Apparatus for and method of providing a hip replacement

Abstract

A short main incision and portal incisions at portal positions strategically displaced from the main incision are provided in a patient's hip. One portal incision (acetabular portal) provides for a disposition of reamers in the patient's acetabulum to shape the acetabulum. A cannula is inserted through the portal incision to the acetabulum and the successive reamers of progressive size are inserted into the acetabulum through the main incision to progressively size and shape the acetabulum. An approximately hemispherical acetabular component is then disposed in the prepared acetabulum to provide for hip rotation relative to the femoral component. The other portal incision (femoral portal) provides for insertion into the patient's hip of a member for driving the femoral stem into a cavity in the patient's femur. The provision of the short main incision and the portal incision minimizes the patient's loss of blood, tissue trauma, length of operating time and patient recovery time.

What is claimed is:  
     
         1 . In a method of providing a hip replacement in a patient, the steps of 
 providing a first incision of a limited length,    determining the position of an incision selected from the group consisting of an acetabulum portal and a femoral portal,    making the portal incision at the determined position, and    providing a positioning of an instrument in the hip through the portal incision to facilitate the hip replacement.    
     
     
         2 . In a method as set forth in  claim 1  wherein 
 the selected portal is the femoral portal and wherein 
 the incision is provided through the femoral portal position to provide for the insertion of the instrument into the hip for positioning the femur in a femur cavity.  
 
 
     
     
         3 . In a method as set forth in  claim 2  wherein 
 a cannula is disposed in the hip through the femoral portal incision to provide for a positioning of a femoral stem in a cavity in the femur.  
 
     
     
         4 . In a method as set forth in  claim 3  wherein 
 a driver is disposed through the cannula to provide for the positioning and final seating of the femoral stem in the cavity in the femur.  
 
     
     
         5 . In a method as set forth in  claim 1  wherein 
 the selected portal is the acetabular portal and wherein 
 the incision is provided through the acetabular portal position to provide for the preparation of the acetabulum.  
 
 
     
     
         6 . In a method as set forth in  claim 5  wherein 
 a cannula is disposed through the acetabular portal incision to provide for the formation of the acetabulum.  
 
     
     
         7 . In a method as set forth in  claim 6  wherein 
 a shaft is disposed in the cannula and wherein a reamer is disposed in the acetabulum and the shaft is coupled to the reamer to provide for an operation of the reamer in shaping the acetabulum.  
 
     
     
         8 . In a method as set forth in  claim 7  wherein 
 reamers of progressive size are disposed in the acetabulum and the shaft is coupled to the reamer in the acetabulum and the reamer is rotated to shape and size the acetabulum.  
 
     
     
         9 . In a method as set forth in  claim 4  wherein 
 a rasp is disposed in the cannula to smooth the walls of the femur cavity before the femoral stem is driven into the femoral cavity.  
 
     
     
         10 . In a method as set forth in  claim 8  wherein 
 the selected portal is the femoral portal and wherein 
 the incision is provided through the femoral portal position to provide for the insertion of the instrument into the hip for positioning the femur in a femur cavity and wherein 
 a cannula is disposed in the hip through the femoral portal incision to provide for a positioning of a femoral stem in a cavity in the femur and wherein 
 a driver is disposed through the cannula to provide for the positioning of the femoral stem in the cavity in the femur.  
 
 
 
 
     
     
         11 . In a method as set forth in  claim 10  wherein 
 a rasp is disposed in the cannula to smooth the walls of the femur cavity before the femoral stem is driven into the femoral cavity.  
 
     
     
         12 . In a method as set forth in  claim 10  wherein 
 the first incision is a main incision and wherein 
 the femoral portal incision is disposed on one side of the main incision and wherein 
 the acetabular portal incision is disposed on the other side of the main incision.  
 
 
 
     
     
         13 . In a method of providing a hip replacement in a patient, the steps of 
 providing a first incision of a limited length in the patient's hip,    providing a portal incision in the patient's hip at a particular disposition displaced from the main incision,    inserting a cannula into the patient's hip through the portal incision to a position providing for an act by a surgeon to facilitate the hip replacement in the patient, and    disposing a tool through the cannula to the position providing for the act by the surgeon to facilitate the hip replacement in the patient.    
     
     
         14 . In a method as set forth in  claim 13  wherein 
 a member is disposed in abutting relationship with a femoral stem to provide a locus for determining the positioning of the portal incision when the portal incision is a femoral portal incision and wherein 
 the femoral portal incision is made at the position determined for the femoral portal incision.  
 
 
     
     
         15 . In a method as set forth in  claim 13  wherein 
 a member is disposed in the acetabulum to provide a locus for determining the positioning of the portal incision when the portal incision is an acetabular portal incision.  
 
     
     
         16 . In a method as set forth in  claim 15  wherein 
 a cannula is disposed to extend from the acetabular portal incision into the hip to the position of the acetabulum in the hip bone.  
 
     
     
         17 . In a method as set forth in  claim 16  wherein 
 a reamer is disposed at the position of the acetabulum in the hip bone and wherein 
 a rotary drive member is disposed in the cannula and is coupled to the reamer to obtain, when operated, a shaping of the acetabulum.  
 
 
     
     
         18 . In a method as set forth in  claim 17 , the step of 
 sequentially reaming the acetabulum with reamers of progressive size by coupling the rotary drive member to the reamers of the progressive-size and rotating the shaft to rotate the reamers.    
     
     
         19 . In a method as set forth in  claim 13  wherein 
 the locus for the portal incision is determined to provide for the positioning of the femoral stem in the femur cavity.  
 
     
     
         20 . In a method as set forth in  claim 13  wherein 
 the locus for the portal incision is determined to provide for the shaping and sizing of the acetabulum in the hip bone.  
 
     
     
         21 . In a method as set forth in  claim 19  wherein 
 the cannula is extended from the femoral portal incision through the hip to the femoral stem which is positioned relative to the femur cavity to be driven into the femur cavity.  
 
     
     
         22 . In a method as set forth in  claim 21  wherein 
 a drive member is extended through the cannula to the femoral stem and wherein 
 forces are imposed against the drive member to drive the femoral stem into the femur cavity.  
 
 
     
     
         23 . In a method as set forth in  claim 20   the cannula is extended from the acetabular portal incision through the hip to the acetabulum to provide for the shaping and sizing of the acetabulum.    
     
     
         24 . In a method as set forth in  claim 23  wherein 
 a rotatable drive member is extended through the cannula and wherein 
 a reamer is disposed in the acetabulum and wherein 
 the drive member is coupled to the reamer and is rotated to provide for a reaming of the acetabulum by the reamer.  
 
 
 
     
     
         25 . In a method as set forth in  claim 24  wherein 
 progressively sized reamers are disposed in the acetabulum and are coupled to the drive member and are rotated by the drive member to shape and size the acetabulum.  
 
     
     
         26 . In a method as set forth in  claim 26  wherein 
 a hemispherical member is disposed in the acetabulum after the shaping and sizing of the acetabulum to provide for a pivotal relationship between the hemispherical member and the acetabulum.  
 
     
     
         27 . In a method of providing a hip replacement in a patient, the steps of 
 providing a main incision in a patient,    providing an instrument which includes a positioning member at one end and a looped portion extending from the positioning member to a marker member at the other end,    disposing the positioning member in the patient with the looped portion extending from the hip through the main incision to a position outside of the hip and with the marker member pointing toward the patient's skin at the patient's hip from the position outside of the hip; and    marking with the marker member the position on the patient's skin at which the marker member contacts the patient's skin.    
     
     
         28 . In a method as set forth in  claim 27 , the step of 
 making a portal incision at the marked position at which the marker member contacts the patient's skin.    
     
     
         29 . In a method as set forth in  claim 27  wherein 
 the marked position indicates a portal position at which an acetabular incision is to be made through which a driver for a reamer is to be inserted to form the acetabulum in the patient's hip bone.  
 
     
     
         30 . In a method as set forth in  claim 29  wherein 
 a reamer is inserted into the patient's hip through the main incision and is coupled to the driver to provide a reaming action on the acetabulum in accordance with the rotation of the driver.  
 
     
     
         31 . In a method as set forth in  claim 27  wherein 
 the marked position indicates a portal position at which a femoral incision is to be made through which a member is to be inserted to drive a femoral stem into a cavity in the patient's femur.  
 
     
     
         32 . In a method as set forth in  claim 27  wherein 
 the positioning member has a substantially hemispherical shape and wherein the hemispherical member is disposed in the patient's acetabulum when the instrument is used to mark the portal position.  
 
     
     
         33 . In a method as set forth in  claim 27  wherein 
 the positioning member constitute a finger and wherein the finger is disposed in abutting relationship to the femoral stem when the instrument is used to mark the portal position.  
 
     
     
         34 . In a method as set forth in  claim 27 , the step of 
 using the main incision and the portal incision to provide for the positioning of a member for facilitating the hip replacement.    
     
     
         35 . A method as set forth in  claim 33  wherein 
 the portal incision is an acetabular portal incision and wherein 
 the main incision and the acetabular portal position are used to provide for the disposition of a reamer in the acetabulum for facilitating the hip replacement.  
 
 
     
     
         36 . In a method as set forth in  claim 34  wherein 
 the portal incision is a femoral incision and wherein the main incision and the femoral portal incision are used to provide for the positioning of a drive member to drive the femoral stem into a cavity in the femur for facilitating the hip replacement.  
 
     
     
         37 . In combination for use in providing for a hip replacement in a patient 
 a first member positionable in the hip of the patient,    a positioning member extending at one end from the positioning member to a position outside of the patient's hip at a second end, and    a marker member at the opposite end of the looped portion and disposed to mark a portal position on the patient's hip.    
     
     
         38 . In a combination as set forth in  claim 37  wherein 
 the first member has a hemispherical shape to fit in the acetabulum of the patient.  
 
     
     
         39 . In a combination as set forth in  claim 37  wherein 
 the marker member is disposed on the positioning portion at an acute angle relative to the skin of the patient to mark the skin at the position of the contact of the marker member with the skin and wherein 
 the positioning member has a boxed configuration and wherein 
 the marker member is attached to the looped portion at the second end of the looped portion.  
 
 
 
     
     
         40 . In a combination as set forth in  claim 37  wherein 
 the first member has a shape to abut the femoral stem of the patient.  
 
     
     
         41 . In a combination as set forth in  claim 38  wherein 
 the marker member is disposed on the positioning member at an acute angle relative to the skin of the patient to mark the skin at the position of the contact of the marker member with the skin and wherein 
 the marker member is attached to the looped portion at the second end of the looped portion.  
 
 
     
     
         42 . In a combination as set forth in  claim 40 , 
 the marker member is disposed on the positioning portion at an acute angle relative to the skin of the patient to mark the skin at the position of the contact of the marker member with the skin and wherein 
 the marker member is attached to the looped portion at the second end of the looped portion.  
   
     
     
         43 . In a combination as set forth in  claim 39  wherein 
 the marker member includes a stylus and wherein 
 the positioning member has a looped configuration.  
 
 
     
     
         44 . In a combination as set forth in  claim 39  wherein 
 the positioning member has a looped configuration and wherein 
 the marker member is disposed on the positioning member at an acute angle relative to the skin of the patient to mark the skin of the patient and wherein 
 the marker member is attached to the looped portion at the second end of the looped portion and wherein 
 the marker member is a stylus.