Surgical device for abrasively machining a natural hip joint

Abstract

The invention relates to a surgical device (1) for abrasively machining a hip joint (2) comprising a first bone (2a) and a second bone (2b). The device (1) comprises a sleeve (3), a stop element (4), a machining means (5), and a guide (6) which can be connected to the machining means (5) in order to guide the machining means (5). The invention additionally relates to a surgical treatment system and to a method for abrasively machining a hip joint (2) of a patient.

Description

[0001] Surgical device for abrasive treatment of a natural hip joint

[0002] TECHNICAL FIELD

[0003] The present invention relates to a surgical device for abrasive treatment of a hip joint, a surgical treatment system and a method for treating a hip joint of a patient.

[0004] STATE OF THE ART

[0005] Various surgical devices for abrasive treatment of a hip joint are known from the prior art. For example, milling cutters are known that can be introduced minimally invasively into the body and used for milling the hip joint. These previously known surgical devices are typically guided freely by the surgeon, possibly with the assistance of simultaneous imaging or computer-assisted navigation.

[0006] Previously known surgical devices are used, for example, to treat femoroacetabular impingement (FAI). Femoroacetabular impingement describes a pathological conflict between the femoral neck and the acetabular rim of the natural hip joint, leading to premature wear (osteoarthritis) of the hip joint. In the final stages, the implantation of a total hip prosthesis may be necessary. In so-called cam impingement, the transition from the femoral head to the femoral neck is not smoothly tapered, but rather a bulge or hump exists, the so-called cam deformity. The deformity can vary in size and be several millimeters high.Through hip movement, especially through bending and internal rotation, this protrusion is forced into the acetabulum and rotated against the labrum, resulting in significant compressive and shear forces that damage the labrum and the articular cartilage of the acetabulum, ultimately leading to cartilage defects (Figs. 1 a and 1 b). The final stage of the wear process results in the development of hip osteoarthritis, which ultimately requires treatment with the implantation of an artificial hip joint (total hip prosthesis).

[0007] One of the first treatments for FAI involved open surgical removal of the cam deformity, which involved dislocating the hip (surgical hip luxation) and restoring the roundness of the femoral head with a chisel. Later, arthroscopic techniques were developed, which involved inserting a reamer to ablate the cam deformity with the aid of imaging techniques. A camera image was projected onto a screen to assist the procedure, allowing the surgeon to determine the location and depth of correction.

[0008] The previously known therapies and surgical devices for treating hip joints are associated with numerous problems.

[0009] For example, when using conventional surgical devices, it is necessary to gradually remove excess bone. This takes time and may require additional surgical interventions. Furthermore, the precision of the surgical procedure is limited when using conventional surgical devices. In particular, it is difficult to achieve a desired target contour through high-precision milling. For example, it is difficult to mill a perfect hemisphere with conventional surgical devices. Another problem is that the stability of the hip joint may be compromised after the procedure. Furthermore, the conventional devices and methods require changing surgical instruments between portals to reach all parts of the joint to be treated.

[0010] Furthermore, existing surgical devices require considerable surgical skill to achieve successful treatment. For example, many existing devices require the simultaneous movement, operation, or control of various elements of the surgical device. Furthermore, many existing surgical devices require the internal reamer to be arthroscopically controlled from outside the body with great care and precision, typically in all three spatial directions. This poses a risk of miscontrol.

[0011] Furthermore, the use of previously known surgical devices carries the risk of over- or undercorrection of the hip joint. Both overcorrection, in which too much bone is removed, and undercorrection, in which the deformity is not completely removed, can lead to poor clinical outcomes with persistent pain. Possible further consequences include hip instability. Over- or undercorrection may also require revision surgery. SUMMARY OF THE INVENTION

[0012] A general object of the invention is to improve the prior art with regard to surgical devices for the abrasive machining of a hip joint and with regard to methods for machining a patient's hip joint. In advantageous embodiments, the disadvantages of the prior art are overcome in whole or in part. In an advantageous embodiment, the present disclosure relates to a surgical device for milling a hip joint, in particular a natural hip joint, and to a method for milling a hip joint, in particular a natural hip joint. In an advantageous embodiment, the present disclosure relates to a surgical device for milling a femoral neck and to a method for milling a femoral neck.

[0013] In a first aspect, the present disclosure relates to a surgical device for the abrasive machining of a joint, preferably a hip joint, comprising a first bone and a second bone. The surgical device comprises a sleeve extending along an axial direction. The surgical device further comprises a stop element for positioning the device on the first bone. The surgical device further comprises a machining means configured for the abrasive machining of the second bone. The surgical device further comprises a guide connectable to the machining means for guiding the machining means. The guide is operatively connected to the stop element. The surgical device enables a hip joint to be abrasive machined with high precision.In particular, the fact that the device can be positioned on the first bone by the stop element allows a first bone of the hip joint to serve as a fixation point and the machining means to be moved relative to this first bone during abrasive machining. The machining means can thus be moved with high precision and control. Furthermore, the disclosed surgical device allows the second bone to be moved relative to the first bone during abrasive machining and to be abrasively machined by this movement. With a spatially stationary tool, the feed movement can therefore be generated by the material to be machined, i.e. the second bone. Furthermore, when using the surgical device, abrasive machining requires less skill and less time than with previously known surgical devices and is therefore less error-prone and more cost-effective.In particular, the disclosed surgical device allows the abrasive treatment of a hip joint to be performed in a single procedure. Furthermore, the repositioning and changing of portals and instruments is minimized. This minimizes soft tissue damage and swelling of the surrounding tissue. Furthermore, the risk of over- and undercorrections and thus the risk of the need for revision surgery is minimized. The disclosed surgical device also allows for precise spherical contouring of the femoral head without tapering the femoral neck into a concave shape. This prevents gaps between the femoral head and labrum from occurring after the procedure, which could lead to hip instability. SURGICAL DEVICE.

[0014] In the present disclosure, a surgical device refers to a device suitable for a surgical procedure. The surgical device is suitable for abrasively machining a hip joint, preferably a femur, in particular a femoral head and a femoral neck. Preferably, the hip joint is a natural hip joint. Preferably, the surgical device is suitable for abrasively machining the hip joint of a mammal, in particular a human hip joint. The surgical device is preferably designed for abrasively machining the hip joint of an adult human, but can also be designed for abrasively machining the hip joint of a child. In one embodiment, the surgical device is suitable for spherically contouring the second bone.The hip joint for which the surgical device is suitable comprises a first and a second bone. The first bone is preferably an acetabulum, and the second bone is preferably the femur, in particular the femoral head and femoral neck of the femur.

[0015] In one embodiment, abrasive machining includes milling, grinding, grinding, and / or machining. Typically, abrasive machining includes milling.

[0016] In one embodiment, the surgical device is configured to assume an insertion position and a processing position. For example, in one embodiment, the surgical device is reversibly transferable from an insertion position to a processing position. In the insertion position, the surgical device is configured for minimally invasive insertion of the surgical device. In the processing position, the surgical device is configured for abrasive processing of the hip joint.

[0017] In one embodiment, at least one invasive working portion of the surgical device has an elongated shape in the insertion position of the surgical device. The invasive working portion comprises at least the processing means, the stop element, and at least one invasive portion of the sleeve. The invasive working portion can optionally further comprise the fixation rod (or at least one invasive portion of the fixation rod). In this context, invasive refers to the portion(s) that are configured to be inserted into the body during use of the surgical device. In the case of the sleeve, for example, at least one portion of the sleeve is configured to be inserted into the body. This portion is typically a proximal portion of the sleeve. In some embodiments, the entire sleeve is configured to be inserted into the body.The invasive working section of the surgical device typically comprises those sections of the device that are, on the one hand, configured to be introduced into the body ("invasive"), and, on the other hand, directly or indirectly support the abrasive processing step ("work"). This can, for example, include those sections configured to contact the first bone and / or the second bone. This includes, for example, the processing means and the stop element. Any peripheral auxiliary structures, for example, in some embodiments, a bracing structure and / or a bracing stop element, are typically not considered part of the invasive working section of the surgical device.

[0018] The embodiments described in the previous paragraph can be advantageously used to enable minimally invasive introduction of the surgical device. For example, at least one invasive working portion of the surgical device can have an elongated shape in the insertion position of the surgical device, so that the invasive working portion can be inserted into the body along its length through a tissue protection tube (or tissue protection sleeve). In some embodiments, the invasive working portion of the surgical device has an elongated shape in the insertion position of the surgical device and has a cross-section with a cross-sectional area of ​​less than 7,000 mm along its length. 2 , preferably less than 1 000 mm 2 , particularly preferably less than 400 mm 2 .

[0019] In one embodiment, the surgical device is sterilized. For example, the surgical device may be sterilized and packaged in a sterile package. Sterile in the present disclosure means free of viable microorganisms.

[0020] SLEEVE The sleeve of the device extends along an axial direction. A first transverse direction and a second transverse direction extend orthogonally to the axial direction, with the first transverse direction extending orthogonally to the second transverse direction. The axial direction, the first transverse direction, and the second transverse direction thus define a Cartesian coordinate system.

[0021] The sleeve extends along the axial direction from a proximal end to a distal end of the sleeve. At the proximal end, the sleeve typically includes an opening. The opening can be closable. The distal end of the sleeve can also include an opening. In one embodiment, a cavity extends at least partially between the proximal end and the distal end of the sleeve. In a typical embodiment, the sleeve includes a sleeve body that delimits the cavity. The sleeve can, for example, be cylindrical.

[0022] In one embodiment, the sleeve extends substantially parallel to the guide. Alternatively or additionally, the sleeve (at least in an insertion position of the surgical device) may extend substantially parallel to the fixation rod. In one embodiment, the sleeve, the guide, and the fixation rod (at least in an insertion position of the surgical device) extend substantially parallel to one another.

[0023] The fixing rod typically extends substantially parallel to the sleeve. The sleeve typically has a length of 50 mm to 500 mm, in particular 50 mm to 200 mm, preferably 65 mm to 200 mm. The length of the sleeve preferably extends in the axial direction. The sleeve typically has an outer diameter and an inner diameter, wherein the outer diameter is larger than the inner diameter. The outer diameter can be, for example, from 8 mm to 18 mm, in particular from 10 mm to 16 mm. The inner diameter can be, for example, from 6 mm to 12 mm, in particular from 8 mm to 10 mm. The sleeve can, for example, have a wall thickness of 1 mm to 12 mm, in particular from 3 mm to 6 mm. The sleeve can have a smooth outer surface. The sleeve is typically sterilizable. For example, the sleeve can be made of metal or plastic, in particular of stainless steel, titanium or tantalum.

[0024] In one embodiment, the sleeve is made of a rigid material, for example, metal or plastic, preferably transparent plastic. This enables high stability and thus high precision when performing the surgical procedure. In another embodiment, the sleeve is flexible, at least in sections. For example, the sleeve can be made of a flexible material, at least in sections. In one embodiment, the sleeve is made of a flexible material, at least in sections. Additionally or alternatively, the guide can also be made of a flexible material, at least in sections. This enables lateral displacement of the processing means relative to the fixing rod. In one embodiment, the sleeve comprises a rigid material and a flexible material. STOP ELEMENT

[0025] The stop element is suitable for positioning the device on the first bone, preferably on an acetabulum. In particular, the stop element can be configured for positioning the device on an acetabulum in an edge region of the acetabulum. Thus, the stop element can, for example, be configured to rest on the acetabulum (for example, in an edge region of the acetabulum). Typically, the stop element is suitable for releasably fixing the device to the first bone. For abrasive machining of the hip joint, the stop element typically rests on the first bone. The stop element typically comprises a stop surface. With this stop surface, the stop element can rest on at least a section of the first bone. Depending on the area of ​​application, the stop surface can, for example, be from 2 mm x 8 mm to 20 mm x 30 mm, in particular 5 mm x 20 mm.In one embodiment, the stop surface is 4 mm. 2 up to 200 mm 2 Depending on the application, the stop surface can be essentially flat or curved. The stop surface can also have a contour that complements an outer contour of at least a portion of the first bone. This allows the stop surface to rest precisely on the first bone. The portion of the first bone on which the stop surface rests can serve as a fixed point and as an abutment.

[0026] In one embodiment, the stop element can be reversibly connected to the first bone. For example, the stop element can be connected to the first bone in a force-locking and / or form-locking manner. This allows the first bone to remain intact after the surgical procedure. For example, the stop element can be connected to the first bone in a force-locking manner during the surgical procedure via a force in the axial direction. This force-locking prevents movement of the stop element relative to the first bone in the transverse direction.

[0027] In one embodiment, the stop element comprises one or more fixation elements for releasably fixing the device to the first bone. The fixation element can, for example, be arranged on the stop surface. In one embodiment, the fixation elements are distributed across the stop surface, in particular evenly distributed. In one embodiment, the one or more fixation elements are configured to block the movement of the stop element relative to the first bone in at least one transverse direction, preferably in the first transverse direction and the second transverse direction, when the device is fixed to the first bone. For example, the fixation element can have fixation structures. The fixation structures can, for example, comprise screws, barbs, nails, points, claws, and / or talons.The fixation structures could, for example, be configured to releasably engage the bone, preferably with an engagement depth of up to 10 mm, in particular up to 3 mm, preferably up to 2 mm. The fixation structures typically have a strength that allows engagement with a bone. For example, the fixation structures can be made of plastic or metal, in particular stainless steel, titanium, and tantalum. The fixation structures can be intended for single use. In one embodiment, the fixation element comprises a claw structure.

[0028] In one embodiment, the fixing structures each extend at an angle alpha to the axial direction. The angle alpha can, for example, be between -80° and +80°, preferably between -50° and +50°. The fixing structures can comprise a first group of fixing structures and a second group of fixing structures. In one embodiment, the angle alpha for the fixing structures of the first group is between -80° and 0°, preferably between -50° and -10°, and the angle alpha for the fixing structures of the second group is between +80° and 0°, preferably between +50° and +10°. In other words, in this embodiment, the fixing structures of the two groups extend in different directions. In a further embodiment, the fixing structures of the two groups extend in the same direction.For example, in this embodiment, the angle alpha for the fixation structures of the first group can be between -80° and 0°, preferably between -50° and -10°, and the angle alpha for the fixation structures of the second group can be between -80° and 0°, preferably between -50° and -10°. The fixation structures of the first group and the fixation structures of the second group can, for example, be arranged opposite one another. In one embodiment, the first group comprises the same number of fixation structures as the second group, and the fixation structures of the first and second groups are each arranged opposite one another in pairs. In a further embodiment, the groups as such are arranged opposite one another. In one embodiment, the stop element is arranged at a proximal end of the surgical device.For example, the stop element can be arranged at a proximal end of the sleeve and / or a fixing rod. The stop element can, for example, be connected directly or indirectly to the sleeve. In one embodiment, the stop element is pivotable relative to the sleeve. For example, the stop element can be pivoted relative to the sleeve along a pivot axis that runs substantially orthogonal to the axial direction of the sleeve. In one embodiment, the stop element is pivotable from a first pivot position to a second pivot position. In one embodiment, the stop element extends substantially along the axial direction in the first pivot position. In one embodiment, the stop element extends substantially radially away from the sleeve in the second pivot position, in particular substantially along a transverse direction.These embodiments enable minimally invasive introduction of the surgical device and, at the same time, secure positioning of the device on the first bone. In particular, the pivotability ensures that, despite the smallest possible soft tissue damage, the stop element rests with a large surface area on the first bone. In one embodiment, the stop element extends substantially radially in the second pivot position with respect to a longitudinal direction of the fixing rod, for example, radially away from a proximal end of the fixing rod. In one embodiment, the stop element has a concave shape at least in the second pivot position. For example, a proximal side of the stop element can have a concave shape at least in the second pivot position.The concave shape can, for example, be designed so that the stop element can rest on the acetabulum (in particular in an edge region of the acetabulum) at least in the second pivot position.

[0029] In one embodiment, the stop element is movable relative to the sleeve in a transverse direction. In one embodiment, the surgical device has a fixation rod, which can be connected to the stop element, for example. In these embodiments, the stop element can be movable relative to the fixation rod in a transverse direction, for example. It is understood that in some embodiments, transverse mobility corresponds to a linear movement, namely a linear movement in a transverse direction, i.e., a direction orthogonal to the axial direction. The mobility of the stop element in the transverse direction can be implemented, for example, by providing different offsets. The mobility of the stop element has various advantages.For example, it can be advantageous for guiding the surgical device past the labrum during insertion (e.g., minimally invasive). Furthermore, transverse mobility can be advantageous for adjusting the stop position, for example, on the acetabulum after insertion of the surgical device, without having to reinsert the device.

[0030] In one embodiment, the stop element is arranged on a fixing rod, preferably at a proximal end of the fixing rod. The stop element can, for example, be connected directly or indirectly to the fixing rod. In one embodiment, the stop element is pivotable relative to the fixing rod. For example, the stop element can be pivoted relative to the fixing rod along a pivot axis that runs substantially orthogonal to the axial direction of the fixing rod. In one embodiment, the stop element is pivotable from a first pivot position to a second pivot position. In one embodiment, the stop element extends substantially along the axial direction in the first pivot position. In one embodiment, the stop element extends substantially radially away from the fixing rod in the second pivot position, in particular substantially along a transverse direction.

[0031] In one embodiment, the first pivot position of the stop element corresponds to the insertion position of the surgical device, and the second pivot position of the stop element corresponds to the processing position of the surgical device. In one embodiment, the second pivot position of the stop element can also be referred to, for example, as the pivoted-out pivot position.

[0032] In one embodiment, the stop element is patient-specific. For example, the stop element can have a surface contour, in particular a proximal surface contour, which is patient-specific. For example, the proximal surface contour of the stop element can be configured such that it is complementary to an outer contour of the first bone of the patient to be treated. The outer contour of the first bone can be determined, for example, by imaging, such as computed tomography and / or magnetic resonance imaging. The outer contour of the second bone can also be determined, for example, by imaging, such as computed tomography and / or magnetic resonance imaging.

[0033] FIXING ROD

[0034] In one embodiment, the surgical device comprises a fixation rod. In one embodiment, the fixation rod is configured to fix the device to the first bone. The fixation rod typically has a proximal and a distal end. The fixation rod typically extends substantially parallel to the sleeve. At a proximal end, the fixation rod can be connected to the stop element. The stop element can be connected directly or indirectly to the fixation rod. The fixation rod can, for example, be substantially cylindrical. The fixation rod can have an outer diameter of 3 mm to 20 mm, in particular of 3 mm to 12 mm, further preferably 3 mm to 8 mm. In a preferred embodiment, the fixation rod has an outer diameter of 3 mm to 5 mm, in particular 4 mm.

[0035] In one embodiment, the fixing rod is spaced from the sleeve by a spacing element. The spacing element is typically configured to adjust the spacing of the fixing rod from the sleeve, preferably within a spacing range of 0 mm to 100 mm, in particular from 0 mm to 50 mm, further preferably 10 mm to 15 mm. The spacing of the fixing rod from the sleeve refers to the distance between the fixing rod and the sleeve. The fact that the spacing is adjustable in one embodiment by the spacing element makes it possible, for example, to introduce the surgical device minimally invasively and to increase the spacing of the fixing rod from the sleeve only after introduction into the body in order to carry out the abrasive processing.In one embodiment, the spacing of the fixing rod from the sleeve in the insertion position of the surgical device is 0 mm and in the processing position of the surgical device is from 0 mm to 100 mm, in particular from 0 mm to 50 mm.

[0036] In one embodiment, the spacing element comprises at least one rail and at least one spacing rod with two ends. The spacing rod can, for example, be pivotally connected to the sleeve, or rather the fixing rod, at a first end and displaceably mounted in the rail at a second end along the axial direction, wherein the rail is arranged on the fixing rod, or rather the sleeve. In other words, if the first end is pivotally connected to the sleeve, the rail is arranged on the fixing rod; if, however, the first end is pivotally arranged to the fixing rod, the rail is arranged on the sleeve. In some embodiments, the spacing element comprises a plurality of rails and a plurality of spacing elements.

[0037] In one embodiment, the surgical device comprises multiple spacing elements. A single spacing element can, for example, also comprise two spacing rods and a rail, wherein the two spacing rods preferably have the same pivot axis and are mounted in the same rail. This prevents the fixation rod and the sleeve from moving axially relative to each other.

[0038] The machining means is configured for abrasively machining the second bone, preferably for abrasively machining a femur, in particular the femoral head and the femoral neck of the femur. In one embodiment, the machining means is configured for milling the second bone. The machining means can comprise, for example, a milling cutter. In one embodiment, the milling cutter comprises a milling head with a diameter of 3 mm to 10 mm, preferably 5 mm to 7 mm, in particular 6 mm. The milling head can, for example, have a spherical surface contour to enable milling of the second bone along a spherical contour. For example, the milling head can be elliptical. Preferably, the milling head is arranged such that it is less high than wide with respect to the axial direction, wherein the height relates to the axial direction and the width relates to a transverse direction.In one embodiment, the milling head has the shape of an ellipsoid. The milling head can also be spherical, for example. In one embodiment, the milling head is connected to a guide rod.

[0039] In one embodiment, the processing means is arranged at a proximal end of the surgical device. For example, the processing means can be arranged at a proximal end of the sleeve and / or at a proximal end of a guide. In one embodiment, the device is designed such that the processing means is movable relative to the stop element, preferably within a range of motion of 1 mm to 40 mm, in particular of 1 mm to 20 mm. This mobility makes it possible to adjust and fix the position of the processing means relative to the first bone. In one embodiment, the device is designed such that the processing means is lockable relative to the stop element, preferably continuously lockable. In particular, the processing means can be lockable relative to the stop element within the range of motion, for example continuously lockable.The lockable mechanism allows the surgeon to fix the processing tool in one position relative to the first bone and to move the second bone for abrasive processing relative to the first bone and thus relative to the processing tool.

[0040] In one embodiment, the device is designed such that the machining means is movable relative to the stop element in at least one transverse direction, preferably within a transverse range of motion of 1 mm to 40 mm, in particular from 1 mm to 20 mm. The device can, for example, be designed such that the machining means is movable relative to the stop element only in the first transverse direction or in the first transverse direction and in the second transverse direction, preferably in each case within the aforementioned transverse range of motion. Alternatively or additionally, in one embodiment the device is designed such that the machining means is movable relative to the stop element in the axial direction, preferably within an axial range of motion of 1 mm to 70 mm, in particular from 5 mm to 40 mm.In one embodiment, the device is designed such that the machining means is movable relative to the stop element in the first transverse direction, in the second transverse direction, and in the axial direction. An advantage of this embodiment is that the machining means is thus movable relative to the stop element in any desired direction in three-dimensional space. In one embodiment, the device is designed such that the machining means is movable relative to the stop element only in the first transverse direction and in the axial direction.

[0041] In some embodiments, the machining means is pivotable relative to the stop element. Optionally, the machining means can be pivotable, for example, together with the sleeve, relative to the stop element. The pivotability of the machining means (optionally together with the sleeve) relative to the stop element can be implemented in different ways. For example, the sleeve can be connected to the fixing rod at a pivot point, and the pivot point defines a pivot axis about which the machining means, together with the sleeve, can be pivoted relative to the stop element. It is also possible to achieve pivoting, for example, by having several spacing elements, each spacing the fixing rod from the sleeve, change their spacing in a concerted manner and to different extents.For example, a spacing element closest to the pivot axis could be extended only slightly (or not at all), while the increasingly distant spacing elements are extended increasingly far in order to pivot the processing means together with the sleeve relative to the stop element. In some embodiments, the surgical device comprises a fixation rod on which the stop element is arranged, for example at a proximal end of the fixation rod. In these embodiments, the processing means (optionally together with the sleeve) can be pivotable relative to the stop element about a pivot axis that runs orthogonal to the fixation rod. The pivot axis can cross the fixation rod, for example in a distal section of the fixation rod.

[0042] In one embodiment, the processing means and the stop element (at least in the processing position of the surgical device) have a lateral offset with respect to the axial direction (along which the sleeve extends). For example, in one embodiment, the processing means and the stop element (at least in the processing position of the surgical device) do not lie on a straight line corresponding to the axial direction. In one embodiment, the processing means and the stop element (at least in the processing position of the surgical device) are spaced apart from one another in a transverse direction orthogonal to the axial direction. In addition, the processing means and the stop element (at least in the processing position of the surgical device) can optionally also be spaced apart from one another in the axial direction.

[0043] In one embodiment, the machining means and the stop element (at least in the machining position of the surgical device) point in the same direction. For example, a stop surface of the stop element and a machining surface of the machining means (at least in the machining position of the surgical device) may point toward a proximal side of the surgical device. The proximal side of the surgical device may, for example, point from a proximal end of the surgical device in a direction away from the surgical device, for example in a direction away from the surgical device and parallel to the axial direction.

[0044] In one embodiment, the device is designed such that the machining means is movable relative to the sleeve in the axial direction, preferably only in the axial direction. The axial range of movement within which the machining means is movable relative to the sleeve can be, for example, from 1 mm to 70 mm, in particular from 5 mm to 40 mm. In one embodiment, the device is designed such that a displacement of a guide within the sleeve brings about a relative movement of the machining means relative to the sleeve in the axial direction. For example, the machining means can be connected to a guide that is displaceably mounted within the sleeve.

[0045] In one embodiment, the device is designed such that the sleeve is movable relative to the stop element in a transverse direction. For example, the device can be designed such that the sleeve is movable relative to the stop element in the first transverse direction and in the second transverse direction. The transverse range of motion within which the sleeve is movable relative to the stop element can be, for example, from 1 mm to 40 mm, in particular from 1 mm to 20 mm. In one embodiment, the device is designed such that a displacement of a fixing rod relative to the sleeve causes a relative movement of the sleeve relative to the stop element in a transverse direction.In one embodiment, the device is designed such that displacement of a fixing rod relative to the sleeve causes a relative movement of the sleeve relative to the stop element in the first transverse direction and / or in the second transverse direction. For example, the sleeve can be connected to a fixing rod, and the fixing rod can be connected to the stop element.

[0046] The term "range of motion" between two components A and B in the present disclosure refers to the maximum change in the relative positioning of A to B without compromising the structural integrity of A and / or B. In other words, the "range of motion" is the space within which the two components A and B can be moved relative to each other. For example, the axial range of motion refers to the maximum distance in the axial direction by which components A and B can be moved relative to each other. Similarly, the first transverse range of motion refers to the maximum distance in the first transverse direction by which components A and B can be moved relative to each other. Relative motion of A and B also occurs when A moves relative to B or B relative to A, and of course also when A and B move simultaneously, relative to each other.

[0047] When a "range of motion" is defined in the present disclosure, for example, a range of motion within which two components A and B are movable relative to each other, then in one embodiment, any relative positioning is possible within this range of motion. For example, the two components can preferably be continuously movable within the range of motion. In one embodiment, the two components are movable within the range of motion in increments of less than 3 mm, preferably in increments of 0.1 mm to 2 mm. In one embodiment, the components are lockable relative to each other within the range of motion.

[0048] GUIDE

[0049] The processing means is connectable to a guide. The guide is typically designed to guide the processing means. The guide can, for example, be detachably connected to the processing means. For example, in one embodiment, the processing means can be plugged or screwed onto the guide. In one embodiment, the sleeve has a receiving contour at its proximal end that corresponds to an outer contour of the processing means. For example, the processing means can be spherical and the outer contour of the sleeve at the proximal end can be ball-socket-shaped. In one embodiment, the processing means can be connected to the guide via a detachable positive connection or a detachable non-positive connection. These embodiments enable the processing means to be replaced, allowing a fresh processing means to be used for each surgical procedure, for example.In one embodiment, the processing means is connected directly or indirectly to the guide. In one embodiment, the processing means is arranged at a proximal end of the guide. For example, the processing means can be connectable to the proximal end of the guide.

[0050] In one embodiment, the guide is at least partially arranged within the sleeve and preferably extends along the axial direction. In one embodiment, the guide is mounted within the sleeve so as to be displaceable in the axial direction. The displaceable mounting can be realized, for example, by the outer diameter of the guide corresponding to the inner diameter of the sleeve. For example, the guide can comprise a guide rod. In an insertion position of the surgical device, the guide rod can be arranged at least partially, preferably completely, within the sleeve. In a processing position of the surgical device, the guide rod can be arranged at least partially within the sleeve and preferably at least partially outside the sleeve. In one embodiment, the guide rod is mounted within the sleeve, preferably mounted so as to be displaceable in the axial direction.The surgical device can comprise a control unit, which can be configured, for example, to control the displacement of the guide rod in the axial direction. In one embodiment, the guide rod is mounted within the sleeve in such a way that the guide rod can only be displaced in the axial direction relative to the sleeve. This prevents displacement of the guide rod in the transverse direction and thus allows a controlled movement of the processing means during a procedure. In one embodiment, the guide, or rather the guide rod, can be pulled out of the sleeve along the axial direction. The guide, or rather the guide rod, can be connected to the sleeve, for example by being inserted into the sleeve. This enables the guide, or rather the guide rod, to be replaced. For example, a new guide, or rather a new guide rod, can be used for each surgical procedure.

[0051] The guide is operatively connected to the stop element. In one embodiment, the guide is connected to the stop element via the sleeve, for example, directly or indirectly. For example, the guide can be connectable to the sleeve or can be connected, and the sleeve, in turn, can be connected to the stop element.

[0052] In one embodiment, the guide is made of a rigid material, for example metal or plastic. This enables high stability and thus high precision when performing the surgical procedure. In a further embodiment, the guide is flexible at least in sections. For example, the guide can be made of a flexible material at least in sections. In one embodiment, the guide is made of a flexible material at least in sections. This enables lateral displacement of the processing means relative to the fixing rod. In one embodiment, the guide comprises a rigid material and a flexible material. In one embodiment, the guide is designed as a flexible drilling shaft. In one embodiment, the guide extends (at least in an insertion position of the surgical device) essentially parallel to the fixing rod.

[0053] STEERING

[0054] In one embodiment, the surgical device comprises a controller configured to control the movement of the processing means relative to the stop element. For example, the controller can be configured to control the movement of the processing means relative to the sleeve and optionally also to control the movement of the sleeve relative to the stop element. In one embodiment, the controller is connected to the distal end of the sleeve and optionally also to the distal end of the fixation rod.

[0055] Bracing structure

[0056] In one embodiment, the surgical device further comprises at least one bracing structure. The bracing structure is configured to position the device on a third bone. The third bone may, for example, comprise an iliac crest or a portion of the iliac crest. In one embodiment, the third bone comprises the anterior superior iliac spine. By additionally positioning the device on the third bone, the bracing structure contributes to additional stabilization of the device and thus to greater precision of the surgical procedure. In particular, the bracing structure reduces the degrees of freedom of movement, particularly in the transverse directions. The bracing structure may also have two, three, or more bracings. In this case, the bracings are preferably arranged orthogonally to one another.For example, a first strut can extend in the first transverse direction and a second strut can extend in the second transverse direction. These embodiments significantly increase the stabilization of the device. For example, three-point stabilization can be achieved.

[0057] The bracing structure may, for example, comprise a rod or a tube. The bracing structure may be connected to the sleeve and / or to the spacer element. Typically, the bracing structure is connected to the sleeve (or the spacer element) at a connection point of the sleeve (or the spacer element), wherein the connection point is at least 20 mm away from the stop element. Typically, the connection point is located extracorporeally during the procedure.

[0058] In one embodiment, the bracing structure comprises a bracing stop element. The bracing stop element is configured to position the device on the third bone. For example, the bracing stop element can be configured to be releasably connected to the third bone.

[0059] In one embodiment, the bracing structure is movable relative to the sleeve and / or relative to the fixing rod. In particular, for example, the bracing stop element can be movable relative to the sleeve and / or relative to the fixing rod. The movability of the bracing structure (or the bracing stop element) relative to the sleeve and / or relative to the fixing rod can be designed differently. For example, in one embodiment, the bracing structure (or the bracing stop element) is displaceable, for example linearly displaceable, relative to the sleeve and / or relative to the fixing rod. In one embodiment, for example, the bracing structure is telescopic. Alternatively or additionally, it can also be pivotable. In one embodiment, the bracing structure (orThe bracing stop element (or the bracing stop element) is pivotable relative to the sleeve and / or relative to the fixation rod, for example, about a pivot axis that can pass through the connection point at which the bracing structure is connected to the sleeve. The mobility of the bracing structure or the bracing stop element relative to the sleeve and / or relative to the fixation rod can be used, for example, to enable attachment to different positions on the iliac crest.

[0060] Tissue protection tube

[0061] Furthermore, a tissue protection tube can be provided, which allows minimally invasive insertion of the device into the body. This can, for example, comprise a trocar. Typically, the tissue protection tube has a smooth outer surface to facilitate insertion into the body. In one embodiment, the tissue protection tube has coils on its outer surface, at least in sections. For example, thread-like elevations can be arranged on the outer surface. The coils allow the tissue protection tube to be screwed through the soft tissue and prevent the tissue protection tube from slipping out during the procedure. Typically, the outer surface of the tissue protection tube is sterilizable. For example, the tissue protection tube can be made of metal or plastic, in particular of stainless steel, titanium, or tantalum. The outer surface can be sterilized.The tissue protection tube may be intended for single use.

[0062] SURGICAL TREATMENT SYSTEM

[0063] In a second aspect, the present disclosure relates to a surgical treatment system comprising a surgical device according to the first aspect of the present disclosure. The surgical treatment system typically further comprises a patient positioning unit for positioning a patient, wherein the surgical device and the positioning unit are operatively connected to one another.

[0064] In one embodiment, the positioning unit comprises a first holding unit for holding a first body part of the patient and a second holding unit for holding a second body part of the patient, wherein the first holding unit and the second holding unit are movable relative to one another. The controller can, for example, be configured to control the relative movement of the first holding unit to the second holding unit. The first body part can, for example, be a hip or pelvis of a patient, and the second body part can, for example, be a leg of the patient. An advantage of these embodiments is that the movement of the second body part relative to the first body part can be used to move the second bone relative to the processing means and thus to abrasively process the second bone. In addition, it is possible to move the processing means relative to the stop element.

[0065] SURGICAL PROCEDURE

[0066] In a third aspect, the present disclosure relates to the use of the surgical device according to one of the embodiments of the first aspect of the present disclosure or the surgical treatment system according to one of the embodiments of the second aspect of the present disclosure for abrasive treatment of a hip joint comprising a first bone and a second bone.

[0067] In a fourth aspect, the present disclosure relates to a method for abrasive machining of a patient's hip joint. The method comprises providing a surgical device according to one of the embodiments according to the first aspect of the present disclosure or a surgical treatment system according to one of the embodiments according to the second aspect of the present disclosure. The provision may, for example, comprise connecting a sterile and new machining means to a guide of the surgical device. The provision may further comprise connecting a stop element to a sleeve or to a fixation rod of the device. The stop element may, for example, be patient-specific.For example, providing the surgical device can comprise the manufacture of a stop element based on patient-specific data, in particular based on imaging of the patient's first bone. The imaging can comprise, for example, x-ray images, magnetic resonance imaging images, and / or computed tomography images. The stop element can be manufactured, for example, such that the stop element is complementary to an outer contour of at least a portion of the patient's first bone. For example, the step of providing a surgical device can further comprise providing a stop element specific to the patient to be treated. In one embodiment, the stop element is manufactured additively, for example by means of 3D printing.

[0068] The method further comprises inserting the surgical device into the patient's body such that the stop element is positioned on a first bone of the hip joint. Insertion may further comprise fixing the device to the first bone, for example, by means of a fixation element.

[0069] The method further comprises machining, in particular abrasive machining, of a second bone of the hip joint using the machining means. The method further comprises removing the device from the patient's body.

[0070] In one embodiment, the processing means comprises a milling cutter with a milling head, and the processing comprises milling the second bone. In one embodiment, the first bone comprises the acetabulum, and the second bone comprises the femur, in particular the femoral head and femoral neck of the femur.

[0071] In one embodiment, the step of working on the second bone comprises moving a thigh, for example a leg, of the patient. The movement of the patient's leg results in a movement of the second bone relative to the first bone. For example, the movement of the leg can comprise a movement of the femoral head within the acetabulum. The movement of the leg can comprise, for example, rotating, pivoting, angling, and / or extending the leg. Those skilled in the art will understand that the leg that comprises the second bone is moved. For example, if the second bone is the right femur, then the right leg is moved. Either the entire leg or just the femur can be moved. In one embodiment, working on the second bone comprises rotating, pivoting the femur towards the torso and / or away from the torso.Additionally or alternatively, working on the second bone may involve lateral rotation or pivoting of the femur.

[0072] In one embodiment, the surgical device is introduced into the patient's body in such a way that the treatment means can treat a large area of ​​the femoral head and femoral neck through axial movement of the treatment means relative to the stop element and through the movements of the thigh or leg mentioned in the previous paragraph. For example, from the perspective of the patient to be treated, the surgical device can be inserted from the front, laterally, or from a direction in between. "Lateral" refers to the side of the patient, facing the arm.

[0073] In one embodiment, the method comprises a further step that is performed between providing the surgical treatment system and inserting the surgical device, wherein this further step comprises inserting a leg of the patient into a second holding unit. The step of working on the second bone of the hip joint can, in this embodiment, comprise, for example, moving the leg inserted into the second holding unit. The movement of the inserted leg can be performed by a physician and / or by a robot. The movement of the inserted leg can, for example, be controlled by the controller. The controller can, for example, be part of a robot. The second holding unit can, for example, comprise a flexible leg holder.

[0074] In one embodiment, the method is performed on patients between the ages of 10 and 50, preferably between 15 and 40. In one embodiment, the patients are male or female, preferably male. In one embodiment, the method is used to treat FA1s, preferably camshaft FA1s.

[0075] One advantage of the disclosed method is that it can be used to treat, for example, femoroacetabular impingements (FAI). By correcting FAIs, osteoarthritis can be slowed or stopped. To facilitate understanding, various embodiments have been described in the present disclosure by way of example in connection with certain aspects of the disclosure. However, the embodiments described in the present disclosure are embodiments that relate to all subject matter according to all aspects of the present disclosure. In particular, the embodiments described in connection with the first aspect of the disclosure are also embodiments of the method according to the fourth aspect of the present disclosure. This also applies accordingly to the other aspects of the present disclosure.

[0076] It should be understood that both the foregoing general description and the following detailed description illustrate embodiments and serve to provide an overview or framework for understanding the nature and character of the disclosure. The accompanying drawings are included to further understand and are incorporated in and constitute a part of this description. The drawings illustrate various embodiments and, together with the description, serve to explain the principles and operation of the concepts presented.

[0077] SHORT DESCRIPTION OF THE CHARACTERS

[0078] Aspects of the invention are explained in more detail with reference to the exemplary embodiments shown in the following figures and the associated description. They show: Figs. 1a, 1b schematically show a human hip joint with a camshaft impingement;

[0079] Fig. 2 shows a possible introduction of an embodiment of the disclosed device; Figs. 3-5 show several embodiments of the device of the present disclosure;

[0080] Fig. 6 shows the treatment of a human hip joint with camshaft impingement for the embodiment shown in Figure 5. DESCRIPTION OF AN EMBODIMENT

[0081] Figures 1a and 1b illustrate a human hip joint with camshaft impingement (also referred to as cam impingement). The femoral head 2b is enlarged and not sufficiently tapered at the transition to the femoral neck, as illustrated in the figures by the hatched areas. This causes the femoral head 2b, at its expanded tapering, to strike the acetabulum 2a during hip movement (illustrated by the arrow in Fig. 1a indicating a rotational movement, which moves the hip joint into the position shown in Figure 1b), creating large compressive and shear forces that damage the articular cartilage of the acetabulum 2a and ultimately lead to a cartilage defect. The wear process can ultimately result in the development of hip osteoarthritis, which may require a total hip replacement.

[0082] Figure 2 illustrates a device 1 according to the present disclosure, which can be used, for example, to treat camshaft impingement. As illustrated in Figure 2, the device can be introduced into the body, for example, through a tissue protection tube T (typically with a trocar) for subsequent use to treat the camshaft impingement. The tissue protection tube allows for minimally invasive introduction of the surgical device into the body.

[0083] Figures 3 and 4 show embodiments of the device 1 according to the present disclosure. In both embodiments, the device 1 comprises a sleeve 3. A guide 6 is displaceably mounted within the sleeve 3. At a proximal end P of the guide, a machining means 5 is arranged, which is designed for the abrasive machining of a femoral head and a femoral neck 2b. In the illustrated embodiment, the machining means 5 is a milling cutter. In the illustrated embodiment, the guide is displaceable relative to the sleeve only in an axial direction A. The axial direction extends essentially vertically in Figure 3.

[0084] The device 1 shown in Figure 3 further comprises a stop element 4. The stop element 4 is arranged at a proximal end P of a fixing rod 7. The fixing rod 7 extends substantially along the axial direction A. The fixing rod 7 can, for example, be connected to the sleeve 3. In the illustrated embodiment, the stop element 4 is connected to the sleeve 3 at the proximal end P of the sleeve 3. The stop element 4 rests, as illustrated in Figure 3, on the acetabulum 2a. Preferably, the stop element 4 comprises at least one screw for releasably fixing the stop element 4 to the acetabulum 2a.

[0085] Due to the axial displaceability of the guide 6 within the sleeve 3, the machining means 5 is axially displaceable relative to the sleeve 3. Thus, the machining means 5 in the illustrated device is also axially displaceable relative to the stop element 4. The illustrated device 1 is further configured such that the machining means 5 is also movable in at least one transverse direction relative to the stop element 4. Preferably, the machining means 5 is movable in both transverse directions relative to the stop element 4.

[0086] The embodiment shown in Figure 4 also comprises a stop element 4. This comprises a claw structure with two claws, which is designed to be pivotable. In order to introduce the device in a minimally invasive manner, the claw structure is preferably initially in an insertion position (schematically indicated in Figure 2), in which it extends substantially along the axial direction A. After insertion, the claw structure is transferred, preferably by a bilateral pivoting movement, from the insertion position into a processing position. In this processing position, the claw structure preferably extends along a transverse plane that is orthogonal to the axial direction. The claw structure preferably comprises at least one screw 42 on each side for releasably fixing the claw structure to the

[0087] Acetabular cup 2a. The claw structure may further comprise additional fixation elements such as barbs and / or nails 41.

[0088] To treat camshaft impingement, the stop element 4 is typically first detachably connected to the acetabulum 2a, as shown in Figures 3 and 4. Subsequently, the femoral head 2b and the femoral neck are abrasively machined by the machining means 5, which in the illustrated embodiment is designed as a milling cutter with a milling head 51. The milling head 51 is axially movable relative to the stop element 4, and thus relative to the femoral head 2a. This allows for a waisting of the femoral head at the transition to the femoral neck through abrasive machining. During the procedure, for example, one of the patient's legs can be moved, which consequently moves the femoral head 2b within the femoral head 2a, and thus the femoral head and femoral neck are waisted by the machining means.Due to the controlled axial mobility of the machining means 5 relative to the acetabulum 2a, the waisting can be carried out with high precision.

[0089] Figure 5 shows a further embodiment of the device 1 according to the present disclosure. The device 1 shown in Figure 5 is also suitable for treating camshaft impingement. It also comprises a guide 6 which is displaceably mounted within a sleeve 3 and is connected to a milling head 51 at a proximal end P of the sleeve 3. The axial direction A is indicated in Figure 5 by a dashed arrow and the letter A. The axial direction corresponds to the x-axis of the indicated coordinate system. A y-axis and a z-axis run orthogonal to the x-axis, with the z-axis extending orthogonally to the paper plane and being indicated by a circle. The y-axis and z-axis represent the first and second transverse directions, respectively.

[0090] In the embodiment shown in Figure 5, the sleeve 3 is connected to a fixing rod 7 via a spacing element 8. The stop element 4 is arranged at a proximal end P of the fixing rod 7. The stop element 4 allows the device 1 to be releasably fixed to a first bone 2a, for example to an acetabulum 2a. The spacing element 8 is configured to allow the sleeve 3 to be moved in the first transverse direction relative to the fixing rod 7. In the embodiment shown, the device comprises two spacing elements 8, each comprising two rods that are each displaceably mounted in a rail arranged on the fixing rod 7. The spacing elements 8 allow the processing means 5 to be displaced relative to the stop element 4 in the first transverse direction. Depending on the application, the spacing elements 8 can be controlled either identically or differently.For example, the two spacing elements can be extended or retracted simultaneously and to the same extent to achieve a linear displacement of the sleeve 3 relative to the fixing rod 7. It is also conceivable for the two spacing elements 8 to be extended or retracted differently. For example, only a distal spacing element can be selectively extended while a proximal spacing element remains stationary in order to achieve a pivoting movement of the sleeve 3 relative to the fixing rod 7. Due to the displaceable mounting of the guide 6 within the sleeve 3, the machining means 5 can be moved in the axial direction relative to the stop element 4. This allows for precise waisting of the femoral head 2b or the femoral neck during the procedure.

[0091] Figure 6 shows an example of how the embodiment of the device 1 shown in Figure 5 can be used to treat a human hip joint with camshaft impingement. As shown, the stop element 4 rests against the acetabulum 2a in a peripheral region of the acetabulum and is preferably detachably connected to it. The peripheral region of the acetabulum 2a is preferably the outer portion of the acetabulum located within 3 cm of the transition to the femoral head.

[0092] Preferably, the device 1 is positioned such that a movement of the patient's leg in combination with a relative movement of the processing means 5 to the stop element 4 in the axial direction and the first transverse direction enables at least a relative positioning of the processing means 5 in all three spatial directions. Said movement of the leg can, for example, comprise a bending of the leg combined with rotations in all directions, in particular internal and external rotations.

[0093] The device disclosed herein may optionally further comprise a bracing structure 9. This bracing structure 9 is shown in dashed lines in the embodiment shown in Figure 6. The bracing structure 9 is configured to position the device on the iliac crest. The bracing structure 9 comprises a bracing stop element 91. In one embodiment, the bracing stop element 91 is movable relative to the stop element 4. For example, the bracing structure 9 may be telescopically extendable and / or pivotable relative to the fixing rod 7. Furthermore, different sections of the bracing structure 9 may be pivotable relative to one another. These embodiments enable the bracing stop element 91 to be applied to different iliac crest positions. The various embodiments of the present disclosure offer a number of advantages.

[0094] For example, a simple yet precise correction of the shape of the femoral neck is possible, effectively eliminating the cause of camshaft impingement. Furthermore, the device allows a reamer to be attached to the rim of the acetabulum so that it just touches the spherical part of the head. By moving the femoral head, all portions outside the spherical surface are removed, ultimately resulting in a perfectly formed head-femoral neck junction. LIST OF REFERENCE SYMBOLS

[0095] 1 device

[0096] 2 hip joint

[0097] 2a First bone / acetabulum

[0098] 2b Second bone / femoral head with neck

[0099] 3 sleeve

[0100] 4 stop element

[0101] 41 nails

[0102] 42 screw

[0103] 5 processing tools

[0104] 51 milling head

[0105] 6 Guide

[0106] 7 Fixing rod

[0107] 8 spacing element

[0108] 9 Bracing structure

[0109] 91 Bracing stop element

[0110] A Axial direction

[0111] D Distal

[0112] P Proximal

[0113] T Tissue protection tube

Claims

PATENT CLAIMS 1. Surgical device (1) for the abrasive treatment of a hip joint (2) comprising a first bone (2a) and a second bone (2b), the device (1) comprising: a. a sleeve (3) extending along an axial direction (A), b. a stop element (4) for positioning the device (1) on the first bone (2a); c. a treatment means (5) configured for the abrasive treatment of the second bone (2b); and d. a guide (6) connectable to the treatment means (5) for Guiding the processing means (5), wherein the guide (6) is in operative connection with the stop element (4).

2. Surgical device (1) according to claim 1, wherein the device (1) is designed such that the processing means (5) is movable relative to the stop element (4) in a transverse direction, preferably within a transverse range of motion of 1 mm to 40 mm, preferably of 1 mm to 20 mm.

3. Surgical device (1) according to claim 1 or 2, wherein the device (1) is designed such that the processing means (5) is movable relative to the Stop element (4) is movable in the axial direction (A), preferably within an axial movement range of 1 mm to 70 mm, in particular of 5 mm to 40 mm.

4. Surgical device (1) according to one of claims 1-3, wherein the device (1) is designed such that the processing means (5) is movable relative to the sleeve (3) in the axial direction (A), preferably only in the axial direction (A).

5. Surgical device (1) according to one of the preceding claims, wherein the processing means (5) comprises a milling cutter with a milling head.

6. Surgical device (1) according to claim 5, wherein the milling head has a diameter of 3 mm to 10 mm, preferably 5 mm to 7 mm, in particular 6 mm.

7. Surgical device (1) according to one of the preceding claims, wherein the stop element (4) is pivotable relative to the sleeve (3).

8. Surgical device (1) according to claim 7, wherein the stop element (4) is adapted to be pivoted from an insertion position into a pivoted-out position.

9. Surgical device (1) according to claim 8, wherein the stop element (4) extends in the insertion position substantially along the axial direction (A).

10. Surgical device (1) according to one of claims 8 or 9, wherein the stop element (4) extends radially away from the sleeve (3) in the pivoted-out position.

11. Surgical device (1) according to one of the preceding claims, wherein the stop element (4) comprises a fixing element for fixing the device (1) to the first bone (2a).

12. Surgical device (1) according to claim 11, wherein the fixing element comprises a claw structure.

13. Surgical device (1) according to one of the preceding claims, wherein the stop element (4) is movable relative to the sleeve (3) in a transverse direction.

14. Surgical device (1) according to one of the preceding claims, wherein the processing means (5), optionally together with the sleeve (3), is pivotable relative to the stop element (4).

15. Surgical device (1) according to one of the preceding claims, wherein at least one invasive working portion of the surgical device (1) has an elongated shape in the insertion position of the surgical device (1), so that the invasive working portion of the surgical device can be inserted into the body along its length through a tissue protection tube (T).

16. Surgical treatment system comprising a surgical device (1) according to one of the preceding claims and a patient positioning unit for positioning a patient, wherein the surgical device (1) and the positioning unit are operatively connected to one another.

17. Surgical treatment system according to claim 16, wherein the positioning unit comprises a first holding unit for holding a first body part of the patient and a second holding unit for holding a second body part of the patient, wherein the first holding unit and the second holding unit are movable relative to each other.

18. A method for the abrasive processing of a hip joint (2) of a patient, comprising: a. providing a surgical device (1) according to any one of claims 1-15 or a surgical treatment system according to any one of claims 16-17; b. introducing the surgical device (1) into the patient's body such that the stop element (4) is positioned on a first bone (2a) of the hip joint (2); c. processing a second bone (2b) of the hip joint (2) by means of the processing means (5); and d. removing the device (1) from the patient's body.

19. The method according to claim 18, wherein the processing means (5) comprises a milling cutter with a milling head and the processing comprises milling the second bone (2b).

20. Method according to one of claims 18 or 19, wherein the first bone (2a) comprises the acetabulum and the second bone (2b) comprises the Femur, in particular the hip bone and the femoral neck of the femur.

21. A method according to any one of claims 18-20, wherein the step of machining the second bone (2b) comprises moving a leg of the patient.

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