook  208  being provided with a certain radius, but it is understood that hook  208  can be provided with a curve having a smaller or a larger radius, depending upon the application. Further, bone hook  22  can be provided as a part of a kit associated with bone elevator system  10  (all or, alternatively, certain ones of bone elevator system  10  can be provided as part of the kit); according to one embodiment of this kit, the kit can include a two bone hooks  22  each with a curve having a different radius relative to one another. The shaft  210  of bone hook  22  can be inserted through the bottom of carrier  160  of ratchet mechanism  146 . When release trigger  164  is in an engagement position, release trigger  164  can selectively engage a particular groove between bone hook teeth  200  so as to lock bone hook  22  in a predetermined position relative to ratchet mechanism  146 . The predetermined positions are determined by the grooves between bone hook teeth  200 . In this way, ratchet mechanism  146  is configured for selectively holding bone hook  22  in a plurality of predetermined positions. Further, toothed wheel  168  can be turned to selectively move bone hook  22  upwardly (moving hook  208  closer to carrier  160  of ratchet mechanism  146 ) relative to ratchet mechanism  146 , teeth  204  of toothed wheel  168  and teeth  200  of bone hook  22  being angled so as to engage one another and to allow teeth  204  of toothed wheel  168  to grab and thereby ratchet bone hook  22  upwardly. Release trigger  164  then prevents bone hook  22  from falling back through central passageway  180  by the force of gravity after releasing toothed wheel  168 . When release trigger  164  is unlocked from bone hook  22 , bone hook  22  can freely fall through central passageway  180  (absent prevention by a surgeon or operating room personnel). Bone hook  22  can be made of 17-4 PH stainless steel adhering to ASTM F899 or ASTM A564, can have a satin finish, can be passivated (per ASTM A967), and can be heat treated to condition H900, Rc 40 min; this is provided by way of example and not by way of limitation. 
     Bone elevator system  10  can optionally include a lateral retention ring assembly  18  (which can also be referred to as a collar stop), which is shown in  FIG. 10 . Lateral retention ring assembly  18  can be added to prevent medial or lateral shift of bone hook  22 . Lateral retention ring assembly  18  includes a collar  216  (which can also be referred to as the main body), a threaded post  218 , and a cap assembly  220 . Collar  216  is formed as an annular ring. Collar  216  includes a threaded through-hole  222  and an additional opposing through-hole  224 . The threads of this threaded through-hole  222  may extend only through a portion of the thickness of this part of the ring  216 . Collar  216  can be made of 17-4 PH stainless steel adhering to ASTM F899 or ASTM A564, can have a satin finish, can be passivated (per ASTM A967), and can be heat treated to condition H900, Rc 40 min; this is provided by way of example and not by way of limitation. Threaded post  218  includes a bottom stopper  226  which is configured for engaging long arm  120  when threaded post  218  is extended far enough to engage long arm  120 . Threaded post  218  further includes a bottom threaded portion  232  (near the bottom stopper) and an upper threaded section  234 . Bottom threaded portion  232  threadably engages the threads of the threaded through-hole  222  of collar  216  so as to attach threaded post  219  to collar  216 . The upper threaded portion  234  threadably engages the threads of cap  228  of cap assembly  220  and thereby attaches threaded post  218  to cap  228 . Threaded post  218  can be made of 304 stainless steel adhering to ASTM F899, can have a satin finish, and can be passivated (per ASTM A967); this is provided by way of example and not by way of limitation. Cap assembly  220  includes cap  228  and a tab  230  (which can also be referred to as a thumb piece  230 ). Cap  228  includes internal threads and a groove which is adjacent the internal threads. The internal threads of cap  228  threadably receive the upper threaded portion  234  of threaded post  218 . Cap  228  can be made of 304 stainless steel adhering to ASTM F899, can have a satin finish (excluding the internal threads of cap), and can be passivated (per ASTM A967); this is provided by way of example and not by way of limitation. Tab  230  is like the tab  206  of ratchet mechanism  146  and includes a groove which is positioned in groove of cap  228 . This groove of tab  230  can include female dovetails at the corners of the groove. Tab  230  can be made of 304 stainless steel adhering to ASTM F899 and can have a satin finish; this is provided by way of example and not by way of limitation. Tab  230  is fully seated into the groove of cap  228 . Tab  230  can be welded to cap  228  using laser beam welding (such as 308 or 308 L, with filler as needed, and polished smooth) such as where the groove of tab  230  contacts the groove of cap  228  (cap  228  can also be referred to as a shaft), such as (but not limited to) the base of the groove of cap  228 . Cap assembly  220  can be passivated per ASTM A967. During assembly of lateral retention ring assembly  18 , threaded post  218  is inserted through the hole in collar  216  opposing the threaded through-hole  222  and then into the threaded through-hole  222  until threaded post  218  stops. Cap  228  is then threaded onto threaded post  218  until cap  228  is fully seated. Then, cap  228  is welded to threaded post  218  (such as at the base of cap  228  facing collar  216 ), such as by way of gas tungsten arc welding (micro-TIG (tungsten inert gas welding) is allowable), 308 or 308L, filler as needed, and polished smooth. This weld area can occur in the area of threaded post  218  between the threaded sections  232 ,  234  but can include a portion of the threads as well. This weld area can be passivated per ASTM A967. In use, with threaded post  218  in a position in which it will not engage with long arm  120 , collar  216  is slid onto the free end of long arm  120  to a selected position on long arm  120 . After collar  216  is slid to the desired point on long arm  120 , threaded post  218  is turned (by way of tab  230 ) in a direction so that threaded post  218  extends further towards long arm  120  and the bottom portion  232  of threaded post  218  presses against long arm  120 , thereby causing lateral retention ring assembly  18  to be tightened and fixedly engaged with long arm  120 . In this way, lateral retention ring assembly  18  keeps ratchet mechanism  146  from moving at least in one direction along long arm  120 . Lateral retention ring assembly  18  can be slid on long arm  120  in either direction, as indicated by double-arrow  238 . Two such lateral retention ring assemblies  18  can be used to capture bone hook coupling device  20  therebetween, if so desired. Only one such lateral retention ring assembly  18  is shown in the figures. 
     During assembly, rail post  12  can be placed on a horizontal rail  24  and secured thereto. Post coupling device  14  can be placed onto short arm  122  of elevator arm member  16  and then (or vice versa) onto rail post  12 . Arm hook  144  can be placed onto long arm  120 , and lateral retention ring assembly  18  can be selectively positioned on and secured to long arm  120 . The straight end of bone hook  22  can be inserted up through the central passageway  180  of carrier  160  of ratchet mechanism  146  and secured to carrier  160  by way of release trigger  164 . 
     In use, bone elevator system  10  can optionally be mounted to a standard operating table. Bone elevator system  10  can be oriented in a variety of positions. Rail post  12  can be slid along rail  24  and clamped thereto in various positions (as indicated by double-arrow  26 ). Further, first coupling half  76  of post coupling device  14  can be raised or lowered on bar  42  (as indicated by double-arrow  117 ) and can be rotated in either direction on bar  42  (as indicated by double-arrow 118 ) and secured thereto at a desired position. Further, first and second coupling halves  76 ,  78  can also be rotated relative to one another (as indicated by double arrow  119 ). For instance, second coupling half  78 , when tightener  84  is loosened, can be rotated in either direction relative to first coupling half  76  and then secured back to first coupling half  76  by way of tightener  84 ; in this way, short bar  122  (and thus elevator arm member  16 ) can be angled upwardly or downwardly at a selected angle. Further, short bar  122  can be slid axially relative to second coupling half  78  so that second coupling half  78  is positioned closer or farther from elbow  124 , for instance (as indicated by double-arrow  132 ). Further, short arm  122  can rotate within second coupling half  78  and secured thereto by tightener  84  (as indicated by double-arrow  130 ). While not limited to this position, short arm  122  generally runs parallel to the longitudinal extent of a patient table or bed, and long arm generally extends transversely relative to the patient table or bed. Further, by way of arm hook  144 , bone hook coupling device  20  can be translated along long arm  120  (as indicated by double-arrow  150 ) and positioned at virtually any location along long arm  120  (and arm hook  144  can be rotated to some degree on long arm  120 , as indicated by double-arrow  236 ), and lateral retention ring assembly  18  can be used to help secure bone hook coupling device  20  on long arm  120  (lateral retention ring assembly  18  being translatable along long arm  120 , as indicated by double-arrow  238 ). Further, by way of projection  170 , ratchet mechanism  146  (which holds bone hook  22 ) can pivot on pivot pin  158  (for example, in a fifty degree swath)(as indicated by double-arrow  171 ). Further, arm hook  144  can pivot to some degree about long arm  120  (as indicated by double-arrow  236 ). Further, bone hook  22  can be raised or lowered relative to ratchet mechanism  146  and held thereby (as indicated by double-arrow  182 ). Toothed wheel  168  can be turned (as indicated by double-arrow  214 ) to raise or lower bone hook  22 . These ways of moving and orienting bone elevator system  10  allows the surgeon to selectively position bone hook  22 . 
     Further, the following generally describes a surgical procedure using the bone elevator system  10  of the present invention; it is understood, however, that a surgeon is not limited to this description of a surgical procedure. The femoral head is cut off from the femur; this can occur after the femur is dislocated from the acetabulum, or, the femoral head can first be cut off and then the femoral head can be removed from the acetabulum. After the femoral head is cut off, bone hook  22  is placed under the femur (bone hook  22  can already be located in ratchet mechanism  146 ), bone hook system  10  having already been positioned in the desired position relative to the femur. Bone hook system  10  can be repositioned as desired prior to elevating the femur. The femur is then elevated with bone hook  22  (using ratchet mechanism  146 ), without straining the patient&#39;s muscles. Bone hook  22  thus elevates the femur and then holds the femur in a desired position. The femur is then broached to prepare the femur to receive a femoral implant (an acetabulum implant can be inserted before the femur is broached). At different points during the surgical procedure, the femur can be manually manipulated to achieve the proper orientation. 
     The components of the bone elevator system  10  of the present invention can be made by a variety of manufacturing processes. For example, the manufacturing processes used may include machining (such as wire EDM), lathe operations, milling operations (such as 3, 4, or 5 axis milling operations), TIG welding, and/or micro-TIG welding. 
     The present invention further provides a method for using a bone elevator system. The method includes: providing a bone hook  22 , a first coupling device  20 , and an elevator arm member  16  including a substantially straight first elongate arm  120  and a substantially straight second elongate arm  122  which is offset from and fixedly coupled with first elongate arm  120 ; coupling, using first coupling device  20 , first elongate arm  120  with bone hook  22 ; coupling, using second coupling device  14 , second elongate arm  122  with an anchoring post  12 . First coupling device  20  includes a ratchet mechanism  146  and an arm hook  144  pivotally connected to ratchet mechanism  146 , the method further including holding selectively, using ratchet mechanism  146 , bone hook  22  in a plurality of positions, arm hook  144  at least partially overlying first elongate arm  120 , the method further including translating selectively arm hook  144  along first elongate arm  120  in a plurality of positions, anchoring post  12  being a rail post  12  which is coupled with a rail  24 . Arm hook  144  includes a window  154  and a pivot pin  158  in window  154 , ratchet mechanism  146  including a projection  170  with a through-hole  172 , pivot pin  158  extending through through-hole  172 , the method including pivoting projection  170  about pivot pin  158 , window  154  forming a pivot boundary  154  relative to projection  170 . Elevator arm member  16  has an L-shaped configuration formed by first elongate arm  120  and second elongate arm  122 . The method can further include rotating selectively second elongate arm  122  relative to second coupling device  14  between a plurality of predetermined positions and moving selectively second elongate arm  122  axially relative to second coupling device  14  between a plurality of positions. The method can further include rotating selectively second coupling device  14  relative to rail post  12  between a plurality of positions. Elevator arm member  16  has an absence of an elongate arm in addition to first elongate arm  120  and second elongate arm  122 , first elongate arm  120  being longer than second elongate arm  122 . 
     While this invention has been described with respect to at least one embodiment, the present invention can be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Further, this application is intended to cover such departures from the present disclosure as come within known or customary practice in the art to which this invention pertains and which fall within the limits of the appended claims.