Patent Description:
When performing surgical procedures on the hip joint, it is common to distract the hip joint prior to the surgery in order to provide additional room within the hip joint during the surgery and in order to better present selected anatomy to the surgeon during the surgery. This hip distraction is commonly achieved by applying a distraction force to the distal end of the leg of the patient. Currently, a surgical boot is placed on the foot and lower leg of the patient, the surgical boot is connected to a distraction frame, and then the distraction frame is used to apply a distraction force to the surgical boot, whereby to apply a distraction force to the leg of the patient.

With conventional hip distraction, it is common to provide a padded post between the legs of the patient. This padded post provides a counterforce to the anatomy when the distraction force is applied to the surgical boot. However, the use of a padded post can create complications, since the padded post can press against the pudendal nerve of the patient, and/or the sciatic nerve of the patient, during distraction. Additionally, the padded post can exert pressure on the blood vessels in the leg of the patient during distraction. Thus, it would be desirable to minimize or eliminate the use of the padded post if other means could be used to provide a counterforce to the anatomy when the distraction force is applied to the surgical boot.

In addition to the foregoing, during many surgeries involving hip distraction, it can be desirable to image the anatomy which is being operated on using X-ray and/or CT imaging. However, conventional surgical tables are typically made out of radiopaque materials, thereby making it difficult or impossible to image the anatomy which is being operated on using these imaging modalities while the anatomy is supported on a conventional surgical table. As a result, it is frequently necessary to suspend the anatomy which is being operated on off one end of the surgical table so that the anatomy which is being operated on can be imaged using X-ray and/or CT imaging. This can significantly complicate and/or impede the surgery. Alternatively, it may be necessary to forego the use of X-ray and/or CT imaging during the surgery. Thus it would be desirable to provide a support for receiving and supporting the anatomy of a patient without significantly interfering with X-ray or CT imaging.

With some surgeries, it can be desirable to position the patient in the so-called "Trendelenburg position", e.g., during abdominal surgery. When disposed in the Trendelenburg position, the patient lies on the surgical table "flat on their back", with their feet higher than their head, e.g., by approximately <NUM>-<NUM> degrees. In order to facilitate this arrangement, the surgical table is typically tilted so that the patient's head is angled downward and the patient's feet are angled upward.

In the case of hip arthroscopy, it has been recognized that positioning the patient in this manner can facilitate distraction of the hip joint without a perineal post; that is, the gravitational weight of the patient inclined in the Trendelenburg position counteracts the distraction force in lieu of the perineal post. The frictional forces of the patient on the surgical table also contribute to counteract the distraction force. This approach has sometimes been referred to as "post-less" hip arthroscopy.

Numerous benefits are achieved by practicing post-less hip distraction.

One benefit of post-less hip distraction is that there is no post to press against the pudendal nerve of the patient, and/or the sciatic nerve of the patient, and/or the blood vessels of the patient, during distraction.

Another benefit of post-less hip distraction is that the non-operative leg remains relaxed while the operative leg is being "pulled on" for distraction. This is because gravity and the friction associated with the tilted surgical table are being used to keep the patient stable on the surgical table, not a post mounted to the surgical table. A post acts as a point of counter-traction; as such, the hip pivots around the post, resulting in a transfer of force to the non-operative leg. Without a post, there is no fulcrum and hence no force is transferred to the non-operative leg. This can benefit the patient inasmuch as any possible risks associated with forces being applied to the non-operative leg (such as neurovascular damage) are eliminated.

Another benefit of post-less hip distraction is that a post-less procedure results in less pelvic tilt than conventional distraction using a post. Again, because the post acts as a point of counter-traction, it imparts a force on the perineum of the patient, and can act as a fulcrum. For example, in the frontal plane, the pelvis can rotate around the post. This can result in pelvic tilt, which can be problematic.

In addition to the foregoing, in a typical hip arthroscopy procedure, distraction is used for central compartment work while peripheral compartment work is typically done "off-traction" (i.e., without a distraction force being applied to the leg of the patient). In a post-less procedure, the surgical table may be inclined for the portion of the procedure which requires traction (i.e., while work is done in the central compartment), but the surgical table can either be inclined or flat during the portion of the procedure which does not require traction (i.e., while work is done in the peripheral compartment). This can provide benefits to the surgeon.

In some hip arthroscopy procedures, the post may be removed when traction is not required, such as while work is being done in the peripheral compartment of the hip. However, there are times when it may be necessary to re-introduce the post (such as when traction is needed to check on work done in the central compartment, or when a bilateral procedure is performed and traction is needed for the other hip). However, it can be cumbersome and difficult to re-mount the post to the surgical table while keeping the sterile drape in place. In fact, the user must crawl under the drape and re-mount the post to the surgical table without having much visibility. Care must also be taken to avoid entrapment of the patient's anatomy (e.g., the genitalia) during the re-mounting of the post to the surgical table, which can be difficult to do and which can carry significant risk for the patient. In a post-less procedure, there is no post to manage.

Thus it will be appreciated that numerous advantages can be obtained using post-less hip distraction.

It should also be appreciated that, even if a post is used, advantages can be obtained if the patient can be positioned so as to minimize the forces applied to the patient via the post. By way of example but not limitation, even if a post is used, positioning the patient in the Trendelenburg position can minimize the forces applied to the patient via the post. In other words, performing a post-less hip arthroscopy has all of the aforementioned benefits, however, in certain circumstances, it may still be required or beneficial to use a post. But even in the instances where a post may be required or beneficial, the forces applied to the patient via the post can be diminished through the use of Trendelenburg positioning.

When the patient is disposed in the Trendelenburg position, gravity acts to pull the patient downward, towards their head, and the body of the patient could slide on the surgical table. Additionally, during post-less hip distraction, the patient could slide on the surgical table when force is applied to the patient's leg in order to effect the hip distraction. For example, the patient could slide distally (i.e., towards their feet) as the leg is pulled distally by the distraction frame. The patient could also slide or roll laterally towards the side edge of the surgical table, e.g., this could be the result of the leg being abducted when the pulling force is applied to the distal end of the leg, thereby generating a lateral force in addition to the distal force. Such unintended movement of the patient's body can disrupt the surgical procedure and/or cause tissue damage. In extreme cases, the patient could even fall off of the surgical table.

Known concepts for positioning and securing a patient onto an operating table are e.g. described in <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT> and <CIT>.

The present invention is intended to provide new and improved approaches for supporting and stabilizing a patient during hip distraction, both with and without a post. Such approaches are intended to provide improved hip distraction, facilitate post-less hip distraction, minimize pressure on a patient if a post is used, and prevent a patient from sliding or rolling on the surgical table during hip distraction.

The present invention provides new and improved approaches for transferring, supporting and stabilizing a patient during hip distraction. Such approaches are intended to provide improved hip distraction, facilitate post-less hip distraction, minimize pressure on a patient if a post is used, and prevent a patient from sliding or rolling on the surgical table during hip distraction.

More particularly, the present invention comprises the provision and use of a novel system for transferring, supporting and stabilizing a patient during hip distraction.

In one aspect, the invention provides a table extender as defined in the appended claims, configured to be connected to a surgical table having side rails extending along the sides of a platform of the surgical table and being spaced from the platform on rail mounts, the table extender comprising:.

These and other objects and features of the present invention will be more fully disclosed or rendered obvious by the following detailed description of the preferred embodiments of the invention, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts, and further wherein:.

In one preferred form of the invention, and looking now at <FIG>, there is provided a novel system <NUM> for transferring, supporting and stabilizing a patient during hip distraction. Novel system <NUM> is intended to provide improved hip distraction, facilitate post-less hip distraction, minimize pressure on a patient if a post is used, and prevent a patient from sliding or rolling on the surgical table during hip distraction.

Novel system <NUM> generally comprises a table extender <NUM> for mounting to one end of a surgical table <NUM>, a stabilizing pad <NUM> for positioning on surgical table <NUM> and table extender <NUM> so that the patient resides on stabilizing pad <NUM>, and a patient strap <NUM> for securing the patient to surgical table <NUM>.

Still looking now at <FIG>, surgical table <NUM> is a conventional surgical table of the sort well known in the art. Surgical table <NUM> typically comprises a base <NUM> for contacting the operating room floor, a pedestal <NUM> rising from base <NUM>, and a platform <NUM> for supporting the patient. Platform <NUM> generally comprises a distal end <NUM> and a proximal end <NUM>. Platform <NUM> can generally be tilted in a longitudinal and/or lateral direction relative to pedestal <NUM> and base <NUM>. Side rails <NUM> typically extend along the sides of platform <NUM>, with side rails <NUM> being spaced from platform <NUM> on mounts <NUM>. A cushion <NUM> is typically disposed on the top surface <NUM> of platform <NUM>.

As noted above, surgical table <NUM> is generally formed out of a radiopaque material, e.g., metal. As a result, it is not possible to image patient anatomy using X-ray technology where the X-rays must pass through the surgical table. For practical purposes, this renders CT imaging impossible and significantly limits X-ray imaging to highly restricted angles of view.

In accordance with the present invention, and looking now at <FIG>, <FIG> and <FIG>, there is provided a novel table extender <NUM> for mounting to one end of surgical table <NUM>. As will hereinafter be discussed, table extender <NUM> is constructed so that patient anatomy supported on table extender <NUM> can be imaged with X-ray technology through the table extender, thereby enabling CT imaging and X-ray imaging with substantially unlimited angles of view.

As seen in <FIG>, table extender <NUM> is sized to support the patient from a point proximal to the hips of the patient to a point proximal to the knees of the patient, whereby to provide optimal support for hip distraction, particularly when the patient is positioned in the so-called "Trendelenburg position" during hip surgery.

Table extender <NUM> also provides increased flexibility in the ability to X-ray the hip joint from multiple viewpoints while the hip joint is supported on table extender <NUM>.

According to the invention, table extender <NUM> comprises a distal end <NUM> and a proximal end <NUM>. More particularly, table extender <NUM> comprises a base <NUM> having a distal end <NUM> and a proximal end <NUM>, a pair of mounts <NUM> for mounting base <NUM> to side rails <NUM> of surgical table <NUM>, and a cushion <NUM> for disposition on base <NUM>.

Base <NUM> preferably comprises a substantially rigid radiolucent material (e.g., a carbon fiber composite) such that X-ray and/or CT imaging may be performed on the anatomy residing on table extender <NUM>, and base <NUM> is sufficiently strong to support a substantial portion of the patient's weight. See, for example, <FIG>, which shows a C-arm X-ray machine <NUM> disposed about table extender <NUM> so that C-arm X-ray machine <NUM> can image anatomy supported on table extender <NUM>. Base <NUM> of table extender <NUM> may comprise one or more openings, e.g., side openings <NUM> for enabling easy grasping of table extender <NUM> during mounting to, and dismounting from, surgical table <NUM>, and/or for receiving straps of stabilizing pad <NUM> (see below), distal openings <NUM> for enabling other equipment to be mounted to table extender <NUM> (e.g., a post), etc..

Mounts <NUM> may be substantially any mounts which allow base <NUM> to be attached to, or detached from, surgical table <NUM> without significantly diminishing the overall radiolucency of table extender <NUM>. In one form of the invention, each of the mounts <NUM> generally comprises a body <NUM> mounted to proximal end <NUM> of base <NUM> and extending proximally therefrom. Bodies <NUM> comprise slots <NUM> for receiving side rails <NUM> of surgical table <NUM>. Clamps <NUM> are pivotally mounted to bodies <NUM>, such that clamps <NUM> can be pivoted towards and away from bodies <NUM>. Clamps <NUM> preferably comprise recesses <NUM> for disposition about mounts <NUM> of side rails <NUM> when side rails <NUM> are received in slots <NUM>. In one form of the invention, mounts <NUM> comprise friction elements (not shown) which prevent clamps <NUM> from falling into their locked position until after the user deliberately pushes clamps <NUM> into their locked position. In one form of the invention, these friction elements comprise spring plungers which are adjusted so as to provide a degree of resistance to clamps <NUM> closing into their locked position. Alternatively, other sources of friction or resistance can be utilized such as interference fits between the machined components, ramps, springs, or additional materials such as rubber or silicone added to increase the friction locally. Locking screws <NUM> extend through bodies <NUM> and project into slots <NUM>, whereby to enable mounts <NUM> to be secured to side rails <NUM> of surgical table <NUM>.

Cushion <NUM> resides on base <NUM> of table extender <NUM>. Cushion <NUM> preferably has a thickness (or height) which is substantially the same as the thickness (or height) of cushion <NUM> of surgical table <NUM>. Cushion <NUM> is also formed out of a radiolucent material such that X-ray and/or CT imaging may be performed on the anatomy residing on table extender <NUM>. If desired, a recess <NUM> may be provided in the distal portion of cushion <NUM> so as to expose distal openings <NUM> in base <NUM>.

Due to the extensive use of radiolucent materials, table extender <NUM> is nearly completely radiolucent, i.e., the only portions of table extender <NUM> which are not radiolucent are mounts <NUM> (which are preferably formed out of a radiopaque metal, e.g., stainless steel). Significantly, the only portion of table extender <NUM> which is not radiolucent in the region extending away from surgical table <NUM> is the distal portions of mounts <NUM> (i.e., the portions of bodies <NUM> of mounts <NUM> which extend alongside or beneath base <NUM> of table extender <NUM>). In one preferred form of the invention, greater than approximately <NUM>% of the surface area of table extender <NUM> is radiolucent (as viewed from a vertical or anterior/posterior perspective). In another preferred form of the invention, greater than approximately <NUM>% of the surface area of table extender <NUM> is radiolucent. Of particular note, the middle and distal portions of table extender <NUM> are completely radiolucent. The distal sections of mounts <NUM> do not extend to the middle and distal portions of table extender <NUM>, and there is no metal reinforcement across the width of table extender <NUM> to support the patient's weight as with existing table extenders. The carbon fiber construction of base <NUM> of table extender <NUM> is able to support the weight of the anatomy carried by base <NUM> without requiring additional structural reinforcements. This is a significant improvement over the prior art as it allows for better imaging and maneuverability of the X-ray equipment; one example of the prior art is <CIT>.

In one method of use, table extender <NUM> is grasped via side openings <NUM>, and then table extender <NUM> is moved towards surgical table <NUM> so that slots <NUM> of mounts <NUM> are aligned with side rails <NUM> of surgical table <NUM>. Note that clamps <NUM> of mounts <NUM> are pivoted upward relative to bodies <NUM> of mounts <NUM> as mounts <NUM> of table extender <NUM> are slid over side rails <NUM> of surgical table <NUM>, with side rails <NUM> being received in slots <NUM> of mounts <NUM>. When table extender <NUM> has been properly positioned relative to surgical table <NUM>, clamps <NUM> are pivoted downwardly so that recesses <NUM> of clamps <NUM> seat over mounts <NUM> of side rails <NUM>. Then locking screws <NUM> are used to further secure mounts <NUM> to side rails <NUM> (and hence to further secure table extender <NUM> to surgical table <NUM>).

Thereafter, when a patient is positioned on surgical table <NUM> and table extender <NUM>, the patient is supported by cushion <NUM> of surgical table <NUM> and cushion <NUM> of table extender <NUM>, both of which are at least partially covered by stabilizing pad <NUM>. Significantly, patient anatomy supported on table extender <NUM> may be imaged using X-ray and/or CT imaging due to the radiolucency of table extender <NUM>. In addition, table extender <NUM> is preferably sized so as to support the patient from a point proximal to the hips to a point proximal to the knees (see <FIG>), whereby to provide optimal support for hip distraction, particularly when the patient is positioned in the so-called "Trendelenburg position" during hip surgery.

The Trendelenburg position requires that surgical table <NUM> be tilted. According to the invention, and looking now at <FIG> and <FIG>, table extender <NUM> comprises an inclinometer 107A to show its angle of incline (and hence to show the angle of incline of surgical table <NUM>).

In one preferred form of the invention, base <NUM> of table extender <NUM> is approximately <NUM>-<NUM> inches long, (following conversion factor <NUM> inch = <NUM>,<NUM> should be used in the description) and more preferably approximately <NUM> inches long, and approximately <NUM>-<NUM> inches wide, and more preferably approximately <NUM> inches wide. Mounts <NUM> extend approximately <NUM> inches along the length of base <NUM> of table extender <NUM> (i.e., mounts <NUM> extend approximately <NUM> inches distal from the proximal edge of base <NUM> of table extender <NUM>). In one preferred form of the invention, the patient is positioned such that their hip joint is approximately <NUM>-<NUM> inches distal to the proximal edge of base <NUM> of table extender <NUM>. With a minimum of <NUM> inches spacing between the patient's hip joint and the proximal edge of base <NUM> of table extender <NUM>, the patient's hip can be X-ray'd without interference from mounts <NUM>, which is important inasmuch as mounts <NUM> are typically made of a radiopaque material such as stainless steel. The hip joint is preferably positioned proximal to the distal edge of base <NUM> of table extender <NUM>; this provides some margin of safety from the possibility of the patient falling off the distal end of table extender <NUM> in the event the patient's hip moves distally on table extender <NUM>. More particularly, when a distal distraction force is applied to the operative leg of the patient, the hip joint may shift slightly in the direction of the force (i.e., the hip joint may move slightly in the distal direction). Having a portion of table extender <NUM> distal to the hip joint provides a safety margin from the possibility of the hip joint sliding off the distal end of the table extender, resulting in the patient falling to the floor. In one preferred form of the invention, the patient's hip is positioned approximately one-third to approximately two-thirds of the distance distal to the proximal edge of base <NUM> of table extender <NUM>.

It should be appreciated that there is a practical limit to the maximum length of table extender <NUM>. If the table extender is too long, then more of the patient's body may be placed on the table extender, requiring the table extender to bear additional weight of the patient. This may require larger mounts <NUM> and/or increased thickness of base <NUM> of table extender <NUM>, neither of which is desirable as they may decrease the radiolucency of the system. Also, an increased length to table extender <NUM> may require a distraction system which extends further away from surgical table <NUM>. This is not preferred inasmuch as it generally increases the size and weight of the distraction system, making it more difficult to physically manipulate and manage by the hospital staff; and this is also not preferred inasmuch as the larger distraction system may not fit into some operating rooms (some older facilities have smaller operating rooms). In one form of the invention, base <NUM> of table extender <NUM> is approximately as long as the average length of a human femur bone (which is approximately <NUM> inches long).

Looking next at <FIG>, <FIG> and <FIG>, stabilizing pad <NUM> is provided to cover the top surface of surgical table <NUM>, and the top surface of table extender <NUM>, so as to increase the friction between the patient and surgical table <NUM>/table extender <NUM>, whereby to reduce the possibility of the patient inadvertently sliding on surgical table <NUM> and table extender <NUM>, particularly during hip distraction and/or leg manipulation and/or during "Trandelenburg positioning". Note that stabilizing pad <NUM> is placed on top of cushion <NUM> of surgical table <NUM> and cushion <NUM> of table extender <NUM>. Note also that while stabilizing pad <NUM> is shown in the figures as extending past the patient's head, stabilizing pad <NUM> can terminate at another location, e.g., in the mid-back region of the patient.

In one preferred form stabilizing pad <NUM> comprises a bottom surface <NUM> for contacting surgical table <NUM> (i.e., cushion <NUM> of surgical table <NUM>) and table extender <NUM> (i.e., cushion <NUM> of table extender <NUM>), and a top surface <NUM> for receiving the patient. Bottom surface <NUM> preferably comprises a high friction material for preventing stabilizing pad <NUM> from sliding relative to surgical table <NUM> (i.e., relative to cushion <NUM> of surgical table <NUM>) and table extender <NUM> (i.e., relative to cushion <NUM> of table extender <NUM>). Top surface <NUM> preferably comprises a high friction material for preventing a patient from sliding relative to stabilizing pad <NUM>. It should be appreciated that top surface <NUM> of stabilizing pad <NUM> is made of a material which is suitable for contacting the skin of a patient, with respect to both patient compatibility and comfort, while also increasing friction with the patient. In one preferred form of the invention, top surface <NUM> of stabilizing pad <NUM> is made of an open cell polyurethane foam.

In one preferred form stabilizing pad <NUM> comprises a foam base <NUM> (which includes the aforementioned bottom surface <NUM>) and a foam upper <NUM> (which includes the aforementioned top surface <NUM>). In one preferred form of the invention, foam base <NUM> is sufficiently dense to provide a stable contact with cushion <NUM> of surgical table <NUM> and with cushion <NUM> of table extender <NUM>, and foam upper <NUM> is flexible enough to allow the patient to sink into the stabilizing pad, increasing the overall contact and effective frictional resistance to sliding in a relatively stable support structure. It should be noted that some foam materials and shapes may be superior for creating sliding friction against human skin, while other materials and shapes may be superior for creating sliding friction against the top surfaces of surgical table <NUM> and table extender <NUM>. In one preferred form of the invention, foam upper <NUM> is an open cell polyurethane foam comprising an "egg crate" top surface <NUM> so as to further enhance friction between the patient and stabilizing pad <NUM> while still being comfortable for contacting the skin of the patient. And in one preferred form of the invention, foam base <NUM> is preferably a closed cell foam (e.g., ethylene-vinyl acetate (EVA)) comprising a flat bottom surface <NUM>. In one preferred form of the invention, foam base <NUM> has a higher density than foam upper <NUM>. It should be appreciated that, by forming foam base <NUM> out of a higher density closed cell foam (e.g., ethylene-vinyl acetate (EVA)) and by forming foam upper <NUM> out of a lower density open cell foam (e.g., polyurethane foam) allows the foam base to provide a stable, high friction foundation on surgical table <NUM> and allows foam upper <NUM> to provide a contouring, high friction support beneath and around the patient.

In one preferred form hook-and-loop fasteners <NUM> are used to secure stabilizing pad <NUM> to cushion <NUM> of surgical table <NUM> and to cushion <NUM> of table extender <NUM>.

And in one preferred form straps <NUM> are used to secure stabilizing pad <NUM> to surgical table <NUM> and to table extender <NUM>, for example, securing stabilizing pad <NUM> to side rails <NUM> of surgical table <NUM> and/or side openings <NUM> of table extender <NUM>.

Still looking at <FIG> and <FIG>, one or more patient straps <NUM> are also provided to secure the patient to surgical table <NUM>. More particularly, one or more patient straps <NUM> may be passed over the torso of the patient, under the arms of the patient and attached to surgical table <NUM>. Patient straps <NUM> prevent the patient from rolling on surgical table <NUM>. Patient straps <NUM> may also be made so as to prevent the patient from sliding longitudinally on the surgical table. Thus, patient straps <NUM> provide a counterforce to the anatomy during post-less hip distraction. In addition, patient straps <NUM> provide an added margin of safety for the patient during a Trendelenburg procedure when surgical table <NUM> is tilted so that the patient's head is angled towards the floor and the patient's feet are angled towards the ceiling, i.e., to prevent the patient from sliding or rolling on surgical table <NUM>.

If desired, patient straps <NUM> may extend completely around platform <NUM> of surgical table <NUM>. Additionally and/or alternatively, patient straps <NUM> may be configured for attachment to side rails <NUM> of surgical table <NUM>, e.g., the ends of patient straps <NUM> may be provided with hook-and-loop fasteners for securing patient straps <NUM> to side rails <NUM> of surgical table <NUM>.

Looking now at <FIG> and <FIG>, stabilizing pad <NUM> further comprises handles (or grips) <NUM>. In transferring a patient onto, and off of, surgical table <NUM> (e.g., from a gurney), it is common practice to transfer the patient such that their entire body is initially supported by surgical table <NUM> and table extender <NUM> while the surgical staff continues preparations for surgery. Once the patient is ready to be connected to the distraction apparatus (i.e., mounting their feet into the surgical boots of the distraction apparatus and connecting the surgical boots to pulling elements of the distraction apparatus), the surgical staff slides the patient distally on surgical table <NUM> until the patient's hips are properly positioned on table extender <NUM> (e.g., in the manner described above). Typically the patient's knees will be just off table extender <NUM> (e.g., in the manner also described above). Normally this transfer of the patient from a more cephalad position on the surgical table during preparation to a more distal (caudal) position on the surgical table for distraction does not present a problem: most surgical tables have a cushion (e.g., cushion <NUM>) on top of platform <NUM> of the surgical table, and this cushion can typically accommodate sliding a patient on cushion <NUM>. However, stabilizing pad <NUM> has a higher degree of friction than a standard cushion; therefore, it may be too difficult to slide the patient on stabilizing pad <NUM> and the surgical staff must resort to lifting the patient in order to move the patient relative to surgical table <NUM> and table extender <NUM>. This is not desirable as it can lead to back injuries for the surgical staff.

To this end, in one form of the invention, and looking now at <FIG>, stabilizing pad <NUM> comprises handles <NUM> which can be utilized to slide the stabilizing pad (and hence the patient) along cushion <NUM>. Stabilizing pad <NUM> may comprise reinforcement structures <NUM> between opposing handles <NUM> so that stabilizing pad <NUM> can support the patient's weight (e.g., a strap <NUM> extending across the width of the pad from one handle <NUM> to another handle <NUM> located on the opposite side of stabilizing pad <NUM>). Alternatively, stabilizing pad <NUM> may comprise a sheet of strong material (not shown) interposed between foam base <NUM> and foam upper <NUM>, e.g., a strong sheet of material interposed between a foam base <NUM> and a foam upper <NUM>.

In one preferred form of the invention, stabilizing pad <NUM> may comprise one or more markings <NUM> for indicating the preferred location of the patient's hip joints on stabilizing pad <NUM> in the caudal/cephalad direction. These markings <NUM> help ensure that, once stabilizing pad <NUM> (with the patient thereon) is moved to the surgical position, the patient's hip joints will be located on table extender <NUM> in the preferred position (i.e., proximal to mounts <NUM> yet spaced from the distal edge of base <NUM> of table extender <NUM>).

A low-friction (e.g., lubricious) transfer sheet <NUM> (<FIG> and <FIG>) is disposed between the patient and stabilizing pad <NUM> before and during patient transfer, and then the low-friction (e.g., lubricious) transfer sheet is removed prior to the start of the surgery (including distraction of the hip).

More particularly, stabilizing pad <NUM> is placed on, and secured to, surgical table <NUM> in the surgical position. In order to slide the patient from the more cephalad initial position (used during patient preparation) to the more caudal surgical position (used for distraction and surgery), a low-friction (e.g., lubricious) transfer sheet <NUM> (<FIG> and <FIG>) can be used. However, this low-frication (e.g., lubricious) transfer sheet <NUM> must be removed from beneath the patient after patient transfer and prior to distraction in order to prevent the patient from sliding on the low-friction (e.g., lubricious) transfer sheet during table tilting and/or distraction, but the low-friction (e.g., lubricious) transfer sheet may be difficult to remove from under the patient due to the patient's weight. Therefore, in one embodiment, and looking now at <FIG>, low-friction (e.g., lubricious) transfer sheet <NUM> may comprise a split-away construction 129A so that the low-frication (e.g., lubricious) transfer sheet can split into <NUM> or more sections 129B, 129C which can more easily be removed from under the patient. In this embodiment, low-friction (e.g., lubricious) transfer sheet <NUM> is placed on surgical table <NUM>. The patient is transferred from their gurney onto low-frication transfer sheet <NUM> (which rests on surgical table <NUM>) in a typical prep position with their body caudal to the surgical position. After prep is completed and the patient is to be moved to the surgical position, the surgical staff then slides the patient down to the surgical position using low-friction (e.g., lubricious) transfer sheet <NUM>. Low-friction transfer sheet <NUM> is then removed from under the patient using the split-away construction 129A.

Note that low-friction (e.g., lubricious) transfer sheet <NUM> is preferably provided with handles 129D to facilitate movement of the low-friction transfer sheet (and hence movement of a patient disposed on the low-friction transfer sheet <NUM>).

In another form of the invention, and looking now at <FIG>, low-friction (e.g., lubricious) transfer sheet <NUM> may comprise sections 129E and 129F which are initially coupled together via their overlapping handles <NUM> and which can be pivoted or pulled out from under the patient when the low-friction transfer sheet <NUM> is to be removed.

Looking now at <FIG>, stabilizing pad <NUM> may comprise (i) a raised distal section <NUM> near its distal end, and/or (ii) raised lateral sections <NUM> on each side of the patient.

Raised distal section <NUM> of stabilizing pad <NUM> functions as a stop to resist movement of the patient distally, e.g., raised distal section <NUM> provides a counterforce to the anatomy during hip distraction.

Raised lateral sections <NUM> of stabilizing pad <NUM> function as lateral stops which resist movement of the patient sliding or rolling laterally, e.g., raised lateral sections <NUM> add an extra margin of safety for post-less hip distraction where there is no padded post to keep the patient from sliding laterally on surgical table <NUM>.

It should be appreciated that, inasmuch as raised lateral sections <NUM> may limit access to surgical portals and/or restrict hand movements by the surgical team, raised lateral sections <NUM> may extend along only portions of the patient's sides, e.g., in the case of hip surgery, raised lateral section <NUM> may extend along the torso of the patient but terminate at, or proximal to, the hip region of the patient.

Raised lateral sections <NUM> are preferably provided on both sides of stabilizing pad <NUM>. However, if desired, stabilizing pad <NUM> may provide a raised lateral section <NUM> on only one side of the patient, e.g., on the operative leg side of the patient, or on the non-operative leg side of the patient.

When stabilizing pad <NUM> comprises a raised distal section <NUM> and/or raised lateral sections <NUM>, stabilizing pad <NUM> may be constructed out of a gel material (e.g., a gel material such as that used to form cushions <NUM> and <NUM>) so as to give raised sections <NUM> and/or <NUM> the requisite firmness. Note that inasmuch as raised sections <NUM> and/or <NUM> serve to keep the patient from sliding on the surgical table, the need for forming the stabilizing pad out of a high friction material is reduced. Thus, where raised sections <NUM> and/or <NUM> are provided, the stabilizing pad may be formed out of a material which is not a high friction material. Of course, it should also be appreciated that a stabilizing pad <NUM> comprising raised sections <NUM> and/or <NUM> may also be constructed out of high friction materials such as is described above, so as to further prevent the patient from sliding on the stabilizing pad.

A hip arthroscopy surgical patient is typically brought into the operating room on a gurney, then transferred to the surgical table with, for example, a transfer board or transfer sheet. In a hip arthroscopy procedure, the patient is typically transferred to a position on the table that supports most, if not all, of the full body length of the patient. Subsequently, the patient is moved distally when the feet are ready to be secured to the surgical boots of the distraction system.

In an alternative approach, the patient is transferred directly to their final position on the surgical table (i.e., the position the patient will be in for surgery). For hip arthroscopy this often involves a portion of the legs being suspended (i.e., the patient's torso and thighs may be on the surgical table, and the patient's feet may be suspended at the distal end of the surgical table). This can be accomplished by the patient walking into the operating room under their own power and placing themselves on the surgical table. In this approach, stabilizing pad <NUM> may be set in its surgical position at the time the patient is to place themselves on the surgical table, with stabilizing pad <NUM> comprising markings <NUM> indicating the desired position for the patient's hip joints. However, in this scenario, the legs of the patient extend past distal end <NUM> of table extender <NUM> and are unsupported for a time period prior to being secured to the surgical boots of the distraction system. This is undesirable as it may be uncomfortable for the patient and/or pose a risk of the patient falling off the surgical table.

Therefore, in another form and looking now at <FIG>, a leg support <NUM> can be provided to support the patient's legs until such time as the patient's legs are secured in the distraction apparatus. In one form of the invention, leg support <NUM> is a tray which mounts to distal end <NUM> of table extender <NUM> and extends distally of table extender <NUM>. Alternatively, leg support <NUM> may mount to surgical table <NUM> and extend distally of table extender <NUM>. Leg support <NUM> may also have a support (not shown) which extends to the floor for additional support.

In another form and looking now at <FIG>, leg support <NUM> comprises a board or boards which mount to the distraction apparatus.

In these embodiments, leg support <NUM> may be readily connected to, and disconnected from, table extender <NUM>, surgical table <NUM> or the distraction apparatus.

In yet another form and looking now at <FIG> and <FIG>, leg support <NUM> is incorporated into table extender <NUM> itself; for example, leg support <NUM> may be in the form of a pivoting member which pivots relative to base <NUM> of the table extender (see <FIG>), or leg support <NUM> may be in the form of a sliding member which slides and raises into a cantilevered position relative to base <NUM> of the table extender (see <FIG>).

In one form leg support <NUM> extends between <NUM> and <NUM> inches from the distal edge of table extender <NUM>. In one preferred form leg support <NUM> extends approximately <NUM> inches from the distal edge of table extender <NUM>.

Claim 1:
A table extender (<NUM>) configured to be connected to a surgical table (<NUM>) having side rails (<NUM>) extending along the sides of a platform (<NUM>) of the surgical table and being spaced from the platform on rail mounts (<NUM>), the table extender comprising:
a base (<NUM>) comprising a proximal portion (<NUM>), a distal portion (<NUM>) and an intermediate portion disposed between the proximal portion and the distal portion; and
a pair of mounts (<NUM>) for mounting the base (<NUM>) of the table extender to the side rails (<NUM>) of the surgical table; and
an inclinometer (107A) for indicating the angular disposition of the table extender relative to horizontal, wherein the inclinometer is attached to a mount of the pair of mounts (<NUM>);
wherein the distal portion of the table extender and the intermediate portion of the table extender are substantially completely radiolucent,
wherein distal sections of the mounts (<NUM>) do not extend to the intermediate and distal portions of the table extender (<NUM>) and there is no metal reinforcement across the width of the table extender (<NUM>) such that the only portions of the table extender (<NUM>) that are not radiolucent are the mounts (<NUM>),
wherein the table extender is sized to support a patient from a point proximal to the hips of the patient to a point proximal to the knee of the patient.