CA2075277A1 - Surgical instrument - Google Patents

Surgical instrument

Info

Publication number
CA2075277A1
CA2075277A1 CA002075277A CA2075277A CA2075277A1 CA 2075277 A1 CA2075277 A1 CA 2075277A1 CA 002075277 A CA002075277 A CA 002075277A CA 2075277 A CA2075277 A CA 2075277A CA 2075277 A1 CA2075277 A1 CA 2075277A1
Authority
CA
Canada
Prior art keywords
teeth
instrument
rod
bone
instrument according
Prior art date
Legal status (The legal status 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 status listed.)
Abandoned
Application number
CA002075277A
Other languages
French (fr)
Inventor
Jayantilal M. Meswania
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
University College London
Original Assignee
Individual
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 Individual filed Critical Individual
Publication of CA2075277A1 publication Critical patent/CA2075277A1/en
Abandoned legal-status Critical Current

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
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A61B17/175—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip for preparing the femur for hip prosthesis insertion
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B23—MACHINE TOOLS; METAL-WORKING NOT OTHERWISE PROVIDED FOR
    • B23D—PLANING; SLOTTING; SHEARING; BROACHING; SAWING; FILING; SCRAPING; LIKE OPERATIONS FOR WORKING METAL BY REMOVING MATERIAL, NOT OTHERWISE PROVIDED FOR
    • B23D77/00—Reaming tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1613—Component parts
    • A61B17/1631—Special drive shafts, e.g. flexible shafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1664—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
    • A61C1/08—Machine parts specially adapted for dentistry
    • A61C1/082—Positioning or guiding, e.g. of drills
    • A61C1/084—Positioning or guiding, e.g. of drills of implanting tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C3/00—Dental tools or instruments
    • A61C3/02—Tooth drilling or cutting instruments; Instruments acting like a sandblast machine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0089—Implanting tools or instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3662—Femoral shafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3662—Femoral shafts
    • A61F2/367—Proximal or metaphyseal parts of shafts

Abstract

ABSTRACT

An instrument for shaping a bone cavity has a frame including a stud for locating the instrument in a bone canal. A curved rod is supported on the frame and a plurality of cutting teeth are threaded on the rod so as to be rotatable thereon. The cutting teeth are drivably interconnected so that rotation of one tooth causes an adjacent tooth to rotate.

Description

~'092/10138 PCT/GB91/02159 2073.~77 SURGICAL INSTRUME~
This invention relates to surgical instruments and in particular to a reaming tool for shaping bone canals ~or insertion of surgical implants.
In recent years surgical implants, e.g. for hip replacement operations, have become more routinely iitted.
Current research in the design of hip replacement ~oints has suggested the desirability of accurate ma~ching of the implant to the internal shape OI the bone canal.
Convent onal practice f~r cutting and shaping bone canals, preparatory to introduction of a surgical implant, in~olves use o~ surgical cutting instruments consisting essentially of a variety o~ hand-held power drills, saws, reamers and cutters. Satisfactory use of such instruments . requires a hi~h degree of manual skill to cut and shape bone canals accurately. A particular difficulty arises where th~re is a requirement to cut or shape a tapered or curved surface, for esample, to shape a bone canal for reception o~ the stem of a hip implant.
According to a first aspect of the in~ention there is provided a surgical instrument for shaping a bone or ca~ity in a bone which comprises a curved rod whose curvature substantially corresponds in one plane to that of a desired shaped surface, means for supporting the curved rod, a plurality of cutting teeth mounted on said rod so as ~o ~e rotatable thereon, said teeth being 2075~77 drivably interconnected 50 that rotation of one of said teeth causes an adjacent tooth to rotate.
According to a second aspect of the present invention there is pro~ided a surgical instrument, especially for shaping a bore or cavity in a bone, which comprises a curved rod whose curvature su~stantially corresponds in one plane to that of a desired ~haped surîace, means ror supporting the cur~ed rod, a plurality of cutting teeth threaded cn said rod so as to be rotatable thereon, said teeth being drivably interconnected so that rotation of one of said teeth causes the others to rotate.
The curved supporting rod may be mounted in a frame, said frame lncluding a guide for location in or on a suitable reference surface, e.g. within a bore in a bone canal. Conveniently, one end of the row of cuttiny teeth is connected to a drive attachment for ~nsertion in the chuck of a drill or similar driving mechanism. The tool may also include a handle for manipulating the tool with respect to the bone.
~inking of the teeth together may ~e achieved by gear-like recesses and projections in adjacent teeth and pre~erably there is a substantial degree of play in the inter-engaging gear teeth and recesses so that the cutting teeth follow a spiral-like ~orm when they are rotated.
Preferably, the surgical instr~ment includes one or more dep~h gauges which are preferably adjustable to WO92/1013~ 159 determine the amount by which the tool extends into the bone cavity. Pre~erably, the depth gauye or gauges is adjustable as appropriate for different bones and implants.
In another application of surgical instruments according to the invention, it may be desired to shape a tapered surface in or on a bony, horny or dental surface.
For s~ch wider applications, it may not be necessary to cut a surface haviny a curvature in two planes. In such a case the interengaging teeth may be mounted on a straight rod and the rod may constitute the frame of the tool.
According to a further aspect of the present invention, therefore, there is provided a surgical instrument which comprises a frame, a rod supported by said frame, a plurality of cutting teeth mounted for rotation on said rod and bein~ mutually engageable, so as to be svtatahle in unison when one of said teeth is connected to driving means. Preferably, the teeth have lateral cutting surfaces so that the ~uriace to be shaped or smoothed is contacted substantially at right angles to the direction of the rod. The ~rame may include a handle and/or guide means ior guiding the translation of the instrument in a desired direction.
Further features and advantages of the presen~
invention will become apparent ~rom the accompanying WO~2/10138 P~ 9g/~ ~

description of one embodiment of a surgical instrument in accordance with the invention, which i5 illustrated in the attached drawings in whicn;-Figure 1 is a side elevation of the instrument, Figure 2 is a perspective Yiew of one of the cuttingteeth on an enlarged scale, Fiyure 2A is a sectional view on a smaller scale of two teeth as shown in Figure 2, Figure 3 is a top view of a resectioned hip ~one, Figure 3A is a view ~imilar to Figure 3 showinq the anterior profile to be reamed, Figure 4 l5 a schematic side elevation showing the reaming of the medial profile using the instrument, Figure 4A is a perspective view on an enlaryed scale of the depth gauge shown in the instrument of Figure 4.
Figure S is a view taken similar to Figure 4 showing the method of reaming the anterior profile, Figure 6 is a view similar to Figure 1 oS a modi~ied instrument in accordance with the invention, and Figure 6A is a view taken in the direction of the arrow A in Figure 6.
Referring to Figure 1, the tool comprises a curved rod 1 which is fi~edly supported in a fr~me ~ comprising a tubular rod 3, to one end of which is attached a handle 4 and .at the other end a cylindrical stud S. One end O r the rod 1 is received in a bore 6 formed in s~ud 5, while '~092~1013~ 5 P~/~7~

the other end is secured in a bracket 7 which is attached at the upper end of tube 3 via a collar 8 an~ bolt 9.
~hreaded onto rod 1 are a serie~ o~ cutting ~eeth 1~, whose construc~ion i5 shown in more detail on enlarged scales in Figures 2 and 2A. Each of the c~tting teeth 18 is driva~ly engaged with an adjacent tooth and the uppermost tooth 18a is drivably connected through a connector 19 to a drive shaft 10 which can be received in the chuck of a drill or ~imilar prime mover. The tee~n 18 may ~oe o~ the same general size or alternat~vely some may have slightly different profiles in order to achieve desired shapes in the bone or other material to be shaped.
For example, as shown in Figure 1, the upper cutting tooth lBa is laryer than the rest and has a generally conical form.
Referring to Figures 2 and ~A, each of the teeth ha~
lateral cutting surfaces 21 which may be 0$ any desired shape or number per tooth. The cutting teeth are geared together by projecting dog-like teeth and recesses 22 and 23, and pre~erably there is a significant degree of play between teeth 22 and corresponding recesses 23. Tne cutting teeth may be of any desired height and number, but conveniently in instruments for cutting cavities in bone for joint implants, teeth are typically 5 to 10 mms high and may comprise 10 to 20 teeth in each tool. One furthPr provision is made whereby the teeth can onlv he 6 2~7~7 inserted over the curved rod with correct orientation by providing a recess 34 at one end of the tooth and a lip-like protrusion 35 at the other end as shown in Figure 2A.
On assembly, the lip 35 of one tooth slides into the recess 34 of another tooth, allowing the dog-like teeth 22 and recesses 23 to engage.
It will be appraciated that when the drive shaft l0 is rotated, which typically would be at about 50 to 15~
rpm, the teeth are rotated on the fixed rod l and, as shown in Figure l, the teeth tend to open ou. on the inside curved surface 13 of the cuttin~ tool and are forced together on the concave inner surface l4. Thic arrangement ensures that the cuttin~ surface presented to the bone or other material comprises an essentially continuous helical cuttin~ surface and the tendency therefore is to cut a smoother profile ~ather than cu~ a series o~ grooves running laterally of the cutting a~sembly. The cutting asse~bly, comprising the bracket 7, rod l and teeth 18 and 18a, may be remo~able from the fræmework and replaceable with another cutting assembly having a different num~er of teeth or with a curved fixed supporting rod having a dif~erent de~ree of curvature.
~owever, it may be preferable for the surgeon to make use of a plurality o~ similar tools having differen~ extents of curvature and a variety of different types OI cut~ins teeth.

`~'092/10138 PCT/GB91/02159 7 2~7~277 One method of using the instrument is illustrated in Figures 3 to S ~or the purpose of cutting a profile in a bone canal for a hip implant. The hip implant may be or the kind described in British Patent Application No.
89~100~.2 (Publication No. 2236679) and US Patent No.
~,936,862. F~r this purpose it is necessary to cut a medial pro~ile and an anterior pro~ile appro~imately at 90 to each other as illustrated in Figures 3 and 3A. The first step is to drill a hole 30 in the bone canal to receive the stem of the implant usiny a conventional bone drill. This bore 30 is used to yui~P the cylindrical sLud S o~ the frame of the instrument. The instrument according to the invention is then inserted into the resulting canal as shown in Figures 4 and 5. As shown in Figure 4, the medial profile 31 is cut by moving ~he tool dowmwardly into the bone while simultaneously rotating the drive connection l0 of the instrument. Cutting is continued until a medial profile of desired shape is cut as indicated at 31 in Figures 3 and ~. ~n adjustable depth stop 3~ is provided on the to~l to contact the top 42 o~ the resectioned bone and to prevent further downward movement of the in~trument when the desired depth has been cut. The anterior profile 43 may then be cut as shown in Figure 5 and~ for this purpo~e, a second depth stop 33 ~which may also be adjustable~ is provided which likewise contacts the top of the resectioned head of the bone when 2~7~277 the correct depth has been machined. Because the instrument i5 intended for surgical use, metallic par~s are preferably manufactured from a non-corrosive metal such as stainless steel.
Referring to Figures 6 and 6A, the same reference numerals are used as in Figure 1 to indicate like components. A fle~ible drive 61 is linked to connector 19 which is received in a housing 62. A bolt 9 releasabl~-fastens th~ housing 62 onto the support rod 3. As described in connection with Figure 1, connector 19 ic drivably connected to uppermost conical-shaped tooth 18A.
For the purpoae of cleaning the teeth, housing 62 is removed by unscrewing the bolt 9. The teeth may then be removed with the guide rod. A grommet 6~ at one end o~
the assembly prevents the teeth sliding ofi the rod.
They can be satisfactorily cleaned without removing the~
from the rod.
Guide stop 32 de~ines the line of transection when reaming the medial profile. The depth of cut is adjustable by removing the guide stop 32 and replacins the guide stop with one having a different length. A bolt 64 is provided for this purpose.
Figure S~ shows the location of the guide stop 33 for determining the depth of cut when reaming the anterior profile. As shown in Figurc 6A, the guide stop can be fitted to the le~t or right hand side of the instrument by 2~7~277 means of the bolt 65 depending on whether the cavity o~
the left or risht femur is being reamed.
Stud 5 is fitted with a tubular adjustment sleeve ~
which is retained on the end of stud 5 by screw thread 61 Sleeve 66 includes an integral Xnurled nut 68 and a number of interchangeable sleeves, havin~ effective diameters which vary in imm steps, may be provided with the instrument. In this way, the distal end of the support rod can be adjusted ~or bone canals 30 of dif~erent diameters. Each sieeve ~6 is formed with opposed apertures 69 which have two purposes. First, they provide flats onto which a spanner may be applied. Secondly, the apertures facilitate cleaning when the sleeve is removed to clean the instrument. As can be seen in Fig~re 6A, sleeve 66 is slightly barrel-shaped. This permits the tubular rod 3 to be tilted by about 2-3 and gives the surgeon scope for slight adjustment of the angle of operating the reaming tool.
While the instrument of the pr~sent invention has been described with particular reference to its use in cutting and shaping bone canals, it will be appreciated that other uses include other surgical, dental and veterinary applications where there is a need to cut and shape bone, teeth or other hard horny material.

Claims (10)

THE EMBODIMENTS OF THE INVENTION IN WHICH AN EXCLUSIVE
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:-
1. A surgical instrument for shaping a bone or cavity in a bone which comprises a curved rod whose curvature substantially corresponds in one plane to that of a desired shaped surface, means for supporting the curved rod, a plurality of cutting teeth mounted on said rod so as to be rotatable thereon, said teeth being drivably interconnected so that rotation of one of said teeth causes an adjacent tooth to rotate.
2. An instrument according to claim 1 wherein said curved rod is mounted in a frame, which includes a guide for location in or on a suitable reference surface and which limits the depth of cut of the instrument.
3. An instrument according to claim 1 or 2 wherein the cutting teeth are arranged as a contiguous row and one end of the row is connected to a drive attachment for releasable connection to driving means.
4. An instrument according to any one of the preceding claims wherein the teeth have lateral cutting surfaces.
5. An instrument according to any one of the preceding claims wherein at least one tooth is drivably connected to an adjacent tooth by one or more longitudinally extending projections which are engageable with one or more recesses in the adjacent tooth.
6. An instrument according to claim wherein the or each projection engages in a corresponding recess in an adjacent tooth with a degree of play, so that the cutting teeth together describe a a helical-like path they are rotated.
7. An instrument according to any one of the preceding claims wherein said teeth are drivably connected to driving means via a flexible drive.
8. An instrument for shaping a bone cavity which comprises a support sod, a guide rod mounted at one end on the support rod and extending at an angle thereto and a plurality of cutting teeth threaded on said guide rod and drivable interconnected so that rotation of one of said teeth causes an adjacent tooth to rotate and to ream the interior of the bone cavity.
9. An instrument according to claim 8 wherein the support rod has a stud portion which is adapted to be located in a hole in the bone cavity and to stabilize the instrument while reaming the bone cavity.
10, An instrument according to claim 8 or 9 wherein the support rod includes a handle for steadying the instrument while reaming the bone cavity.
CA002075277A 1990-12-06 1991-12-05 Surgical instrument Abandoned CA2075277A1 (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
GB9026592.7 1990-12-06
GB909026592A GB9026592D0 (en) 1990-12-06 1990-12-06 Surgical instrument
PCT/GB1991/002159 WO1992010138A1 (en) 1990-12-06 1991-12-05 Surgical instrument

Publications (1)

Publication Number Publication Date
CA2075277A1 true CA2075277A1 (en) 1992-06-07

Family

ID=10686614

Family Applications (1)

Application Number Title Priority Date Filing Date
CA002075277A Abandoned CA2075277A1 (en) 1990-12-06 1991-12-05 Surgical instrument

Country Status (11)

Country Link
US (1) US5387218A (en)
EP (1) EP0514521B1 (en)
AT (1) ATE129141T1 (en)
AU (1) AU645380B2 (en)
CA (1) CA2075277A1 (en)
DE (1) DE69113990T2 (en)
ES (1) ES2080479T3 (en)
GB (2) GB9026592D0 (en)
GR (1) GR3018232T3 (en)
IE (1) IE66259B1 (en)
WO (1) WO1992010138A1 (en)

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DE69113990T2 (en) 1996-03-21
EP0514521A1 (en) 1992-11-25
GB2250441A (en) 1992-06-10
ATE129141T1 (en) 1995-11-15
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AU645380B2 (en) 1994-01-13
GR3018232T3 (en) 1996-02-29
IE66259B1 (en) 1995-12-27
DE69113990D1 (en) 1995-11-23
GB2250441B (en) 1994-10-19
US5387218A (en) 1995-02-07
WO1992010138A1 (en) 1992-06-25
ES2080479T3 (en) 1996-02-01
GB9026592D0 (en) 1991-01-23
AU8959491A (en) 1992-07-08
IE914194A1 (en) 1992-06-17
EP0514521B1 (en) 1995-10-18

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