WO2012093368A1 - A retractor for use in surgery - Google Patents

A retractor for use in surgery Download PDF

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Publication number
WO2012093368A1
WO2012093368A1 PCT/IB2012/050058 IB2012050058W WO2012093368A1 WO 2012093368 A1 WO2012093368 A1 WO 2012093368A1 IB 2012050058 W IB2012050058 W IB 2012050058W WO 2012093368 A1 WO2012093368 A1 WO 2012093368A1
Authority
WO
WIPO (PCT)
Prior art keywords
femur
acetabulum
retractor
arm
blade
Prior art date
Application number
PCT/IB2012/050058
Other languages
French (fr)
Other versions
WO2012093368A4 (en
Inventor
Ian Walter Dryden DYMOND
Graeme Francois Dryden DYMOND
Original Assignee
Dymond Ian Walter Dryden
Dymond Graeme Francois Dryden
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Dymond Ian Walter Dryden, Dymond Graeme Francois Dryden filed Critical Dymond Ian Walter Dryden
Publication of WO2012093368A1 publication Critical patent/WO2012093368A1/en
Publication of WO2012093368A4 publication Critical patent/WO2012093368A4/en
Priority to ZA2013/02635A priority Critical patent/ZA201302635B/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0206—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with antagonistic arms as supports for retractor elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0275—Joint distractors for the hip

Definitions

  • the invention is in the field of medical devices, specifically those used for the retraction of tissue during surgical procedures.
  • the acetabulum of the hip joint shall be deemed to include the capsule and labrum of the hip joint.
  • a retractor for use in surgery wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against tissue, wherein the blade is pivotably attachable to the first arm, positioning means for positioning the second arm relative tissue and wherein the actuation of the hinged arms permits linear displacement of an end of the blade relative the positioning means.
  • the positioning means may be in fixed arrangement relative the second arm thereby preventing rotation and translation of the second arm.
  • the positioning means may be in the form of a spike and/or a collar and/or a blade.
  • the second arm may be stationery.
  • At least one of the arms may be configured to receive auxiliary instrumentation.
  • the second arm may be configured to receive auxiliary instrumentation.
  • Auxiliary instrumentation may include any one or more of the group including a further retractor and/or a device to measure the force of retraction and/or a lighting means.
  • the pivotable attachment of the blade on the first arm may allow for rotation without translation, thereby diffusing and reducing the retraction force exerted on the tissue.
  • the hinged arrangement may allow for sliding and translation, thereby allowing for displacement of the first arm relative the stationery second arm whilst optimising the linear displacement relative the angle of rotation of the hinged arrangement.
  • a retractor for use in hip surgery wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against at least a part of the acetabulum of the hip socket, wherein the blade is attachable to the first arm, a femur spike receivable by the femur shaft, post amputation of the femur head, wherein the femur spike is attachable to the second arm and wherein the actuation of the hinged arms permits displacement of the long axis of the femur relative the acetabulum and simultaneous displacement of the joint capsule, thereby facilitating exposure of the acetabulum.
  • the hinged arrangement may be an expansile hinged arrangement.
  • the blade may be levered against the capsule of the acetabulum.
  • the blade may be L-shaped and may include at least one row of angled teeth for assisting in maintaining the blade's position relative the acetabular tissue.
  • the blade may be pivotally mounted on the first arm.
  • the mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like.
  • the mounting means may include a pin and socket arrangement.
  • the femur spike may be pivotally mounted on the second arm by way of mounting means.
  • the femur spike may be mounted in fixed, immobile arrangement on the second arm by way of mounting means.
  • the mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like.
  • the mounting means may include a pin and socket arrangement.
  • the hinged arms may be actuated by means of a screw configured to increase an angle of rotation between the arms, thereby permitting the displacement of the long axis of the femur relative the acetabulum and the simultaneous displacement of the joint capsule for facilitation of the exposure of the acetabulum.
  • the screw may permit controlled actuation of the hinged arms.
  • At least one of the arms may be configured to receive auxiliary instrumentation.
  • the second arm may be configured to receive a further retractor for assisting with the exposure of the acetabulum.
  • the further retractor may be a Homman retractor.
  • a retractor for use in hip surgery wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against at least a part of the acetabulum of the hip socket, wherein the blade is attachable to the first arm, a femur spike receivable by the femur shaft, post amputation of the femur head, wherein the femur spike is attachable to the second arm and wherein the actuation of the hinged arms permits posterior displacement of the long axis of the femur relative the acetabulum and simultaneous anterior elevation of the joint capsule, thereby facilitating exposure of the acetabulum.
  • the hinged arrangement may be an expansile hinged arrangement.
  • the blade may be levered against the capsule of the acetabulum.
  • the blade may be L-shaped and may include at least one row of angled teeth for assisting in maintaining the blade's position relative the acetabular tissue.
  • the blade may be pivotally mounted on the first arm.
  • the mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like.
  • the mounting means may include a pin and socket arrangement.
  • the femur spike may be pivotally mounted on the second arm by way of mounting means.
  • the femur spike may be mounted in fixed, immobile arrangement on the second arm by way of mounting means.
  • the mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like.
  • the mounting means may include a pin and socket arrangement.
  • the hinged arms may be actuated by means of a screw configured to increase an angle of rotation between the arms, thereby permitting the displacement of the long axis of the femur relative the acetabulum and the simultaneous displacement of the joint capsule for facilitation of the exposure of the acetabulum.
  • the screw may permit controlled actuation of the hinged arms.
  • the second arm may be configured to receive a further retractor for assisting with the exposure of the acetabulum.
  • the further retractor may be a Homman retractor.
  • a method of exposing the acetabulum of the hip joint that includes the steps of:
  • the method of exposing the acetabulum of the hip joint may include inserting a further retractor shaped and dimensioned to elevate the tissue of the hip joint, which may include knocking at least a part of the retractor into the side wall of the pelvis and locating the retractor in one of the hinged arms.
  • a method of replacing a hip joint including the steps of:
  • a further retractor shaped and dimensioned to elevate the tissue of the hip joint which may include knocking at least a part of the retractor into the side wall of the pelvis and locating the retractor in one of the hinged arms;
  • a method of replacing a hip joint including the steps of:
  • a further retractor shaped and dimensioned to elevate the tissue of the hip joint which may include knocking at least a part of the retractor into the side wall of the pelvis and locating the retractor in one of the hinged arms;
  • Figure 1 is a plan view of retractor
  • Figure 2 is a representation of a side view of the retractor
  • Figure 3 is a further view of the retractor
  • Figure 4 -10 are representations of the surgical approach
  • Figure 1 1 is a drawing showing the exposure of the greater trochanter of the femur
  • Figure 12 shows the dislocation of the hip joint
  • Figure 13 and 14 is a representation of the osteotomy of the femur head and removal respectively;
  • Figures 15(A) and (B) depict the insertion and positioning of the blade of the retractor
  • Figure 16 is a drawing of the insertion of the spike into the femur shaft
  • Figure 17 depicts the attachment of the blade to the arm of the retractor
  • Figure 18 depicts the initial retraction where stretch of the joint capsule is obtained
  • Figure 19 depicts further retraction facilitating exposure of the acetabulum
  • Figure 20 (A) - (D) are representations of the placement of the hip joint prosthesis
  • Figure 21 (A) and (B) are drawings of the surgical closure of the wound
  • Figure 22 is a drawing showing the directional vectors of the forces applied by the retractor on the hip joint and surrounding tissue;
  • Figure 23 is a representation of the mechanical principle of an aspect of the invention disclosed herein.
  • FIG. 24A and Figure 24B showing a further embodiment of the invention.
  • a retractor 10 for use in hip surgery having a first arm 12 and a second arm 14 in hinged arrangement.
  • the femur spike 22 can be replaced with any one or more of the group including a blade (not shown) and/or a collar 60.
  • the blade 16 is L-shaped, pivotally mounted by means of a pin and socket arrangement 40 on the first arm 12.
  • the blade 16 includes rows of angled teeth 38 for assisting in maintaining the blade's position relative the joint capsule 36.
  • the femur spike 22 is pivotally mounted, by way of pin and socket arrangement 42 on the second arm 14.
  • the hinged arms 12 and 14 are actuated 26 by means of a screw 44 configured to increase an angle of rotation 46 between the arms 12 and 14, thereby permitting the posterior displacement 28 of the long axis 30 of the femur 32 relative the acetabulum 18 and the simultaneous anterior elevation 34 of the joint capsule 36, thereby facilitating exposure of the acetabulum 18.
  • the screw 44 permits controlled actuation 26 of the hinged arms 12 and 14.
  • the second arm 14 is configured to receive a Homman retractor 48 for assisting with the exposure of the acetabulum 18.
  • Auxiliary instrumentation (not shown) can be attachable to the retractor, the auxiliary instrumentation including a further retractor and/or a device to measure the force of retraction and/or a lighting means.
  • Figures 15 - 19 depicts a method of exposing the acetabulum of the hip joint that includes the steps of inserting a blade 16 into the empty acetabulum 18 of a hip socket 20 (Figure 15A), adjusting the blade 16 relative the acetabulum 18 that the blade 16 lies centrally the acetabulum 18, approximately 10mm from the acetabular rim ( Figure 15B).
  • a femur spike 22 mounted on an arm 14 of a pair of hinged arms 12 and 14 is inserted into the cancellous bone 50 of the femur shaft 24, the femur spike 22 directed towards the lateral cortex 52 of the femur shaft 24 (Figure 16).
  • the blade 16 is then attached to the other arm 12 of the hinged arm pair 12 and 14 ( Figure 16).
  • a Homman retractor 48 is inserted to elevate the tissue of the hip joint and is located on the arm 14.
  • Figures 4 to 21 illustrate a method of replacing a hip joint, the method including the steps of gaining access to the hip joint through an oblique anterior lateral approach, thereby exposing the hip joint through the abductor muscles of the lower limb ( Figures 4 to 1 1 ), dislocating the hip joint ( Figure 12), performing an osteotomy of the femur head and removing same ( Figure 13 and 14).
  • a blade 16 is inserted relative the empty acetabulum 18 of a hip socket 20 ( Figure 15A), adjusting the blade 16, that the blade 16 lies centrally the acetabulum 18, approximately 10mm from the acetabular rim ( Figure 15B).
  • a femur spike 22 mounted on an arm 14 of a pair of hinged arms 12 and 14 is inserted into the cancellous bone 50 of the femur shaft 24, the femur spike 22 directed towards the lateral cortex 52 of the femur shaft 24 ( Figure 16).
  • the blade 16 is attached to the other arm 12 of the hinged arm pair 12 and 14 ( Figure 16).
  • Increasing the angle of rotation 46 between the hinged arms 12 and 14, stretches the joint capsule 36 and facilitates posterior displacement 28 of the femur 32 whilst elevating the capsule anteriorly 34 for visualisation of the acetabulum 18 ( Figures 17 and 18).
  • Figures 20A-D and Figures 21 A and B depict the reaming the acetabulum, broaching the femur shaft, inserting the prosthetic femur head into the shaft of the femur, relocating the femur head in the acetabulum and the surgical closing the wound.

Abstract

A retractor for use in surgery, wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against tissue, wherein the blade is pivotably attachable to the first arm, positioning means for positioning the second arm relative tissue and wherein the actuation of the hinged arms permits linear displacement of an end of the blade relative the positioning means. The positioning means may comprise a spike for insertion in the cancellous bone of the proximal shaft of a femur following an osteotomy of the femoral head during hip replacement surgery.

Description

A retractor for use in surgery
Field of the invention
The invention is in the field of medical devices, specifically those used for the retraction of tissue during surgical procedures.
Summary of the invention
Definition: For the purpose of interpreting this specification, the acetabulum of the hip joint shall be deemed to include the capsule and labrum of the hip joint.
According to an aspect of the invention, there is provided a retractor for use in surgery, wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against tissue, wherein the blade is pivotably attachable to the first arm, positioning means for positioning the second arm relative tissue and wherein the actuation of the hinged arms permits linear displacement of an end of the blade relative the positioning means.
The positioning means may be in fixed arrangement relative the second arm thereby preventing rotation and translation of the second arm.
The positioning means may be in the form of a spike and/or a collar and/or a blade.
The second arm may be stationery.
At least one of the arms may be configured to receive auxiliary instrumentation.
The second arm may be configured to receive auxiliary instrumentation.
Auxiliary instrumentation may include any one or more of the group including a further retractor and/or a device to measure the force of retraction and/or a lighting means.
The pivotable attachment of the blade on the first arm may allow for rotation without translation, thereby diffusing and reducing the retraction force exerted on the tissue.
The hinged arrangement may allow for sliding and translation, thereby allowing for displacement of the first arm relative the stationery second arm whilst optimising the linear displacement relative the angle of rotation of the hinged arrangement.
According to another aspect of the invention, there is provided a retractor for use in hip surgery, wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against at least a part of the acetabulum of the hip socket, wherein the blade is attachable to the first arm, a femur spike receivable by the femur shaft, post amputation of the femur head, wherein the femur spike is attachable to the second arm and wherein the actuation of the hinged arms permits displacement of the long axis of the femur relative the acetabulum and simultaneous displacement of the joint capsule, thereby facilitating exposure of the acetabulum.
The hinged arrangement may be an expansile hinged arrangement.
The blade may be levered against the capsule of the acetabulum.
The blade may be L-shaped and may include at least one row of angled teeth for assisting in maintaining the blade's position relative the acetabular tissue.
The blade may be pivotally mounted on the first arm. The mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like. In an embodiment of the invention, the mounting means may include a pin and socket arrangement.
The femur spike may be pivotally mounted on the second arm by way of mounting means.
The femur spike may be mounted in fixed, immobile arrangement on the second arm by way of mounting means.
The mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like. In an embodiment of the invention, the mounting means may include a pin and socket arrangement.
The hinged arms may be actuated by means of a screw configured to increase an angle of rotation between the arms, thereby permitting the displacement of the long axis of the femur relative the acetabulum and the simultaneous displacement of the joint capsule for facilitation of the exposure of the acetabulum.
The screw may permit controlled actuation of the hinged arms.
At least one of the arms may be configured to receive auxiliary instrumentation.
The second arm may be configured to receive a further retractor for assisting with the exposure of the acetabulum. The further retractor may be a Homman retractor.
According to another aspect of the invention, there is provided a retractor for use in hip surgery, wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against at least a part of the acetabulum of the hip socket, wherein the blade is attachable to the first arm, a femur spike receivable by the femur shaft, post amputation of the femur head, wherein the femur spike is attachable to the second arm and wherein the actuation of the hinged arms permits posterior displacement of the long axis of the femur relative the acetabulum and simultaneous anterior elevation of the joint capsule, thereby facilitating exposure of the acetabulum.
The hinged arrangement may be an expansile hinged arrangement.
The blade may be levered against the capsule of the acetabulum.
The blade may be L-shaped and may include at least one row of angled teeth for assisting in maintaining the blade's position relative the acetabular tissue.
The blade may be pivotally mounted on the first arm.
The mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like. In an embodiment of the invention, the mounting means may include a pin and socket arrangement.
The femur spike may be pivotally mounted on the second arm by way of mounting means.
The femur spike may be mounted in fixed, immobile arrangement on the second arm by way of mounting means.
The mounting means may include any one or more of the group including nuts and bolts; pins; dowel pins; screws and the like. In an embodiment of the invention, the mounting means may include a pin and socket arrangement. The hinged arms may be actuated by means of a screw configured to increase an angle of rotation between the arms, thereby permitting the displacement of the long axis of the femur relative the acetabulum and the simultaneous displacement of the joint capsule for facilitation of the exposure of the acetabulum.
The screw may permit controlled actuation of the hinged arms.
The second arm may be configured to receive a further retractor for assisting with the exposure of the acetabulum. The further retractor may be a Homman retractor.
According to yet a further aspect of the invention there is provided a method of exposing the acetabulum of the hip joint that includes the steps of:
inserting a blade in relation to the empty acetabulum of a hip joint;
adjusting the blade relative the acetabulum to a desired position;
inserting a femur spike mounted on an arm of a pair of hinged arms into the cancellous bone of the femur, the femur spike directed towards the lateral cortex of the femur shaft;
attaching the blade to the other arm of the hinged arm pair; and
increasing the angle of rotation between the hinged arms, thereby retracting the joint capsule and facilitating the displacement of the long axis of the femur relative the acetabulum and simultaneous displacement of the joint capsule, thereby facilitating exposure of the acetabulum.
The method of exposing the acetabulum of the hip joint may include inserting a further retractor shaped and dimensioned to elevate the tissue of the hip joint, which may include knocking at least a part of the retractor into the side wall of the pelvis and locating the retractor in one of the hinged arms.
According to yet another aspect of the invention, there is provided a method of replacing a hip joint, the method including the steps of:
gaining access to the hip joint by way of any suitable surgical approach;
dislocating the hip joint;
performing an osteotomy of the femur head and removing same;
inserting a blade in relation to the empty acetabulum of the hip joint;
adjusting the blade relative the acetabulum to a desired position;
inserting a femur spike mounted on an arm of a pair of hinged arms into the cancellous bone of the femur shaft, the femur spike directed towards the lateral cortex of the femur neck;
attaching the blade to the other arm of the hinged arm pair;
increasing the angle of rotation between the hinged arms, thereby retracting the joint capsule and facilitating the displacement of the femur whilst lifting the capsule for visualisation of the acetabulum;
releasing the inferior capsule of the hip joint; inserting a further retractor shaped and dimensioned to elevate the tissue of the hip joint which may include knocking at least a part of the retractor into the side wall of the pelvis and locating the retractor in one of the hinged arms;
reaming the acetabulum and inserting a prosthetic cup;
broaching the femur shaft;
inserting the prosthetic femur head into the shaft of the femur;
relocating the prosthetic femur head in the prosthetic acetabular cup; and
surgically closing the wound.
According to yet another aspect of the invention, there is provided a method of replacing a hip joint, the method including the steps of:
gaining access to the hip joint by way of any suitable surgical approach that preserves the abductor muscles of the hip joint;
dislocating the hip joint;
performing an osteotomy of the femur head and removing same;
inserting a blade in relation to the empty acetabulum of the hip joint;
adjusting the blade relative the acetabulum to a desired position;
inserting a femur spike mounted on an arm of a pair of hinged arms into the cancellous bone of the femur shaft, the femur spike directed towards the lateral cortex of the femur neck;
attaching the blade to the other arm of the hinged arm pair;
increasing the angle of rotation between the hinged arms, thereby retracting the joint capsule and facilitating the displacement of the femur whilst lifting the capsule for visualisation of the acetabulum;
releasing the inferior capsule of the hip joint;
inserting a further retractor shaped and dimensioned to elevate the tissue of the hip joint which may include knocking at least a part of the retractor into the side wall of the pelvis and locating the retractor in one of the hinged arms;
reaming the acetabulum and inserting a prosthetic cup;
broaching the femur shaft;
inserting the prosthetic femur head into the shaft of the femur;
relocating the prosthetic femur head in the prosthetic acetabular cup; and
surgically closing the wound. It is to be appreciated from this specification that the use of the retractor herein disclosed is not limited to a use in any particular positioning of a patient not is it limited to a particular surgical approach to a join
Detailed description of drawings
The invention will now be explained with reference to the following non-limiting drawings wherein;
Figure 1 is a plan view of retractor;
Figure 2 is a representation of a side view of the retractor;
Figure 3 is a further view of the retractor;
Figure 4 -10 are representations of the surgical approach;
Figure 1 1 is a drawing showing the exposure of the greater trochanter of the femur;
Figure 12 shows the dislocation of the hip joint;
Figure 13 and 14 is a representation of the osteotomy of the femur head and removal respectively;
Figures 15(A) and (B) depict the insertion and positioning of the blade of the retractor;
Figure 16 is a drawing of the insertion of the spike into the femur shaft;
Figure 17 depicts the attachment of the blade to the arm of the retractor;
Figure 18 depicts the initial retraction where stretch of the joint capsule is obtained;
Figure 19 depicts further retraction facilitating exposure of the acetabulum;
Figure 20 (A) - (D) are representations of the placement of the hip joint prosthesis;
Figure 21 (A) and (B) are drawings of the surgical closure of the wound;
Figure 22 is a drawing showing the directional vectors of the forces applied by the retractor on the hip joint and surrounding tissue;
Figure 23 is a representation of the mechanical principle of an aspect of the invention disclosed herein; and
Figure 24A and Figure 24B showing a further embodiment of the invention.
A retractor 10 for use in hip surgery having a first arm 12 and a second arm 14 in hinged arrangement. A blade 16 for levering against the capsule of the acetabulum 18 of the hip socket 20, wherein the blade 16 is attachable to the first arm 12, a femur spike 22 receivable by the femur shaft 24, post amputation of the femur head, wherein the femur spike 22 is attachable to the second arm 14 and wherein the actuation 26 of the hinged arms 12 and 14 permits posterior displacement 28 of the long axis 30 of the femur 32 relative the acetabulum 18 and simultaneous anterior elevation 34 of the joint capsule 36, thereby facilitating exposure of the acetabulum 18.
It is to be appreciated in an embodiment of the invention, that the femur spike 22 can be replaced with any one or more of the group including a blade (not shown) and/or a collar 60. In the embodiment shown in the drawings, the blade 16 is L-shaped, pivotally mounted by means of a pin and socket arrangement 40 on the first arm 12. The blade 16 includes rows of angled teeth 38 for assisting in maintaining the blade's position relative the joint capsule 36.
The femur spike 22 is pivotally mounted, by way of pin and socket arrangement 42 on the second arm 14.
The hinged arms 12 and 14 are actuated 26 by means of a screw 44 configured to increase an angle of rotation 46 between the arms 12 and 14, thereby permitting the posterior displacement 28 of the long axis 30 of the femur 32 relative the acetabulum 18 and the simultaneous anterior elevation 34 of the joint capsule 36, thereby facilitating exposure of the acetabulum 18. The screw 44 permits controlled actuation 26 of the hinged arms 12 and 14.
The second arm 14 is configured to receive a Homman retractor 48 for assisting with the exposure of the acetabulum 18.
Auxiliary instrumentation (not shown) can be attachable to the retractor, the auxiliary instrumentation including a further retractor and/or a device to measure the force of retraction and/or a lighting means.
Figures 15 - 19 depicts a method of exposing the acetabulum of the hip joint that includes the steps of inserting a blade 16 into the empty acetabulum 18 of a hip socket 20 (Figure 15A), adjusting the blade 16 relative the acetabulum 18 that the blade 16 lies centrally the acetabulum 18, approximately 10mm from the acetabular rim (Figure 15B). A femur spike 22 mounted on an arm 14 of a pair of hinged arms 12 and 14 is inserted into the cancellous bone 50 of the femur shaft 24, the femur spike 22 directed towards the lateral cortex 52 of the femur shaft 24 (Figure 16). The blade 16 is then attached to the other arm 12 of the hinged arm pair 12 and 14 (Figure 16). Increasing the angle of rotation 46 between the hinged arms 12 and 14, stretches the joint capsule 36 and facilitates posterior displacement 28 of the femur 32 whilst elevating the capsule anteriorly 34 for visualisation of the acetabulum 18 (Figures 17 and 18) .
A Homman retractor 48 is inserted to elevate the tissue of the hip joint and is located on the arm 14.
Figures 4 to 21 illustrate a method of replacing a hip joint, the method including the steps of gaining access to the hip joint through an oblique anterior lateral approach, thereby exposing the hip joint through the abductor muscles of the lower limb (Figures 4 to 1 1 ), dislocating the hip joint (Figure 12), performing an osteotomy of the femur head and removing same (Figure 13 and 14). A blade 16 is inserted relative the empty acetabulum 18 of a hip socket 20 (Figure 15A), adjusting the blade 16, that the blade 16 lies centrally the acetabulum 18, approximately 10mm from the acetabular rim (Figure 15B). A femur spike 22 mounted on an arm 14 of a pair of hinged arms 12 and 14 is inserted into the cancellous bone 50 of the femur shaft 24, the femur spike 22 directed towards the lateral cortex 52 of the femur shaft 24 (Figure 16). The blade 16 is attached to the other arm 12 of the hinged arm pair 12 and 14 (Figure 16). Increasing the angle of rotation 46 between the hinged arms 12 and 14, stretches the joint capsule 36 and facilitates posterior displacement 28 of the femur 32 whilst elevating the capsule anteriorly 34 for visualisation of the acetabulum 18 (Figures 17 and 18). Figures 20A-D and Figures 21 A and B depict the reaming the acetabulum, broaching the femur shaft, inserting the prosthetic femur head into the shaft of the femur, relocating the femur head in the acetabulum and the surgical closing the wound.

Claims

Claims:
1. A retractor for use in surgery, wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against tissue, wherein the blade is pivotably attachable to the first arm, positioning means for positioning the second arm relative tissue and wherein the actuation of the hinged arms permits linear displacement of an end of the blade relative the positioning means.
2. A retractor for use in surgery as claimed in claim 1 , wherein the positioning means is in fixed arrangement relative the stationary second arm thereby preventing rotation and translation of the second arm, the actuation of the positioning means assisting in displacing the first arm relative the second stationary arm whilst optimising the linear displacement relative the angle of rotation of the hinged arrangement, the positioning means being in the form of a spike and/or a collar and/or a blade.
3. A retractor for use in surgery as claimed in any one of the preceding claims, wherein an arm is configured to receive auxiliary instrumentation, said auxiliary instrumentation including but not limited to a further retractor and/or a device for measuring the force of retraction and/or a lighting device.
4. A retractor for use in surgery as claimed in any one of the preceding claims, wherein the pivotable attachment of the blade on the first arm allows for rotation of the blade without translation, thereby diffusing and reducing the retraction force exerted on the tissue.
5. A retractor for use in surgery of a hip joint, the hip joint including a femur head attached to a femur shaft and an acetabulum, the acetabulum comprising a capsule and a labrum; wherein the retractor includes a first and a second arm in hinged arrangement, a blade for levering against at least a part of the acetabulum of the hip socket, wherein the blade is attachable to the first arm, a femur spike receivable by the femur shaft, post amputation of the femur head, wherein the femur spike is attachable to the second arm and wherein the actuation of the hinged arms permits displacement of the long axis of the femur relative the acetabulum and simultaneous displacement of the joint capsule, thereby facilitating exposure of the acetabulum.
6. A retractor for use in hip surgery as claimed in claim 5, wherein the actuation of the hinged arms permits posterior displacement of the long axis of the femur relative the acetabulum and simultaneous anterior elevation of the joint capsule, thereby facilitating exposure of the acetabulum. .
7. A retractor for use in hip surgery as claimed in any one of claims 5 to 6, wherein the hinged arrangement is expansile, the hinged arms actuated by means of a screw configured to control the increase in an angle of rotation between the arms, thereby permitting the displacement of the long axis of the femur relative the acetabulum and the simultaneous displacement of the joint capsule for facilitation of the exposure of the acetabulum.
8. A retractor for use in hip surgery as claimed in any one of claims 5 to 7, wherein the blade is pivotally mounted onto the first arm by any one or more of the group including nuts and bolts; pins; dowel pins; a pin and socket arrangement and the like, the blade being L- shaped and including angled teeth for assisting in maintaining the blade's position when levered relative the acetabular tissue.
9. A retractor for use in hip surgery as claimed in any one of claims 5 to 8, wherein the femur spike is pivotally mounted or mounted in a fixed, immobile arrangement on the second arm by way of mounting means, the mounting means including any one or more of the group including nuts and bolts; pins; dowel pins; screws; a pin and socket arrangement and the like.
10. A retractor for use in hip surgery as claimed in any one of claims 5 to 9, wherein the second arm is configured to receive a further retractor for assisting with exposing the acetabulum, the further retractor being a Homman retractor.
1 1. A method of exposing the acetabulum of a hip joint, the hip joint including a femur head attached to a femur shaft and an acetabulum, the acetabulum comprising a capsule and a labrum, the method of exposing the acetabulum of the hip joint including the steps of:
inserting a blade in relation to the empty acetabulum of a hip joint;
adjusting the blade relative the acetabulum to a desired position;
inserting a femur spike mounted on an arm of a pair of hinged arms into the cancellous bone of the femur, the femur spike directed towards the lateral cortex of the femur shaft;
attaching the blade to the other arm of the hinged arm pair; and
increasing the angle of rotation between the hinged arms, thereby retracting the joint capsule and facilitating the displacement of the long axis of the femur relative the acetabulum and simultaneous displacement of the joint capsule, thereby facilitating exposure of the acetabulum.
12. A method of exposing the acetabulum of the hip joint as claimed in claim 1 1 , wherein a further retractor shaped and dimensioned to elevate the tissue of the hip joint is inserted by knocking at least a part of the retractor into the side wall of the pelvis and locating the retractor in one of the hinged arms.
13. A method of replacing a hip joint, the hip joint including a femur head attached to a femur shaft and an acetabulum, the acetabulum comprising a capsule and a labrum, the method of replacing a hip joint including the steps of:
gaining access to the hip joint by way of any suitable surgical approach; dislocating the hip joint;
performing an osteotomy of the femur head and removing same;
inserting a blade in relation to the empty acetabulum of the hip joint;
adjusting the blade relative the acetabulum to a desired position;
inserting a femur spike mounted on an arm of a pair of hinged arms into the cancellous bone of the femur shaft, the femur spike directed towards the lateral cortex of the femur neck;
attaching the blade to the other arm of the hinged arm pair;
increasing the angle of rotation between the hinged arms, thereby retracting the joint capsule and facilitating the displacement of the femur whilst lifting the capsule for visualisation of the acetabulum;
releasing the inferior capsule of the hip joint;
inserting a further retractor shaped and dimensioned to elevate the tissue of the hip joint which may include knocking at least a part of the retractor into the side wall of the pelvis and locating the retractor in one of the hinged arms; reaming the acetabulum and inserting a prosthetic cup;
broaching the femur shaft;
inserting the prosthetic femur head into the shaft of the femur;
relocating the prosthetic femur head in the prosthetic acetabular cup; and surgically closing the wound.
14. A method of replacing a hip joint as claimed in claim 13, wherein the abductor muscles of the hip joint are preserved when gaining access to the hip joint by way of any surgical approach.
15. A method of replacing a hip joint as claimed in any one of claims 13 to 14, wherein the use of the retractor is not limited to a particular positioning of a patient and furthermore, it is not limited to a particular surgical approach to a joint.
16. A retractor for use in surgery as claimed in claim 1 , substantially as herein described and illustrated.
17. A new retractor for use in surgery, substantially as herein described and illustrated.
18. A retractor for use in hip surgery as claimed in claim 5, substantially as herein described and illustrated.
19. A new retractor for use in hip surgery, substantially as herein described and illustrated.
20. A method of exposing the acetabulum of a hip joint as claimed in claim 1 1 , substantially as herein described and illustrated.
21. A new method of exposing the acetabulum of a hip joint, substantially as herein described and illustrated.
A method of replacing a hip joint as claimed in claim 13, substantially as herein described and illustrated.
A new method of replacing a hip joint, substantially as herein described and illustrated.
PCT/IB2012/050058 2011-01-06 2012-01-05 A retractor for use in surgery WO2012093368A1 (en)

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