Source: https://patents.google.com/patent/DE60121850T2/en
Timestamp: 2019-12-09 08:33:37
Document Index: 513174003

Matched Legal Cases: ['art 168', 'art 168', 'art 168', 'art 188', 'art 168', 'art 188']

DE60121850T2 - Devices for minimally invasive total hip arthroplasty - Google Patents
Devices for minimally invasive total hip arthroplasty
DE60121850T2
DE60121850T2 DE60121850T DE60121850T DE60121850T2 DE 60121850 T2 DE60121850 T2 DE 60121850T2 DE 60121850 T DE60121850 T DE 60121850T DE 60121850 T DE60121850 T DE 60121850T DE 60121850 T2 DE60121850 T2 DE 60121850T2
DE60121850T
DE60121850D1 (en
Kevin Leesburg Greig
Dana Londonville Mears
Paul A. Brighton Zwirkoski
MEARS, DANA, LONDONVILLE, N.Y., US
2000-04-26 Priority to US558044 priority Critical
2000-04-26 Priority to US09/558,044 priority patent/US6676706B1/en
2001-04-26 Application filed by Bristol Myers Squibb Co filed Critical Bristol Myers Squibb Co
2006-09-14 Publication of DE60121850D1 publication Critical patent/DE60121850D1/en
2007-07-26 Publication of DE60121850T2 publication Critical patent/DE60121850T2/en
The Invention relates to total hip arthroplasty and in particular a device for performing a minimally invasive total hip arthroplasty.
In For the past 30 years, orthopedic procedures have been completed or completed partially developed joint replacement of a patient. Currently The procedures used to prepare the bone and insert it the implants are used, generally as open procedures. For the discussion Herein, open method refers to a procedure in which a Incision through the skin and underlying tissue, a big one Completely expose the section of the special articular surface. In a total hip arthroplasty the required incision is usually about 25 inches (10 inches) long. After initial incision in the skin, the internal wound can to be enlarged around the areas to be prepared Completely expose. Although surgeons in this way an excellent View of the bone surface the underlying injury to the soft tissues, u. a. of the muscles, prolonging the postoperative rehabilitation time of a patient. While the Implants can be well fixed during the surgery, lasts It may take several weeks, or maybe months, until that during the Surgery can completely heal injured soft tissues. The FR-A-2775889, on which the preamble of claim 1 is based, discloses a device for displaying a cutting line on a femoral head. US-A-5624447 on which the preamble of claim 2 is based, discloses a surgical tool guide with a cannulated one Sleeve and a handle.
The The invention provides an improved apparatus for carrying out a minimally invasive total hip arthroplasty ready. Carry out can be one total hip arthroplasty with the aid of the device of the invention using two incisions, the size of each the on the surface overcoming wounds the total depth of the wound is substantially constant. The first Incision is an anterior incision of about 3.75 to 5 centimeters (1.5 up to 2 inches) in length, in agreement made with the femoral neck and the central axis of the acetabulum becomes. The second incision is about 2.5 to 3.75 inches (1 to 10.5 inches) long posterior incision positioned so that she generally axially aligned with the femoral stem.
Of the Femoral head is separated from the femoral shaft and through the anterior incision away. The acetabular cup (Denture) is determined by the anterior incision in the acetabulum placed while the posterior incision serves to prepare the femur shaft, to record a femoral stem (femoral implant). A femur trunk is introduced through the posterior incision and positioned in the femoral shaft. By carried out the posterior incision Procedures can be performed through the anterior incision and vice versa observe.
For the following Discussion is a total hip arthroplasty by definition a replacement of the Femoral head with or without use of a separate acetabulum component. Among the specific designs that come together with the invention can be used counting a total hip replacement and a bipolar or monopolar endoprosthesis. The technique is for cemented or cementless anchoring of the components suitable.
The Device is used in a procedure for performing a total hip arthroplasty used. Belong to the procedure the following steps: making an anterior incision, making a posterior incision, dissecting an acetabulum around a hip socket through the anterior incision, insertion of an acetabulum into the acetabulum through the anterior incision, dissecting a femur, around one Femurstamm or a Femurschaftprothese record, and insertion femoral stem prosthesis into the femur.
Further For example, the device may be used in a method that includes the following steps: Dissecting of a femur to pick up a femoral stem prosthesis a protective bag over femoral stem prosthesis and insertion of the femoral stem prosthesis in the femur.
In addition, the device can be used in a method with the following steps: placing the patient supine; Palpating the femoral neck and establishing an anterior incision of about 3.75 to 5 centimeters (1.5 to 2 inches) in correspondence with the femoral neck and the central axis of the acetabulum; Performing a blunt dissection of the muscle exposed by the anterior incision to expose the capsule of the hip joint; Incising the capsule of the hip joint; Retracting a portion of the capsule to visually expose the femoral neck; Using an osteotomy guide to mark a cutting path where a cut is made to remove the femoral head and a portion of the femoral neck; Cutting along the cutting path; Cutting in the league tums teres femoris; if necessary in situ crushing of the cut femoral head and neck for removal by the anterior incision; Removing the minced pieces of the femoral neck and head through the anterior incision; Milling the acetabulum; Insert the appropriate acetabulum into the milled acetabulum; Inserting a curved awl having a substantially straight distal end into the anterior incision; Aligning the distal end of the awl with the axis of the femur; Palpating the distal end of the awl and making a posterior incision about 2.5 to 3.75 centimeters (1 to 1.5 inches) in length at the distal end of the awl; Performing a blunt dissection to provide access through the posterior incision to the femoral shaft; Screwing a retractor into the recess formed between the posterior incision and the femoral shaft; Guiding a guidewire through the retractor and into the bone cancellous bone of the femoral shaft; Positioning the guidewire in the cannula of a femoral cutter; Milling or drilling the femoral stem with the femoral reamer or bur using the guidewire to locate the bone cancellous bone of the femur; Observing the milling or drilling activity through the anterior incision; Removing the femur cutter or bur; Use the guidewire to guide a rasp to the femur shaft; Positioning the rasp in the femur shaft under observation by the anterior incision; Removing the guidewire; Removing the retractor from the posterior incision; Positioning a trial socket insert in the acetabulum through the anterior incision; Fixing a provisional neck to the rasp through the anterior incision; Fixing a provisional head to the provisional neck through the anterior incision; Performing a trial reduction with the trial socket insert, provisional neck and provisional head in place; Dislocating the provisional head; Removing the trial socket insert through the anterior incision; Removing the provisional neck and head through the anterior incision; Removing the rasp through the posterior incision; Inserting an end cup insert into the acetabulum through the anterior incision; Inserting a femoral implant through the posterior incision; Inserting an end femoral head through the anterior incision; Fixing the end femoral head to the femoral implant; Repositioning the hip; and closing the incisions.
In In one form of the method, the step of positioning a Rasp in the femoral shaft on: Locking the rasp on a rasp handle with a cannula insertion part with a distal rasp engagement guide and an elongated opening, which is such that it is accommodates a flexible cable, an engagement slot for selective engagement one end of the flexible cable, one selectively operable Handle that is so operable that he the flexible cable biases a lock for selective locking the handle in a position to tension the flexible cable, and a collision surface for Picking up punches, to place or remove the rasp; Positioning the guidewire in a cannula the rasp and the cannula the rasp handle; To lead the rasp and the cannula insertion part through the posterior retractor to a proximal end of the femoral shaft below Use of the guide wire; Beat on the abutment area to to position the rasp in the femur shaft; Unlock the handle; Releasing the flexible cable from the engagement slot; and removing of the rasp handle.
In In one form of the method, the step of locking the Rasp on a rasp handle on: engaging a distal End of the flexible cable in the rasp; Insert the flexible cable through the oblong opening of the Raspelhandgriffs; To lead the distal rasp engagement guide in one the rasp engagement guide receiving section on the rasp; Engaging the proximal End of the flexible cable in the engagement slot; and clamping the flexible cable.
In one form of the method comprises the step of removing the rasp from the femoral shaft to: reinsert the flexible cable through the oblong opening of the Cannula insertion part (the flexible cable remains in engagement with the rasp placed in the femur and stands out from the posterior wound); Reintroducing the Kanüleneinführteils through the posterior retractor; To lead the distal rasp engagement guide into which the rasp engaging guide receives Section on the rasp; Engaging the proximal end of the flexible cable in the engagement slot; Tensioning the flexible cable; and pushing on the abutting surface, um to remove the rasp from the femur shaft.
The Device may be in a procedure for removing a femoral head and neck are used. The method has the following Steps to: Making an Anterior Incision in Accordance with the femur neck; Providing an osteotomy guide with a handle and with an alignment section and a cut guide, the attached to the handle; Align the alignment section to the femoral axis, highlighting one determined by the incision Cutting way, and cutting along the cut away to a cut section remove a portion of the femoral neck and femoral head having.
The method includes a method of producing a posterior incision aligned with a longitudinal axis of the femur. The procedure includes the following steps: making an anterior incision aligned with the femoral neck by providing an awl with a handle and a curved stem having a distal end, aligning the distal end with the longitudinal axis of the femur, palpating a ply of the distal end of the awl, and producing a posterior incision at the location of the distal end of the awl.
The Device may also be used in a method for preparing a femur to pick up a femoral implant. The method has the following steps: as needed remove the femoral head and neck, making a posterior incision of about 2.5 to 3.75 cm, which is aligned substantially to the central axis of the femoral shaft is, performing a blunt dissection to gain access through the posterior incision to expose the femoral shaft, inserting a retractor with a Tunnel in the access, which is designed to be introduced through the access is, and dissecting of the femur to receive a femoral implant through the retractor.
In a form the invention over an osteotomy guide with a handle that demonstrates the use of the osteotomy guide in allows a distance from a femur, as well as an alignment section and a cut, which are fixed on the handle.
The osteotomy can be used with other instruments, u. a. an awl, the one handle and a stem shaft with a distal end Has. The distal end of the Ahlenschafts is suitable in an anterior incision introduced and to the longitudinal axis to be aligned with a femur to allow for a posterior incision Locate that is manageable so that it has a proximal end of the Femurs uncovered.
In another form has the invention over a retractor formed by a tunnel for insertion through is an access leading to the femur shaft in a body.
The Instruments can be used with a rasp handle having an insertion part with an engaging means for selectively engaging a Cable has, which is fixable to a rasp. In a form points the engagement means has an engagement slot for selective engagement of the cable.
The Instruments can be used with a provisional femoral neck device, a provisional femoral neck with a hollow, essentially cylindrical body having. A spring-loaded locking piston is in the hollow cylindrical body provided and accommodated. The locking piston has a tapering body portion on. The exercise a radial force on the tapered body portion moves the locking piston against the biasing force of the spring. The leaves of a pair of pliers can be used Radial force on the tapered section of the locking piston exercise.
The Instruments can with a provisional prosthetic femoral neck with a guide surface and a provisional femur stem with a counterpart to the guide surface used become. The guide surface becomes to the counterpart piloted to unite the femoral head and the femur trunk. In a In the form of the invention, the femoral head is substantially cylindrical and is directed to the femoral stem prosthesis in the radial direction.
Advantageous allows the device of the invention performing a total hip arthroplasty in a minimally invasive way, which accelerates the patient's recovery.
These and other features and advantages of the invention, the manner their realization and the invention itself will become apparent from the following description an embodiment of the invention in conjunction with the accompanying drawings clearer out. Show it:
1 a side view of a patient showing a pair of incisions made for the use of the invention and the incision used in known methods;
2 an anterior view of a hip joint showing the femoral neck axis;
2A an anterior view of the capsule of the hip joint;
3 an anterior view of the femoral neck exposed by incising the hip capsule;
4 an anterior view of the femoral neck with an osteotomy guide of a form of the invention operatively positioned to define a cut line thereon;
5A a side view of an alternative embodiment of an osteotomy guide according to the invention;
5B an elevational view thereof along the longitudinal axis of the handle;
6 an anterior view of the femoral head and neck separated along the cut line indicated by the osteotomy guide;
7 an anterior view showing the removal of a portion of the femoral head and neck;
8A and 8B the preparation of the acetabulum to receive the acetabulum;
9 a side view of a Hüftpfanneninserters relative to a supine patient;
10 an anterior view of a portion of the in 9 shown pan inserter and a patient lying supine;
11 a side view showing the use of a curved awl to locate a posterior incision;
12 a partially sectioned side view of an awl;
13 a perspective view showing insertion of a posterior retractor into the posterior incision;
14 an exploded perspective view of an embodiment of a tubular retractor according to the invention;
14A a side view of an alternative embodiment of the tubular retractor;
15 a perspective view showing the insertion of a guide wire in the tubular retractor;
16 a perspective view showing the milling or drilling of the femoral shaft;
17A a perspective view of an end miller;
17B a perspective view of a femur drill;
18 a partially sectioned side view of an end mill inserted into a tubular retractor of the invention;
19 a perspective view of a rasp handle after insertion of a rasp in the femoral shaft;
19A a perspective view of an inserted rasp with the rasp handle removed and with the cable used to fix the rasp to the rasp handle projecting from the posterior incision;
20A and 20B Partial sectional views of the rasp handle;
21 an exploded view of the rasp handle and a rasp to be connected thereto;
21A a partial view on the line 21A-21A of 21 ;
22 a perspective view showing the placement of a provisional neck;
23 a perspective view of a provisional neck and paired pliers;
24A a partially sectioned radial view of the provisional neck;
24B and 24C Radial views thereof;
25 a perspective view showing the insertion of a femoral stem prosthesis with a protective bag through the Posteriorinzision;
26 a perspective view showing the alignment of the femoral stem prosthesis under observation by the anterior incision;
27 an incision in the protective bag of the femoral stem prosthesis prior to insertion of the femoral stem prosthesis into the femoral shaft;
28 a perspective view showing the removal of the protective bag of the femoral stem prosthesis during insertion of the femoral stem prosthesis under observation through the anterior incision;
29 a perspective view of an insertion tool for the femoral stem prosthesis; and
30 a perspective view of a hip prosthesis.
In The several views designate corresponding reference numerals throughout corresponding parts. The exemplary illustration illustrated herein a preferred embodiment of the invention in one form, and this exemplary illustration is not a limitation the scope of the invention.
Total hip arthroplasty can be performed by two incisions, each no more than 5 centimeters (2 inches) in length. An anterior incision is made along the axis of the femoral neck, while a posterior incision is made generally in axial alignment with the femoral shaft becomes. According to 1 shows a partial view of a patient 40 with hull 52 , Buttocks 50 and leg 48 an incision 42 of the prior art as well as an anterior incision 44 and posterior incision 46 the invention. The known incision 42 is about 25 centimeters (10 inches) long, while the anterior incision 44 and posterior incision 46 each at most 5 centimeters (2 inches) long.
According to this total hip arthroplasty procedure, the patient becomes 40 initially placed on a conventional operating table in the supine position. According to 2 then be with the leg 48 in neutral position two prominent bone orientation points palpated: the anterior superior iliac spine (ASIS for short) 59 and the greater trochanter 58 of the femur 62 , The ilium 64 and pubis 66 the hip 68 are shown to better illustrate the relevant area of the body. The approximate starting point 71 The anterior incision becomes two fingers inferior and two fingers wide anterior to the tuber of the greater trochanter 58 established. The approximate endpoint for the anterior incision is three fingers inferior and two fingers lateral to the anterior superior iliac spine (ASIS) 59 established. Using a spinal needle will be the approximate starting point 71 and the path of the anterior incision established by puncture in the skin down to the bone, around the central axis 70 of the femoral neck 60 to control.
An oblique incision of about 3.75 to 5 centimeters (1.5 to 2 inches) is from the starting point 71 to the prominence of the greater trochanter along the axis 70 of the femoral neck 60 and the central axis of the acetabulum 54 carried out. The incision is dilated along the same plane by subcutaneous tissue, exposing the underlying fascia lata. The innervation area between the tensor fasciae latae and the sartorius muscle is palpated and opened by curved scissors and blunt dissection. The sartorius can be made more prominent by external rotation of the leg to put the muscle under tension. Below the tensor fasciae latae and the sartorius lies an innervation interval between the rectus femoris and the gluteus medius. This area is accessed by blunt dissection. By a lateral retraction of the tensor fasciae latae the capsule can 74 of the hip joint according to 2A be visualized.
The leg 48 is externally rotated to voltage on the capsule 74 to create. The capsule 74 gets along the axis 70 ( 2 ) of the femoral neck 60 from the equator of the femoral head 56 Crista intertrochanterica on the femur 62 incised. The capsule incision has the shape of a "H-shaped" window that cuts through 72 is formed. The H-shaped window is formed by adding complementary vertical legs around the equator of the femoral head 56 and the base of the femoral neck 60 to the initial incision along the axis 70 of the femoral neck 60 , As retraction form heavy sutures are used to capsule the flaps 73 provisionally to attach to the subcutaneous tissue. According to 3 become retractors 76 inside the capsule flaps 73 and below the upper and lower margins of the femoral neck 60 placed to the entire length of the femoral neck 60 from the lower aspect of the femoral head 56 to expose Crista intertrochanterica. Each retractor can house a light source and can also serve to anchor an endoscope. This is ensured by the retractors 76 for continuous visualization and illumination of the wound.
According to 4 becomes a femoral cutting tool 86 , z. As a pendulum saw or an electric drill used to the femoral neck 60 to excise. A special osteotomy guide 78 gets through the anterior incision 44 ( 1 ) and serves to guide the femoral neck. An alignment section 82 the osteotomy guide 78 becomes the longitudinal axis of the femur 62 aligned while a cut 84 at the femur neck 60 is positioned. A handle 80 the osteotomy guide 78 facilitates the positioning and repositioning of the osteotomy guide 78 through the anterior incision 44 , After placement of the osteotomy guide 78 becomes a cutting line 85 marked, which is known in the art. Thereafter, the osteotomy guide 78 through the anterior cut 44 removed, and the femur cutting tool 86 gets through the anterior incision 44 introduced and used along the line 85 to cut and a section 88 ( 6 ) from the femur 62 to relocate.
The retractors 76 are repositioned around the margins anterior and posterior to the acetabulum. As known in the art, a special curved cutting tool (ie, the "ligamentum teres cutting tool") is placed behind the femoral head 56 performed to sharpen the ligamentum teres sharply what the cut section 88 according to 6 mobilized. The section section 88 shows the femoral head 56 and a section of the femoral neck 60 ( 4 ) on. After that, the section will be cut 88 through the anterior incision 44 with a special bone gripper (grasping forceps) 94 removed for the femoral head ( 7 ). In case of difficulty, the cutting section 88 In one piece, he can remove with a cutting tool 87 ( 6 ) are crushed in situ, z. B. with an electric drill. Then you can shred pieces 92 through the anterior incision 44 remove. The crushing of the cutting section is achieved 88 by making cuts that are essentially the cuts in the hip capsule 74 Flushing and suction devices can be used to cool the bone and remove bone bones the hip capsule 74 to facilitate. A fiber optic endoscope can be placed in the hip joint to control complete removal of bone debris.
According to 8A The fibrous fatty tissue in the acetabular fossa of the acetabulum 54 z. B. using a high-speed cutting tool 96 with an acorn-shaped tip, a Rongeur forceps and a curette removed. Thereafter, the labrum acetabulare is trimmed with a scalpel. According to 8B The acetabulum is then filled with a standard ladle cutter 98 milled. Cup cutters with a predetermined size range are used until the optimal size of the acetabulum is achieved. The sizing of the acetabulum is facilitated by means of preoperative templates and X-ray images, which is known in the art. Again, an endoscope may be used to aid visualization during the milling process. Normally, the acetabulum is milled about 2 mm smaller than the diameter of the expected hip socket to create a tight fit. The high-speed acorn-shaped cutting tool 96 and the pan cutter 98 occur through the anterior cut 44 into the body.
After a trial fit, a suitable sized Preßfit acetabulum is made with a standard pan inserter 100 according to 9 firmly inserted and driven as technically known in the Pfannenaushöhlung. Proper positioning of the acetabular cup is achieved with a special anteflexion and pelvic alignment guide. The patient 40 is on an operating table 102 placed in supine position. An alignment bar 104 becomes the center lateral axis of the fuselage 52 aligned while a main shaft 105 about 30 ° to the operating table 102 is held for proper insertion of the acetabular cup. To enhance cup fixation, a flexible drill may be used to guide the placement of one or more pan screws. The insertion of the socket insert is postponed until the proximal femur has been prepared for insertion of a trial socket prosthesis. Like the anterior view of 10 shows, the patient remains 40 in the supine position on the operating table 102 ( 9 ), during the pan inserter 100 is used to insert the acetabulum.
For preparation of the femur, the patient is repositioned with a pad placed under the ipsilateral hip. The hips are slightly flexed, about 30 ° adducted and maximally externally rotated. The retractors 76 become the medial and lateral aspect of the femur 62 repositioned. Alternatively, a self-retaining retractor with a light source attachment and an endoscope holder in the anterior incision 44 be positioned to provide constant visualization and illumination of the femur 62 to care.
With a scalpel or curved osteotome, the soft tissues along the anterior surface of the femur become 62 just inferior to the crest intertrochanterica subperiostal, to expose the bone over a width of about 1 cm. This sharp subperiosteal detachment continues superolaterally on the anterior margo of the greater trochanter. Thereafter, a curved Mayo scissors open a passageway through blunt dissection, which leads to the anterior fibers of the gluteus minimus to the buttocks 50 superficially directed ( 11 ).
According to 11 becomes an awl 106 through the anterior incision 44 introduced to the cleft in the gluteus minimus superficially and into the soft tissues of the buttocks 50 advanced until her pointed distal end 108 can be palpated on the surface of the skin. The distal end 108 the awl 106 becomes generally the longitudinal axis of the femur 62 aligned. At the point where the distal end 108 palpation becomes the posterior incision 46 from about 2.5 to 3.75 cm (1 to 1.5 inches) and expanded by the subcutaneous tissue and the fascia lata to expose the underlying gluteus maximus. A tract to the femur 62 gets along the through the awl 106 opened way. The gluteus maximus is blunt-ended in accordance with its fibers with a curved Mayo scissors. In this passage is about the posterior incision 46 an elliptical special posterior retractor 122 completely introduced with its inner sleeves down to the severed femoral neck ( 13 ). In an exemplary embodiment, the elliptical posterior retractor 122 a posterior lip 128 on ( 14 ). In this embodiment, the retractor 122 screwed to the severed femoral neck, until the posterior lip 128 lies below the crista intertrochanterica posterior. 14A illustrates an embodiment of a rasp tunnel 130 without posterior lip 128 , In an alternative embodiment, each component of the posterior retractor becomes 122 (ie guide tube 124 , Drill tunnel 126 and rasp tunnel 130 ) individually inserted and removed as needed. In an embodiment in which the guide tube 124 , the drill tunnel 126 and the rasp tunnel 130 individually in the posterior incision 46 can be introduced and removed from it, each individual tunnel with a posterior lip similar to the posterior lip 128 according to 14 be provided.
According to 15 then becomes a guidewire 146 with a blunt tip through the guide tube 124 the posterior retractor 122 introduced and into the femoral canal 148 advanced. Even though 15 the guide tube 124 in the drill tunnel 126 and rasp tunnel 130 plugged in, the guide tube can 124 through the posterior incision 46 directly be introduced. Is the bone cancellous bone of the femur 62 too tight to insert the blunt-headed guidewire 146 A conical cannula drill or end mill is used to prepare the femoral metaphysis. When using a nested posterior retractor configuration, the guide tube must 124 be removed so that the drill through the drill tunnel 126 the posterior retractor 122 can be introduced. If similarly no nested configuration is used, the drill tunnel 126 in the posterior section 46 be introduced. In any case, the guidewire becomes 146 with a blunt tip about half way into the femoral canal 148 introduced. The following detailed description of the invention relates to a nested configuration of the posterior retractor. It will be apparent to those skilled in the art that when not in use, the nested configuration will require each and every component of the post-retractor 122 as required by the posterior incision 46 introduced and removed.
16 illustrates the preparation of the femoral canal 148 for receiving a rasp 204 ( 19 ). The guide tube 124 gets out of the posterior retractor 122 removed, and an end mill 150 ( 17A ) is through the drill tunnel 126 introduced. 18 shows the end mill 150 in the drill tunnel 126 is positioned. The end mill 150 has an elongated opening 160 on, through which the guidewire 146 runs and the end mill 150 leads. The end mill 150 is actuated by any of the many actuators known in the art. After completion of the end milling, the end mill becomes 150 through the drill tunnel 126 removed and a (drill) drill 151 ( 17B ) is introduced by him. The drill 151 has a drill guide opening 161 on, through which the guidewire 146 runs and the drill 151 leads, while this the femoral canal 148 aufbohrt. Drills of progressively larger outer diameter are successively over the guidewire 146 placed, and the femoral canal 148 is drilled until cortical bouncing is felt. As known in the art, the optimal diameter of the femoral canal becomes 148 provisionally determined by preoperative stenosis. Some surgeons may choose to avoid drilling the femur shaft and instead use a scraper as known in the art. A reamer can be introduced according to the invention as described later for the rasp insert.
After boring to the correct diameter of the femoral canal 148 becomes the drill tunnel 126 ( 14 ) from the posterior retractor 122 removed so the rasp 204 and a rasp handle 212 ( 19 ) over the guidewire 146 can be introduced to the preparation of the femur 62 complete. The guidewire 146 gets into a rasp guide opening 214 and a rasp handle guide opening 202 introduced to the rasp 204 to the prepared femur 62 respectively. On a collision surface 164 is beaten as known in the art to the rasp 204 in the femur 62 to place. W hen the rasp 204 The rotational alignment can be achieved by direct visual monitoring of the femur 62 through the anterior incision 44 be estimated. Further, the assessment of the orientation of the rasp handle facilitates 212 with regard to the kneecap, lower leg and foot alignment.
Increasingly larger rasps are being introduced to ensure the optimal fit and filling in the femur 62 to reach. Once the last rasp is fully seated, the rasp handle becomes 212 along with the guide wire 146 and posterior retractor 122 removed, leaving a distal end 208 a flexible cable 192 ( 19A ) at the proximal end of the rasp 204 remains attached and a proximal end 194 of the flexible cable 192 from the posteriorinzisiori 46 protrudes. The following is the operation of the rasp handle 212 explained in more detail.
After the last rasp in the femoral canal 148 inserted, a trial socket insert is inserted through the anterior incision 44 and placed in the inserted acetabulum using a well-known insert inserter. A provisional neck 222 is through the anterior cut 44 inserted and at the top of the inserted rasp according to 22 locked. A trial femoral head becomes on the Morse rejuvenation of the provisional neck 222 through the anterior incision 44 placed. The hip joint is reduced for stability control of the hip joint and limb length. If necessary, a second check is made. Once the trial reduction is satisfactorily completed, the hip is dislocated, and the provisional head and provisional neck 222 being deleted. The rasp handle 212 becomes through the posterior incision 46 over the free end of the flexible cable 192 reintroduced. The rasp handle 212 is pushed forward until it can be locked with the inserted rasp, so that the impact surface 164 beaten and the entire tool (ie rasp 204 and rasp handle 212 ) can be removed. The trial socket insert is inserted through the anterior incision 44 away.
About the anterior incision 44 becomes the Endpfanneneinlage 252 ( 30 ) in the acetabulum 250 ( 30 ) with a liner insert that allows it to be wedged, which is known in the art. A femoral implant 238 ( 30 ) is attached to a femoral stem prosthesis insertion tool 240 ( 29 ) and through the posterior incision 46 placed. According to 25 is the femoral implant 238 in a protective disposable bag 242 before its introduction into the posterior incision 46 placed: The protective disposable bag 242 holds the femoral implant 238 clean while passing through the posterior incision 46 is introduced. It should be noted that 25 the femoral implant 238 in its orientation when placed in the femur 62 shows. For insertion of the femoral implant 238 through the posterior incision 46 must the femoral implant 238 be rotated 180 ° from this position to prevent impact on the body. After that, the femoral implant 238 after complete insertion through the posterior section 46 Turned 180 °.
26 illustrates the femoral stem prosthesis 238 and the bag 242 through the posterior incision 46 are introduced. Approaching the tip of the femoral stem prosthesis 238 The severed femoral neck becomes the distal end of the pouch 242 according to 27 cut. A scalpel 246 gets into the anterior incision 44 introduced to the bag 242 incise. When driving the femoral stem prosthesis 238 in the femoral canal 148 becomes the bag 242 according to 28 through the posterior incision 46 progressively removed. After the femoral stem prosthesis 238 is fully inserted, the femoral stem prosthesis insertion tool 240 ( 29 ) through the posterior incision 46 away. Through the anterior incision 44 The end femoral head is positioned on the Morse taper of the femoral neck using a standard fixture and secured with a standard impact tool and hammer. Then the hip is repositioned and checked for stability.
To suitable antibiotic rinse become the hip capsule and the soft tissues repaired with heavy sutures or staples. A suitable local anesthetic solution will be in the closed hip joint as well as the capsule layer and the subcutaneous tissue are injected, which is excellent postoperative pain relief. The fascial layers, subcutaneous tissue and the skin of both the anterior and posterior wounds in a conventional Procedure closed, and associations become created. At the discretion of the surgeon, a suction drainage for Use come.
The osteotomy guide 78 , in the 4 shown in use, points the handle 80 , the registration section 82 and the cut 84 on. The cut 84 and the alignment section 82 form a 60 ° angle. In an exemplary embodiment, the alignment section 82 a tapered distal end according to 5A and 5B on. The osteotomy guide 78 gets through the anterior incision 44 inserted and positioned, wherein the alignment section 82 so on the femur 62 is placed that the alignment section 82 to the longitudinal axis of the femur 62 is generally oriented. The handle 80 stands through the anterior incision 44 before and can be used, the osteotomy guide 78 to position. After correct positioning of the osteotomy guide 78 becomes the cutting guide 84 used the cutting line 85 at the femur neck 60 according to 4 to mark. The osteotomy guide 78 can be made to work on either side of the body. 4 shows an osteotomy guide designed to function on the right femur while 5B shows an osteotomy guide that works on the left femur.
As previously discussed, the awl is 106 ( 12 ) for insertion through the anterior incision 44 designed to the posterior incision 46 ( 11 ) to locate. A people shaft 116 has a proximal end 110 on, for insertion into a handle 112 is designed. The handle 112 has a longitudinal channel 120 on, in which the proximal end 110 of Ahlenschafts 116 can be used. A locking screw 118 is in the handle 112 operably positioned and can by a locking button 114 be operated. The lock button 114 is used to lock the locking screw 118 in locking engagement with the proximal end 110 the awl 106 to move. The proximal end 110 the awl 106 may have a flat portion to a handle with the locking screw 118 and the locking engagement of the Ahlenschafts 116 on the handle 112 to facilitate. Furthermore, the Ahlenschaft 116 the distal end 108 on. The distal end 108 is generally straight and is used, a general orientation to a longitudinal axis of the femur 62 to make ( 11 ). According to 12 has the distal end 108 of Ahlenschafts 116 a tapered end to the insertion of the awl 106 through the anterior incision 44 to facilitate the posterior incision 46 to locate. In addition, the distal end 108 the awl 106 a smaller diameter than the body of the Ahlenschafts 116 according to 12 to have. Alternatively, the awl 106 formed in one piece and a disposable instrument.
According to 14 rejects the posterior retractor 122 three nested parts on. The guide tube 124 gets into the drill tunnel 126 plugged while the drill tunnel 126 in the rasp tunnel 130 is plugged. When screwing the posterior retractor 122 into the posterior incision 46 can the guide tube 124 , the drill tunnel 126 and the rasp tunnel 130 be intertwined to form a single entity. The rasp tunnel 130 has external thread 132 on to the screws of the posterior retractor 122 through the posterior incision 46 to facilitate. The rasp tunnel 130 has a rasp opening 134 through which the drill tunnel 126 can be introduced, and in an alternative embodiment on the posterior lip 128 for positioning the posterior retractor 122 according to the discussion above. The drill tunnel 126 has a flange 136 which is operable to the position of the drill tunnel 126 in the rasp tunnel 130 maintains. The drill tunnel 126 has a drill hole 138 on, through which the guide tube 124 can be introduced. The guide tube 124 has a tapered distal end 140 on to their introduction to the drill hole 138 to facilitate. The guide tube 124 has a guide wire opening 144 on, through which the guidewire 146 ( 15 ) can be introduced. The drill hole 138 is sized so that the end mill 150 ( 18 ) or the femoral drill 151 can be introduced according to the discussion above. According to 18 is the guide tube 124 from the drill tunnel 126 removed, and the end mill 150 is through the drill hole 138 introduced. The longitudinal drill hole 138 is sized to guide cylinder 156 accommodate and so for leadership and stability of the end mill 150 can provide. After the end mill (and if necessary the boring) is completed, the drill tunnel becomes 126 from the rasp tunnel 130 away. The rasp opening 134 is sized to withstand the insertion of the rasp 204 and a cannula insertion part 168 of the rasp handle 212 Can take account. For procedures that do not use boring, the posterior retractor may include a rasp tunnel with a guide tube inserted therein and may not have a drill tunnel as described above. As previously stated, the posterior retractor becomes 122 not always used in its nested configuration. In an exemplary embodiment, the guide tube 124 , the drill tunnel 126 and the rasp tunnel 130 as needed in the posterior incision 46 introduced and removed from it.
According to 21 has the rasp handle 212 via the cannula insertion part 168 , the impact surface 164 , a handle 166 , the elongated guide opening 202 , an elongated opening 200 and an engagement channel 190 , The rasp 204 has an opening 216 which is dimensioned to be a holder 210 at the distal end 208 of the flexible cable 192 absorbs and holds. The holder 210 will be in the opening 216 placed, and the flexible cable 192 follows a cable channel 217 to get out of the rasp 204 withdraw. The proximal end 194 of the flexible cable 192 gets through the elongated opening 200 of the cannula insertion part 168 introduced, and a distal rasp engagement guide 206 becomes a guide channel 215 the rasp 204 piloted. After exiting the proximal end of the elongated opening 200 may be the proximal end 194 of the flexible cable 192 in the engagement channel 190 be recorded. The engagement channel 190 is sized to hold the bracket 196 absorbs and holds. After the bracket 196 in the engagement channel 190 Operationally positioned, the handle can 166 be pressed to the flexible cable 192 to stretch.
According to 20B is the holder 196 in the engagement channel 190 operationally positioned. fastening devices 184 , z. As rivets bands, etc., are used to biasing elements 172 on the handle 166 and on an inner handle surface 182 to fix. The handle 166 gets through the handle biasing elements 172 biased outward and pivots about a pivot point 198 , The handle 166 has a clamping part 188 and a lock 174 on. The barrier 174 is to engage with a tapered end 186 a latch 176 designed. The handle 176 has a pawl flange 178 on. A feather 180 engages in the palm of the handgrip 82 and the jack flange 178 one to the latch 176 to the cannula insertion part 168 pretension. By pressing the handle 166 against the biasing force of the biasing elements 172 the handle turns 166 around the pivot point 198 , the barrier 174 comes in working engagement with the tapered end 186 the latch 176 , and the clamping part 188 contacts the flexible cable 192 , 20A shows the handle 166 that by the latch 176 is held in the closed position. As shown, the clamping part contacts and tensions 188 the flexible cable 192 , causing the rasp 204 at the rasp handle 212 is locked. A lock release button 170 can be against the biasing force of the spring 180 be pulled out to the handle 166 to unlock.
According to 23 can the provisional neck 222 at the rasp 204 with the help of a pair of pliers 220 be locked. The forceps 220 has leaf ends 230 . 232 on. The leaves ends 230 . 232 are for insertion in temporary head openings 234 respectively. 236 ( 24B and 24C ). According to 24A has the provisional neck 222 a locking cylinder 224 and a spring 228 on. The feather 228 clamps the locking cylinder 224 upwards. After insertion into the openings 234 . 236 can the leaf ends 230 . 232 a tapered section 226 of the locking cylinder 224 to contact. By pressing the leaf ends 230 . 232 against the tapered section 226 the locking piston moves 224 in the opposite direction to the biasing force of the spring 228 , The provisional neck 222 gets on the pliers 220 clamped and in a radial direction in an engagement surface 218 for the provisional neck ( 21 and 21A ) on the rasp 204 pushed. After the provisional neck 222 full on the rasp 204 pushed, can the pliers 220 be released, causing the locking piston 224 under the biasing force of the spring 228 can return to its locked position. The rasp 204 has circular cutouts 217 in which the locking cylinder 224 can engage to the provisional neck 222 to lock in place.
channels 225 ( 24A ) on the provisional neck 222 take tabs 219 ( 21 ) on the rasp 204 on. The provisional neck 222 gets on the rasp 204 pushed, with the projections 219 the channels 225 of the provisional neck 222 occupy. An attack 223 of the provisional neck 222 abuts the protrusions 219 when the provisional neck 222 completely on the rasp 204 pushed. The stop hits 223 to the projections 219 on, the locking cylinder can 224 locked (ie the forceps blades 230 . 232 let go), so that the locking cylinder 224 in the circular cutouts 217 engages what the provisional neck 222 at the rasp 204 locked.
Preferred methods for using the invention are listed below (the aspects given are aspects of the method, not the invention).
A method for performing total hip arthroplasty comprising the steps of: preparing an anterior incision; Producing a posterior incision; Preparing an acetabulum to receive an acetabulum through the anterior incision; Inserting a acetabulum acetabulum through the anterior incision; Preparing a femur to receive a femoral trunk; and inserting the femoral stem prosthesis into the femur.
2. The method of aspect 1, wherein the anterior incision has a length of about 3.75 to 5 cm.
3. The method of aspect 1, wherein the step of preparing a femur to receive a femoral trunk comprises: preparing the femur to receive the femur trunk through the posterior incision.
4. The method of aspect 1, wherein the step of inserting the femoral stem into the femur comprises: inserting the femur stem through the posterior incision and then inserting the femur stem into the femur.
5. A method for performing total hip arthroplasty comprising the steps of: preparing a femur to receive a femoral trunk; Placing a protective bag over the femur trunk; and inserting the femoral stem into the femur.
6. The method of aspect 5, wherein the step of inserting the femoral stem comprises: cutting the distal end of the protective pouch as the femoral stem prosthesis approaches the femur; and progressively removing the protective pouch from the femoral implant while inserting the femoral implant into the femur.
7. A method for performing total hip arthroplasty, comprising the steps of: placing a patient supine; Palpation of a femoral neck; Making an anterior incision approximately 3.75 to 5 centimeters in length in correspondence with the femoral neck to expose underlying muscle; Performing a blunt dissection of the underlying muscle to expose a capsule of a hip joint; Incising the capsule; Retracting a portion of the capsule to visually expose the femoral neck; Providing an osteotomy guide with a handle, an alignment portion fixed to the handle for alignment with a femoral central axis and a cut guide fixed to the handle; Aligning the alignment section with the femoral axis, wherein the incision line is on the femoral neck; Marking a cutting path defined by the cut; Cutting along the cutting path to remove a cut portion from a femoral stem, the cut portion having a femoral head and a portion of the femoral neck; Incising a ligament of the teres femoris; if necessary in situ crushing of the cut section for removal by the anterior incision; Removing the incision section through the anterior incision; Milling an acetabulum; Inserting a acetabular cup into the acetabulum; Inserting a curved awl having a substantially straight distal end into the anterior incision; Aligning the distal end of the awl with the axis of the femur; Palpating a ply of the distal end of the awl; Making a posterior incision about 2.5 to 3.75 centimeters in length at the distal end of the awl; Performing a blunt dissection to provide access through the posterior incision to expose the femoral shaft; Inserting a retractor into the accessway, the retractor comprising: a rasp tunnel sized to allow passage of a femoral rasp through it; a drill tunnel sized to allow the passage of a femoral drill through it, the drill tunnel being inserted in the rasp tunnel; and a guide tube sized to allow passage of a guidewire therethrough, the guide tube being inserted into the bore tunnel is plugged in; Passing a guidewire through the guide tube and into the bone cancellous bone of a femur; Removing the guide tube from the retractor; Positioning the guidewire in a cannula of a femoral drill; Guiding the femoral drill to the femoral shaft with the guide wire; Drilling the femoral shaft with the femoral drill under observation through the anterior incision; Removing the drill tunnel from the retractor; Positioning a rasp in the femoral shaft using the guide wire to properly position the rasp as viewed through the anterior incision; Removing the guidewire; Removing the retractor from the posterior incision; Positioning a trial socket insert in the acetabulum through the anterior incision; Fixing a provisional neck to the rasp through the anterior incision; Fixing a provisional head to the provisional neck through the anterior incision; Performing a trial reduction with the trial socket insert, provisional neck and provisional head in place; Dislocating the provisional head; Removing the trial socket insert through the anterior incision; Removing the provisional neck and head through the anterior incision; Removing the rasp through the posterior incision; Inserting an end cup insert into the acetabulum through the anterior incision; Inserting a femoral implant through the posterior incision; Inserting an end femoral head through the anterior incision; Fixing the end femoral head to the femoral implant; Repositioning the hips; and closing the incisions.
8. The method of aspect 7, wherein the step of palpating a femoral neck comprises palpating anterior superior iliac spine and a greater trochanter of the femur.
9. The method of aspect 7, wherein the step of incising the capsule comprises: incising an H-pattern into the capsule.
10. The method of aspect 7, wherein the step of retracting a portion of the capsule comprises: suturing the portion of the capsule with subcutaneous tissue.
11. The method of aspect 7, wherein the rasp tunnel has a projection for aligning the rasp tunnel with the femoral stem, and wherein the method further comprises the step of: aligning the projection with the femoral stem after insertion of the retractor into the access.
12. The method of aspect 7, wherein the rasp tunnel has external threads and wherein the step of inserting a retractor into the accessway comprises screwing the retractor into the access.
13. The method of aspect 7, wherein the step of positioning a rasp in the femoral shaft comprises: locking the rasp to a rasp handle comprising: a cannula insert portion, the cannula insert portion having a distal rasp engagement guide, an elongated aperture, and a guide aperture, the elongate aperture sized is that it houses a flexible cable; an engagement slot for selectively engaging a proximal end of the flexible cable; a selectively operable handle operable to bias the flexible cable; a latch for selectively locking the handle in a position to tension the flexible cable; and an impact surface for receiving beats to place or remove a rasp; Positioning the guide wire in a guide opening of the rasp and the guide opening of the rasp handle; Guiding the rasp and the cannula insertion part through the rasp tunnel to a proximal end of the femoral shaft by means of the guide wire; Hitting the abutment surface to position the rasp in the femoral shaft; Unlock the handle; Releasing the flexible cable from the engagement slot of the rasp handle; and removing the rasp handle.
14. The method of aspect 13, wherein the step of locking the rasp on the rasp handle comprises: engaging a distal end of the flexible cable in the rasp; Inserting the flexible cable through the elongated opening of the rasp handle; Guiding the distal rasp engagement guide into a rasp engagement guide receiving portion on the rasp; Engaging the proximal end of the flexible cable in the engagement slot of the rasp handle; and tensioning the flexible cable.
15. The method of aspect 7, wherein the step of fixing a provisional neck to the rasp through the anterior incision comprises: unlocking a provisional neck with a locking mechanism; Inserting the provisional neck into the anterior incision; Positioning the provisional neck on the rasp; and locking the provisional neck to the rasp.
16. The method of aspect 14, wherein the step of removing the rasp comprises: reinserting the flexible cable through the elongate opening; Reinserting the cannula insertion part through the posterior incision; Guiding the distal rasp engagement guide into the rasp engagement guide receiving portion; Engaging the proximal end of the flexible cable in the engagement slot; Tensioning the flexible cable; and hitting the abutment surface to remove the rasp from the femoral shaft.
17. The method of aspect 7, wherein the step of inserting a femoral implant through the posterior incision comprises: locking the femoral implant to a femoral stem prosthesis insertion tool; Placing the femoral implant and a distal end of the femoral stem prosthesis insertion tool in a pouch; Inserting the femoral implant and the distal end of the femoral stem prosthesis insertion tool through the posterior incision; Considering the progress of the movement of the femoral implant to the femur through the anterior incision; Cutting the distal end of the bag with a scalpel inserted through the anterior incision as the femoral stem prosthesis approaches the femoral shaft; and progressively withdrawing the bag from the femoral implant while the femoral implant is being further inserted into the femur.
18. A method of removing a femoral neck and head comprising the steps of: making an anterior incision in accordance with a femoral neck; Providing an osteotomy guide with a handle, an alignment portion fixed to the handle for alignment with a femoral axis, and a cut guide secured to the handle; Aligning the alignment section with the femoral axis, wherein the incision line is on the femoral neck; Marking a cutting path defined by the cut; and cutting along the cutting path to remove a cut portion having a portion of the femoral neck and the femoral head.
19. The method of aspect 18, wherein the step of establishing an anterior incision in accordance with a femoral neck comprises: placing a patient supine; Palpation of the femoral neck; and establishing an anterior incision in correspondence with the femoral neck to expose underlying muscle.
20. The method of aspect 19, wherein the step of aligning the femoral axis alignment section comprises: performing a blunt dissection of the muscle to expose an anterior capsule of a hip joint; Incising the anterior capsule; Retracting a portion of the anterior capsule to visually expose the femoral neck; and inserting the osteotomy guide through the anterior incision.
21. Method according to aspect 20 , further comprising the steps of: incising a ligamentum teres; if necessary in situ crushing of the cut section for removal by the anterior incision; and removing the incision section through the anterior incision.
22. A method of producing a posterior incision aligned with a femoral longitudinal axis, comprising the steps of: producing an anterior incision aligned with a femoral neck; Providing an awl with a handle and a curved stem with a distal end; Aligning the distal end with the longitudinal axis of the femur; Palpating a ply of the distal end of the awl; and producing a posterior incision at the location of the distal end of the awl.
23. A method of preparing a femur to receive a femoral implant comprising the steps of: removing a femoral head and a femoral neck from a femoral shaft as needed; Producing a posterior incision about 2.5 to 3.75 centimeters in length that is substantially aligned with a central axis of the femoral stem; Performing a blunt dissection to provide access through the posterior incision to expose the femoral shaft; Inserting a retractor into the access, the retractor having a tunnel sized to be inserted through the access; and dissecting the femur to receive the femoral implant through the retractor.
24. The method of aspect 23, wherein the tunnel has a guide tube sized to allow passage of a guidewire therethrough, and wherein the method further comprises the steps of: directing a guidewire through the guide and into the bone cancellous bone of the femur; and removing the guide tube.
25. The method of aspect 24, further comprising the steps of: providing a tunnel sized to permit passage of a femoral drill therethrough; Inserting the drill tunnel into the access; Positioning the guidewire in a cannula of a femoral drill; Guiding the femoral drill to the femoral shaft with the guide wire; Drilling the femoral stem with the femoral drill; and removing the femoral drill and the drill tunnel from the access.
26. The method of aspect 24, further comprising the steps of: providing a rasp tunnel sized to allow the passage of a femoral rasp through it; Inserting the rasp tunnel into the access; Position a rasp in the femoral shaft through the rasp tunnel using the guide wire to properly position the rasp; and removing the guidewire, rasp and rasp tunnel.
27. The method of aspect 26, wherein the rasp tunnel has a projection for aligning the rasp tunnel with the femoral stem, and wherein the method further comprises the step of: aligning the projection with the femoral stem after inserting the rasp tunnel into the access.
28. The method of aspect 26, wherein the rasp tunnel has external threads and wherein the step of inserting the rasp tunnel into the accessway comprises screwing the retractor into the access.
Osteotomy guide ( 78 ) for locating a cutting line on a femoral neck with an elongate handle ( 80 ), which may protrude through an incision, an alignment section ( 82 ) for aligning the osteotomy guide ( 78 ), wherein the alignment section ( 82 ) on the handle ( 80 ) has a fixed first end and a second end opposite to the first end, wherein the alignment section ( 82 ) is adapted to align with a femoral axis, and a cutting guide ( 84 ), characterized in that the alignment section ( 82 ) and the cutting guide ( 84 ) with the handle ( 80 ) are integral, and in that the alignment section ( 82 ) and the cutting guide ( 84 ) form a 60 ° angle.
Retractor ( 122 ) for use in performing a minimally invasive total hip arthroplasty with a tunnel sized to be inserted through a 2.5 to 3.75 cm (1 to 1.5 inch) incision in a body, the incision into a femoral shaft characterized in that the tunnel has a rasp tunnel ( 130 ) sized to permit passage of a femoral rasp through it.
Retractor ( 122 ) according to claim 2, characterized in that the retractor is a drill tunnel ( 126 ) dimensioned to permit passage of a femur drill therethrough.
Retractor ( 122 ) according to claim 2, characterized in that the retractor is a guide tube ( 124 ), which is dimensioned so that it allows the passage of a guide wire through them.
Retractor ( 122 ) according to claim 2, characterized in that it further comprises a guide tube ( 124 ), which is dimensioned so that it allows the passage of a guide wire through them, and in that the guide tube ( 124 ) in the rasp tunnel ( 130 ) is inserted.
Retractor ( 122 ) according to claim 5, characterized in that it further comprises a drill tunnel sized to allow the passage of a standard femoral drill through it, and in that the drill tunnel ( 126 ) in the rasp tunnel ( 130 ), and in that the guide tube ( 124 ) in the drill tunnel ( 126 ) is inserted.
Retractor ( 122 ) according to one of the preceding claims 2 to 6, characterized in that the rasp tunnel ( 130 ) Has external threads for screwing the retractor into the incision.
Retractor ( 122 ) according to one of the preceding claims 2 to 7, characterized in that the rasp tunnel has a posterior lip ( 128 ) located at a distal end of the rasp tunnel (FIG. 130 ) is formed.
DE60121850T 2000-04-26 2001-04-26 Devices for minimally invasive total hip arthroplasty Active DE60121850T2 (en)
US558044 2000-04-26
DE60121850D1 DE60121850D1 (en) 2006-09-14
DE60121850T2 true DE60121850T2 (en) 2007-07-26
DE60121850T Active DE60121850T2 (en) 2000-04-26 2001-04-26 Devices for minimally invasive total hip arthroplasty
DE60131301T Active DE60131301T2 (en) 2000-04-26 2001-04-26 Rasp handle for minimally invasive total hip arthroplasty
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Owner name: MEARS, DANA, LONDONVILLE, N.Y., US
Owner name: ZIMMER, INC. (N.D.GES.D. STAATES DELAWARE), WA, US