US006953480B2 (12) United States Patent (10) Patent N0.: US 6,953,480 B2 Mears et al. (45) Date of Patent: Oct. 11, 2005 (54) METHOD AND APPARATUS FOR OTHER PUBLICATIONS PERFORMING A MINIMALLY INVASIVE Lusskin et la., Combined Anterior and Posterior Approach to TOTAL HIP ARTHROPLASTY the Hip Joint in Reconstruective and Ccomplex Arthroplasy, Dec. 1988, The Journal of Arthroplasty vol. 3 No. 4, pp (75) Inventors: Dana Mears, Pittsburgh, PA (US); 313—322.* Kevin Greig, Leesburg, IN (US); Paul The Elevated—Rim Acetabular Liner in Total Hip Arthro A. ZWirkoski, Brighton, MI (US) plasty: Relationship to Postoperative Dislocation by T.K. Cobb, M.D., B.F. Morrey, M.D., and D.M. Ilstrup, MS, The (73) Assignee: Zimmer Technology, Inc., Chicago, IL Journal of Bone and Joint Surgery, vol. 78—A, No. 1, Jan. (Us) 1996, pp. 80—86. Displacement after Total Hip—Replacement Arthroplasties ( * ) Notice: Subject to any disclaimer, the term of this by George E. LeWinnek, M.D., Jack L. LeWis, PhD, Richard patent is extended or adjusted under 35 Tarr, M.S., Clinton L. Compere; MD. and Jerald R. Zim U.S.C. 154(b) by 0 days. merman, BS, The Journal of Bone and Joint Surgery, vol. 60—A, No. 2, Mar. 1978, pp, 217—220. (21) Appl. No.: 10/053,931 (Continued) (22) Filed: Jan. 22, 2002 Primary Examiner—Eduardo C. Robert (65) Prior Publication Data (74) Attorney, Agent, or Firm—Jonathan FeucthWang; Baker & Daniels LLP US 2002/0116067 A1 Aug. 22, 2002 (57) ABSTRACT Related US. Application Data A method and apparatus for performing a minimally inva sive total hip arthroplasty. An approximately 3.75—5 centi (63) Continuation-in-part of application No. 09/558,044, ?led on meter (1.5—2 inch) anterior incision is made in line With the Apr. 26, 2000, now Pat. No. 6,676,706. femoral neck. The femoral neck is severed from the femoral shaft and removed through the anterior incision. The (51) Int. Cl.7 ................................................. .. A61F 2/32 acetabulum is prepared for receiving an acetabular cup (52) US. Cl. .................................................. .. 623/2211 through the antenor incision, and the acetabular cup is (58) Field of Search ................. .. 623/22.1, 23.15—23.38 placed into the acetabulum through the anterior incision. A posterior incision of approximately 2—3 centimeters (0.8—1.2 (56) References Cited inches) is generally aligned With the axis of the femoral shaft U.S. PATENT DOCUMENTS and provides access to the femoral shaft. Preparation of the femoral shaft including the reaming and rasping thereof is 3,829,904 A * 8/1974 Ling et al. ............. .. 623/2239 performed through the posterior incision, and the femoral 4,341,220 A 7/1982 Perry stem is inserted through the posterior incision for implan 4,552,136 A 11/1985 Kenna tation in the femur. Avariety of novel instruments including (Continued) an osteotomy guide; an aWl for locating a posterior incision FOREIGN PATENT DOCUMENTS aligned With the axis of the femoral shaft; a tubular posterior retractor; a selectively lockable rasp handle With an engage EP 0 558 203 A 9/1993 ment guide; and a selectively lockable provisional neck are EP 1149562 A 10/2001 utilized to perform the total hip arthroplasty of the current FR 1041311 A 10/1953 invention FR 01 FR-A-2775889 9/1999 W0 W0 03/065906 A 8/2003 6 Claims, 30 Drawing Sheets / I ‘)1,’ I /f 1‘ ‘ 4o 1 l / / | / \ ‘A I // //7 3 m1 // ,24 z / ~_ ~ / / l / \ \ / / / __ N. J / , / //"' / // / / / / / // \ Z’I/ 4/ 4 / l l / |22 ~‘\_‘/ / ‘ 5s / _,/ 46 / US 6,953,480 B2 Page 2 US. PATENT DOCUMENTS Femoral Head Containment in Total Hip Arthroplasty, Stan dard vs. Extended Lip Liners, T.A. Maxian, T.D. BroWn, 4,765,328 A 8/ 1988 Keller et al. D.R. Pedersen, and J .J . Callaghan, 42nd Annual Meeting, 4,905,148 A 2/1990 Crawford Orthopaedic Research Society, Feb. 19—22, Atlanta, Geor 5,007,936 A 4/1991 Woolson gia, p. 420. 5,086,401 A 2/1992 Glassman et al. 5,089,003 A 2/1992 Fallin et al. An Image—Directed Robotic System for Precise Orthopaedic 5,089,004 A 2/1992 Averill et al. Surgery by Russell H. Taylor, Brent D. Mittelstadt, HoWard 5,190,550 A 3/1993 Miller et al. A. Paul et al., IEEE Transactions on Robotics and Automa 5,242,455 A 9/1993 Skeens et al. tion, vol. 10, No. 3, Jun. 1994, pp. 261—275. 5,251,127 A 10/1993 Raab Techniques for Fast and Accurate Intrasurgical Registration 5,299,288 A 3/1994 Glassman et al. by David A. Simon, Martial Herbert, and Takeo Kanade, 5,305,203 A 4/1994 Raab Journal of Image Guided Surgery, 1:17—29 (1995). 5,320,625 A 6/1994 Bertin 5,360,446 A 11/1994 Kennedy Computer—Assisted Knee Anterior Cruciate Ligament 5,364,403 A 11/1994 Petersen Recontruction: First Clinical Tests by Vincent Dessenne, 5,383,454 A 1/1995 BucholZ Stephane Lavallee, Remi Julliard et al., Journal of Image 5,389,101 A 2/1995 Heilbrun et al. Guided Surgery, vol. 1, No. 1, 1995, pp. 59—64. 5,408,409 A 4/1995 Glassman et al. Comparison of Relative Accuracy BetWeen a Mechanical 5,474,560 A 12/1995 Rohr, Jr. and an Optical Position Tracker for Image—Guided Neuro 5,517,990 A 5/1996 Kalfas et al. surgery by Robert Rohling, Patrice Munger, John M. Hol 5,540,692 A 7/1996 Tidwell 5,616,147 A 4/1997 Gadelius lerbach and Terry Peters,Journal of Image Guided Surgery, 5,676,673 A 10/1997 Ferre et al. vol. 1, No. 1, 1995, pp. 30—34. 5,682,886 A 11/1997 Delp et al. Computer—Assisted Spine Surgery: A Technique for Accu 5,690,635 A 11/1997 Matsen, III et al. rate Transpedicular ScreW Fixation Using CT Data and a 5,741,215 A 4/1998 D’Urso 3—D Optical LocaliZer by S. Lavallee, P. Sautot, J. TroccaZ, 5,748,767 A 5/1998 Raab P. Cinquin and P. MerloZ, Journal of Image Guided Surgery, 5,769,092 A 6/1998 Williamson, Jr. vol. 1, No. 1, 1995, pp. 65—73. 5,776,064 A 7/1998 Kalfas et al. 5,800,352 A 9/1998 Ferre et al. Etude Du Cotyle Non Scelle De Bousquet Dans Cent 5,803,089 A 9/1998 Ferre et al. Protheses Totales De Hanche Hybrides by J .H. Aubriot, P. 5,806,518 A 9/1998 Mittelstadt Lesimple and S. Leclercq, Acta Orthopaedica Belgica, vol. 5,814,050 A * 9/1998 Benson ..................... .. 606/102 59, Suppl. 1, 1993, pp. 267—271. 5,817,105 A 10/1998 Van Der Brug La Tige Vissee De Bousquet Dans L’Arthroplastie Totale De 5,824,083 A 10/1998 Draenert Hanche En Premiere Intention by M.H. Fessy, J. Bejui and 5,824,085 A 10/1998 Sahay et al. LP. Fisher, Acta Orthopaedica Belgica, vol. 59, Suppl. 1, 5,829,444 A 11/1998 Ferre et al. 5,871,018 A 2/1999 Delp et al. 1993, pp. 207—211. 5,871,445 A 2/1999 BucholZ Anatomy—based Registration for Computer—integrated Sur 5,885,295 A 3/1999 McDaniel et al. gery by Ali Hamadeh, Stephane Lavallee, Richard SZeliski, 5,950,629 A 9/1999 Taylor et al. Philippe Cinquin, and Olivier Peria, Computer Vision, Vir 5,997,582 A 12/1999 Weiss tual Reality and Robotics in Medicine, First International 6,010,535 A 1/2000 Shah Conference, CVR Ned ’95 Nice, France, Apr. 3—6, 1995 2003/0220698 A1 11/2003 Mears Proceedings, pp. 212—218. 2003/0229356 A1 12/2003 Dye BIAS Total Hip System Surgical Technique for Primary Hip OTHER PUBLICATIONS Arthroplasty and Revision of Hip Arthroplasty With Bone Grafting by Ramon B. Guistilo, MD. and Rijchard F. Kyle, Range of Motion in Comtemporary Total Hip Arthroplasty M.D. by Robert J. Krushell, MD., Dennis W. Burke, M.D., and Kenneth A. KrackoW, MD. et al.: “Clinical Experience With William H. Harris, M.D., The Journal of Arthroplasty, vol. a Triradiate Exposure of the Hip for Dif?cult Total Hip 6, No. 2, Jun. 1991, pp. 97—101. Arthroplasty,” pp. 267—378, The Journal of Arthroplasty, Elevated—Rim Acetabular Components byRobert J. Krush Sep. 1988. ell, M.D., Dennis W. Burke, M.D., and William H. Harris, Pasquale Petrera, MD. et al.: “Revision Total Hip Arthro M.D., The Journal of Arthroplasty, vol. 6 Supplement, Oct., plasty With a Retroperitoneal Approach to the Iliac Vessels,” 1991, pp. S53—S58. The journal of Arthroplasty, 1996, pp. 704—708. Range of Motion Studies for Total Hip Replacements, G. Lang et al.: “Arthroplasty of the Hip by Cemented Harlan C. AmstutZ, M.D., R.M. LodWig, D.J. Schurman, M.D., and AG. Hodgson, Clinical Orthopaedics and Related Coupled Cups,” 1978, Masson, Paris, Nouv. Presse Med., Research,, No. III, Sep., 1975, pp. 124—130 pp. 3925—3928. Dislocation After Total Hip Arthroplasty, by Donald E. J. C. Bos et al.: “The surgical anatomy of the superior gluteal McCollum, M.D., and William J. Gray, M.D., Clinical nerve and anatomical radiologic bases of the direct lateral approach to the hip” Surgical Radiologic Anatomy, 1994, Orthopaedics and Related Research, No. 261, Dec., 1990, pp. 159—170. pp. 253—258. Finite Element Modeling of Dislocation Propensity in Total Mansho ItokaZu et al.: “Exposure of the Hip by Anterior Hip Arthroplasty, T.A. Maxian, T.D. BroWn, D.R. Pedersen, Osteotomy of the Greater Trochanter,” Hospital for Joint and J .J . Callaghan, 42nd Annual Meeting, Orthopaedic Diseases Bulletin, 1998, pp. 159—161. Research Society, Feb. 19—22, 1996, Atlanta, Georgia, p. John J. Joyce, III et al.: “The Anatomical Basis of the Hip 259—44. Joint Exposures,” No. 98, Jan.—Feb. 1974, pp. 27—31. US 6,953,480 B2 Page 3 “Surgery of the Hip Joint,” Edited by Raymond G. TronZo, Total Hip Replacement Update: Cement v. Cementless M.D., Copyright 1973, Lea & Fibiger, Philadelphia. Arthroplasty, Ronald W. Lindsey, M.D., et al., Connecticut Journal of the Japanese Orthopedic Association 75 (2), Medicine, vol. 52, No. 7, Jul. 1988, pp. 399—401. 2001; KaZuo Kaneko et al., “Total Hip Arthroplasty and “Primary Ceramic Hip Replacement: AProspective Study of Femoral Head Prosthetic Replacement Using Mini Inci 119 Hips,” Scott A. Hof?nger, M.D., et al., Orthopaedics, sions” and Shoichi Shinoda et al., Joint Use of Acetabular May 1991, vol. 14, pp. 523—531. Abduction Osteotomy and Anterior Trochantic Slide for Osteoarthritis of the Hip Joint. Anatomy and Osteotomy of the Greater Trochanter, John P. Ralph Lusskin et al.: “Combined Anterior and Posterior Fulkerson, M.D., et al., Archives of Surgery, vol. 114, Jan. Approach to the Hip Joint in Reconstructive and Complex 1979, pp. 19—21. Arthroplasty,” Department of Orthopedic Surgery, NeW “One—Stage Bilaterial Total Hip Arthroplasty in Patients>75 York University Medical Center, NeW York, NY, Dec. 1988, Years,” Marc A. Weinstein, M.D., et al., Orthopedics, vol. pp. 313—322. 25, No. 2, Feb. 2002, pp. 153—156. James B. Stiehl et al.: “Extensile Triradiate Approach for “A Comparison of the Cost Effectiveness of One—Stage Complex Acetabular Recontruction in Total Hip Arthro versus TWo—Stage Bilaterial Total Hip Replacement,” Mark plasty,” Clinical Orthopaedics and Related Research, 1993, Lorence, M.D., et al., Orthopedics, vol. 21, No. 12, Dec. pp. 162—169. 1998, pp. 1249—1252. Richard H. Walker, M.D.: “Pelvic Reconstruction/Total Hip Arthroplasty for Metastatic Acetabular Insufficiency,” Clini “Surgical Exposure and Cement Removal in Revision Total cal Orthopaedics and Related Research, 1993, pp. 170—175. Hip Arthroplasty,” Thomas H. Mallory, Seminars in Arthro Joel M. Matta, M.D.: “Operative Treatment of Acetabular plasty, Col. 3, No. 4, Oct. 1992, pp. 257—263. Fractures Through the Ilioinguinal Approach, a 10—year “Mini—Incision for Total Hip Arthroplasty,” John M. Wright, Perspective,” Clinical Orthopaedics and Related Research, M.D., et al., Orthopedic Special Edition, vol. 7, No. 2 0f 2, 1994, pp. 10—19. 2001, pp. 18—20. http://WWW.orthoteers.co.uk, “Pelvis & Acetabulun—Surgi “Robotics For Surgery,”, Robert D. HoWe et al., Annual Rev. cal Approaches,” 3 pages, Jan., 2001. Biomed. Eng. 1999, pp. 211—240. http://WWW.orthoteers.co.uk, “Hip—Surgical Approaches,” 9 “Minimally Invasive Total Hip Arthroplasty,” George F. pages, Jan. 2001. Video Tape—Cementless Ceramic Hip Replacement: The Chimento, M.D., et al., Operative Techniques in Ortho Anterior Approach, Kristaps Keggi, M.D., Jun. 1, 1985. paedics, vol. 11, No. 4, Oct. 2001, pp. 270—273. Curriculum Vitae of Dr. Kristaps Juris Keggi. “Application of Arthroplasty Principles to Canine Cemented “Anterior Approach to Hip Arthroplasty,” Terry R. Light, Total Hip Replacement,” Kurt S. SchultZ, Veterinary Sur M.D., et al. Clinical Orthopaedics and Related Research, pp. gery, 2000, pp. 578—593. 255—260. “Anterior Approach to Resurfacing Arthroplasty of the Hip: Reference—The Yale Journal of Biology and Medicine, vol. A Preliminary Experience” Robert P. Hendrikson, MD. et 66, No. 2, May—Jun. 1993, pp. 243—256. al, Connecticut Medicine, Mar. 1983, vol. 47, No. 3, pp. “Superior Mesenteric Vein Tear With Total Hip Arthro 131—135. plasty,” Jonathan N. Grauer, M.D., et al., The Journal of Arthroplasty vol. 16, No. 5, 2001, pp. 671—673. “A NeW Era of Minimally Invasive Surgical Approaches for “Total Hip Arthroplasty Using the SWeymuller Stem THA,” Timothy McTighe, Ph.D., Joint Implant Surgery & Implanted Without Cement,” Michael H. Huo, M.D., et al., Research Foundation Dec. 2002, pp. 2—7. The Journal of Arthoplasty vol. 10, No. 6, 1995, pp. 793—799. * cited by examiner U.S. Patent Oct.11,2005 Sheet 1 0130 US 6,953,480 B2 /-4O FIG-1 46 52 U.S. Patent Oct.11,2005 Sheet 2 0f30 US 6,953,480 B2 FIG-2 U.S. Patent Oct.11,2005 Sheet 3 0f30 US 6,953,480 B2 U.S. Patent Oct.11,2005 Sheet 4 0f30 US 6,953,480 B2 FIO-3 U.S. Patent Oct.11,2005 Sheet 5 0f30 US 6,953,480 B2 U.S. Patent Oct.11,2005 Sheet 6 0f30 US 6,953,480 B2 FIG-5B U.S. Patent Oct.11,2005 Sheet 7 0f30 US 6,953,480 B2 FIG-6