Methods and apparatus for joint distraction
View Patent ↗A method of treating a patient's joint having opposing joint surfaces includes providing an elongate member having a proximal end, a distal end and an expandable member near the distal end. The expandable member is positioned in the joint between the joint surfaces and expanded so as to separate the joint surfaces away from one another into a distracted position. The joint is manipulated while in the distracted position so that the joint is distracted and in flexion. A diagnostic or therapeutic procedure is then performed on the joint while maintaining the joint in the flexed and distracted position.
1. A method for treating a hip joint of a leg, wherein the hip joint comprises a concave acetabular cup surface rotatably supporting a convex femoral head surface, the concave acetabular CUP surface of the hip joint comprises a fossa, said method comprising the steps of:
providing an elongate member having a proximal end, a distal end and an ex 1 pandable member near the distal end;
positioning the expandable member in the joint between the concave acetabular cup surface and the convex femoral head surface, wherein the step of positioning the expandable member in the joint comprises positioning at least a portion of the expandable member in the acetabular fossa;
expanding the expandable member, while the expandable member remaining in the acetabular fossa during the expansion of the expandable member, so as to displace the convex femoral head surface from the concave acetabular cup surface;
while the displaced convex femoral head surface is supported on the expanded expandable member, manipulating the displaced convex femoral head surface vis-a-vis the concave acetabular cup surface, wherein such manipulation comprises rotating the displaced convex femoral head surface about the concave acetabular cup surface, and further wherein such manipulation comprises at least one from the group consisting of flexion, extension, lateral rotation, medial rotation, abduction and adduction of the leg; and
while the displaced and manipulated convex femoral head surface is supported on the expanded expandable member, performing a therapeutic procedure on the joint.
2. The method of claim 1 , wherein manipulation comprises flexion of more than 20 degrees.
3. The method of claim 1 , further comprising reducing tension in an anterior portion of a capsule surrounding the hip joint.
4. The method of claim 3 , wherein performing the therapeutic procedure comprises positioning at least one instrument through the anterior portion of the capsule while tension in the capsule of the joint is reduced.
5. The method of claim 1 , wherein manipulation comprises bending the knee ipsilateral to the hip joint being treated.
6. The method of claim 1 , further comprising maintaining the hip joint in a manipulated configuration with a brace releasably coupled with the patient's leg ipsilateral to the hip joint being treated.
7. The method of claim 1 , wherein the step of positioning comprises advancing the expandable member over a guidewire into the hip joint.
8. The method of claim 1 , wherein the step of positioning comprises advancing the expandable member through a cannula extending into a capsule surrounding the hip joint.
9. The method of claim 8 , further comprising deploying a retention mechanism from the cannula, the retention mechanism anchoring the cannula in the capsule of the hip joint.
10. The method of claim 1 , wherein the step of expanding the expandable member comprises inflating a balloon.
11. The method of claim 10 , wherein the balloon is inflated to a pressure not exceeding about 100 psi.
12. The method of claim 10 , wherein the balloon exerts at least about 50 pounds of force against the concave acetabular cup surface and the convex femoral head surface.
13. The method of claim 1 , wherein the expandable member engages each of the concave acetabular cup surface and the convex femoral head surface within a contact area, the contact area being no more than about 800 mm 2 .
14. The method of claim 1 , wherein each of the concave acetabular cup surface and the convex femoral head surface has a total area, and wherein the expandable member engages each of the concave acetabular cup surface and the convex femoral head surface within a contact area, the contact area being no larger than about 50% of the total area.
15. The method of claim 8 , wherein the expandable member has an outer surface with a radius of curvature when expanded, the radius of curvature being about 8-18 mm.
16. The method of claim 1 , wherein the acetabular cup surface of the hip joint having a total surface area outside the fossa, wherein the expandable member contact s one of the joint surfaces along a contact area, the contact area being less than about 50% of the total surface area outside the fossa when the expandable member is expanded.
17. The method of claim 1 , wherein expanding the expandable member separates the convex femoral head surface from the concave acetabular cup surface by at least about 10 mm.
18. The method of claim 1 , wherein the step of manipulating the joint comprises abducting the joint through an angle of about 30 to 80 degrees.
19. The method of claim 1 , wherein the step of manipulating the joint comprises adducting the joint through an angle of about 10 to 30 degrees.
20. The method of claim 1 , wherein the step of performing the therapeutic procedure comprises at least one of labral repair, debridement, lavage, osteotomy, microfracture, and chondral repair.
21. The method of claim 1 , further comprising a step of removing the expandable member from the hip joint.