Apparatus for use in surgery

Abstract

A targeting kit comprises (i) a mounting arrangement for releasably mounting the targeting kit on an implant, (ii) first and second guide members having an elongate shape with a bore running along its longitudinal axis (iii) a holding arrangement for holding the first and second guide members, the holding arrangement being adjustable between a release condition, in which the positions of the first and second guide members are adjustable, and a holding condition, in which the first and second guide members are in a fixed position, and (iv) a bridging arrangement between the mounting arrangement and the first and second guide members, to space the first and second guide members with respect to the mounting arrangement, the bridging arrangement being adjustable between a release condition, in which the position of the mounting arrangement is adjustable, and a holding condition, in which the first and second guide members are fixedly spaced.

Claims

1. A targeting kit suitable for use in removing an implant, especially a femoral implant, from the surrounding tissue, wherein the targeting kit comprises: a mounting arrangement for releasably mounting the targeting kit on the head or neck of a femoral implant, first and second guide members, each of which is an elongate shape with a bore running along its longitudinal axis, each guide member being able to receive a drill bit through its bore, a holding arrangement for holding the first and second guide members, the holding arrangement being adjustable between a release condition, in which the positions of the first and second guide members are adjustable relative to each other, and a holding condition, in which the first and second guide members are held by the holding arrangement in a fixed position relative to each other, a bridging arrangement between the mounting arrangement and the first and second guide members, said bridging arrangement being configured to space the first and second guide members with respect to the mounting arrangement, and to permit the mounting arrangement and the first and second guide members to be pivotably adjustable relative to each other, with there being a pivoting movement of the mounting arrangement and the first and second guide members with respect to each other about a pivot point, such that the angle between the mounting arrangement and the first and second guide members can be increased or decreased, with the bridging arrangement being adjustable between a release condition, in which the position of the mounting arrangement is adjustable relative to the first and second guide members, and a holding condition, in which the first and second guide members are fixedly spaced with respect to the mounting arrangement by the bridging arrangement, such that the mounting arrangement can be secured onto the head or neck of the implant, with the first and second guide members being located on the neck or shoulder of the implant, with the first guide member located at the anterior of the implant and the second guide member located at the posterior of the implant, the first guide member being angled such that its longitudinal axis is spaced from and substantially parallel to the anterior surface of the implant and the second guide member being angled such that its longitudinal axis is spaced from and substantially parallel to the posterior surface of the implant.

2. The targeting kit of claim 1, wherein the mounting arrangement for releasably mounting the targeting kit on the head or neck of a femoral implant comprises a clamping component.

3. The targeting kit of claim 2, wherein the clamping component includes an elongate bore within which the neck of the femoral implant can be received.

4. The targeting kit of claim 2, wherein the clamping component has an open configuration, in which it can be placed around the neck of the femoral implant, and a closed configuration, in which it can be clamped shut, with the bore of the clamping component securely receiving and holding the neck of the femoral implant, wherein the clamping component may be locked in this closed configuration.

5. The targeting kit of claim 1, wherein the first and second guide members are slidably adjustable relative to each other, such that the distance between the guide members can be increased or decreased.

6. The targeting kit of claim 1, wherein the first and second guide members are secured to the holding arrangement by the use of first and second securing bores in the holding arrangement that are shaped and sized to receive the guide members.

7. The targeting kit of claim 6, wherein the holding arrangement comprises a body portion that can be located on the shoulder of the implant, wherein the first securing bore is located at a distal end of the body portion and can be located against the anterior surface of the implant when the body portion is located on the shoulder of the implant and the second securing bore is located at a proximal end of the body portion and can be located against the posterior surface of the implant when the body portion is located on the shoulder of the implant, and wherein the distance between the first and second securing bores can be adjusted, set and locked.

8. The targeting kit of claim 7, wherein the body portion has two parts, wherein the first part includes the first of the securing bores and the second part includes the second of the securing bores and wherein the first part and second part of the body portion can be connected together to form the body portion.

9. The targeting kit of claim 8, wherein the body portion comprises an adjustment member that allows the distance between the two parts to be altered.

10. The targeting kit of claim 8, wherein each body part has an interlocking section extending therefrom, wherein each interlocking section has an elongate aperture, such that the two body parts can be fixed at a desired distance to each other by using a fastening member, such as a bolt, to extend through both elongate apertures and fix them together.

11. The targeting kit of claim 8, wherein one body part has an interlocking section extending therefrom, with this interlocking section having an elongate aperture, and the other body part has an interlocking section extending therefrom, with this interlocking section having a fastening member that can extend through the elongate aperture and be secured thereto.

12. The targeting kit of claim 1 wherein the angle between the mounting arrangement and the first and second guide members can be adjusted to be an angle in the range of from 5 degrees to 60 degrees.

13. The targeting kit of claim 12 wherein the angle between the mounting arrangement and the first and second guide members can be adjusted to be an angle in the range of from 30 to 60 degrees.

14. The targeting kit of claim 1, wherein the bridging arrangement includes a ratchet and pinion system to permit the mounting arrangement and the first and second guide members to be pivotably adjustable relative to each other.

15. The targeting kit of claim 1, wherein the pivoting movement of the mounting arrangement and the first and second guide members with respect to each other is about a pivot point which is a ball joint, e.g. a restricted articulation ball joint.

16. The targeting kit of claim 1 wherein: (a) a first mounting base connects the bridging arrangement to the mounting arrangement; or (b) a first mounting base connects the bridging arrangement to the holding arrangement; or (c) a first mounting base connects the bridging arrangement to both the mounting arrangement and the holding arrangement.

17. The targeting kit of claim 1 wherein a first mounting base connects with the holding arrangement at or near the pivot point about which the relative pivotal movement of the mounting arrangement and the first and second guide members occurs.

18. The targeting kit of claim 1 wherein the bridging arrangement includes a locking mechanism for locking the mounting arrangement relative to the first and second guide members.

19. A kit comprising the targeting kit as defined in claim 1 together with one or more of (and in particular three or more of, or four or more of, or all of): (a) an extra medullary targeting device that can attach to the first guide member and the second guide member in turn to check their alignment, to check that the guide member in question is pointing to the distal tip of implant, as determined via x-ray; (b) an osteotome device that can remove bony ingrowth located adjacent to the anterior access tunnel, and remove bony ingrowth located adjacent to the posterior access tunnel and the posterior surface of the implant; (c) a curette device that can remove bony ingrowth located between the implant and the femur in the anterior aspect, and remove bony ingrowth located between the implant and the femur in the posterior aspect; (d) a medial-lateral cavity maker device that can remove bony ingrowth located at the distal end of the implant, to create a cavity at the distal end of the implant that extends in the medial and lateral directions; (e) a wire delivery device that can provide a wire to extend from a first access point at the proximal surface of the surrounding tissue to a second access point at the proximal surface of the surrounding tissue via the anterior access tunnel, the cavity at the distal end of the implant and the posterior access tunnel, the wire comprising a cutting portion that can be used to cut away bony ingrowth at the surface of the implant; or a medial-lateral clearance device that can remove bony ingrowth located at the antro-lateral edge of the implant, at the antro-medial edge of the implant, at the postro-lateral edge of the implant and at the postro-medial edge of the implant.

Description

DESCRIPTION OF THE DRAWINGS

(1) The invention will now be further described with reference to the drawings, which are exemplary of the invention rather than limiting, and in which:

(2) FIG. 1a is a postro-medial perspective view of a targeting kit of the invention

(3) FIG. 1b is a medial side view of the targeting kit of the invention

(4) FIG. 1c is an antro-lateral perspective view of the targeting kit of the invention

(5) FIG. 1d is an antro-medial perspective view of the targeting kit of the invention

(6) FIG. 1e is a perspective view from below of the targeting kit of the invention

(7) FIG. 1f is a perspective view of an extra medullary targeting device that can be used with the kit of FIGS. 1a-1e

(8) FIG. 1g is a further perspective view of the device of FIG. 1f, in a configuration where the distance between the checking guide members has been slidably increased

(9) FIG. 2a is a postro-medial perspective view of an alternate targeting kit of the invention

(10) FIG. 2b is a postro-lateral perspective view of the alternate targeting kit of the invention

(11) FIG. 2c is an antro-medial perspective view of the alternate targeting kit of the invention

(12) FIG. 2d is a perspective view of the mounting arrangement section of the alternate targeting kit of the invention

(13) FIG. 2e is a is a perspective view of the holding arrangement section of the alternate targeting kit of the invention

(14) FIG. 3a is a plan view of an osteotome device of the invention, including a detail of the cutting portion and a cross section thereof

(15) FIG. 3b is a perspective view of the osteotome device of the invention

(16) FIG. 3c is a plan view of a set of three osteotome devices of the invention, each with different sizes of cutting portion

(17) FIG. 3d is a side view of an osteotome device of the invention

(18) FIG. 3e is a detailed view of the osteotome device shown in FIG. 3d, showing Detail B

(19) FIG. 4a is a plan view of a first curette device of the invention

(20) FIG. 4b is a plan view of an alternate curette device of the invention

(21) FIG. 4c is a plan view of a further alternate curette device of the invention

(22) FIG. 5a is a plan view of a medial-lateral cavity maker device of the invention, including a detail of the cutting portion and an end view

(23) FIG. 5b is a perspective view of the medial-lateral cavity maker device of the invention

(24) FIG. 5c is a further plan view of a medial-lateral cavity maker device of the invention

(25) FIG. 6a is a plan view of a medial-lateral clearance device of the invention,

(26) FIG. 6b is a further plan view of the medial-lateral clearance device of the invention, having been rotated 90 degrees as compared to FIG. 6a

(27) FIG. 6c is a cross sectional view of the distal end of the medial-lateral clearance device of FIG. 6a

(28) FIG. 7a is a plan view of a wire delivery device of the invention, including a detail of the guide in plan and perspective view

(29) FIG. 7b is a perspective view of the wire delivery device of the invention

(30) FIG. 7c is a plan view of the inner guide tube of the invention, including a detail in plan and a cross section of the proximal end

(31) FIG. 7d is a perspective view of the inner guide tube of the invention

(32) FIG. 8 is a plan view of a wire kit of the invention, including a detail of the ends of the wires

(33) FIG. 9 is a plan view of a dislodger device of the invention.

(34) All values given in the description below in terms of dimensions for the products are not limited solely to the specific embodiments as illustrated. Instead, it will be appreciated that the dimensions as mentioned also apply to the broader definitions of each product as given above.

(35) The targeting kit of the invention is shown in FIG. 1.

(36) The targeting kit comprises a mounting arrangement 1 for releasably mounting the targeting kit on the head of a femoral implant 6, first guide member 2 and second guide member 3, a holding arrangement 4 for holding the first and second guide members, and a bridging arrangement 5 between the mounting arrangement and the first and second guide members, to space the first and second guide members from the mounting arrangement.

(37) The mounting arrangement 1 comprises a clamping component which is a jig 1a with a central elongate bore 1b. The jig can be adjusted between a position where the bore can be accessed and can receive a neck of a femoral implant, and a position where the jig is clamped shut and therefore the neck of the femoral implant that is located within the bore is secured therein. The clamping component is locked in this closed configuration during use of the apparatus.

(38) The first guide member 2 and second guide member 3 are both elongate in shape, with a bore running along the longitudinal axis, with each guide member being able to receive a drill bit through its bore due to the bore diameters being sized to substantially correspond to the diameter of access tunnels that will be created.

(39) The holding arrangement 4 is adjustable between a release condition, in which the positions of the first and second guide members are adjustable relative to each other, and a holding condition, in which the first and second guide members are held by the holding arrangement in a fixed position relative to each other.

(40) The guide members 2 and 3 are secured to the holding arrangement 4 by the use of securing bores 4a, 4b in the holding arrangement 4 that are shaped and sized to receive the guide members.

(41) The holding arrangement 4 comprises a body portion that can be located on the shoulder of the implant. The first of the securing bores is located at a distal end of the body portion and can be located against the anterior surface of the implant when the body portion is located on the shoulder of the implant. The second of the securing bores is located at a proximal end of the body portion and can be located against the posterior surface of the implant when the body portion is located on the shoulder of the implant. The distance between the bores can be adjusted, set and locked.

(42) This body portion has two parts. The first part includes the first of the securing bores and the second part includes the second of the securing bores. The first part and second part of the body portion can be connected together to form the body portion. In this regard, the first part and second part can be connected together to provide a desired separation between the securing bores.

(43) The bridging arrangement 5 is adjustable between a release condition, in which the position and angle of the mounting arrangement 1 is adjustable relative to the first and second guide members 2,3, and a holding condition, in which the first and second guide members 2,3 are fixedly spaced and angled from the mounting arrangement 1 by the bridging arrangement 5.

(44) In this regard, the bridging arrangement 5 permits the mounting arrangement 1 and the first and second guide members 2,3 to be pivotably adjustable relative to each other by use of a ratchet and pinion system 7, such that the angle between the mounting arrangement 1 and the first and second guide members 2,3 can be increased or decreased as required.

(45) The mounting arrangement 1 is attached to a first mounting base 6, and the first mounting base 6 is connected to the ratchet and pinion system 7. The first and second guide members 2,3 are attached to a second mounting base 8, and the second mounting base 8 is connected to the ratchet and pinion system 7.

(46) In this regard, the first mounting base 6 pivotably moves with respect to the second mounting base 8 via the ratchet and pinion system 7, thereby altering the angle between the mounting arrangement 1 and the first and second guide members 2,3. In this regard, the second mounting base 8 is fixedly connected to the ratchet and pinion system 7, whilst the first mounting base 6 is moveably connected to the ratchet and pinion system 7.

(47) The pivoting movement is about a pivot point which is a ball joint, e.g. a restricted articulation ball joint.

(48) The first mounting base 6 connects the bridging arrangement 5 to both the mounting arrangement 1 and the holding arrangement 4. This first mounting base 6 connects with the holding arrangement 4 at or near the pivot point about which the relative pivotal movement of the mounting arrangement 1 and the first and second guide members 2,3 occurs.

(49) The pivoting movement via the ratchet and pinion system can be effected by the user via the use of thumb wheel 9.

(50) The bridging arrangement 5 includes a locking mechanism for locking the mounting arrangement 1 relative to the first and second guide members 2,3 once they are at the desired angle to each other.

(51) Thus the relative positions of the first and second guide members 2, 3 and the mounting arrangement 4, both in terms of their distance apart and angle to one another, can be adjusted as required.

(52) Therefore in the targeting kit the mounting arrangement 1 can be secured onto the shoulder of the implant, with the neck of the implant in the bore 1b, with the first and second guide members 2 and 3 being located on the shoulder of the implant, with the first guide member 2 located at the anterior of the implant and the second guide member 3 located at the posterior of the implant, the first guide member 2 being angled such that its longitudinal axis is spaced from and substantially parallel to the anterior surface of the implant and the second guide member 3 being angled such that its longitudinal axis is spaced from and substantially parallel to the posterior surface of the implant.

(53) The targeting kit may be used in combination with an extra medullary targeting device as shown in FIG. 1f and 1g.

(54) The extra medullary targeting device comprises a targeting kit interlocking portion 121. This targeting kit interlocking portion 121 comprises a first guide member interlocking component 121a, which comprises a bore within which the first guide member 2 of the targeting kit can be received. The targeting kit interlocking portion 121 also comprises a second guide member interlocking component 121b, which comprises a locking pin 123 that can be received in the bore of the second guide member 3 of the targeting kit. The elongate axis of the locking pin 123 is parallel to the longitudinal axis of the bore of the first guide member interlocking component 121a.

(55) The extra medullary targeting device also comprises an extra medullary guidance portion 122. The extra medullary guidance portion 122 comprises a bore within which a test pin 124 having an elongate body can be received.

(56) The extra medullary targeting device also comprises a holding arrangement 125 for holding and spacing the targeting kit interlocking portion and the extra medullary guidance portion 121,122. This holding arrangement holds the portions 121, 122 fixedly relative to each other in terms of their angle, such that the bore of the first guide member interlocking component and the bore of the extra medullary guidance portion have their longitudinal axes aligned, such that these bores run parallel to each other. However, the holding arrangement is adjustable in terms of the distance between the two portions. In this regard, the holding arrangement 125 is adjustable between a release condition, in which the distance between the two portions is adjustable, and a holding condition, in which the distance between the two portions is fixed.

(57) The locking pin may have a length of elongate body that is from 30 to 100 mm; for example it may be a length between 40 and 80 mm.

(58) The test pin may have a length of elongate body that is from 70 to 250 mm; for example it may be a length between 100 and 200 mm.

(59) The distance between the portions 121, 122 may be from 30 to 60 mm; for example the distance may be adjustable from a minimum of 34 mm up to a maximum of 52 mm. When reference is made to the distance between the portions this is measured as the distance between the bore that receives the locking pin and the bore that receives the test pin.

(60) The holding arrangement 125 has two parts. The first part includes the portion 121 and the second part includes the portion 122. The first part and second part can be connected together to form the holding arrangement. The first part and second part may be connected together to provide a desired separation between the checking guide members.

(61) Each body part has an interlocking section extending therefrom, wherein each interlocking section has an elongate aperture, such that the two body parts can be fixed at a desired distance to each other by using a fastening member 126, such as a bolt, to extend through both elongate apertures and fix them together.

(62) By selecting the position within the elongate apertures where the fastening member 126 is located, different separation distances can be achieved, as can be seen by reference to FIGS. 1f and 1g where different separation distances are shown.

(63) Accordingly, the bore of the first guide member interlocking component 121a can receive the first guide member 2 of the targeting kit, and the locking pin 123 of the second guide member interlocking component 121b can be received in the bore of the second guide member 3 of the targeting kit. The test pin 124 can be received within the bore of the extra medullary guidance portion 122. Therefore the bore of the first guide member interlocking component 121a is angularly aligned with the first guide member 2 of the targeting kit, and the locking pin 123 of the second guide member interlocking component 121b is angularly aligned with the second guide member 3 of the targeting kit. Consequently, the test pin 124 located in the bore of the extra medullary guidance portion 122 is also angularly aligned with the first and second guide members 2, 3 of the targeting kit.

(64) The test pin 124 will lie outside the femur. This test pin reflects the alignment of the guide members 2,3 of the targeting kit. The test pin 124 and the guide members 2,3 of the targeting kit all lie in the saggital plane.

(65) Due to the fact that this test pin extends outside the patient's body, the alignment of the test pin can be checked, e.g. with reference to the location of the distal tip of implant, as determined via x-ray, or with reference to the middle of the medio-lateral diameter of the femur at the level of the distal tip of the implant. It can be ensured that the test pin is pointing in that direction, and thus that the guide members 2,3 of the targeting kit are also pointing in that direction.

(66) Accordingly, this provides a double check that the guide members 2,3 are correctly aligned before drill bits are used in these guide members to drill the access tunnels.

(67) An alternate targeting kit of the invention is shown in FIG. 2.

(68) The targeting kit comprises a mounting arrangement 101 for releasably mounting the targeting kit on the head of a femoral implant 106, first guide member 102 and second guide member 103, a holding arrangement 104 for holding the first and second guide members, and a bridging arrangement 105 between the mounting arrangement and the first and second guide members, to space the first and second guide members from the mounting arrangement.

(69) The mounting arrangement 101 comprises a cup-shaped component. This cup-shaped component is sized and shaped to be able to fit round and engage with part of the head of a femoral implant.

(70) The first guide member 102 and second guide member 103 are both elongate in shape, with a bore running along the longitudinal axis, with each guide member being able to receive a drill bit through its bore due to the bore diameters being sized to substantially correspond to the diameter of access tunnels that will be created.

(71) The holding arrangement 104 is adjustable between a release condition, in which the positions of the first and second guide members are adjustable relative to each other, and a holding condition, in which the first and second guide members are held by the holding arrangement in a fixed position relative to each other.

(72) The guide members 102 and 103 are secured to the holding arrangement 104 by the use of securing bores in the holding arrangement 104 that are shaped and sized to receive the guide members.

(73) The holding arrangement 104 comprises two body portions 104a and 104b, each of which includes one of the securing bores that can be used to hold one of the guide members 102 and 103.

(74) Each body portion 104a, 104b has an interlocking section extending therefrom, wherein each interlocking section has an elongate aperture, such that the two body portions can be fixed at a desired distance and angle to each other by using a fastening member, such as a bolt, to extend through both elongate apertures and fix them together.

(75) By selecting the position within the elongate apertures where the fastening member is located, different separation distances and angles can be achieved.

(76) The provision of the elongate apertures therefore allows the relative positions of the two body portions, both in terms of their distance apart and angle to one another, to be adjusted as required. Thus the relative positions of the securing bores can be adjusted.

(77) The distance between the guide members can of course be adjusted by adjusting the distance between the securing bores, and the angle between the guide members can be adjusted by adjusting the angle between the securing bores.

(78) The bridging arrangement 105 is adjustable between a release condition, in which the position of the mounting arrangement 101 is adjustable relative to the first and second guide members 102 and 103, and a holding condition, in which the first and second guide members are fixedly spaced from the mounting arrangement by the bridging arrangement.

(79) The bridging arrangement permits the mounting arrangement 101 and the first and second guide members 102,103 to be slidably adjustable relative to each other, such that the distance between the mounting arrangement and the first and second guide members can be increased or decreased as required, and to be pivotably adjustable relative to each other, such that the angle between the mounting arrangement and the first and second guide members can be increased or decreased as required.

(80) The bridging arrangement 105 includes an elongate aperture 105a and a fastening member 105b that can extend through the elongate aperture and be secured thereto.

(81) The elongate aperture 105a is linked to the first and second guide members via the holding arrangement 104 and the fastening member 105b is linked to the mounting arrangement 101. The fastening member can extend through the elongate aperture and can then be secured in position, fixing the elongate aperture and the fastening member together.

(82) By selecting the position within the elongate aperture where the fastening member is located, different separation distances and angles can be achieved.

(83) Thus the relative positions of the first and second guide members 102, 103 and the mounting arrangement 104, both in terms of their distance apart and angle to one another, can be adjusted as required.

(84) Therefore in the targeting kit the mounting arrangement 101 can be secured onto the head of the implant, with the first and second guide members 102 and 103 being located on the shoulder of the implant, with the first guide member 102 located at the anterior of the implant and the second guide member 103 located at the posterior of the implant, the first guide member 102 being angled such that its longitudinal axis is spaced from and substantially parallel to the anterior surface of the implant and the second guide member 3 being angled such that its longitudinal axis is spaced from and substantially parallel to the posterior surface of the implant.

(85) The osteotome device of the invention is shown in FIG. 3. The device comprises an elongate body 11, having a proximal end 11a that is provided with a handle 11d and a distal end 11b that is blunt, and a cutting portion 14.

(86) The elongate body 11 includes a distal section 12 extending from the distal end 11b to a shoulder point 11c, and an indented section 13 extending from the shoulder point 11c towards the proximal end 11a. The shoulder point is located closer to the distal end than the proximal end, e.g. at a distance from the distal end of from 2.5 to 15 mm such as from 5 to 10 mm. The depth of the distal section 12 is greater than the depth of the indented section 13.

(87) The cutting portion 14 has a front face and a back face, with the back face being attached to the indented section of the elongate body. The cutting portion 14 therefore extends from the indented section of the elongate body.

(88) The cutting portion 14 is attached to the elongate body 11 at joint 14a. Joint 14a may, for example, be a laser welded joint.

(89) The distance between the back face and the front face of the cutting portion is substantially the same as the difference in depth between the distal section and the indented section of the elongate body. Therefore the front face of the cutting portion does not protrude outwardly from the elongate body. This can be seen in, for example, FIG. 3e.

(90) The front face of the cutting portion 14 is blunt but is connected to the back face by a first cutting side 15 and a second cutting side 16. The cutting portion is triangular in cross sectional shape, with two of the three sides of the triangle being the first cutting side and the second cutting side.

(91) Therefore part of the first cutting side and part of the second cutting side angularly extend outwardly of the elongate body, providing cutting surfaces for cutting away bony ingrowth.

(92) The triangle is an isosceles triangle, with the first cutting side and the second cutting side being the same length. The first cutting side and the second cutting side are suitably at an angle to one another of from 50 to 80 degrees, e.g. from 60 to 70 degrees.

(93) It may be that the third side of the triangle, i.e. the non-cutting side, is any suitable width. One example of a suitable width is 25 mm. It will be appreciated that a range of different widths could be suitable, e.g. within a range of from 5 mm to 50 mm, such as from 10 mm to 40 mm. As shown in FIG. 3c, a set of osteotomes, each having a different size of cutting portion 14, each with a different width, can be provided.

(94) The cutting portion 14 may also have any suitable length, i.e. the distance from this non-cutting side to the tip of the cutting potion 14 (where the two cutting sides meet). One example of a suitable length is 19 mm. It will be appreciated that a range of different lengths could be suitable, e.g. within a range of from 5 mm to 50 mm, such as from 10 mm to 40 mm. As shown in FIG. 3c, a set of osteotomes, each having a different size of cutting portion 14, each with a different length, can be provided.

(95) The osteotome device can be located in an access tunnel and pushed in the direction of the distal end of the implant so as to cut away bony ingrowth with the first cutting side and the second cutting side.

(96) When a set of osteotomes is provided, the osteotome with the smallest size of cutting portion will be used first. This will therefore cut away a first width of bony ingrowth with the first cutting side and the second cutting side. The osteotome that is the next size up can then be used, to cut away a second, broader, width of bony ingrowth with the first cutting side and the second cutting side.

(97) This process can then be repeated further with additional osteotomes of increasing size, in terms of the size of the cutting portion, until a channel where bony ingrowth has been cut away is achieved that has a desired size.

(98) It will be appreciated that due to the shape of the osteotome cutting portion, the channel where bony ingrowth is cut away will be wider towards the proximal end of the implant than the distal end of the implant.

(99) The curette device of the invention is shown in FIG. 4. The device comprises an elongate body 110 and a cutting portion 111 extending outwardly from the elongate body.

(100) The elongate body 110 has a proximal end that is provided with a handle 110a. It also has a distal end 110b that is blunt. The elongate body 110 is in the shape of a flat plate. This extends from a first elongate edge to a second elongate edge.

(101) In one embodiment, the width of this body 110 is from 3 to 6 mm, e.g. about 4 to 5 mm. In one embodiment the depth of this body 110 is from 0.5 to 1.5 mm, preferably from 1 to 1.5 mm.

(102) The cutting portion 111 is located near the distal end 110b of the elongate body. This cutting portion 111 has a blunt edge 112 which is substantially parallel to the elongate axis E-E of the elongate body. The cutting portion 111 also has a cutting edge 113, which is at an angle of from 30 to 150 degrees to the elongate axis E-E of the elongate body. The cutting portion also has an attachment edge which is the edge by which the cutting portion is attached to the elongate body (at the second elongate edge).

(103) The cutting edge 113 extends from a proximal end, where it adjoins the elongate body, to a distal end, which is away from the body. The cutting edge 113 is sharp at least at the distal end 113a. It may optionally be sharp along some or all of the remainder of its length. For example, going from the distal end towards the proximal end the first 10% or more of the length may be sharp.

(104) In FIG. 4a the cutting edge is at an angle of about 45 degrees to the elongate axis of the elongate body.

(105) In FIG. 4b the cutting edge is at an angle of about 135 degrees to the elongate axis of the elongate body.

(106) In FIG. 4c the cutting edge is at an angle of about 45 degrees to the elongate axis of the elongate body.

(107) The cutting edge may be any suitable width. One example of a suitable width is 3 mm. It will be appreciated that a range of different widths could be suitable, e.g. within a range of from 0.5 mm to 6 mm, such as from 1 mm to 4 mm. It is possible that a set of curettes, each having a different size of cutting edge, can be provided.

(108) The distal end of the cutting edge may be any suitable distance from the elongate body. It may be that the distance from the elongate body (e.g. from its second elongate edge) to the distal end of the cutting edge, when measured in a direction that is perpendicular to the elongate axis of the elongate body, is from 4 to 9 mm, especially from 5 to 8 mm.

(109) It is possible that a set of curettes, each having a different distance for the distal end of the cutting edge, can be provided.

(110) The curette device can be located in an access tunnel, with its elongate axis E-E substantially aligned with the central axis running along the length of the tunnel, and with the distal end located at or near the distal (closed) end of the access tunnel. It can then be angled within that tunnel such that its elongate axis is angled with respect to the central axis running along the length of the tunnel, until the cutting edge 113 (especially the distal end 113a of said cutting edge) contacts the bony ingrowth located between the surface of the implant and the femoral cortex. The curette device can then be withdrawn from the access tunnel whilst being retained in an angled position, such that as the device is withdrawn the cutting edge 113 cuts away bony ingrowth located between the surface of the implant and the inner femoral cortex.

(111) The medial-lateral cavity maker device of the invention is shown in FIG. 5.

(112) The medial-lateral cavity maker device comprises an elongate body 21 having a proximal end 21a that is provided with a handle and a distal end 21b that is blunt; and a cutting portion 22 extending outwardly from the elongate body 21.

(113) The cutting portion 22 is located closer to the distal end 21b of the elongate body than the proximal end 21a of the elongate body. The cutting portion may be located at a distance from the distal end of from 2 to 10 mm.

(114) The cutting portion 22 has a connecting end attached to the elongate body and a protruding end located away from the elongate body. The connecting end and the protruding end are connected by a first edge 23 located towards the distal end of the elongate body and a second edge 24 located towards the proximal end of the elongate body.

(115) The cutting portion 22 overall has a hook shape. The first edge 23 is blunt and is a curved edge that is convex and the second edge 24 is a cutting edge and is a curved edge that is concave.

(116) Therefore the medial-lateral cavity maker device can be located in an access tunnel and once the cutting portion is beyond the distal end of the implant it can be rotated so as to cut away bony ingrowth with the second edge 24 at the distal end of the implant, to create a cavity at the distal end of the implant that extends in the medial and lateral directions.

(117) The medial-lateral clearance device is shown in FIG. 6.

(118) The medial-lateral clearance device comprises an elongate body 120 and a cutting portion 121 that extends outwardly from the elongate body.

(119) The elongate body 120 has a proximal end that is provided with a handle 120a and a distal end 120b that is blunt. The elongate body 120 is in the shape of a flat plate that extends from a first elongate edge 120c to a second elongate edge 120d.

(120) In one embodiment, the width of this body 120 is from 2.5 to 4 mm, e.g. about 3 mm. In one embodiment the depth of this body 120 is from 0.5 to 1.5 mm, preferably from 1 to 1.5 mm.

(121) It can be seen that the distal end is angled upwardly from its first elongate edge to its second elongate edge. The angle may, for example, be from 20 to 45 degrees, such as about 30 degrees, to the elongate axis of the elongate body.

(122) The cutting portion is located near the distal end 120b of the elongate body. The cutting portion 121 is in the shape of a flat plate. This extends from an inner elongate edge 121a which connects with the first elongate edge 120c of the elongate body at a substantially 90 degree angle, as can be best seen in FIG. 6c.

(123) The depth of this flat plate cutting portion 121 is suitably from 0.5 to 1.5 mm, preferably from 1 to 1.5 mm.

(124) The flat plate of the cutting portion is also provided with a blunt edge 122 that is located towards the distal end 120b of the elongate body.

(125) The blunt edge is angled upwardly. The angle may, for example, be from 20 to 45 degrees, such as about 30 degrees, to the elongate axis of the elongate body.

(126) The flat plate of the cutting portion is also provided with a cutting edge 123 that is located towards the proximal end of the elongate body.

(127) The cutting edge may have any suitable length. In one embodiment its width is from 2 to 5 mm or from 2.5 to 4 mm, e.g. about 3 mm.

(128) As can be seen, the cutting edge is angled upwardly, e.g. at an angle of from 30 to 60 degrees to the elongate axis of the elongate body, such as about 45 degrees.

(129) The medial-lateral clearance device can be located in an access tunnel, with its flat plate elongate body 120 in said tunnel and the flat plate cutting portion 121 located alongside and substantially parallel to the surface of the implant. It can then be moved towards the distal end of the implant until the flat plate cutting portion 121 is completely located in a cavity at the distal end of the implant that extends in the medial and lateral directions. Within that cavity the flat plate cutting portion 121 is free to rotate. At that point the device can then be rotated by ninety degrees, such that the flat plate elongate body 120 is located alongside and substantially parallel to the surface of the implant, with the flat plate cutting portion 121 extending beneath the implant. Once this has been done the flat plate elongate body 120 can then be moved in a direction parallel to the surface of the implant until the flat plate cutting portion 121 is aligned with either the medial or lateral surface of the implant. Then the medial-lateral clearance device can be withdrawn posteriorly, with the flat plate elongate body 120 lying alongside the anterior or posterior surface and the flat plate cutting portion 121 lying alongside the medial or lateral surface. This then means that as the device is withdrawn posteriorly the cutting edge 123 of the device cuts away bony ingrowth located at said medial or lateral surface of the implant.

(130) It will be appreciated that a pair of such medial-lateral clearance devices should be provided: one where the flat plate cutting portion is ninety degrees clockwise from the flat plate elongate body and one where the flat plate cutting portion is ninety degrees anticlockwise from the flat plate elongate body.

(131) In addition, for both the “left handed” version and the “right handed” version, two or more different sizes may be provided. For example, for each version there may be a first size where the cutting edge is from 1.5 mm to 3.5 mm long, such as 3 mm, and a second size where the cutting edge is from 4.5 mm to 7 mm long, such as 5 mm or 6 mm.

(132) The wire delivery device of the invention is shown in FIG. 7.

(133) The wire delivery device comprises an elongate body 31 having a proximal end 31a that is provided with a handle and a distal end 31b that is blunt and a wire guidance portion 32 extending outwardly from the elongate body.

(134) The wire guidance portion 32 is located closer to the distal end 31b of the elongate body than the proximal end 31a of the elongate body.

(135) The wire guidance portion 32 has a connecting end attached to the elongate body and a protruding end located away from the elongate body, the connecting end and the protruding end being connected by a first curved surface 33 and a second curved surface 34.

(136) The wire guidance portion 32 overall has a hook shape that curves upwardly (that is, towards the proximal end rather than the distal end). Thus the first curved surface 33 is convex and is located towards the distal end of the elongate body whilst the second curved surface 34 is concave and is located towards the proximal end of the elongate body.

(137) The elongate body has a bore 36 running from its proximal end 31a to an exit hole 35 located adjacent to the second curved surface 34 of the wire guidance portion. The exit hole 35 is aligned with the second curved surface, so that a wire exiting the exit hole directly falls onto that concave surface. The exit hole may include a notch to assist with aligning a wire exiting the exit hole 35 onto the centreline of the concave surface.

(138) Therefore the wire delivery device can be located in an access tunnel and wire passed through the bore 36 from the proximal end to the exit hole 35, and can then be guided into the cavity at the distal end of the implant.

(139) The inner guide tube of the invention is also shown in FIG. 7.

(140) The inner guide tube comprises an elongate body 41 having a proximal end 41a that is provided with a handle and a distal end 41b. A flexible section 42 extends from the distal end 41b to a junction point 41c, the flexible section being formed from a spring and therefore being sufficiently flexible that the flexible section can bend so that the elongate body can form a J-shape.

(141) The elongate body 41 has a bore running from its proximal end to its distal end, such that the inner guide tube can be located in the bore of the wire delivery device, with the flexible section 42 extending from the exit hole 35 and over the second curved surface 34 of the wire guidance portion.

(142) The wire kit of the invention is shown in FIG. 8.

(143) The wire kit comprises a first wire 130 having engagement means on is distal end and a second wire 131 having corresponding engagement means on its distal end.

(144) It can be seen, especially from the detail section of FIG. 8, that the first wire 130 has a hook 130a on its distal end and the second wire has a loop 131a on its distal end. However, alternatives to this could be envisaged. For example, both wires could have a hook at their distal ends, or a magnet-based system could be used to cause engagement.

(145) The dislodger device of the invention is shown in FIG. 9.

(146) The dislodger device has elongate body 51 with a proximal end 51a and a distal end 51b. There is a dislodging portion 52 extending outwardly from the elongate body 51, the dislodging portion being located closer to the distal end of the elongate body than the proximal end of the elongate body e.g. at a distance from the distal end of from 2.5 to 10 mm. The dislodging portion has a curved smooth outer surface 52a, with the outer surface having a convex curvature.

(147) Therefore in the event the wire become stuck as it travels up the medial or lateral face of the implant, the dislodging portion can be provided to present its curved surface and the wire can ride over the curved surface.