Orthopedic adapter for electric impacting tool

Abstract

To provide an adapter for an electrically driven orthopedic impacting tool.SOLUTION: An electrically driven orthopedic impactor 200 may include an adapter for interfacing an adapter 202 and a surgical implement. The adapter may have a first surface that transmits a forward impact energy and a second surface that transmits a reverse impact energy. The adapter can connect to the surgical implement and to the orthopedic impactor without the use of external tools. The adapter may connect to the impactor via a pushing motion and may disconnect from the impactor via a reciprocal sleeve. A sensor can communicate a spatial orientation of the adapter with respect to at least one reference point that is not located on the adapter or the impactor. A communication device may transmit frequency information or impact energy information to the impactor on the basis of a type of a surgical implement attached to the adapter.SELECTED DRAWING: Figure 2A

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims priority to U.S. Provisional Patent Application No. 62 / 599,616, entitled "Orthopedic Adapter for an Electric Impacting Tool," filed December 15, 2017. This application is related to the following prior patent applications, which are directed to orthopedic impacting devices: U.S. patent application Ser. No. 12 / 980,329, entitled "Electric Motor Driven Tool for Orthopedic Impacting," filed on December 29, 2010, now U.S. Patent No. 8,695,726; U.S. patent application Ser. No. 13 / 466,870, entitled "Electric Motor Driven Tool for Orthopedic Impacting," filed on May 8, 2012, now U.S. Patent No. 8,393,409; U.S. patent application Ser. No. 13 / 790,870, entitled "Electric Motor Driven Tool for Orthopedic Impacting," filed on March 8, 2013, now U.S. Patent No. 8,602,124; and U.S. patent application Ser. No. 14 / 250,102, entitled "Electric Motor Driven Tool for Orthopedic Impacting," filed on April 10, 2014, now U.S. Patent No. 9,901,354. U.S. patent application Ser. No. 14 / 332,767, filed July 16, 2014, entitled "Electric Motor Driven Tool for Orthopedic Impacting," now U.S. Patent No. 8,936,105; U.S. patent application Ser. No. 14 / 332,790, filed July 16, 2014, entitled "Electric Motor Driven Tool for Orthopedic Impacting," now U.S. Patent No. 8,936,106; U.S. patent application Ser. No. 14 / 850,588, filed September 10, 2015, entitled "Electric Motor Driven Tool for Orthopedic Impacting," now U.S. Patent No. 8,936,106;No. 620, entitled "Electric Motor Driven Tool for Orthopedic Impacting," filed on September 10, 2015; U.S. Patent Application No. 14 / 850,639, entitled "Electric Motor Driven Tool for Orthopedic Impacting," filed on September 10, 2015; U.S. Patent Application No. 14 / 850,660, entitled "Electric Motor Driven Tool for Orthopedic Impacting," filed on September 10, 2015; U.S. Patent Application No. 14 / 850,674, entitled "Electric Motor Driven Tool for Orthopedic Impacting," filed on September 10, 2015; U.S. Patent Application No. 14 / 850,695, entitled "Electric Motor Driven Tool for Orthopedic Impacting," filed on September 10, 2015. U.S. patent application Ser. No. 14 / 992,781, filed January 11, 2016, entitled "Electric Motor Driven Tool for Orthopedic Impacting," U.S. patent application Ser. No. 15 / 009,723, filed January 28, 2016, entitled "Battery Enclosure for Sterilizable Surgical Tools Having Thermal Insulation," U.S. patent application Ser. No. 15 / 098,662, filed April 14, 2016, entitled "Electric Motor Driven Tool for Orthopedic Impacting," U.S. patent application Ser. No. 15 / 439,692, filed February 22, 2017, entitled "Orthopedic Impacting Device Having a Launched Mass Delivering a Controlled, Repeatable & Reversible Impacting" "Orthopedic Impacting Device Delivering a Controlled Force," U.S. Patent Application No. 15 / 446,862, filed March 1, 2017, entitled "Orthopedic Impacting Device Delivering a Controlled Force,""Repeatable Impact," U.S. Patent Application No. 15 / 544,317, filed July 18, 2017, entitled "Battery Enclosure for Sterilizable Surgical Tools Having Thermal Insulation," U.S. Patent Application No. 15 / 600,234, filed May 19, 2017, entitled "Orthopedic Impacting Delivering a Controlled, Repeatable Impact," U.S. Patent Application No. 15 / 600,284, filed May 19, 2017, entitled "Orthopedic Impacting Device Having a Launched Mass Delivering a Controlled, Repeatable & Reversible Impacting Force," U.S. Patent Application No. 15 / 677,933, filed August 15, 2017, entitled "Electric Motor Driven Tool for Orthopedic No. 15 / 789,493, filed October 20, 2017, entitled "Orthopedic Impacting Device Having a Launched Mass Delivering a Controlled, Repeatable & Reversible Impacting Force," and U.S. patent application Ser. No. 15 / 857,385, filed December 28, 2017, entitled "Electric Motor Driven Tool for Orthopedic Impacting." All of the above-identified applications are incorporated herein by reference in their entirety. [Background technology]

[0002] The present disclosure relates to an adapter for a powered surgical impacting tool used in surgical applications such as orthopedic procedures, including procedures using a motor-driven tool for bidirectional surgical impaction driven by a projectile mass to provide controlled, repeatable impacts to surgical instruments.

[0003] In the field of orthopedics, prosthetic devices, such as artificial joints, are often implanted or seated within a patient's bone cavity. The cavity is typically created during surgery before the prosthesis is seated or implanted. For example, a physician may remove or compress existing bone to create the cavity. The prosthesis usually includes a stem or other protrusion that is inserted into the cavity.

[0004] To create the lacunae, a physician may use a broach that conforms to the shape of the stem of the prosthesis. Solutions known in the art include providing a handle with the broach for the physician to manually strike during surgery to drive the broach into the implant area. Unfortunately, this approach is notoriously crude and imprecise, resulting in unnecessary mechanical stress on the bone. Results can be unpredictable and depend on the skill of the particular physician. Historically, this approach often resulted in inaccuracies in the location and configuration of the lacunae. Additionally, the surgeon is required to expend an inordinate amount of physical force and energy to strike the broach and manipulate the bone and prosthesis. Most importantly, this approach carries the risk of the physician causing unnecessary additional trauma to the surgical area and damaging otherwise healthy tissue, bone structure, etc.

[0005] Another technique for creating an artificial lacuna is to pneumatically, i.e., drive the broach with compressed air. This approach has disadvantages in that it hinders the portability of the impact tool, for example, due to the presence of tethered air lines, air venting from the tool into the sterile surgical site, and fatigue for the surgeon operating the tool. This approach, as exemplified in U.S. Pat. No. 5,057,112, does not allow for precise control of impact force or frequency, instead functioning much like a jackhammer when actuated. Again, this lack of precise control makes accurate broaching of the lacuna more difficult and can result in unnecessary patient complications and trauma. These types of tools can produce movements with a wide range of motion perpendicular to the cutting axis, further hindering accuracy and precision. In some instances, such accuracy and precision, or lack thereof, can be quantified by describing the total indicator reading ("TIR") of a surgical instrument connected to the tool's adapter.

[0006] A third technique relies on a computer-controlled robotic arm to create the cavity. While this approach overcomes the fatigue and precision issues, it suffers from a very high capital cost and eliminates the tactile feedback that surgeons can get from manual approaches. Furthermore, unless the approach relies on milling, an impact means (pneumatic, electric, or manual) is still required.

[0007] Other techniques may include hammer throwing methods using the inventor's own work and including linear compressors, vacuum actuation, or mechanical or gas springs, all of which are powered. However, in hammer throwing methods, the use of existing commercially available adapters to couple the impact energy created by the thrown mass (hammer) or striker from within the powered impactor to the surgical instrument has resulted in very poor coupling of the internal energy to the surgical instrument, with losses of 50% or more being typical. Summary of the Invention [Problem to be solved by the invention]

[0008] As a result, a need exists for an improved adapter between an impact tool and a surgical instrument that overcomes various disadvantages of existing adapters. [Means for solving the problem]

[0009] In consideration of the aforementioned disadvantages, an adapter for an orthopedic impacting tool driven by an electric motor is provided to enable coupling of a surgical instrument capable of delivering orthopedic impact to the tool, such as a hip, knee, or shoulder. The adapter can hold a broach, chisel, or other end effector and deliver a force from the impactor with a controlled vibrational impact into the laminae to gently tap the broach, chisel, or other end effector, resulting in a better fit to the prosthesis or implant. The adapter can also be used for placement and removal of broaches, implants, cups, liners, head balls, nails, wires, pins, and other devices. Furthermore, the adapter can enable additional control of the powered orthopedic impactor by transmitting or otherwise directing impact settings based on the patient, surgical instrument, or surgical procedure. The adapter further enables proper seating and, in the case of bidirectional movement, removal of a prosthesis or implant into or from the laminae, beneficially augmenting existing surgeon skills in guiding the powered orthopedic impactor.

[0010] To provide context, a brief description of a powered orthopedic impactor is provided (other similar related devices are also described in the related applications identified above and incorporated herein by reference). An electric motor-powered orthopedic impacting tool includes a power source (battery, fuel cell, or compressed gas cartridge), a motor assembly, a controller, a housing, a stored energy system or mechanism such as a gas spring or mechanical spring that can store and release potential energy, and a striker biased to move in a forward and / or rearward direction by the stored energy drive system, which can generate an impact force in either the forward or rearward direction.

[0011] In one embodiment, the adapter is used to transfer force between the powered impactor and the surgical instrument. In a further embodiment, the adapter has two separate surfaces that are used to transfer the impulse forward or backward from the powered impactor (hereafter referred to as the tool) to the surgical instrument.

[0012] In one embodiment, the surgical instrument can be combined with the adapter.

[0013] In one embodiment, the adapter transfers at least 50% of the striker's energy to the surgical instrument.

[0014] In an exemplary embodiment, the adapter communicates to the tool whether the surgeon or robot is either pushing or pulling the adapter and surgical instrument toward or away from the patient.

[0015] In a further exemplary embodiment, a surgical instrument (e.g., a broach, chisel, or other end effector) can be rotated to several positions while still maintaining axial alignment, for example, as shown in FIG. 2A, and the adapter can be rotated to four different positions, each position rotated 90°. This facilitates use of the adapter or broach in various anatomical presentations during a surgical procedure, for example.

[0016] In some embodiments, the adapter is configured to communicate the spatial position of the adapter relative to the patient. For example, the adapter or impactor may include sensors and / or cameras that communicate the relative position and / or alignment of the instrument to the patient. This can be achieved by tracking reference points relative to the patient and not positioned on the adapter or impactor. In further embodiments, the sensors may be configured to communicate the position of the adapter or impactor in coordination with a surgical navigation system to inform the surgeon or robot of the position compared to an optimal position, a planned final position, or any other desired position.

[0017] In an exemplary embodiment, the adapter of the implement includes at least one of two impact points: a forward striking surface or first surface, and a rearward striking surface or second surface.

[0018] In an exemplary embodiment, the anvil and adapter may comprise a single element, or one may be integral with the other.

[0019] In an exemplary embodiment, the adapter weighs less than the anvil, striker, or other thrown mass of the impactor.

[0020] In an exemplary embodiment, the weight of the adapter is less than half the weight of the impactor tool, and preferably less than 40% of the weight of the impactor.

[0021] In an exemplary embodiment, the adapter is substantially axially aligned with the anvil, striker, or other projected mass of the impactor. This has an unexpected advantage in that bone is an anisotropic material and is strongest in compression, then tension, then shear. By keeping the forces aligned, the action of the tool places less stress on the bone, resulting in better results.

[0022] In an exemplary embodiment, the adapter can transfer force, frequency, and throw settings to the tool based on the surgical instrument or surgical procedure.

[0023] In an exemplary embodiment, the adapter can include a dampening mechanism, such as a viscoelastic material or a resilient or mechanical spring, that limits the total energy transferred from the tool to the surgical instrument. The dampening device can be selected or configured to provide any desired capability, such as a particular level of dampening or dampening only in a particular direction. For example, the dampening device can reduce the impact energy from the tool by 10% or 50%, preferably at least 20%, or the dampening device can dampen energy only in the forward direction, leaving a more abrupt impact force in the rearward direction.

[0024] In exemplary embodiments, the adapter may include a mechanism that creates an audible or visual cue that indicates that the adapter is properly connected to the tool. For example, tabs, grooves, raised edges, and other similar features may be configured to snap into place and create an audible cue upon proper connection of the adapter to the tool or surgical instrument. A visual cue may also indicate that the adapter is properly connected to the tool or surgical instrument. For example, a window or other designated area on the adapter, tool, or surgical instrument may display red when the adapter is not properly connected and green when the adapter is properly connected.

[0025] In an exemplary embodiment, the adapter may be connected to a surgical instrument having cutting teeth useful for final shaping of the bone prior to placement of the implant. In a still further embodiment, the pitch (spacing in the direction of impact) of the cutting teeth is determined to be less than the power throw of the instrument. In a still further embodiment, it has been found beneficial to have bidirectional cutting teeth, which allows for bone shaping in both forward and rearward impacts.

[0026] These, together with the various features of novelty which characterize this disclosure, as well as other aspects thereof, are particularly pointed out in the claims annexed hereto and forming a part hereof. For a better understanding of the present disclosure, its operating advantages, and certain non-limiting objectives attained by its uses, reference should be made to the accompanying drawings and detailed description, in which illustrative embodiments of the disclosure are shown and described.

[0027] The foregoing general description of exemplary implementations and the following detailed description thereof are merely exemplary aspects of the teachings of the present disclosure and are not limiting. [Brief explanation of the drawings]

[0028] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate one or more embodiments and, together with the description herein, explain these embodiments. The accompanying drawings are not necessarily drawn to scale. Any values ​​and dimensions shown in the accompanying graphs and figures are for illustrative purposes only and may or may not represent actual or preferred values ​​or dimensions. Where applicable, some or all features may not be shown to aid in the explanation of underlying features. The drawings are as follows: [Figure 1] 1 shows a perspective view of an orthopedic impacting tool. [Figure 2A] 1 shows a diagram of an adapter with an impactor having four different degrees of rotation about the insertion axis. [Figure 2B] The impactor, adapter, and surgical instrument are shown as three separate parts. [Figure 2C] 1 shows the connected impactor, adapter, and surgical instrument. [Figure 3] 1 shows a cross-sectional view of an impactor. [Figure 4] The mass of the impact tool is shown for calculating the mass ratio. [Figure 5] 1 shows the measurement of TIR for an adapter connected to the output of the tool. [Figure 6A] 1 shows the adapter with the reciprocating sleeve as it is inserted into the tool. [Figure 6B] 1 shows the adapter with the reciprocating sleeve as the adapter is removed from the tool. [Figure 7] 1 shows an orthopedic surgical instrument used to reshape bone by providing cutting teeth in at least one direction. [Figure 8] 1 shows an adapter that includes features for communicating with an impactor or surgical instrument. DETAILED DESCRIPTION OF THE INVENTION

[0029] The following description, taken in conjunction with the accompanying drawings, is intended to be a description of various exemplary embodiments of the disclosed subject matter. Specific features and functionality are described in connection with each exemplary embodiment. However, it will be apparent to one skilled in the art that the disclosed embodiments may be practiced without each of those specific features and functionality.

[0030] References throughout this specification to "one embodiment" or "an embodiment" mean that a particular feature, structure, or characteristic described in connection with an embodiment is included in at least one embodiment of the disclosed subject matter. Thus, the appearances of the phrases "in one embodiment" or "in an embodiment" in various places throughout this specification are not necessarily all referring to the same embodiment. Furthermore, particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Furthermore, embodiments of the disclosed subject matter are intended to cover such modifications and variations.

[0031] It should be noted that, as used in this specification and the appended claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise. That is, unless expressly specified otherwise, when used herein, the words "a," "an," "the," etc., mean "one or more." In addition, terms such as "left," "right," "top," "bottom," "front," "rear," "side," "height," "length," "width," "upper," "lower," "internal," "external," "inside," and "outside" that may be used herein are understood to merely describe points of reference and do not necessarily limit embodiments of the present disclosure to any particular orientation or configuration. Furthermore, terms such as "first," "second," and "third" merely identify one of many parts, components, steps, operations, functions, and / or points as disclosed herein and, similarly, do not necessarily limit embodiments of the present disclosure to any particular configuration or orientation.

[0032] Additionally, the terms "approximately," "about," "approximately," "slight variation," and similar terms generally refer to ranges that include, in certain embodiments, within 20%, 10%, or preferably 5% limits of the identified value, and any value therebetween.

[0033] All functionality described in connection with one embodiment is intended to be applicable to the additional embodiments described below, unless expressly stated otherwise or unless the feature or function is incompatible with the additional embodiments. For example, if a given feature or function is explicitly described in connection with one embodiment but not explicitly mentioned in connection with an alternative embodiment, it should be understood that the inventors intend that the feature or function can be developed, utilized, or implemented in connection with the alternative embodiment, unless the feature or function is incompatible with the alternative embodiment.

[0034] Describing an exemplary tool with which the improved adapter can communicate, a motor-driven orthopedic impact tool is provided with controlled vibrational impacts. The motor may be electric, such as a brushless, autoclave motor, such as those commonly available from Maxon Motor® and / or Portescap®. The motor may be battery-powered. Energy supply to the orthopedic impact tool can provide wireless portability and transmission for the orthopedic impact tool. The tool may include the ability to perform single and multiple impacts, as well as impacts of variable and varied direction, force, and frequency. In some embodiments, the impact energy is adjustable. In certain embodiments, the impact is transmitted to a surgical instrument, such as a broach, chisel, or other end effector, connected to the tool.

[0035] In some embodiments, the tool includes a housing. The housing can securely encase and retain at least one component of the instrument and may be formed of a material suitable for surgical applications, such as aluminum or polyphenylsulfone (PPSF or PPSU), also known as Radel®. In some embodiments, the housing includes a motor assembly, at least one reduction gear, a spring element, a striker or fired mass, a control circuit or module, an anvil, a first or forward striking surface for a forward impact, and a different second or rearward striking surface for a rearward impact. The motor assembly may include a linear motion converter for converting the rotary motor drive. The spring element may be a mechanical spring, an elastic spring, or a gas spring.

[0036] The tool may further include a handle portion with an optional handgrip for comfortably and securely holding the tool, or a suitable mounting interface for integrating the tool into a robotic assembly during use, as well as an adapter, a battery, and position, orientation, and torsion sensors. The tool may further deliver focused illumination from a semiconductor light source, such as an LED or a conventional incandescent light source, to provide light to the surgical work area where the surgeon uses the tool. The anvil may be coupled to surgical instruments known in the art, such as broaches, chisels, or other end effectors, through the use of an interfacing adapter, which may have a quick-connect mechanism to facilitate rapid changeover between different cut sizes. The tool may further include an axially locking but rotationally variable feature that allows the adapter to be positioned in different spatial manners to obtain tissue clearance for tool features such as the handle.

[0037] In some embodiments, the axis of the launching or thrown mass is axially aligned along the direction of motion to within 20 degrees of the axis of the adapter, and more preferably within 10 degrees of the axis of the adapter. Such axial alignment is important from the standpoint of maximizing energy transferred to the surgical instrument as well as minimizing the generation of off-axis forces, which can contribute to adverse surgical outcomes such as fractures. The inventors have discovered that these benefits of axial alignment are, in part, a result of bone being an anisotropic material, making it stronger against compression or tension forces than against shear forces.

[0038] The inventors have determined that the mass ratio and materials used for the projectile or thrown mass, anvil, and adapter are important in terms of how efficiently the kinetic energy of the thrown mass is transferred to the surgical instrument. For purposes of certain embodiments, the ratio of energy delivered to the surgical instrument as a function of the kinetic energy in the thrown mass or striker is referred to as the transfer function. The transfer function is used as a measure of performance in terms of how efficiently the tool performs a broaching, impacting, or extraction surgical procedure. For example, in one design in which the thrown mass, anvil, and adapter were all made of hardened stainless steel, the ratio of energy transferred to the surgical instrument to the kinetic energy of the thrown mass, or transfer function, was found to be less than 50%. By increasing the mass ratio of the thrown mass to the impacted mass (the sum of the masses of the anvil, adapter, and surgical instrument), the efficiency of the adapter and system, specifically the transfer function of the adapter and system, increased by more than 60%, and in many cases, close to 75%. FIG. 4 illustrates one embodiment of the tool, showing the aforementioned masses, including an impact mass 400 and a thrown mass 402 .

[0039] In a further embodiment, the tool includes a compliance element inserted between the striker and the adapter. Preferably, the compliance element is a resilient material that recovers sufficiently from impact and provides minimal cushioning to the total energy. As one example, a urethane component can be inserted at the interface where the striker impacts the anvil. In another example, the compliance element may be inserted in a manner that only reduces the forward impact force but does not affect the need for sudden rearward impact forces. This type of compliance element can limit peak forces during impact, preventing such peaks from causing fractures in the patient's bone, yet maintain the high peak forces necessary to be able to retract a loaded broach or other surgical instrument.

[0040] In some embodiments, for example, the impactor is coupled to the robot, potentially eliminating the need for a portable power source (battery) and / or a hand grip on the tool.

[0041] In some embodiments, coupling the adapter to the tool includes a linkage arrangement or other adjustment mechanism known in the art to allow the surgeon to change the position of the surgical instrument (broach, chisel, or other end effector) without having to rotate the tool.

[0042] FIG. 1 shows a perspective view of one example of an orthopedic impacting tool with which the improved adapter can communicate. A motor 8 of the mechanical spring assembly system is provided in combination with a linear motion converter including a cannular or cylindrical cam 12 and a cam follower 13 to actuate a first spring piston 19a and / or a projectile mass or striker 15, ultimately generating a forward impact force. (A second spring piston 19b is also provided, engaging a second spring 2b compressed against a second pusher plate 26b to generate a rearward impact force.) Note that piston generally refers to a piercing or pushing element and can have any of several shapes. The spring assembly system, in some embodiments, further includes an anvil 5.

[0043] The cylindrical cam 12 may include a cylindrical portion 120 mounted longitudinally on a shaft 122 extending between the motor 8 and a bearing support 124, and a worm 126 projecting radially from the cylindrical portion 120 and spirally along the length of the cylindrical portion 120 from a first worm end 126a to a second worm end 126b.

[0044] The bearing support 124 may include a housing 125 supported by the second pusher plate 26 b and a bearing nested within the housing 125 to support the shaft 122 .

[0045] The worm 126 may include, for example, a rear surface 126bs whose surface faces the first pusher plate 26a, and a front surface 126fs of the worm 126 whose surface faces the second pusher plate 26b, for example, that contacts the cam follower 13 and causes the cam follower 13 to follow a linear movement between the first worm end 126a and the second worm end 126b when the worm 126 rotates.

[0046] The cam follower 13 can be displaced in a forward direction, for example, along the worm 126, toward the second pusher plate 26b, by having the cam follower 13 in contact with the forward surface 126fs of the worm 126 and having the worm 126 rotating in the first direction 42a.

[0047] The cam follower 13 can be displaced rearward, for example, along the worm 126 toward the first pusher plate 26a, for example, by having the cam follower 13 in contact with the rear surface 126bs of the worm 126, whose surface faces the pusher plate 26a, and having the worm 126 rotating in a second direction opposite the first direction 42a.

[0048] The bumpers 14 a and 14 b function as stoppers to prevent the end faces of the pistons 19 a and 19 b from colliding with the striker 15 .

[0049] The cylindrical cam 12 can improve the efficiency of the orthopedic impacting tool by allowing the motor 8 to rotate through a larger angle compared to conventional linear motion converters that may rely on a conventional vertical cam that impinges on the cam follower 13 through a small, repeating stroke. That is, the cylindrical cam 12 allows the motor to use more radians of rotation to obtain energy, thus significantly reducing the current drain on the battery. Thus, in certain embodiments, a single primary battery can be used by taking advantage of the reduced current drain provided by the cylindrical cam 12.

[0050] Additionally, because the barrel cam 12 can be mounted directly onto the shaft 122, the barrel cam 12 can, in some cases, allow for the elimination of an intermediate gear assembly, thereby increasing efficiency while reducing the cost of the orthopedic surgical instrument.

[0051] The tool, in some embodiments, facilitates controlled sequential impacts, which are dependent, for example, on the position of a trigger switch 30 operably coupled to a power source or motor. For such sequential impacts, after the trigger switch is activated and depending on the position of the trigger switch 30, the tool can undergo a complete cycle, for example, at a speed proportional to the position of the trigger switch. Thus, in either the single impact or sequential impact mode of operation, the creation or reshaping of the surgical area can be easily controlled by the surgeon.

[0052] In some embodiments, when the barrel cam 12 assembly completes its course—for example, the cam follower 13 is displaced along either the rear surface 126bs or the front surface 126fs between the first worm end 126a and the second worm end 126b—it preferably activates a sensor 28 operably coupled to the controller 21. The sensor 28 assists in regulating the desired cyclical action of the barrel cam 12. For example, the sensor 28 may signal the motor 8 to stop the barrel cam 12 so that it is at or near a minimum potential energy storage point. Thus, in one complete cycle, a forward or rearward impact force may be applied to a broach, chisel, or other end effector, or to an implant or prosthesis. In further embodiments, it may be beneficial to insert a delay or count the number of impacts for any given procedure before initiating the next cycle, allowing the surgeon to precisely control the rate at which impacts are applied, which in turn allows the surgeon to precisely control the rate of energy delivery in any given operation. In still further embodiments, it may be beneficial to stop the barrel cam 12 near the point of maximum potential energy storage to reduce latency in the surgeon's hand. Latency is defined as the time between when the surgeon (or user) activates the orthopaedic impacting tool and when the tool actually delivers the impact. The inventors have determined that a latency of approximately 100 milliseconds or less will be perceived as an essentially instantaneous response. By stopping the barrel cam 12 at a point where at least a portion of the potential energy is stored, the tool effectively releases potential energy nearly instantaneously upon actuation of the tool trigger 30.

[0053] 2A-8, orthopedic impactors are shown along with various configurations of adapters for use therewith.

[0054] FIG. 2A illustrates a surgical impactor 200 and adapter 202, where the adapter 202 can be inserted into the impactor 200 at any of four different rotations about the impact axis. Of course, while insertion through four different rotations is shown via the square mating surface illustrated in FIG. 2A, additional rotational positions may be possible. For example, an adapter with a hexagonal mating surface could have six different rotational configurations, and an adapter with an octagonal mating surface could have eight different rotational configurations. The different insertion angles allow the surgeon multiple positioning of the surgical instrument while maintaining the ability to hold the tool in a more ergonomic orientation.

[0055] In Figures 2B and 2C, the impactor 200, adapter 202, and surgical instrument 204 (e.g., a broach) are shown in both an unconnected and connected state.

[0056] FIG. 3 illustrates an embodiment in which multiple surfaces on the adapter, such as a front impact surface 300 and a rear impact surface 302, allow for both proximal and distal impact on the adapter and, consequently, the surgical instrument. The ability to generate proximal and distal impacts is particularly useful when an instrument becomes lodged within the laminae. By applying a reverse blow directly to the adapter, the lodged instrument can be easily removed from the laminae. The inventors have discovered that for typical durability over time as a surgical impactor, the surface area should be designed to withstand impact forces in the range of 1 kilonewton to 50 kilonewtons, more specifically, approximately 15 kilonewtons.

[0057] FIG. 5 illustrates locations on an adapter where the adapter's TIR can be measured. As shown, the adapter's TIR should be measured at the adapter's tip 500, and in some embodiments, the adapter should be designed to have a TIR of less than 5 mm, and more preferably less than 2 mm. A small TIR improves the precision of the orthopedic impactor. In use, this precision translates to minimized lacuna distortion, reduced lateral energy loss, improved implant fit, and improved surgical outcomes. By comparison, other known surgical instruments have TIRs on the order of 20 mm. A TIR of 2 mm or less is a significant improvement, producing lacunae with significantly more precise morphology and shape.

[0058] 6A and 6B illustrate one embodiment of an insertion and removal procedure for the adapter connection to the impactor via the reciprocating sleeve.

[0059] In one embodiment, the reciprocating sleeve can include a release collar 606, a snap ring 604, and a retaining clip 602. As shown in FIG. 6A , the adapter 202 is inserted toward the impactor via a single insertion motion 600, securing the connection to the impactor 200. During that motion, the retaining clip 602 within the release collar 606 is pulled apart as the adapter 202 moves inward. The snap ring 604 locks or otherwise seats and holds the retaining clip 602 in place on the adapter 202. In one example, the snap ring 604 can be an O-ring, but may also be implemented as a garter spring or an elastomeric ring.

[0060] 6B, the adapter 202 can be disconnected from the impactor by depressing the release collar 606. The release collar 606 includes a cam surface 608 configured to separate the retaining clip 602 when the release collar 606 is moved. When the retaining clip 602 has separated sufficiently to clear the adapter 202, the adapter 202 can be moved outwardly, away from the impactor 200. In an alternative embodiment, the reciprocating sleeve can include a pinion and rack instead of the cam surface 608 to separate the retaining clip 602 when the adapter 202 is disconnected from the impactor.

[0061] As shown in FIG. 7 , a surgical instrument for use with the adapter and a powered orthopedic impactor has cutting teeth 700 for preparing bone 702 to receive an implant. In one example, the cutting teeth 700 can be arranged on the surface of the impactor such that the teeth 700 cut linearly with the axis of the impactor. In a further embodiment, the teeth can be configured in a manner to improve the fit of a press-fit implant, such as in a knee. In yet a further embodiment, a surgical instrument for use with the adapter may include features that increase the surface area available for bonding with an adhesive implant.

[0062] FIG. 8 shows an example of a sensor 800 included on the adapter 202 that communicates information to the impactor, allowing the surgeon to more precisely control the impactor. The information may be used, for example, to adjust the stroke, power, or frequency of the impact. For example, if the adapter is being used for ball-head seating and continuous impacts are undesirable, the adapter sensor may be configured to communicate a requirement for single actuation rather than repeated impacts to the impactor. In this situation, the surgeon is less likely to cause implant collapse during ball-head impaction, improving surgical outcomes. The adapter may also detect surgical instruments and their type or configuration information, such as the ball-head placement tool example described above, by communicating with the surgical instrument using the same sensor or a second sensor. In some embodiments, the surgical instrument is integrally formed with the adapter and therefore not detachable from the adapter. In these embodiments, the adapter stores information about the surgical instrument and rapidly communicates that information to the impactor.

[0063] As another example, frequency information transmission and control allows the tool to precisely and consistently control the frequency of the impact movement. By adjusting the striker frequency, the tool can deliver a greater total time-weighted vibration impact while maintaining the same impact magnitude. This allows the surgeon to better control the cutting speed of the surgical instrument. For example, the surgeon can choose to cut at a faster speed (higher frequency impacts) during the majority of the surgical instrument's movement, and then slow the cutting speed as the surgical instrument approaches the desired depth. In fact, during tool testing, it was discovered that a higher frequency impact rate of 3 impacts per second, preferably up to 10 impacts per second, coupled with a substantially constant energy per impact, delivered 2-6 joules per second, preferably up to 40 joules per second, allowing the surgeon to better position a particular surgical instrument. This was seen, for example, during seating of the acetabular cup, where an impact frequency of at least 3 impacts per second with an energy of 2-6 joules per second resulted in far greater control of the acetabular cup's position than prior art manual impact techniques. In a further unexpected benefit of the rapid impact capabilities of a powered orthopedic impactor, the inventors discovered that because the movement of the surgical instrument was more fluid and continuous (i.e., less of a start-and-stop function, similar to that of a mallet), the energy required to perform the operation could be reduced. This advantage of rapid impacts (e.g., at rates greater than three per second) is based on the engineering difference between static and dynamic friction. Dynamic friction is almost always less than static friction, and therefore, more continuous movement of a broach, implant, or other surgical instrument allows for a reduction in overall force during surgery. Additionally, it has been the inventors' experience in the operating room that near-continuous movement of a surgical instrument not only lowers the total energy required, but also leads to better surgical outcomes. In certain cases of a widened acetabulum, a reamer can leave valleys and cusps. By using the more continuous or higher-frequency impacts described herein, the valleys and cusps are reduced and effectively resolved. This is clearly observed in many cadaver laboratories. Specifically, when the cup is placed in the acetabulum, closer contact between the surfaces results in better fixation results.

[0064] The information communicated between the adapter, impactor, and surgical instrument may be in the form of settings or other identifying information that is then looked up in a table or database to determine the configuration settings, as described in the examples above. Communication between the adapter, surgical impactor, and surgical instrument can be accomplished in a variety of ways, including mechanical, magnetic, electrical, or wireless (e.g., through radio frequency identification (RFID) technology, etc.).

[0065] While specific embodiments have been described, these embodiments are presented by way of example only and are not intended to limit the scope of the present disclosure. Indeed, the novel methods, apparatus, and systems described herein may be embodied in a variety of other forms. Furthermore, various omissions, substitutions, and changes can be made in the form of the methods, apparatus, and systems described herein without departing from the spirit of the present disclosure. The appended claims and their equivalents are intended to cover such forms or modifications as fall within the scope and spirit of the present disclosure.

[0066] [Embodiment] (1) An adapter configured to interface between a powered orthopedic impactor and a surgical instrument, comprising: a first surface for transmitting forward impact energy; a second surface for transmitting reverse impact energy; The adapter is configured to connect to the surgical instrument and the orthopedic impactor without the use of external tools. (2) The adapter of claim 1, wherein the indicator return (TIR) ​​between the tip of the adapter and the orthopedic impactor is less than 5 mm. (3) The adapter of embodiment 1, wherein the weight of the adapter is less than the weight of a striker in the orthopedic impactor. (4) The adapter of embodiment 3, wherein the weight of the adapter is less than 40% of the weight of the orthopedic impactor. (5) An adapter as described in embodiment 1, wherein the adapter transfer function is greater than 60%.

[0067] (6) An adapter configured to interface between a powered orthopedic impactor and a surgical instrument, comprising: Equipped with a reciprocating sleeve, the adapter is configured to connect to the orthopedic impactor via a pushing action; The adapter is configured to be disconnected from the orthopedic impactor via the reciprocating sleeve. (7) The adapter of embodiment 6, wherein the adapter is configured to be inserted into the orthopedic impactor in at least four orientations along the axis of the orthopedic impactor. (8) The adapter of embodiment 6, further comprising a communication mechanism for communicating with the orthopedic impactor to change one of the frequency, energy, or throw of the orthopedic impactor. (9) The adapter of embodiment 6, wherein the adapter generates an audible or visual cue indicating that the adapter is connected to the powered orthopedic impactor. (10) The adapter of embodiment 6, further comprising a shock absorber that reduces impact energy from the orthopedic impactor in a forward direction by at least 20%.

[0068] (11) The adapter of embodiment 6, wherein the surgical instrument includes teeth adapted to cut bone, the teeth having a spacing distance between the teeth that is less than the throw distance of the impactor. (12) The adapter of claim 11, wherein the teeth include bidirectional cutting teeth configured to cut bone on both forward and rearward impacts of the impactor. (13) The adapter of embodiment 6, wherein the surgical instrument is adapted to increase the surface area available for adhesive bonding of a surgical implant. (14) The adapter of embodiment 6, wherein the surgical instrument includes at least one cutting surface or tooth for cutting linearly relative to the axis of the impactor. (15) An adapter for interfacing with an impactor, an adapter comprising: a sensor configured to communicate a spatial orientation of the adapter relative to at least one reference point, the reference point not being located on the adapter or the impactor.

[0069] (16) An adapter configured to interface between a powered orthopedic impactor and a surgical instrument, comprising: an adapter comprising a communication device configured to communicate frequency information or impact energy information to the powered orthopedic impactor based on the type of surgical instrument attached to the adapter. (17) The adapter of embodiment 16, wherein the adapter is configured to receive information indicative of the type of the surgical instrument from the surgical instrument via the communication device. (18) The adapter of embodiment 17, wherein the communication device operates wirelessly. (19) The adapter of embodiment 16, wherein the surgical instrument is integrated with the adapter and is not detachable from the adapter.

Claims

1. 1. A surgical system comprising: a surgical impacting tool configured to drive forward and rearward impacts against a bone, the surgical impacting tool having a hand grip; an adapter configured to be removably attached to a forward portion of the surgical impacting instrument at a plurality of predetermined rotational orientations relative to the surgical impacting instrument; A surgical system, wherein the rear portion of the adapter has a plurality of flat outer surfaces configured to penetrate an interior of the surgical impacting instrument upon removably attaching the adapter to the surgical impacting instrument.

2. The surgical system of claim 1 , wherein a surface of the adapter defines a surface that can be impacted to drive the impact in the forward direction against bone.

3. the plurality of flat outer surfaces are formed on an enlarged portion of the adapter; The surgical system of claim 2 , wherein the surface that is impacted is a surface of the expansion portion.

4. The surgical system of claim 1 , wherein a surface of the adapter defines a surface that can be impacted to drive the impact in the rearward direction against bone.

5. the plurality of flat outer surfaces are formed on an enlarged portion of the adapter; The surgical system of claim 4 , wherein the surface that is impacted is a surface of the expansion portion.

6. The surgical system of claim 1 , wherein a direction of force applied by a user to the surgical impacting tool is configured to control whether the impact against bone is in the forward direction or the rearward direction.

7. The surgical system of claim 6, further comprising a sensor configured to detect the direction of the force applied by the user to the surgical impacting tool.

8. the plurality of flat outer surfaces are formed on an enlarged portion of the adapter; a maximum width of the first portion of the adapter immediately forward of the enlarged portion is less than a maximum width of the enlarged portion; The surgical system of claim 1 , wherein a maximum width of a second portion of the adapter immediately rearward of the enlarged portion is less than the maximum width of the enlarged portion.

9. a maximum width of a fourth portion of the adapter immediately forward of the first portion of the adapter is greater than the maximum width of the first portion of the adapter; 9. The surgical system of claim 8, wherein the fourth portion of the adapter is configured to abut an outer surface of the surgical impacting instrument when the adapter is removably attached to the surgical impacting instrument.

10. the surgical impacting tool is configured to drive the impact against a bone along an axis; The surgical system of claim 1 , wherein the adapter is configured to removably mount the surgical impacting instrument along the axis.

11. The surgical system of claim 1 , wherein a number of the plurality of flat outer surfaces defines a number of the predetermined rotational orientations.

12. The surgical system of claim 11 , wherein the number of the plurality of flat outer surfaces is four, six, or eight.

13. the surgical impacting tool having a collar; the collar is configured to be moved by a user from a first position to a second position relative to the hand grip; when the collar is in the first position, the adapter is secured to the surgical impacting instrument; The surgical system of claim 1 , wherein the adapter is removable from the surgical impacting instrument when the collar is in the second position.

14. 14. The surgical system of claim 13, wherein the collar has a central opening, the adapter configured to move rearwardly into the central opening when removably attached to the surgical impacting instrument and move forwardly out of the central opening when removed from the surgical impacting instrument.

15. the surgical impacting tool is configured to drive the impact against a bone along an axis; the adapter is configured to extend along the axis through an opening in the surgical impacting instrument and be removably attached to the forward portion of the surgical impacting instrument; The surgical system of claim 1 , wherein the longitudinal axis of the hand grip is transverse to the axis.

16. a surgical instrument configured to directly contact the bone during said impaction; The surgical system of claim 1 , wherein the forward portion of the adapter is configured to be removably attached to the surgical instrument.

17. 1. A surgical system comprising: an adapter configured to be removably attached to a surgical impacting tool configured to drive forward and rearward impacts against a bone; a rear portion of the adapter configured to move rearwardly into the surgical impacting tool when removably attached to the surgical impacting tool and to move forwardly out of the surgical impacting tool when removed from the surgical impacting tool; the rear portion of the adapter has a first portion, a second portion, and a third portion aligned with one another; the first portion has a first maximum width and is immediately forward of the second portion; the second portion has a second maximum width; the third portion has a third maximum width and is immediately rearward of the second portion; The second maximum width is greater than the first maximum width and greater than the third maximum width.

18. The surgical impact instrument further comprises: The surgical system of claim 17, wherein the adapter is configured to be removably attached to the surgical impacting instrument at a plurality of predetermined rotational orientations relative to the surgical impacting instrument.

19. The surgical system of claim 18 , wherein the second portion of the adapter has a number of flat outer surfaces that define a number of the plurality of predetermined rotational orientations.

20. a surgical instrument configured for direct contact with the bone; The surgical system of claim 17 , wherein the forward portion of the adapter is configured to be removably attached to the surgical instrument.

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