Dilator for accessing a joint space
Systems and methods for accessing an interior space of a joint such as a hip joint in preparation for arthroscopic surgery are provided. In general, the described techniques utilize a joint access device having a handle and a dilator shaft and/or sheath coupled to a distal end of the handle. The device can be advanced over a guidewire inserted into a joint to a first position and the guidewire can be reversibly locked to the handle. The handle can be associated with an actuator configured to be actuated to cause the dilator shaft and/or sheath to advance distally toward a second position within the joint while simultaneously retracting the guidewire coupled to the handle.
1. A surgical method for accessing an interior space of a joint, comprising:
advancing a guidewire into the joint capsule;
advancing a cannulated dilating instrument over the guidewire toward the joint capsule to a first position outside the joint capsule , the dilating instrument being coupled at a proximal end thereof to a handle such that the dilating instrument is configured for moving relative to the handle;
reversibly locking the guidewire within the handle when the dilating instrument is in the first position; and
actuating an actuator on the handle to:
cause the cannulated dilating instrument to advance distally from the first position toward a second position within the joint capsule, and
cause the guidewire to retract proximally with respect to the joint capsule simultaneously with advancing the dilating instrument toward the second position.
2. The method of claim 1 , wherein the handle has first and second couplings disposed therein.
3. The method of claim 2 , wherein actuating the actuator comprises:
moving the first coupling to cause the dilating instrument to advance distally from the first position toward a second position within the joint capsule; and
moving the second coupling to cause the guidewire to retract proximally simultaneously with advancing the dilating instrument toward the second position.
4. The method of claim 2 , wherein reversibly locking the guidewire comprises locking the guidewire to the second coupling.
5. The method of claim 2 , wherein the second coupling is configured to be operably coupled to the guidewire and to be moved by rotation.
6. The method of claim 2 , wherein the actuator includes a first engaging component operatively coupled to the first coupling and a second engaging component operatively coupled to the second coupling.
7. The method of claim 6 , wherein the first engaging component is operatively coupled to the first coupling via a first threaded connection.
8. The method of claim 6 , wherein moving the first engaging component causes the first coupling to move in a first direction and moving the second engaging component causes the second coupling to move in a second direction that is opposite to the first direction.
9. The method of claim 1 , wherein a rate of retracting the guidewire is substantially the same as a rate of advancing the dilating instrument.
10. The method of claim 1 , wherein a rate of retracting the guidewire is different than a rate of advancing the dilating instrument.
11. The method of claim 1 , wherein a distal tip of the dilating instrument has a cutting thread.
12. The method of claim 1 , wherein the joint comprises a hip joint capsule.