METHOD OF USING A MEASURING INSTRUMENT IN AN ORTHOPAEDIC SURGICAL PROCEDURE

Abstract

A method of performing an orthopaedic surgical procedure. The method includes using a measuring instrument to size orthopaedic components.

Claims

1. A method of performing an orthopaedic surgical procedure, comprising: resecting a proximal end of a patient's tibia to form a planar proximal surface, resecting a distal end of a patient's femur to form a planar distal surface, the patient's femur including at least one posterior condyle, inserting an intramedullary rod into an intramedullary cavity of the patient's femur, locating a measurement structure on the intramedullary rod by positioning the end of the rod such that the measurement structure housing is pressed against the planar distal surface of the patient's femur, drawing a plate member of the measurement structure upwardly to engage an upper face of the plate member with the at least one posterior condyle, attaching a reference structure to the measurement structure to advance a tip of a stylus of the reference structure into contact with an anterior cortex of the patient's femur, noting an indicated size of a femoral component using a first scale provided by the measurement structure and the reference structure, attaching a mask to the reference structure and the measurement structure such that the femoral component size indicated on a scale portion of the reference structure is visible through one of a number of windows in the mask, moving the plate member of the measurement structure downwardly to engage a lower face of the plate member with the planar proximal surface of the patient's tibia and place soft tissue extending between the patient's tibia and femur under appropriate tension, noting an indicated size of a bearing component using a second scale of the measurement structure and the reference structure, and inserting pins through the mask windows and into corresponding holes of reference structure to provide location for a cutting block.

2. The method of claim 1, wherein noting the indicated size of the femoral component using the first scale provided by the measurement structure and the reference structure includes: identifying a single indicium on the measurement structure, and identifying a single indicia of a set of indicia on the scale portion of the reference structure aligned with the single indicium of the measurement structure, the identified single indicia identifying the indicated size of the femoral component.

3. The method of claim 2, wherein noting the indicated size of the bearing component using the second scale of the measurement structure and the reference structure includes identifying a single indicia of a set of indicia on the measurement structure aligned with the identified single indicia of the reference structure.

4. The method of claim 1, wherein locating the measurement structure on the intramedullary rod by positioning the end of the rod includes positioning the end of the rod through a plurality of slots in the wall of a housing of the measurement structure and through a hole in a connector block of the measurement structure.

5. The method of claim 1, wherein drawing the plate member of the measurement structure upwardly to engage the upper face of the plate member with the at least one posterior condyle includes turning a knob on the measurement structure.

6. The method of claim 1, wherein moving the plate member of the measurement structure downwardly includes sliding the measurement structure relative to the reference structure.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0046] Embodiments of the invention are described below by way of example with reference to the accompanying drawings, in which:

[0047] FIG. 1 is a lateral view of a measuring instrument (without its mask), shown schematically in relation to a femur and a tibia as they might be positioned in flexion during a surgical procedure to replace a knee joint.

[0048] FIG. 2 is an anterior view of the measuring instrument shown in FIG. 1 (with its mask).

[0049] FIG. 3 is an exploded view showing separated components of the instrument shown in FIGS. 1 and 2.

[0050] FIG. 4 is a front view of the measuring instrument shown in FIG. 1 (without its mask).

[0051] FIG. 5 is a view from behind of the mask which can be fitted to the measuring instrument shown in FIG. 4.

[0052] FIG. 6 is an isometric view of the instrument when the plate member in contact with the femoral posterior condyles.

[0053] FIG. 7 is an enlarged view of the first scale on the instrument as shown in FIG. 6.

[0054] FIG. 8 is an isometric view of the instrument when the plate member in contact with the tibia.

[0055] FIG. 9 is an enlarged view of the first scale on the instrument as shown in FIG. 7.

[0056] The drawings show a measuring instrument which can be used in a surgical procedure to implant a knee joint prosthesis. Such a prosthesis comprises a femoral component which is fitted to the femur and a tibial component which is fitted to the tibia. The femoral component has a convex bearing surface which provides medial and lateral bearing surfaces corresponding to those provided by the anterior, distal and posterior surfaces of the medial and lateral condyles of the natural knee. The tibial component generally presents a flat proximal surface. A bearing component is provided between the femoral and tibial components. The bearing component has medial and lateral concave recesses on its proximal surface in which the medial and lateral condylar bearing surfaces of the femoral component can be received and can articulate. The distal surface of the bearing component is planar so that the bearing component can slide on the tibial component, in rotation or in translation or in both rotation and translation. Knee prostheses of these general types are well known.

DETAILED DESCRIPTION OF THE INVENTION

[0057] It is common in knee replacement surgery to resect the tibia before cutting the femur. The distal cut of the femur is frequently performed after the tibial resection. The instrument that is provided by the invention can then be used to ensure that the size of the femoral component that is used is appropriate having regard to the size of the femur. It can also be used to ensure that the bearing component that is used as the appropriate thickness having regard to (a) the size of the femoral component and (b) the soft tissue which extends between the femur and the tibia.

[0058] Referring to the drawings, FIGS. 1 and 2 show a measuring instrument 2 that is in use in a surgical procedure to implant a knee joint prosthesis, illustrating the way in which the instrument is used in such a procedure. The drawings show the tibia 4 which has been resected proximally to define a flat surface 5 on to which the tibial component (not shown) of the prosthesis can be implanted, and the femur 6 which has been resected distally.

[0059] The instrument has a plate member 8 and a stylus 10. The instrument is mounted on an intramedullary rod 12 which is located in the intramedullary cavity in the femur. The instrument allows the position of the plate member 8 to be moved relative to the intramedullary rod 12 until the upper face 16 of the plate member is in contact with the femoral posterior condyles 18. The instrument is shown in this configuration in FIG. 1. As discussed below, the location of the tip of the stylus can be adjusted relative to the reference portion (on which it is mounted) along the superior-inferior axis, and the location of the reference portion (with the stylus) can be adjusted relative to other component of the instrument along the anterior-posterior axis. These adjustments allow the position of the stylus 10 to be adjusted until the tip of the stylus is in contact with the anterior cortex 20, beyond the femoral sulcus 22.

[0060] The instrument provides a first scale 24 (see FIGS. 4 and 6) from which information relating to the distance between the posterior condyles and the anterior cortex, measured in a direction parallel to the anterior-posterior axis, can be obtained. As discussed below, this is provided by locating a single indicium 104 on the measurement structure against a set 108 of indicia on the reference structure, where the set of indicia provides a first scale portion and the single indicium provides a second scale portion.

[0061] The position of the plate member 8 can be moved relative to the intramedullary rod 12 until the lower face 27 of the plate member is in contact with the flat face 5 of the resected tibia. The movement of the plate member can result in the soft tissue which extends between the tibia and the femur to be placed under tension. The instrument is shown in this configuration in FIG. 2.

[0062] FIG. 2 shows the instrument shown in FIG. 1 with its mask 26 attached. The mask provides a window 132 through which a limited length of a second scale 28 (see FIG. 7) on the instrument is visible, which provides information relating to the distance between the anterior cortex and the flat face of the resected tibia, measured in a direction parallel to the anterior-posterior axis, can be obtained. This information can be used to select a bearing component having an appropriate thickness having regard to the size of the femoral component, and the soft tissue which extends between the femur and the tibia.

[0063] FIG. 3 shows separate components of the instrument. A measurement structure 50 comprises a hollow elongate housing 52 which is hollow and has a circular cross-section when viewed along its length. The housing has upper and lower ends 53, 54. A pair of slots are formed in the housing wall. The front slot 55 is visible in FIG. 3. A turret portion 57 extends from the upper end 53 of the housing 52.

[0064] The hollow housing contains a connector block 56 which has a transverse bore 58 extending through it. A shaft 60 extends through the housing 52 and through the turret 57 along the housing axis from the connector block towards the upper end 53 of the housing. The shaft is threaded at the end 61 which is remote from the connector block.

[0065] The measurement structure includes a driver assembly 62 which is mounted on the upper end 53 of the housing 52. The driver assembly includes a driver knob 75 and a driver sleeve 76. The driver sleeve fits over the turret on the housing so that the lower end of the driver sleeve sits on the upper end of the housing. The turret is a close fit within the driver sleeve so that the driver sleeve and the driver knob can rotate on the turret relative to the housing. The driver knob has a threaded bore 63 within it, the thread in the bore of the knob 62 cooperating with the thread on the end 61 shaft 60 so that, when the driver knob and the driver sleeve are rotated relative to the housing and turret, the shaft is cause to move within the housing and the turret along the housing axis. The bore can be open at the top end of the knob. This can facilitate cleaning of the bore.

[0066] The measurement structure cooperates with an intramedullary rod 64 which is a sliding fit in the transverse bore 58 in the connector block 56. The intramedullary rod extends through one or both of the slots in the wall of the housing when it is received in the transverse bore in the connector block. The measurement structure can rotate around the axis which is defined by the intramedullary rod.

[0067] The measurement structure includes a plate member 66 which is fixed to the elongate housing 52 at its lower end 54 when the instrument is in use. The plate member has two lobes 68, 70 whose upper faces are shaped so as to replicate approximately the shape of the proximal face of the tibia, and which are intended to cooperate with the posterior faces of the medial and lateral femoral condyles respectively. It has upper and lower faces 72, 74 which are for contacting the posterior femoral condyles and the proximal tibia respectively.

[0068] The instrument includes a reference structure 80 which comprises a bridge portion 82 and medial and lateral limbs 84, 86. The bridge portion has a circular hole 88 extending through it which is slightly bigger than the housing 52 of the measurement structure 50 so that the reference structure can be slid on to the housing of the measurement structure.

[0069] The reference structure includes a locking collet 90 which comprises a plurality of flexible fingers 92 and a collar 94 which is threaded on to the bridge portion of the reference structure. The fingers can be deformed inwardly so as to grip the housing of the measurement structure by tightening the collar 94 down on to the bridge portion of the reference structure.

[0070] The reference structure includes a stylus 96 having a body portion 98 which has a slot 100 formed in it. The stylus is mounted on a spigot on the bridge portion of the reference structure so that it can slide relative to the bridge portion, with the spigot sliding in the slot. In this way, the effective length of the stylus can be adjusted so that it extends just beyond the sulcus to the anterior cortex. This allows the tip of the stylus to be moved along the superior-inferior axis. The stylus can include indicia 102 on the edges of the slot 100 to indicate the lengths of the different sizes of femoral component that correspond to the different positions of the stylus.

[0071] The housing 52 of the measurement structure 50 bears a single indicium 104, which is marked SZ in the drawings (for example see FIGS. 6 and 7) which forms part of a first scale, and a set of indicia 106 which form part of a second scale (which is discussed in more detail below). The set of indicia of the second scale is marked mm in the drawings (for example see FIG. 3). The reference structure 80 has a set of indicia 108 (a first scale portion) in two groups on its medial and lateral limbs respectively which cooperate with the single indicium 104 (a second scale portion) on the measurement structure to provide the first scale. The two groups of indicia on the reference structure are marked SZ on each of the medal and lateral limbs. The first scale is used to obtain information concerning the distance between the posterior condyles and the anterior cortex, measured in a direction parallel to the anterior-posterior axis, for use in selecting the appropriate size of a femoral component of the knee joint prosthesis. In the example shown in the drawings, the first scale indicates that the appropriate size of femoral component having regard to the measured anterior-posterior dimension is size 5.

[0072] As can be seen in particular in FIG. 4, the outside edges of the medial and lateral limbs 84, 86 of the reference structure are shaped with a plurality of parallel grooves 87 extending in a direction which is parallel to the intramedullary rod 64. The spacing between the grooves can (but need not) correspond to the spacing between the indicia 108 on the reference structure.

[0073] FIGS. 3 and 5 show the mask component 120 of the instrument. The mask has a front wall 122 and a pair of side walls 124, 126. The inside surface of each of the side walls carries a series of inwardly extending ribs 127. The spacing between the ribs corresponds to the spacing between the grooves 87 in the outside edges of the limbs of the reference structure. The ribs are a sliding fit in selected grooves of the medial and lateral limbs of the reference structure so that the side walls of the mask can be slid on to the edges of the reference structure.

[0074] The front wall 122 of the mask 120 is shaped to fit over the reference structure 80 and the housing 52 of the measurement structure 50 when the reference structure is fitted on to the measurement structure. Accordingly, the front wall has a central portion 128 which is arcuate. It also has a slot 130 formed in it which is aligned with the front slot 55 in the housing of the measurement structure when the mask is fitted to the reference and measurement structures, to accommodate the end portion of the intramedullary rod 64. The mask has a pair of windows 132 formed in it. The windows are generally T-shaped (with the T turned through 90 so that the limb of the T that is generally referred to as the upright limb is horizontal and the limb of the T that is might be referred as the cross limb is vertical). When the mask is fitted on to the assembled reference and measurement structures with the ribs on the inside surfaces of the side walls of the mask are a sliding fit in selected grooves in the outside edges of the medial and lateral limbs of the reference structure, the horizontal limb of each of the windows exposes a selected indicium from the set of indicia 108 (the first scale portion) on the reference structure, and exposes one of the indicia from the set of indicia 106 (a third scale portion) on the measurement structure 50. This can be seen in FIGS. 2 and 9, which show that the appropriate size of bearing component as 5 mm.

[0075] The instrument that is shown in the drawings has a first scale 24 which provides indicia corresponding to ten different sizes of femoral component. The distance between the anterior cortex and the posterior condyles differs between consecutive sizes of component differs by 3 mm. The distance between adjacent grooves 87 on the outside edges of the limbs of the reference structure is 3 mm.

[0076] The instrument that is shown in the drawings has a second scale which provides for bearing components to be used which have thicknesses between 5 and 22 mm. The second scale 28 indicates bearing component thickness increments of 1 mm for bearing component thicknesses from 5 to 8 mm, and bearing component thickness increments of 2 mm for bearing component thicknesses from 8 to 22 mm.

[0077] The instrument that is shown in the drawings can be used in a surgical method to replace a knee, which includes the following steps: [0078] 1. Perform the proximal tibial cut to form the planar proximal surface 5 on the tibia on which a tibial component of a knee joint prosthesis can be seated. [0079] 2. Perform the distal cut on the femur. [0080] 3. Insert the intramedullary rod 64 in the intramedullary cavity of the femur 6. [0081] 4. Locate the measurement structure 50 on the intramedullary rod 64 by positioning the end of the rod through the slots 55 in the wall of the housing 52 and through the hole 58 in the connector block 56, so that the measurement structure housing is pressed against the distal face of the resected femur. [0082] 5. Turn the knob 62 on the measurement structure (in the direction indicated by the SZ arrowsee FIG. 2) to draw the plate member 66 upwardly towards the femoral posterior condyles until the upper face 72 of the plate member is in contact with the posterior condyles. [0083] 6. Slide the reference structure 50 on to the measurement structure 50 so that the measurement structure housing 52 extends through the hole 88 in the bridge portion 82 and through the collar 94, effectively moving the tip of the stylus along the anterior-posterior axis until the tip of the stylus 96 touches the femoral anterior cortex, adjusting the length of the stylus as necessary by sliding it along the anterior-posterior axis relative to the bridge portion. [0084] 7. Note the indicated size of the femoral component using the first scale provided by the single indicium 104 on the measurement structure 50 and the set 108 of indicia on the reference structure 80. [0085] 8. Fit the mask 120 to the measurement and reference structures 50, 80 by sliding the ribs on the mask into the grooves 87 on the reference structure, the grooves being selected so that the femoral component size as indicated on the scale portion on the reference structure appears towards the outward end of the horizontal limb of one of the windows 130 in the mask. [0086] 9. Turn the knob 62 on the measurement structure 50 (in the direction indicated by the mm arrowsee FIG. 2) to move the measurement structure including the plate member 66 downwardly towards the resected tibia until the lower face 74 of the plate member is in contacted with the tibia, and until the soft tissue extending between the tibia and the femur is placed under appropriate tension. [0087] 10. Ensure that the tip of the stylus 98 touches the femoral anterior cortex. [0088] 11. Note the size of the bearing component as indicated towards the inward end of the horizontal limb of the mask window which shows the femoral component size in towards its outward end. [0089] 12. Assess the location of the posterior cuts (through the posterior condyles) for the chosen size of femoral component of a knee joint prosthesis using the posterior edges of the mask. [0090] 13. Tighten the collar 94 on the reference structure to prevent relative sliding movement between the reference structure and the measurement structure housing. [0091] 14. Insert pins through the vertical limbs of the mask window and into the holes in medial and lateral limbs (84, 86) of reference structure to provide location for cutting block.