Patent Publication Number: US-2016228262-A1

Title: An instrument for positioning a cup component of an orthopaedic joint prosthesis

Description:
This invention relates to an instrument for positioning a cup component of an orthopaedic joint prosthesis. 
     Certain orthopaedic joint prostheses include a hollow cup with an inner surface which defines a generally hemispherical hollow region, and another component which has a spherical part which can be received in the hollow region for articulation relative to the cup component. Such joint prostheses can include hip joint prostheses and shoulder joint prostheses. The exterior of the cup will contact the prepared surface of the patient&#39;s bone in which the component is to be implanted. The interior of the cup will present a smooth bearing surface to the spherical part of the other component of the joint prosthesis. The bearing surface can be provided by a single piece cup component. Alternatively, the cup component can comprise a shell part which contacts the prepared surface of the patient&#39;s bone, and a bearing part which provides the bearing surface, and which fits into the shell part. The bearing part can be made from a material which is different from the material of the shell part: for example the bearing part can be made from a polymeric material (such as polyethylene) or a ceramic material and the shell part (and the spherical part of the other component) can be made from a metal (such as a cobalt-chromium based alloy, or a stainless steel, or a titanium based alloy). 
     It is important that the components of an orthopaedic joint prosthesis are positioned accurately in a patient&#39;s bone. Both location and alignment are important. Accurate positioning of a component requires that the component be engaged by an appropriate instrument, allowing considerable force to be applied to the component if and as necessary. However, it can be important not to contact the external surface or the internal surface or both of the component with the instrument, especially the internal surface when it has been provided with a smooth polished bearing surface. Scratching or otherwise damaging that surface can impair the bearing properties of the prosthesis. 
     U.S. Pat. No. 5,171,243 discloses an acetabular cup for use in a hip joint prosthesis. The cup comprises a shell which has a circumferential groove cut into its inner surface. The groove can received a flange at the free end of an insertion tool so that the cup is retained on the instrument, allowing the shell to be manipulated using the instrument. The grooved shell part receives a bearing part which has a smooth inner surface against which a bearing surface of another component of the joint prosthesis can articulate. The shell part can have fastening holes extending through its wall through which bone screws can extend to fasten the shell part to the surface of a bone. 
     WO-A-2008/099242 discloses an instrument for gripping a cup component of an orthopaedic joint prosthesis which includes a plurality of jaw members which extend radially from a central drive shaft. The jaw members can be made to slide radially inwardly so that they engage the outside wall of a cup component. Each of the jaw members has a pin at one end which is received in a spiral track on a drive plate. The jaw members are made to slide radially by rotating the drive plate. 
     The present invention provides an instrument for positioning a cup component of an orthopaedic joint prosthesis, which includes a plurality of jaw members each having an inclined face, and an actuator which can slide longitudinally in contact with the inclined faces of the jaw members to cause them to move between deployed and retracted positions. 
     An aspect of the invention provides an instrument for positioning a cup component of an orthopaedic joint prosthesis, comprising an actuator and a plurality of jaw members arranged around a longitudinal axis of the instrument. Each jaw member can have a mounting end and a gripping end with a transversely extending member which can be received in a recess in a wall of a cup component. The gripping end of each of the jaw members can be displaced between a retracted position and a deployed position in which the gripping end is displaced from the retracted position in the direction in which the transversely extending member is directed. Each jaw member can further include a surface between the mounting end and the gripping end which is inclined to the longitudinal axis of the instrument, and wherein the actuator and the plurality of jaw members are capable of relative movement along the longitudinal axis of the instrument with the actuator in contact with the inclined surfaces of the jaw members so that said relative movement causes the jaw members to move between their retracted position and deployed position. 
     The instrument of the invention has the advantage that the number of parts from which it is made is small. Furthermore, assembly of the instrument from its parts can be simple. These advantages mean that the instrument can be manufactured simply and at low cost and is easy to clean. 
     The surface between the mounting end and the gripping end of each jaw member may be curved in an outward direction away from the longitudinal axis. The surface between the mounting end and gripping end may transition as a smooth and/or continuous curve extending from the mounting end to the gripping end. The surface between the mounting end and the gripping end of each jaw member may also be curved in a peripheral direction around the longitudinal axis. 
     The gripping end of each jaw member may include a flat underside surface arranged to engage an upper surface of a rim of the cup component. The flat underside surfaces may all be perpendicular to the longitudinal axis of the instrument. Each flat underside surfaces may be positioned between a respective transversely extending member and the longitudinal axis of the instrument. The flat underside surfaces may extend in a peripheral direction sufficiently to form a complete annular underside surface when the jaw members are in the deployed position. 
     The transversely extending members at the gripping ends of the jaw members can be directed inwardly. The transversely extending members can then be received in one or more recesses which are provided in an outwardly facing side wall of the cup component. Optionally, the actuator can be a hollow sleeve and the jaw members can extend within the actuator. The inclined surfaces of the jaw members can then be outwardly facing surfaces of the jaw members which contact an inwardly facing surface of the actuator. 
     When the transversely extending members at the gripping ends of the jaw members are directed inwardly, so that they can then be received in one or more recesses which are provided in the outwardly facing side wall of the cup component, the jaw members can have a surface towards the gripping ends of the jaw members which faces generally along the axis of the instrument, towards a cup component which is engaged by the fingers. The surface can act against a rim of the cup component so that an impaction force that is applied to the instrument is transmitted to the cup component. 
     The actuator can be in the form of a hollow cylinder. The cylinder can have a circumferentially continuous wall, although the invention can be implemented using an actuator in the form of a cylinder which has slots formed in its wall. The cylinder might be short so that it might be viewed as a collar. The jaw members can be arranged within the bore of an actuator which is in the form of a hollow cylinder. 
     The transversely extending members at the gripping ends of the jaw members can be directed outwardly. The transversely extending members can then be received in one or more recesses which are provided in an inwardly facing side wall of the cup component. Optionally, the jaw members can be located around the actuator and the inclined surfaces of the jaw members can then be inwardly facing surfaces of the jaw members which contact an outwardly facing surface of the actuator. 
     The actuator can be in the form of a rod having a cylindrical outer surface. The rod might be short so that it might be viewed as a cylindrical plug. The rod can be located within a hollow space which is defined by and between the jaw members, so that it and the jaw members are capable of relative movement along the longitudinal axis. 
     Optionally, the jaw members are biased resiliently towards their retracted positions. In an instrument which has this feature, the actuator can be used to apply a force to the jaw member against the bias, to cause them to move towards their deployed positions. The jaw members can move towards their retracted positions by moving the actuator and allowing the jaw members to move as a result of the biasing force. This can be a preferred arrangement because it means that the cup component is engaged positively by the instrument. 
     The jaw members can be biased resiliently towards their deployed positions. In an instrument which has this feature, the actuator can be used to apply a force to the jaw member against the bias, to cause them to move towards their retracted positions. The jaw members can move towards their deployed positions by moving the actuator and allowing the jaw members to move as a result of the biasing force. 
     Optionally, the jaw members can be provided by a component which flares outwardly towards the gripping ends of the jaw members. The component can have generally conical side walls. The inclined surfaces of the jaw members can be curved when the jaw members are viewed tangentially so that, for example, the component can be approximately bell-shaped when viewed from the side. The jaw members can be formed in the component by slots in the wall of the component which are open at the gripping end of the jaw members. The slots can extend from the gripping ends of the jaw members towards but not as far as the top of the component. The flared side walls of the component can be acted on by a hollow actuator which acts on the outwardly facing surfaces of the side walls. The flared side walls of the component can be acted on by an actuator which is located inside the housing and acts on the inwardly facing surfaces of the side walls. 
     The slots between adjacent jaw members can be relatively narrow. For example, when the cup component is circular so that the jaw members form a circle, it can be preferred that the ratio of the angle subtended at the axis of the instrument by each jaw member to the angle subtended by a slot between two adjacent jaw members is at least about 3, more preferably at least about 4. 
     The transversely extending member on each of the jaw members can have the same width as the jaw member itself so that the transversely extending member on each of the jaw members subtends the same angle at the axis of the instrument as the jaw member on which it is located. 
     The transversely extending member on each of the jaw members can be narrower than the jaw member so that the angle subtended by the transversely extending member on each of the jaw members at the axis of the instrument is smaller than the angle subtended by the jaw member on which it is located. For example, when the cup component is circular so that the jaw members form a circle, the ratio of the angle subtended at the axis of the instrument by the transversely extending member on each jaw member to the angle subtended by the jaw member can be less than about 0.5, or less than 0.3, for example less than 0.15. 
     The component can comprise a tube whose wall is flared outwardly and has slots formed in it at one end. 
     Optionally, the instrument includes a handle. Optionally, the jaw members are attached to the handle, and the actuator can be moved relative to the handle and the jaw members. 
     The instrument can have an impaction surface through which an impaction force can be applied to the instrument and to a cup component which is attached to the instrument. The instrument can include a central shaft which is in communication with the impaction surface to transfer the impaction force to the cup component. This can be used to force the cup component into tight fitting engagement with a prepared bone cavity. 
     Optionally, the instrument includes an actuator mechanism for causing the actuator to move relative to the handle and to the jaw members. The actuator mechanism can include a driver which is mounted so that rotation of the driver causes displacement of the actuator along the longitudinal axis of the instrument relative to the handle. The driver can have a sloped or tilted end face and the actuator can have a sloped or tilted end face against which the driver end face abuts. The degree of tilt or slope of the end faces of the driver and actuator relative to the longitudinal axis of the instrument can be the same. 
     The actuator mechanism can have other forms. For example, the actuator mechanism can include a camming arrangement, a threaded arrangement, a pin travelling in a helical slot, a wedge or a simple push action. 
     The instrument can have two jaw members. Preferably, the instrument has more than two jaw members. A preferred embodiment has three or four jaw members. The instrument can have up to ten jaw members. 
     Preferably the jaw members are arranged so that they are spaced apart uniformly around a cup component with which they are to be used. For example, when the instrument has three jaw members and the cup component is circular, the angle subtended between adjacent jaw members at the longitudinal axis of the instrument can be 120°. When the instrument has four jaw members and the cup component is circular, the angle subtended between adjacent jaw members at the longitudinal axis of the instrument can be 90°. 
     Component parts of the instrument can be made from polymeric materials or metallic materials or from both polymeric and metallic materials. Suitable polymeric materials include polyolefins, polyesters, engineering polymers such as polyether-ether-iketones, and acetals. Suitable metals include certain stainless steels, and titanium and its alloys. The use of polymeric materials for at least some of the component parts of the instrument has the advantage of lower cost and ease of manufacture, for example by moulding. 
     For many applications, the cup component will be rotationally symmetrical about a polar axis. It will often be preferred that the cup component has the shape of a portion of a sphere. As is known, the rim of a cup component to be fitted in a patient&#39;s acetabulum in a hip replacement procedure will frequently subtend an angle of at least 140° at the centre of the sphere, for example at least 150° or at least 160° or at least 170°. The rim of an acetabular cup component will frequently be circular, although sometimes the rim can have an extension on one side for example to reduce the risk of dislocation. When the rim of the cup component is circular, the rim can be planar around at least 50% of the periphery of the cup component. The plane defined by the rim can be perpendicular to the polar axis of the component. 
     The glenoid component of a shoulder prosthesis will generally be more shallow than the cup component of a hip prosthesis and its rim might not be circular. 
     The bone facing surface of the cup component can be adapted for contact with bone tissue. For example, it can be adapted to bond to the bone tissue as a result of direction interaction (for example bone ingrowth) of bone into the surface of the component, or it can be adapted to bond to the tissue by means of a bone cement material. 
     The cup component can have a plurality of discrete recesses arranged around its periphery in which the transversely extending members on the jaw members can be received. When the cup component has discrete recesses arranged around its periphery, the number of recesses should not be less than the number of jaw members. Frequently, the number of recesses and the spacing between the recesses should correspond to the number of transversely extending members and the spacing between the fingers. 
     The cup component can have a recess which is longer than each of the transversely extending members which are received in it, for example in the form of a groove which extends around at least part of the cup component. The groove can extend continuously around the entire periphery of the cup component. 
     The invention also provides an assembly for use in a surgical procedure to replace an orthopaedic joint, which comprises an instrument according to the preceding aspect of the invention, and a cup component of an orthopaedic joint prosthesis, in which each of the generally transversely extending members on the jaw members of the instrument are received in a recess in the wall of the cup component. 
    
    
     
       Embodiments of the invention are described below in detail, by way of example only, and with reference to the accompanying drawings, in which: 
         FIG. 1  is an isometric view of a cup component and an instrument for positioning the cup component according to the invention; 
         FIG. 2  is a cross sectional side view of the cup component and the instrument shown in  FIG. 1 ; 
         FIG. 3  is an isometric view of an actuator mechanism part of the instrument shown in  FIGS. 1 and 2 ; 
         FIG. 4  is an isometric view of an actuator part of the instrument shown in  FIGS. 1 and 2 ; 
         FIG. 5  is an isometric view of a cup holding part of the instrument shown in  FIGS. 1 and 2 ; 
         FIG. 6  is an isometric view of the cup component shown in  FIGS. 1 and 2 ; and 
         FIG. 7  is an isometric view of a further embodiment of a cup holder part of the instrument and a cup component. 
     
    
    
     With reference to  FIG. 1  there is shown an isometric view of an instrument  102  for positioning a cup component  104  of an orthopaedic joint prosthesis. The instrument  102  and cup  104  can be combined to form an assembly  100 .  FIG. 2  shows a transverse cross section along a longitudinal axis of the instrument  102  and cup component  104 . 
     The instrument  102  includes a handle  106  at a proximal end, and a cup holding part  108  at a distal end. As best illustrated in  FIG. 2 , the instrument  102  has a central shaft  110  extending along its longitudinal axis and terminating at the proximal end in an impaction head  112 . A first peg  114  and a second peg (not shown) extend transversely along its longitudinal axis from the central shaft. A sleeve  116  of a metal or engineering polymer surrounds shaft  110 . A distal end of sleeve  116  defines a blind threaded bore by which the cup holding component  108  is attached to the instrument. 
     A further sleeve  120  of a metal or an engineering polymer surrounds a more proximal part of shaft  110  and handle  106  is formed by a grip  122  surrounding the shaft. The grip  122  may be formed of any suitable material, such as a silicone rubber or an engineering polymer. The grip  122  can include a plurality of longitudinal recesses, e.g. recess  124 , to provide an enhanced grip for the handle part  106  of the instrument. 
     An actuator is provided between the handle  106  and cup holding component  108 . The actuator includes a cylindrical tube  124  having a longitudinally extending closed slot, e.g. slot  126 , in each side and for accepting each of the pair of pins,  114 , which act to prevent rotation of the tube  124 . A distal end  128  of push shaft  124  encircles and surrounds the cup holding component  108 . A proximal end  130  of the push shaft  124  has end surfaces which are tilted relative to the longitudinal axis of the instrument in that they do not subtend an angle of 90° relative to the longitudinal axis of the instrument. 
     A rotatable collar  140  provides an actuator mechanism and is journalled about sleeve  116  between the push shaft  124  and handle  106 . Collar  140  includes a number of longitudinal recesses, e.g.  142 , in its outer surface to provide grip formations. The collar  140  is generally tubular and tapers from a greater outer diameter at a proximal end to a lesser outer diameter at a distal end  146 . Distal end  146  provides an end surface  148  defining a plane which is tilted relative to the longitudinal axis of the instrument, in that it subtends an angle different to 90° and is not perpendicular to the longitudinal axis. The end face  148  of the collar subtends the same angle as the end face of the push shaft such that they are parallel, as illustrated in  FIG. 1 . The angle subtended by the end face of the collar/end face of the push shaft depends on the force needed to hold the cup. 
     The cup holding component  108  is shown in isolation in  FIG. 5  and generally has the form of a flared, rotationally symmetric cylinder. A threaded boss  150  extends from a proximal end. The cup holding component  108  includes four jaw members  152 ,  154 ,  156 ,  158 . Each jaw member  152 ,  154 ,  156 ,  158  is defined by a pair of slits, e.g. slit  160  extending through the wall of the component. Each slit can be a few mm wide, for example about 1 mm wide. Each jaw member includes a mounting end, e.g.  162  by which the jaw member includes a mounting end, e.g.  162  by which the jaw member is mounted to the main body  164  of the component. Each jaw member also includes a gripping end  166  which bears a member,  168  arranged to engage a corresponding recess in the cup component  104 . Each member  168  extends at least partially in a direction transverse to the longitudinal axis of the instrument and presents an inwardly facing slightly sloped surface, e.g.  170 . Each jaw member includes a surface, e.g.  174  extending between the gripping end and the mounting end and which is inclined relative to the longitudinal axis of the instrument. As best illustrated in  FIGS. 1 and 2 , an inner surface of the distal end  128  of the actuator  124  engages the inclined surface  174  and can be urged there over when the actuator  124  is translated along the longitudinal axis of the instrument as described in greater detail below. 
       FIG. 6  shows a perspective view of the cup component  104 . As illustrated in  FIG. 6 , the cup  104  has a generally hemispherical shape and includes a rim portion  180  with an upper surface  182  and a peripheral side surface  184 . Four recesses  186 ,  188 ,  190 ,  192  and a peripheral side surface  184 . Four recesses  186 ,  188 ,  190 ,  192  are formed in an outer surface of the rim portion at equi-angularly spaced positions. Each recess,  186 ,  188 ,  190 ,  192  is positioned, sized and spaced to accept a respective one of the transverse extending members  152 ,  154 ,  156 ,  158 . An inner surface e.g.  194  tilts inwardly slightly to form a recess into which the transversely extending member can be received and to abut against the inner wall  170  of each transversely extending member. 
     Operation of the instrument will now be described.  FIG. 1  shows the jaw members in a retracted position in which the transversely extending members  152 ,  154 ,  156 ,  158  can be introduced into a respective recess  186 ,  188 ,  190 ,  192  in the rim of the cup component  104 . The cup holding member  108  is made from a plastic material and is resiliently biased so that the jaw members are naturally held in the retracted position. In order to securely lock the cup component to the instrument  102 , a user can operate the actuator mechanism by rotating collar  140  about the longitudinal axis of the instrument. The tilted end surface of the collar  140  acts against the tilted end surfaces of the proximal portion  130  of the push shaft. The pair of pegs engaged in the pair of slots in the push shaft constrain the push shaft to prevent its rotation such that the push shaft is caused to translate along the longitudinal axis of the instrument and toward the cup holding component  108 . The distal end  128  of the push shaft  124  drives against the inclined surface  174  of each jaw member and causes the gripping ends of each jaw member to be displaced in a generally transverse direction into a deployed position in which the transversely extending members are urged into the recesses in the cup component and into abutment with the inner surfaces of each recess, e.g.  194 . As the inner surface of each transversely extending member and recess are tilted slightly relative to the longitudinal axis, this provides a recess and tooth arrangement which prevents the cup from being released from the instrument in a longitudinal direction. 
     The instrument can then be used to manipulate the cup component into position and an impactor can be used to impart an impaction force on the cup instrument by impacting impaction head  112  of the instrument. As the impaction head is attached to the central shaft  110  of the instrument, this helps to transfer the impaction force along the instrument and on to the upper surface of the rim of the cup  182  via the flat underside surfaces, e.g.  157 , of the gripping end of each jaw member. 
     In order to remove the instrument from the cup component  104 , the actuator mechanism is rotated in the opposite sense which allows the actuator shaft  124  to travel along the longitudinal axis by the action of the inclined surfaces of each jaw, being resiliently biased toward the retracted position, acting on the distal end  128  of the actuator shaft  124 . Hence, the jaw members can retain the original retractor position in which the transversely extending members are no longer received within the recesses in the cup and so the instrument can be removed from the cup component. 
       FIG. 7  shows a further embodiment of the cup holding component  250  and cup component  204 . The cup holding component  250  is similar in construction to that shown in  FIG. 5  other than the form of the transversely extending members. In the second embodiment of the cup holding member  250 , each transversely extending member,  252 ,  254 ,  256 ,  258  extends along the entire peripheral length of the gripping end of each jaw member. The cup component  204  includes a single recess  206  in the rim of the cup component and extending around the entire periphery of the cup component  204 . 
     Hence, in the retracted position, as illustrated in  FIG. 7 , the transversely extending members, which have a generally arcuate shape, can all be introduced into the same single recess  206  and the relative angular position of the cup and cup holding component  250  does not need to be carefully controlled. The actuator mechanism, when operated, causes the transversely extending members to move toward the deployed position in which an inner surface of the transversely extending members abuts an inner surface  208  of recess  206 . Inner surface  208  is inclined slightly relative to the longitudinal axis as is an inner surface of the transversely extending members so as to prevent the cup component becoming detached by movement in a longitudinal direction. 
     Operation of the instrument and its actuation are largely described above. All that is varied are the details of the mechanism by which the cup component can be releasably and securely attached to the cup holding component of the instrument.