EA007729B1 - Apparatus for hip joint surgery - Google Patents

Abstract

The surgeon grasps the jig (140) by its handle (141) and manipulates the head (210) of the jig through the patient wound and onto the femoral neck (4), as best illustrated in figure 67. The head (210) of the jig (140) includes jig location means in the form of an elongate rod which acts as a spacer (142). The spacer (142) has an end (211) which abuts the trochanteric fossa so as to position the slot (143) of the jig (140) at the required position, which, in the preferred embodiment, is between 5mm and 25mm, and most preferably 15mm, from the trochantic fossa. Additional jig location means are provided by a surface (212) adapted to receive a bone formation. This surface (212) is provided by contours (146) on the base of the head (210) which are adapted to mate with contours of the femur. The slot (143) is oriented generally perpendicularly to the elongate dimension of the rod (142). The slot (143) functions as a surgical tool guide means which is positioned by the jig (140) at the correct position for osteotomisation of the neck (4). Advantageously, osteotomisation takes place whilst the femoral head (3) is still disposed within the acetabulum.

Description

Technical field

The present invention relates to a surgical device for use in a hip arthroplasty in a surgical operation, and in particular, relates to a device adapted for use in surgical operations on patients of various anatomical structures.

Description of the prior art

In known methods for performing hip replacement surgery, the surgeon usually first makes a large initial incision to expose the hip joint. Then the surgeon usually manipulates the patient’s leg to dislodge the femur. In this case, considerable effort is often required to effect the displacement. Excessive manipulation and the use of force can cause side injuries in the patient, and this can lead to postoperative pain and / or increase the healing period. Then the femoral head is cut off along the neck. In the femoral joint, the cavity is expanded to receive the acetabular prosthesis (for example, type L-T.O.P.), and the prosthesis of the femoral leg (for example, type ΟΝΚ C.E.R.) is inserted into the body of the femur. Usually, the surgeon will orient the cutting and expanding instruments on the eye, which can lead to minor displacements. Therefore, after the installation of the prosthesis, visually imperceptible inconsistencies between the prosthesis of the acetabular cup and the prosthesis of the femoral head can occur. As a result, problems such as leg displacement, improper leg length and / or improper soft tissue tension can occur. In addition, in the end, the inconsistent components of the prosthesis can wear out much faster, which leads to aseptic weakening of the components and may necessitate a repetition of the operation, (see, for example, υδ 5601563А (VINKE e! А1.) From 11.02.1997, ϋδ 5709689А ( ΕΕΗΗΑΝΤΕ е! А1.) From 01.20.1998, ϋδ 5916220А (ΜΑ8ΙΝΙ) from 06/29/1999, υδ 5980526А (ΙΟΗΝδΟΝ е! А1.) From 11/09/1999, EP 466659 A2 (O. SNEM8CO1 8.N.) from 01/15/1992).

Any discussion of a known level in this description should in no case be construed as an assumption that it is either widely known or forms part of general knowledge in this field.

SUMMARY OF THE INVENTION

The basis of the present invention is the task to overcome or reduce at least one of the disadvantages of the known level or to create a useful alternative.

According to one aspect of the invention, there is provided a device for use in a hip arthroplasty in a surgical operation, which comprises a spacer having a first end with an opening for receiving a prosthesis of a femoral leg, a guide means at a first end, a mounting surface forming one side of said first end, the mounting surface adapted to engage the acetabular cup prosthesis to determine the displacement of the cup and leg, so that when using the cup is in this ratio with the acetabulum of the patient.

Preferably, the mounting surface defines a plane to mate with the corresponding plane of the acetabular prosthesis. The spacer may further comprise a handle extending from said first end, and said plane forms an acute angle in the range of 5 to 25 °, more preferably 15 °, with a plane formed by a handle extending from the first end.

In one embodiment, the plane is formed by a semicircular surface, and said opening has a groove capable of receiving the end of the prosthesis of the femoral leg protruding from the osteotomized neck of the femur.

The guide means may comprise a plurality of guide marks for determining the desired position of the acetabulum to facilitate expansion of the acetabulum of the patient. Alternatively, or additionally, the guiding means comprises orientation guiding means capable of indicating whether the mounting surface is in a predetermined ratio with the acetabulum of the patient.

In one embodiment, the spacer comprises a mounting handle having a housing defining a distal end and a proximal end, an indicator located at or near the proximal end, and a connector located at or near the distal end to attach the acetabular prosthesis, the indicator being able to indicate whether the acetabular prosthesis is in a predetermined orientation with respect to at least the first plane in the control system.

In accordance with another aspect, a method for extracting an osteotomized femoral head from a patient’s hip joint is provided, which consists in performing one or both of the following operations:

a) drill a hole in the femoral head, screw a self-cutting threaded element into the hole and exert an outward force on the threaded element, which, in turn, acts on the femoral head, and / or

- 1 007729

B) jam the end of the spoon under the femoral head and use the spoon as a lever to exert an outward force on the femoral head.

In another aspect, a method for inserting an acetabular cup prosthesis into an expanded acetabulum of a patient is provided, wherein

a) install the acetabular cup prosthesis on the cup installation tool,

b) manipulate the cup installation tool so that the prosthetic acetabular cup is located next to the expanded acetabulum,

c) orient the cup installation tool so that the prosthesis of the acetabular cup is in an anatomically correct orientation for insertion into the expanded acetabulum, and

b) drive the cup of the acetabular prosthesis into the expanded acetabulum.

Preferably, the cup installation tool has a positioning handle, as described above, and the indicator is used in step c) to determine whether the prosthesis of the acetabular cup is in the anatomically correct orientation with respect to the first plane.

In accordance with a further aspect of the invention, there is provided a method for determining the length of a neck prosthesis during a hip replacement operation, the method comprising:

a) install the prosthesis of the femoral leg in the femur of the patient so that the end of the femoral leg protrudes from the end of the femur,

b) place the test head on the end of the prosthesis of the femoral leg,

c) use a spacer installation tool to place the spacer between the test head and the end of the femur,

b) orient the spacer installation tool so that the test head is in the anatomically correct orientation,

e) check the anatomical correctness of the leg length, and / or tension of the tissues, and / or tension of the muscles of the patient,

ί) repeat steps c), b) and e) with spacers of different thicknesses or with a different number of spacers until the patient’s leg length and / or tissue tension and / or muscle tension are anatomically acceptable, and take into account spacer thickness or the number of spacers that gives the best result, and

e) correlate the thickness of the spacer or the number of spacers determined in step ί) with the required length of the neck prosthesis according to a predetermined correlation scheme.

In accordance with yet another aspect, a method is provided for performing hip replacement surgery on a patient, the method comprising:

a) expose the first femoral bone formation and the second femoral bone formation of the patient,

b) applying a clamp having a surgical instrument guide means to the first femoral bone formation such that the surgical instrument guide is close to the second femoral bone formation,

c) use a surgical instrument guide means to guide the cutting tool to perform an osteotomy of the second bone formation, and

b) remove the cut off head of the femur from the patient's hip joint.

Brief Description of the Drawings

Hereinafter, preferred embodiments of the present invention will be described in more detail only by way of example with reference to the accompanying drawings, in which FIG. 1 is a perspective view of a clamp according to one embodiment of the present invention; FIG. 2 is a plan view of the clamp shown in FIG. 1, FIG. 3 is a side view of the clamp shown in FIG. 1; FIG. 4 is a front view of the clamp shown in FIG. 1; FIG. 5 is a large trochanter, neck and head of the femur with marks illustrating the places at which the three existing incision lines intersect the femoral neck, and a method for engaging the clamp with formations on the femur, FIG. 6 is a perspective view of a spacer; FIG. 7 is a plan view of the spacer shown in FIG. 6; FIG. 8 is a perspective view of a spoon; FIG. 9-16, inclusive, views showing some of the steps of a preferred method for performing hip replacement surgery, where FIG. 15 and 16 are schematic views, FIG. 17 - the femur, Fig. 18 is a plan view of another spacer, FIG. 19 is a side view of the strut shown in FIG. 18, FIG. 20 is a front view of an alternative spacer; FIG. 21 is a plan view of the spacer shown in FIG. twenty,

- 2 007729 Fig. 22 is a left side view of the strut shown in FIG. 20, FIG. 23 is a front view of yet another alternative spacer; FIG. 24 is an enlarged view of a portion of a spacer illustrating a method for engaging an acetabular prosthesis, FIG. 25, 26 and 27 are side views, plan and end views of another embodiment of a clamp according to the present invention, FIG. 28 is a plan view of a drill, FIG. 29 is a plan view of a spoon, FIG. 30 is a plan view of the extractor, FIG. 31 and 32 are plan and side views of a punch, respectively; FIG. 33 and 34 are plan views of a left and right cup holder, FIG. 35 is a plan view of the handle assembly, FIG. 36 is a plan view of the installation handle, FIG. 37 and 38 are respectively views of the first strut from the side and in plan, FIG. 39 and 40 are respectively views of the second strut from the side and in plan, FIG. 41 and 42 are respectively views of the third strut from the side and in plan, FIG. 43 and 44 are respectively side views and a plan view of the mounting frame, FIG. 45 is a sectional view of the punch assembly, FIG. 46 and 47 are respectively side views and a plan view of a screwdriver, FIG. 48 and 49 are respectively side views and in plan of the rotational head of the screwdriver wrench shown in FIGS. 46 and 47, FIG. 50 and 51 are plan views of spacer elements for surgery on the left and right hip joints, respectively, of FIG. 52 and 53 are respectively views of an additional spacer of medium width in plan and end view, FIG. 54 and 55 are respectively views of an additional spacer of large width in plan and from the end, FIG. 56 is a side view of the pin extractor, FIG. 57 and 58 are respectively views of the pin in plan and from the end, FIG. 59-62 are plan views of screws; FIG. 63, 64 and 65 are views of another embodiment of a clamp according to the invention from the side, top and end, respectively, of FIG. 66 is a perspective view of a patient immediately before the start of hip replacement surgery, showing the pelvic holder and the location of the initial incision relative to the protrusion of the greater trochanter, FIG. 67 is a perspective view of a clamp according to a second embodiment of the invention superimposed on the femur before osteotomy of the femoral neck, FIG. 68 is a perspective view showing the end of the extractor shown in FIG. 30 applied to an osteotomy femoral head; FIG. 69 is a perspective view of a part of an acetabular cup prosthesis installation tool applied to the acetabulum of a patient, and FIG. 70 is a perspective view showing a portion of a spacer installation tool attached to an acetabulum of a patient.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

In FIG. 1 shows a surgical clamp 1 intended to be applied to the femur 2, as best seen in FIG. 17, the femur 2 contains the head 3 of the femur, the neck 4 of the femur, which often, although not always, serves as the incision site, and the greater trochanter 5. If the surgeon uses acetabular prostheses of the ίΙΝΚ T.O. type in the hip replacement operation. R. and prostheses of the femoral leg such as C.E.R., it is necessary to osteotomize (in other words, cut off) the head 3 of the femur, while the incision is made along the line transverse to the neck of the femur, at a distance of about 1.5 cm from the base of the greater trochanter 5. Of course, other prostheses, for example ΜΆΚΟΚΘΝ TNK and 8P2 prostheses, may require an incision in other parts of the femur 2, for example, on the large trochanter 5. For such applications, the geometry of the clamp 1 is adapted accordingly.

The clamp 1 comprises a clamp placement means 6 capable of mating with the bone formations 3, 4 and 5 to place the clamp 1 in a predetermined ratio with the bone 2. The clamp 1 also has a surgical instrument guiding means 7 located in relation to the clamp holding means 6 in this way that when the clamp 1 is associated with bone formations 3, 4 and 5, the means of directing the surgical instrument is able to direct the surgical instrument, for example, a blade, making a reciprocating movement, to a specific place on bone formation.

The clamp 1 has a housing 8. One aspect of the clamp placement means 6 is implemented in the form of first and second opposed brackets 9 and 10 located on the housing 8. The brackets 9 and 10 are able to mate with the femoral neck 4. Each bracket 9 and 10 has a longitudinal dimension, oriented in such a way that when the clamp 1 is mated with the neck 4 of the femur, a longitudinal measurement of the brackets 9 and 10

- 3 007729 is oriented practically in the same direction as the longitudinal measurement of the femoral neck 4. This is better seen in FIG. 5, where lines 11 and 12 show the places where the staples 9 and 10, respectively, mesh with the neck of the femur. The brackets 9 and 10 snap into the femoral neck 4. Each bracket 9 and 10 has an arcuate shape with a center of curvature extending along a longitudinal dimension.

Another aspect of the clamping means 6 is a surface 13 capable of receiving a bone formation, such as a femoral head 3. In a preferred embodiment, the surface 13 has the shape of an inverted letter V, as best seen in figure 4. The surface 13 in the form of an inverted letter V is formed by the element 14 in the form of an inverted letter V mounted on the body 8 through the transverse element 16. The element 14 in the form of an inverted letter V is located transversely with respect to the brackets 9 and 10. Part of the head 3 of the femur, on which superimposed element 14 in the form of an inverted letter V, shown by lines 15 in FIG. 5.

Another aspect of the clamp placement means 6 is the side wall 17 of the housing 8, the shape of which allows it to mate with the bone formation. More specifically, the side wall 17 has an arcuate shape with a curvature of such a shape that is adjacent to the natural curvature of the major trochanter 5. The line along which the side wall 17 is practically adjacent to the natural curvature of the major trochanter 5 is best shown by line 18 in FIG. 5.

Thus, the preferred clamping embodiment shown in FIG. 1-5, mates with bone formations on the femur 2 through the brackets 9 and 10, which engage the neck of the femur, the V-shaped element that engages the part of the femoral head, and the arched side wall 17 adjacent to the natural curvature of the greater trochanter.

These placement means together make it possible to precisely position the clamp 1 on the femur 2 and hold it in this position to assist in performing an osteotomy of the femoral neck 4. Alternatively, the clamp 1 can be oriented differently so that the inverted V element 14 fits against the neck of the femur 4, and the brackets 9 and 10 to the femoral head. Clamp 1 can be further secured in position by inserting one or more fasteners, such as pins, through body 8 or staples 9 and 10 into the femoral head 3. In this case, damage to the femoral head 3 by the fastening elements is not of particular importance, since the head 3 must be osteotomized. The fixation of the clamp 1 by installing the pins in the femoral head 3 can be used as an aid in removing the femoral head after performing the incision, as will be described in more detail below.

In the embodiment shown in FIG. 1-5, the tool 7 for the direction of the surgical instrument is located between the element 14 in the form of an inverted letter V and the brackets 9 and 10. It prevents the rotation or movement of the clamp 1 under the action of forces that can be transmitted from the surgical instrument to the clamp 1. The tool 7 for the direction of the surgical instrument has the shape of one or more grooves 20 located inside the body 8. The preferred embodiment has three grooves 20. Each groove is located in a different transverse direction on the body 8, to allow the surgeon to guide the grooves 20 An instrument in more than one specific location on bone formation. Presets are chosen in such a way as to fit prostheses of various sizes. For example, for one type of prosthesis, an osteotomy of the neck of the femur 4 is required in a position 1.5 cm from the base of the greater trochanter 5, so one of the grooves 20 is positioned so as to direct the surgical instrument to this position. Each groove 20 extends laterally through the housing 8 and is capable of receiving and guiding a surgical instrument, such as a blade, making a reciprocating motion, such as a hacksaw. The position of the grooves 20 after the clamp 1 was paired with the femur 2, shown by lines 21 in figure 5. Other preferred options (not shown) are adapted for guiding other tools, for example, one guiding means may be in the form of a hollow cylindrical element capable of guiding a rotary drill.

Although not shown in FIG. 1-4, the preferred embodiment has a handle located on the body 8. The handle has a length sufficient to protrude outward from the patient's body when the clip 1 is associated with a bone formation. This allows the surgeon to manipulate the clamp 1 outside the patient's body to interface with the femur 2.

A preferred method of performing a surgical operation is particularly suitable for hip replacement surgery in cases of osteoarthritis, rheumatoid arthritis and osteonecrosis. However, it is usually not recommended in the following circumstances: for use on patients with large anatomical deformities of the head or neck of the femur, or if the patient is obese, which makes palpation of anatomical attachments difficult.

During a preferred method of performing hip replacement surgery on a patient, posterolateral surgical access is preferred, although other approaches are also possible. Indeed, other surgical approaches may be required if posterolateral access is contraindicated, for example, due to a previously seriously injured sciatic nerve.

- 4 007729

The preferred method begins with step a), exposing the greater trochanter 5 and neck 4 of the patient's femur. To do this, an initial incision is made on the patient’s thigh with a length of 3 to 7 cm, preferably 5 cm. One end of the incision begins approximately 1-3 cm behind the large trochanter 5 and bends backward from it. The posterior side of the femoral neck 4 is opened by separating the tendon of the patient's triceps muscle, which can be marked for subsequent reattachment. Capsules are also excised to completely expose the femoral neck 4. It should be noted that at this stage, the femoral head 3 does not move. The patient’s leg is held at approximately 45 ° relative to the vertical, preferably with a leg holder. The surgeon may also use a frontal illuminator.

In step b), a clamp 1 is inserted, having a surgical instrument guiding means 7, on the femur 2 so that the means 7 is located near the femoral neck 4, as shown in FIG. 9. In this case, the clip 1 preferably has the configuration described above. Proper pairing of the clamp 1 with the femur 2 leads to the fact that the means 7 of the direction of the surgical instrument is located approximately at a predetermined distance from the base of the greater trochanter 5. More specifically, the specified distance is from 10 to 20 mm, and in the preferred embodiment, at least one of the grooves 20 is located at a distance of 15 mm from the base of the greater trochanter 5.

Optionally, the surgeon can make a notch 22 on the neck 4 on the side of the head 3 of the femur in place 26 of the osteotomy incision to facilitate sequential removal of the femoral head from the acetabulum. A notch 22 is preferably made before an osteotomy incision. It can be done by a light blow with a saw blade on the neck 4 or head 3 of the femur.

In step c), a surgical instrument guide means is used to guide the cutting instrument to osteotomy the femoral neck. Typically, the saw blade is fed through one of the grooves 20 in order to place it on the neck 4 of the femur at the osteotomy site, although other cutting tools can be used. Then the saw is turned on to make a reciprocating motion, and the saw blade is gradually moved across the neck 4 of the femur, as it is guided by the groove 20, until the head 3 and part of the neck 4 of the femur are osteotomized.

In step b), the cut off femoral head is removed from the patient’s hip joint. To do this, you can use a number of different methods. For example, the spoon 23 shown in FIG. 8, to extract the cut off head 4 of the femur from the joint. The notch 22 may be a convenient place from which the femoral head 3 can be lifted by lever using a spoon 23, as shown in FIG. 10. Part 24 of spoon 23 has a cutting tool, such as a sharpened edge, helping to dissect the tendon 25, which holds the femoral head 3 inside the hip joint 26. The sharpened edge 24 is located between the two protrusions 27 and 28, which help the surgeon to manipulate the spoon 23 in such a way so that the sharpened edge 24 is directed toward the tendon 25. In other words, the surgeon places the spoon 23 so that the protrusions 27 and 28 are on both sides of the tendon 25, then the spoon is shifted along its longitudinal axis in the direction of the tendon 25 so that the sharpened Paradise 24 cut the tendon 25.

An alternative method of removing the femoral head 4 can be used if the clamp is fixed with pins on the femoral head 3, as mentioned above. In this case, you can apply force to the clamp 1, which is transmitted through the pins to the head 3 of the femur. In some cases, this effort alone may be enough to remove the femoral head 3 from the hip joint. In other cases, this effort may help another removal tool, such as spoon 23 mentioned above.

It will be understood by those skilled in the art that osteotomy of the femoral neck 4 before removing the cut off head 3 of the femur eliminates the need for prior displacement of the hip joint, which is characteristic of a known level, and this eliminates or reduces possible damage and simplifies the surgical procedure. After removing the cut off head 3 of the femur, the hip joint operation can be completed according to a known technique. However, several further improvements to the known surgical procedure will be described below.

A known method for implanting a femoral leg prosthesis into the body of the femur involves introducing a bone tamper into the femoral canal. An alternative preferred method is provided in which

e) place the guide wire 29 in the femoral canal 30 of the body 31 of the femur of the patient (see Fig.11),

1) use a guide wire 29 to guide the flexible auger expander 32 to drill a hole in the femoral canal 30, and

d) insert the prosthesis of the femoral leg 33 into the hole so that the first end 34 of the prosthesis of the femoral leg 33 protrudes from the end of the body 31 of the femur. Alternatively, you can use

- 5 007729 removable test leg instead of the final femoral leg 33. Then, after checking the hip joint and obtaining a satisfactory result, the actual components are implanted in place of the removable test components.

In a known method for expanding a cavity in the acetabulum, an expansion tool is mounted on the eye. In contrast, a preferred step for expanding the acetabulum for receiving an acetabular prosthesis is that

11) place the first end 34 into the acetabulum of the patient, 1) insert the spacers 35 (also called lollipops) between the end of the body 31 of the femur and the acetabulum,

_)) use the spacer 35 to determine the control points 36 on the acetabulum of the patient (see figure 12), and

j) use control points 36 to provide direction for the expansion of the acetabulum.

More specifically, in step 1), spacers 35 are used, examples of which are shown in FIG. 6 and 7. The purpose of their application is to place the femur approximately in the position that it will take after the operation is completed. Marks 40 on spacers 35 are used to define control points in step _)). Preferably, the test points 36 are burned out on the acetabulum using a heating element that functions like a heated soldering iron tip. The spacers 35 have a handle 37 and a groove 38 for placement on the first end 34 of the prosthesis of the femoral leg 33.

The center of the control points 36 defined in step _)) is the starting point for the expansion of the acetabulum in step k). This is a more accurate and consistent alternative to the known method of expansion, which focuses on the eye.

Another example of spacers 100 that can be used in steps 1) and C is shown in FIG. 20-24. These spacers 100 have an outer circumferential edge 123 whose radius of curvature substantially corresponds to the radius of curvature of the prosthesis of the acetabulum cup 104. In a preferred embodiment, the radius of curvature of the outer circumferential edge 123 corresponds to the radius of curvature of the smallest cup from the set of prosthetic acetabular cups 104. At step _)), the surgeon uses the edge 123 as a guide when burning control points 36 on the acetabulum before expanding at step k).

In a known method for performing hip replacement surgery, the surgeon professionally evaluates the required size of the prosthesis components, namely the length of the neck / head and the size of the acetabular cup prosthesis. The hip joint is then temporarily assembled using trial components having an estimated size. If the obtained test joint is not satisfactory, for example, due to improper tension of the tissues, it is disassembled and test components of a different size are used. A preferred method provides an alternative to this known procedure by using spacers 35. As best seen in FIG. 18, one or more spacers 35 or 45 have a central spherical surface 48, which follows the shape of the femoral head, to perform the function of a test femoral head. In some embodiments, the spherical surface 48 is a hemisphere corresponding to a portion of the prosthesis head. A spacer 35 or 45 having a spherical surface 48 is positioned at the first end 34 of the prosthesis of the femoral leg 33 closest to the acetabulum so that the spherical surface 48 faces the acetabulum. The thickness 39 of each spacer 35 is selected relative to the dimensions of the existing components of the prosthesis. For example, one known component of an endoprosthesis has three sizes: 40 mm, 43.5 mm and 47 mm. In this case, the thickness 39 of the at least two spacers 35 is 3.5 mm to correspond to the size of the increments between the existing components of the prosthesis. These two spacers have flat parallel surfaces 46 and 47. The effect of using components of an endoprosthesis of different sizes can be copied by using a different number of spacers 41 or spacers 41 of different thicknesses. For example, FIG. 14 shows the edges of three spacers 35 superimposed on the first end 34 of the prosthesis of the femoral leg 33. Thus, the distance achieved using the component of the prosthesis of 47 mm is copied. If two spacers 35 are used, they copy the distance associated with the prosthesis component 43.5 mm, etc. As best seen in FIG. 14, another spacer 45 is in the form of a wedge. This wedge shape determines the anversion (or orientation) of the acetabular prosthesis and the femoral leg prosthesis. A reverse wedge shape is required if anterior or anterolateral surgical approach is adopted. The wedge shape tapers from a maximum width of 14 mm to a minimum width of approximately 3.5 mm.

Other forms of spacers 100 for adjusting the anteversion of the prosthesis of the acetabulum cup 103 are shown in FIG. 20-24. The spacer 100 has a handle 101 forming the first end 102. The installation means 103 is located on or near the first end 102. The installation tool 103 is able to mate with the prosthesis of the acetabulum cup 104, so that when used, the cup 103 is in a predetermined ratio with the patient's acetabulum.

The installation tool 103 forms a plane 105 capable of abutting against the corresponding plane 106 of the prosthesis of the acetabulum cup 104. The installation tool 103 has an engagement means in the form of one or more brackets 119 capable of engaging with an internal concave

- 6 007729 surface 120 of the prosthesis cup 104 of the acetabulum. The plane 105 is formed by a semicircular surface 107 and is located at an acute angle 111 relative to the plane 112 formed by the handle 101. Therefore, the installation tool 103 takes the form of a wedge-shaped element 110 located at the first end 102. The angle 111 is preferably from 5 to 25 °. More preferably, the angle 111 is from 10 to 20 °, and in a preferred embodiment, the angle 111 is approximately 15 °. This angle 111 is chosen so as to correspond to the natural angle of inclination of the hip joint.

In a preferred embodiment, the geometry of the installation tool relative to the handle is selected so that it corresponds to the posterolateral surgical access for surgery on the hip joint. Of course, other surgical approaches may require a slightly modified geometry, for example in FIG. 23 shows a different handle geometry compared to FIG. 20, which is more suitable for other surgical approaches. The overall objective is to ensure that when a spacer 100 is applied to the open end 34 of the femoral leg prosthesis 33, the installer 103 positions the prosthesis of the acetabulum cup 104 with an anversion that is substantially identical to the desired anteversion of the prosthesis of the acetabular cup 104 after the operation.

The installation means 103 has a groove 108 that is capable of receiving the protruding end 34 of the prosthesis of the femoral leg 33. When the end 34 of the femoral leg 33 is placed inside the groove 108, the spacer 100 engages with the femoral leg 33 just like the spacer 45 engages with the end 34 of the femoral leg in FIG. 14.

The angular inclination of the acetabular prosthesis relative to the femoral leg prosthesis 33 should mirror and reflect the natural geometry of the hip joint as accurately as possible. When the spacer 100 rotates around the axis of rotation 118, the direction of inclination changes at an angle of 15 °. So that the surgeon can determine whether the installation tool 103 is located in a predetermined ratio with the acetabulum of the patient, the orientation guidance tool 109 is placed on the spacer 100 or near its second end 113. The orientation guidance tool 109 has a plumb 114, which is rotatably located on the spacer 100 and hangs almost vertically by gravity. A plumb line 114 is rotatably attached to the round element 115 of the spacer 100 with a pin 116. A reference point 117 is located on the spacer 100 so that the plumb line 114 hangs over the reference point 117 when the setting means 103 is in a predetermined ratio with the acetabulum of the patient. In other words, when the spacer 100 assumes a predetermined rotational position with respect to the axis of rotation 118, the plumb line 114 hangs over the control point 117, as seen in FIG. 20 and 23. Therefore, if the patient is lying on his side, the groove 108 is aligned with the end 34 of the femoral leg prosthesis and the spacer 100 is rotated around the axis 114 until the plumb 114 is aligned with the control point 117, and the prosthesis of the acetabular cup 103 will have the required anversion with respect to the femoral leg 33. That is, when used correctly, the spacer ensures that the wider end 121 of the wedge-shaped element 110 is located in the direction of the front side of the patient and the narrow end 122 in the direction of the back side of the patient. Thus, a 15 ° slope is directed towards the patient's outer front side, mirroring the natural geometry of the hip joint.

More specifically, a preferred method for determining the required size of a prosthetic component is as follows:

1) place the test head 41 on the first end 34,

r) place a test cup 42 of the acetabulum in the expanded acetabulum (see Fig. 13),

o) place the test head 41 in the test cup 42 of the acetabulum, and

o) insert one or more spacers 35 between the end of the body 31 of the femur and the test head 41 until the desired fit is reached between the test head 41 and the test cup 42 of the acetabulum (see Figs. 13,14,15 and 16 ), and

p) correlate the number or size of the spacers 35 with the required size of the prosthesis component.

The surgeon determines in step o) whether the required fit between the test head 41 and the acetabulum test cup 42 is achieved by examining factors such as tissue tension, matching of components, leg length. After determining the required size of the prosthesis component in step p), the trial prosthesis components 41 and 42 (Fig. 15) are replaced with the final prosthesis components 43 and 44 (Fig. 16), although at this point the acetabulum cup is not fixed. The further use of the spacers 35 allows the exact and final orientation of the cup 44 to be determined relative to the femoral leg 33, then the cup 44 is firmly fixed for a permanent fit. A gasket is inserted into the prosthesis of the acetabulum cup 44, and then the prosthesis head 43 is inserted. After confirming the range of motion of the new joint, the layers are closed and the tendon of the triceps muscle is reattached.

In FIG. 25-65 illustrate instruments together forming a variant of a kit for performing a preferred hip replacement procedure. The tool kit includes a second version of the clamp 140 (Fig. 25-27) for application to the femur 2 in the acetabulum

- 7 007729 to create a place for osteotomy of the femoral neck 4. This preferred procedure begins with the patient being placed in a lateral position in which the side to be operated is on top, as shown in FIG. 66. Preferably, a pelvic holder 230 is used to hold the patient in position. In addition, before and during the operation, the temperature of the limb of the patient is preferably lowered.

The opening of the site of surgery begins with an incision of approximately 5 cm in length along line 231, approximately 2 cm behind the protrusion (shown by line 232 in FIG. 66) of the major trochanter 5. Then, the tension fascia is incised and the surgeon performs a blunt dissection until the femoral neck 4 will not open 2. Under the skin line and in the intervals, self-retaining retractors are used. The posterior side of the femoral neck 4 is opened by detaching the triceps tendon and short external rotator muscles that are labeled for subsequent attachment. Excision of the capsule opens the trochanteric fossa (i.e., the base of the greater trochanter 5), and also opens the neck of the femur 5, and then the accessible osteophytes of the acetabulum are removed. In contrast to the known methods for hip joint arthroplasty, at this moment the head 3 is not removed. The surgeon may use a frontal illuminator to improve visibility. Preferably, any irrigation fluid used during surgery is cooled to reduce bleeding.

The leg is placed in the leg holder and held at an angle of 45 ° to the vertical. The surgeon takes the clamp 140 by the handle 141 and manipulates the clamp head 210 in the patient’s wound and on the femoral neck 4, as shown in FIG. 67. The head 210 of the clamp 140 comprises means for holding the clamp in the form of an elongated shaft that acts as a spacer 142. The spacer 142 has an end 211 that abuts the spit hole to place the groove 143 of the clamp 140 in a predetermined position, which is preferably at a distance from 5 to 25 mm and more preferably 15 mm from the trochanteric fossa.

The first embodiment of the clamp 140 shown in FIG. 67, is intended for use on the patient's left hip joint. Another embodiment of clamp 140 is for use on the patient's right hip joint. The only significant difference between these options is that the spacer 142 is located on opposite sides of the head 210.

Additional clamp placement means is provided by a surface 212 capable of receiving bone formation. This surface 212 has contours 146 at the base of the head 210, which are able to mate with the contours of the femur.

After the clamp is correctly positioned, locking means, such as pins 243, shown in FIG. 57 and 58, are passed through holes 144 in the head 210 of the clamp 140 to the femoral head 3.

The groove 143 is oriented at an acute angle to the longitudinal dimension of the rod 142, and this angle depends on the desired incision angle corresponding to the specific components of the prosthesis used in this operation. The groove 143 functions as a guiding tool for the surgical instrument, which is placed by the clamp 140 in the correct position for the osteotomy of the neck 4. As noted earlier, the osteotomy is performed when the neck 3 of the femur is still in the acetabulum. If necessary, the surgeon can also perform secondary proximal sphenoid osteotomy.

After osteotomy of the neck 4, the femoral head 3 is bent forward and removed using one or more possible options. The drill 147 shown in FIG. 28, for drilling a hole 233 in the femoral head 3. Then, the self-tapping threaded element 148 of the extractor 149 is screwed into the hole 22 by screwing the handle 150. After entering the femoral head 3, the surgeon exerts an outward force on the handle 150, which, in turn, acts on the femoral head 3 to remove it. Another option, which can optionally be used with the extractor 149, is provided with a spoon 151. The distal end narrows to the edge, which can be wedged under the head 3 of the femur to help pull the lever 3 out of the acetabulum. The tapered end 152 can also be used to dissect a tendon that holds the head 3 in the acetabulum. Other removal options include incision, or dissection, of the head 3.

For the next stage of the operation, the patient’s leg is fixed perpendicular to the operating table. The proximal femur is prepared according to a standard technique using the awl of a trocar and a guide. Gabled retractors (such as HoBtapi) are placed on each side of the neck 4 femurs. Alternatively, you can attach a wide blunt retractor under the neck 4 to lift it.

The bone tamper is mounted on the punch 153 on the leading surface 154 and fixed with a pin 156. The bone tamper is inserted into the longitudinal axis of the femur using the punch 153 using the blows of a surgical hammer or other suitable tool at the proximal end 157. This process creates an empty space in the femoral canal for subsequent insertion of the femoral leg prosthesis 34 (see below). The leading surface 154 of the punch 153 is shifted away from the elongated longitudinal element 155 to facilitate the insertion of bone by the surgeon

- 8 007729 tamping in the right direction when fitting the punch 153 and manipulating it through the patient's wound. This reduces the risk that the bone tamper will be inserted into the femur at an angle and the outer end of the femur may crack. A firing dilator is then used to create a circular plane at the end of the neck 4. After that, the femur is ready for insertion of the femoral leg prosthesis, which is performed after insertion of the acetabular prosthesis, as will be described below.

The surgeon then places the patient's limb in a neutral position on the operating table to prepare for the expansion of the acetabulum. A sharp extractor is placed on the front edge of the acetabulum. Then the acetabulum is gradually expanded by increasing diameters.

To insert the acetabular prosthesis into the expanded acetabulum, the cup installation tool 167 is assembled from the following three components: the positioning handle 159 shown in FIG. 36, the handle 213 shown in FIG. 35, and the left or right cup holder 158 shown in FIG. 33 and 34, respectively. The installation handle 159 has a housing 182 that forms the distal end 161 and the proximal end 223, and between them is a handle 182. An indicator in the form of a plumb line 172 is located at the proximal end 223. The indicator (plumb line) 172 is able to indicate whether the prosthesis of the acetabular cup is in a predetermined position orientation with respect to at least the first plane in the control system. The connector, which includes a sleeve 163 with a female thread, is located at the distal end 161.

Depending on the situation, the left or right cup holder 158 is attached to the set handle 159 via fastening means 160 located at the proximal end 164 of the cup holder 158. More specifically, the fastening means 160 has a protrusion 169, which is jammed in the connector at the distal end 161 of the installation handle 159 to ensure proper relative alignment between the two components. After jamming with each other, sleeve 163 with internal thread engages with external thread 224 on cup holder 158, connecting them to each other.

The handle 213 provides the surgeon with an additional lever mechanism when manipulating the cup fitting tool 167.

To connect the handle 213 to the cup holder 158, the external thread 163 on the handle 213 forms a threaded connection with the internal thread 162 located inside the cup holder 158. The assembled cup setting tool 167 is shown in FIG. 69 (together with a portion of the cup holder 158 hidden as a result of the introduction of 234 patients into the wound)

In a next step, an acetabular cup prosthesis of an appropriate size is attached to the cup fitting tool 167. A spacer 174, 215, or 216 may be required depending on the size of the acetabular prosthesis. The spacers of different widths shown in FIG. 37-42, can be connected to the first end 168 of the boss 170, which is located at the distal end 165 of the holder 158 cups. More specifically, the protrusion 166 on the spacer 174 is connected by means of a press fit to the corresponding hole 214 at the first end 169 of the boss 170.

The surgeon selects a spacer 174, 215 or 216 having a width corresponding to the size of the acetabular cup prosthesis inserted into the patient's joint. For the smallest cup, a spacer 174 is not required. The spacers 174, 215 and 216 are disposable elements made of plastic, capable of withstanding only one use in an operation. The tool kit includes four screws 217, 218, 219 and 220 of various lengths, shown respectively in FIG. 59-62. Therefore, such an assembly of a screw and a spacer provides four sizes of an acetabular cup prosthesis, namely:

size 1 of the acetabular cup prosthesis: screw 217 without a spacer, size 2 of the acetabular cup prosthesis: screw 218 with a spacer 174, size 3 of the acetabular cup prosthesis: screw 219 with a spacer 215 and size 4 of the acetabular prosthesis: screw 220 with a spacer 216.

Preferably, the screws 217, 218, 219 and 220 have an internal hex socket 221. Each screw has a length that is sufficient to extend axially through the hole 214 in the boss 170, with the screw head 222 near the second end 171 of the boss 170, and the threaded end 223 extends beyond the first end of the boss 170 and to the point where the spacer 174, 216 or 216 of any type can engage with the first end 168. The protruding top of the threaded end 223 is connected by thread to the prosthesis of the acetabular cup 104. Thus, the acetabular cup prosthesis is mounted on the cup installation tool 167. More specifically, the acetabulum cup is connected to the cup holder 158 so that the concave surface of the acetabulum faces the second end 171 of the boss 170.

The surgeon then manipulates the cup setting tool 167 in the wound 234, as shown in FIG. 69, so that the cup is located next to the expanded acetabulum. Further, it is necessary to orient the cup setting tool 167 in such a way as to ensure that the cup is in an anatomically correct orientation for insertion into the expanded acetabulum. This is achieved using the indicator 172 on the installation handle 159 in combination with the installation frame 176.

- 9 007729

The indicator 172 has a needle 173, which acts as a plumb line. The needle 173 is rotatably disposed on the set handle 159 and hangs substantially vertically under the influence of a local gravitational field. The indicator allows the surgeon to correctly align the acetabulum in at least the first plane by positioning the cup fitting tool 167 so that the rotating needle 173 of the plumb line 172 is aligned with a control point made in the form of a fixed needle 175.

The mounting frame 176 shown in FIG. 43 and 44, can be used to accurately position the acetabular cup prosthesis in a plane different from that affected by the plumb 172. The mounting frame 176 includes a frame member 177 that forms the first end 178 and the second end 179. The frame member 177 has the shape of the letter b when viewed from the side, and the shape of the letter A, when viewed from above. The thrust pad 180 is located at the first end 178 and is able to abut against a flat surface, in particular, on the vertical side of the working table. For example, the surgeon may use the knee to press the thrust pad 180 against the side of the operating table. The second end 179 of the mounting frame 176 is located next to the hip of the patient.

The engagement means in the form of a groove element 181 is located at the second end 179 and is mounted so as to protrude to the patient's hip. An open end groove 225 in the groove element 181 forms a semicircular surface 226 having an internal radius of curvature that coincides with the external curvature radius of the housing 182 of the installation handle 159. In other words, the groove 225 is of such a size that allows receiving and guiding the housing 182 of the installation handle 159 This geometry is such that the connection of the positioning handle 159 to the engaging means 181 forces the positioning handle 159 to take a predetermined orientation with respect to a second plane (different from the first plane associated with the plumb line 172). This is ensured by the fact that the groove element 181 has a sufficient width 227 to ensure that when the housing 182 is connected to the groove element 181, the longitudinal axis of the housing 182 coincides with the axis of the groove element 181. More specifically, when the housing 182 is located in the groove element 181, the housing 182 is essentially perpendicular to the side of the desktop.

Preferably, the patient’s hip is fixed to the operating table in a predetermined position relative to the operating table, for example, using a pelvic holder 230 and / or other means of fixing the patient’s position on the operating table. The surgeon can be sure that the acetabular cup prosthesis is correctly positioned for installation in the patient's hip if each of the following conditions is met:

the patient’s hip is in a predetermined position on the operating table, the first end 178 of the installation frame 176 abuts against the operating table next to the patient’s hip, so that the groove element 181 faces the patient’s hip, the housing 182 of the installation handle 159 is connected to the groove element 181, and the rotating needle 173 plumb bore combined with a fixed needle 175, indicating that the prosthesis of the acetabular cup is located in a given orientation.

At this point, the surgeon uses the punch assembly 183 shown in FIG. 45 to firmly install the acetabular cup in the expanded acetabulum. More specifically, the driving head 184 of the punch assembly 183 is placed at the second end 171 of the boss 170 and striking the impact surface 185 with a surgical hammer or the like while the surgeon holds the punch assembly 183 by the handle 186. In this way, the prosthesis of the cup is fixed in the expanded acetabulum.

The screwdriver key 187 is preferably the hex key shown in FIG. 46 and 47, which mates with the internal hex socket 221 of the screw 217, 218, 219 or 220 used to secure the acetabular prosthesis to the cup holder 158. The hex wrench 187 has a rounded leading end, which allows you to work with a screw 217, 218, 219 or 220 from a number of angles in addition to the direct direction. This gives the surgeon a certain degree of freedom to adapt to the difficulties associated with directing the screw through the wound 234 of the patient. The hex key 187 also has a handle 189 to facilitate rotation of the drive head 188. After disconnecting the screw 217, 218, 219 or 220 from the acetabular prosthesis, the cup holder 158 is removed from the patient’s body.

If desired, the acetabular cup prosthesis can optionally be additionally secured to the expanded acetabulum using fixing means, such as a screw, which is passed through the acetabulum into the patient's pelvis. Then, a gasket is inserted into the acetabular prosthesis cup, and a blunt retractor can be inserted under the gasket to prevent subsequent displacement.

Now, the patient’s leg is brought upright to allow the insertion of the femoral leg 33, for example a C.P.P. leg, into the femoral canal. After insertion, the end 34 of the legs 33 protrudes from the end of the femur.

Next, it is necessary to determine the length of the prosthesis of the femoral leg, which is necessary so that after the operation the leg has the correct length and the correct tension of tissues and muscles. A short test head is placed on the prosthesis of the femoral leg and the hip joint is set. As best seen in FIG. 70, now assemble the spacer installation tool 189 by attaching the left or right

- 10 007729 of the spacer element 190, depending on the need, to the handle mounting assembly 159, similarly to how the cup holder 158 was previously attached to the handle assembly 159. That is, the protrusion 191 is jammed into the hole located at the distal end 161 of the handle assembly 159, and the sleeve 163 is threadedly connected to the proximal end 192 of the spacer element 190. Also similar to the previous assembly of the cup fitting tool 167, the handle 162 is screwed into the spacer element by an internal thread 193 provided adjacent to the proximal end 192 of the spacer element 190. In other words, the assembly of the spacer installation tool 189 simply begins with the cup installation tool 167 and replaces the cup holder 158 with the spacer element 190.

The spacer element 190 comprises a spacer 194, which has a groove 195 capable of engaging with the end 34 of the thigh leg 33. This positions the spacer 194 between the test head and the end of the femur 34, as shown in FIG. 70 (although in the drawing the test head is hidden in the expanded acetabulum). With proper positioning, the test head is located on the hemispherical surface 203. The surgeon can again use the plumb bob 172 and the mounting frame 176 to ensure that the spacer 194 and the test head are oriented anatomically in the right way when performing the following checks.

When the spacer 194 is in place, the surgeon checks if the leg length and / or tissue tension and / or muscle tension are sufficient. If not, the surgeon removes the spacer installation tool 189 and clamps the medium-width additional strut 196 (shown in FIGS. 52 and 53) on the strut 194. The medium-width additional strut 196 is clamped on the strut 194 due to the press fit elements 198 provided on these two components . If the leg length, and / or tissue tension, and / or muscle tension is still not sufficient, the process is repeated again with an extra spacer 197 of large thickness, which is used instead of an extra spacer 196 of medium thickness.

In other words, the verification process is repeated with spacers 194, 196 or 197 of different thicknesses (or with a different number of spacers) until anatomically correct leg length and / or tissue tension and / or muscle tension are achieved. Then the surgeon takes note of the thickness of the spacer (or the number of spacers) that gives the best results, and correlates it with the required length of the neck prosthesis according to a predetermined correlation scheme. For example, if the correct leg length and / or tissue tension and / or muscle tension is achieved without the need for an additional strut 196 or 197, then use the shortest neck prosthesis. If the correct leg length, etc. is achieved using an additional strut 196 of average thickness, then use a neck prosthesis of medium length. If the correct leg length, etc. achieved with the help of an extra strut 197 large width, then use the longest neck prosthesis. Of course, other correlation schemes may also be provided for other preferred methods.

This process of determining the size of the endoprosthesis necessary to obtain the correct leg length, etc., is preferable to the known method in which the hip joint is repeatedly displaced until the correct size of the components of the endoprosthesis is determined.

After this, the joint is displaced, and the trial components of the endoprosthesis are replaced by the actual components, after which the joint is repaired. The surgeon then makes sure that the patient’s leg has the correct range of motion and double-checks whether acceptable leg length, tissue tension and muscle tension have been achieved. The surgeon completes the operation in a standard way, attaching the triceps tendon and short external rotator muscles and closing the different layers. To assist in postoperative rehabilitation, it is recommended to use a cryo-cuff in the joint area.

You can use the extractor 199 pins, if you want to save the pins 243, which were previously inserted into the head 3 of the femur and remained immersed in it after the head 3 was removed from the patient’s body. It may also be necessary to carry out tests on the femoral head 3, in which case it may be necessary to remove the pins 243. The pin 243 can be inserted into the hole 202 behind the engaging element 203, spreading the tongues 200 and 201 radially to the sides. Then, the tongues are compressed radially together, so that the engaging element 203 exerts a lateral force on the notches 228 located near the end 229 of the pin 243, thereby forcing the pin extractor 199 to grip the pin 243 tightly. After that, the longitudinal force is exerted on the pin extractor 199, which transferred to the pin 243 and helps to remove the pin 243 from the cut off head 3 of the femur. The longitudinal force can be exerted by hammering the protrusion 204.

It should be understood that the preferred method for performing hip replacement surgery provides a number of advantages over known methods. In particular, the hip joint does not require displacement before the osteotomy, the accuracy and consistency of the expansion of the femoral canal and acetabulum increases, and the process of determining the required size and orientation of the components of the endoprosthesis generally requires fewer checks and causes fewer errors. Typically, in such a surgical procedure, the ligaments and joints of the muscles are subjected to minimal disturbances, which allows a faster rehabilitation of the patient with less postoperative pain. Additional benefits associated with preferred options include

- 11 007729 reduction of scarring, reduction of blood loss and its coagulation, lower risk of infection, shorter hospitalization and lower cost of surgery.

Although the invention has been described with reference to specific examples, those skilled in the art will understand that it can be implemented in many other forms.

Claims (53)

1. A device for use in hip arthroplasty, comprising a spacer having a first end with an opening for receiving the prosthesis of the femoral leg, a guiding means at the first end, a mounting surface forming one side of the first end, and the mounting surface is adapted to mesh with the acetabular prosthesis cups to determine the displacement of the cup and legs, so that when using the cup was in a predetermined ratio with the acetabulum of the patient. 2. The device according to claim 1, in which the mounting surface forms a plane for interfacing with the corresponding plane of the acetabular prosthesis. 3. The device according to claim 1 or 2, in which the spacer further comprises a handle extending from the first end. 4. The device according to claim 2, in which said plane forms an acute angle with a plane formed by said handle extending from the first end, said angle being in the range from 5 to 25 °. 5. The device according to claim 4, in which said angle is in the range from 10 to 20 °. 6. The device according to claim 5, in which said angle is approximately 15 °. 7. The device according to any one of claims 2 to 6, in which said plane is formed by a semicircular surface. 8. The device according to any one of claims 1 to 7, in which said hole contains a groove capable of receiving the end of the prosthesis of the femoral leg protruding from the osteotomy neck of the femur. 9. The device according to any one of claims 1 to 8, in which said guide means comprises a plurality of guide marks for determining the required position of the acetabulum to simplify the expansion of the acetabulum of the patient. 10. The device according to any one of claims 1 to 9, wherein said guide means comprises orientation guiding means capable of indicating whether the mounting surface is in a predetermined ratio with the acetabulum of the patient. 11. The device according to any one of claims 1 to 10, wherein said guide means comprises a plumb, rotatably disposed on a spacer spaced from said first end, so as to hang substantially vertically by gravity. 12. The device according to claim 11, in which the aforementioned guide means further comprises a control point located on the spacer, so that the plumb line hangs through the control point when the mounting surface is in a predetermined ratio with the acetabulum of the patient. 13. The device according to any one of claims 1 to 12, in which the mounting surface has an engagement means capable of engaging with an acetabular prosthesis. 14. The device according to item 13, in which the means of engagement has one or more staples made with the possibility of pairing with the inner surface of the prosthesis of the acetabular cup. 15. The device according to any one of claims 1 to 14, in which the mounting surface forms an outer circumferential edge having a radius of curvature essentially corresponding to the radius of curvature of the acetabular prosthesis. 16. The device according to any one of claims 1 to 15, in which the spacer comprises a mounting handle having a housing defining a distal end and a proximal end, an indicator located on or near the proximal end, and a connector located on or near the distal end, for attaching the acetabular prosthesis, the indicator being able to indicate whether the acetabular prosthesis is in a predetermined orientation with respect to at least the first plane in the control system. 17. A device for use in a hip arthroplasty operation, comprising a positioning handle having a housing defining a distal end and a proximal end, an indicator located at or near the proximal end, and a connector located at or near the distal end for attaching the acetabular prosthesis cups - 12 007729 and the indicator is able to indicate whether the prosthesis of the acetabular cup is in a given orientation with respect to at least the first plane in the control system. 18. The device according to 17, in which said control system has a local gravitational field. 19. The device according to p, in which the indicator contains a plumb, located rotatably on the housing, to hang, essentially vertically under the influence of a local gravitational field. 20. The device according to 17, additionally containing a control point located on the body, so that the plumb line hangs through the control point when the acetabular prosthesis is in a predetermined orientation relative to the first plane. 21. The device according to any one of paragraphs.17-20, further comprising a handle located between said distal end and the proximal end. 22. The device according to any one of paragraphs.17-21, further comprising an installation frame adapted for use with the installation handle, wherein the installation frame includes a first end configured to abut against a flat surface to establish a second end of the installation frame relative to a flat surface, and means an engagement located at the second end and capable of engaging with the positioning handle. 23. The device according to item 22, in which the means of engagement has a groove with an open end. 24. The device according to item 22 or 23, in which the groove with an open end forms a semicircular surface having an internal radius of curvature, consistent with the external radius of curvature of the housing of the installation handle. 25. The device according to any one of paragraphs.22-24, in which the engagement means has such a geometry that engagement of the installation handle with the engagement means forces the installation handle to take a predetermined orientation relative to the installation frame. 26. The device according to any one of paragraphs.22-25, in which the engagement of the installation handle in the means of engagement forces the installation handle to take a predetermined orientation relative to at least a second plane other than the first plane. 27. The device according to any one of paragraphs.22-26, further having a predetermined position of the patient's hip relative to the operating table, so if each of the conditions is met: the patient’s hip is in a predetermined position, the first end of the installation frame abuts against the flat surface of the operating table, the housing of the installation handle is engaged with the engagement means of the installation frame, and the indicator of the installation handle indicates that the acetabular cup prosthesis is in the set position, then the acetabular cup prosthesis is located for insertion into the patient’s hip joint. 28. The device according to item 27, in which the flat surface of the operating table is the side of the operating table and in which the second end is located next to the hip of the patient. 29. A method of extracting an osteotomized femoral head from a patient's hip joint, which consists in performing one or both of the following operations: a) drill a hole in the femoral head, screw a self-tapping threaded element into the hole and exert an outward force on the threaded element, which in turn acts on the femoral head, and / or b) jam the end of the spoon under the femoral head and use the spoon as a lever to exert an outward force on the femoral head. 30. A method of inserting an acetabular cup prosthesis into an enlarged acetabulum of a patient, comprising a) install the acetabular cup prosthesis on the cup installation tool, b) manipulate the cup installation tool so that the prosthetic acetabular cup is located next to the expanded acetabulum, c) orient the cup installation tool so that the prosthesis of the acetabular cup is in an anatomically correct orientation for insertion into the expanded acetabulum, and b) drive the cup of the acetabular prosthesis into the expanded acetabulum. 31. The method according to clause 30, in which the cup installation tool has the adjusting handle according to clause 22 and said indicator is used in step c) to determine whether the prosthesis of the acetabular cup is in the above anatomically correct orientation relative to the first plane. 32. The method according to p, in which in step c) additionally use the installation frame according to p. 22 for orienting the acetabular cup prosthesis in an anatomically correct orientation relative to a second plane other than the first plane. 33. The method according to p, in which at step c) perform additional sub-steps: c1) place the patient’s hip in a predetermined position on the operating table, c2) rest the first end of the installation frame on the flat surface of the operating table, - 13 007729 c3) insert the housing of the installation handle into engagement with the means of engagement of the installation frame, c4) use the indicator of the installation handle to indicate whether the prosthesis of the acetabular cup is in the anatomically correct orientation. 34. The method of determining the size of the length of the neck prosthesis during hip replacement surgery, which consists in the fact that a) install the prosthesis of the femoral leg in the femur of the patient so that the end of the femoral leg protrudes from the end of the femur, b) place the test head on the end of the prosthesis of the femoral leg, c) use a spacer installation tool to place the spacer between the test head and the end of the femur, b) orient the spacer installation tool so that the test head is in the anatomically correct orientation, e) check the anatomical correctness of the leg length, and / or tension of the tissues, and / or tension of the muscles of the patient, ί) repeat steps c), b) and e) with spacers of different thicknesses or with a different number of spacers until the patient’s leg length and / or tissue tension and / or muscle tension are anatomically acceptable, and take into account spacer thickness or the number of spacers that gives the best result, and e) correlate the thickness of the spacer or the number of spacers determined in step ί) with the required length of the neck prosthesis according to a predetermined correlation scheme. 35. A method for performing a hip arthroplasty operation on a patient, the method comprising a) expose the first femoral bone formation and the second femoral bone formation of the patient, b) applying a clamp having a surgical instrument guide means to the first femoral bone formation such that the surgical instrument guide is close to the second femoral bone formation, c) use a surgical instrument guide means to guide the cutting tool to perform an osteotomy of the second bone formation, and b) remove the cut off head of the femur from the patient's hip joint. 36. The method according to clause 35, in which the first femoral bone formation is a greater trochanter, and the second femoral bone formation is the neck of the femur. 37. The method according to p. 35 or 36, in which, at step a), an initial incision is made on the patient's hip from 3 to 7 cm long. 38. The method according to clause 37, in which one end of the cut is located at a distance of approximately 1-3 cm behind a large trochanter and bends back from this end. 39. The method according to any one of claims 35-38, wherein, in step a), the posterior side of the femoral neck is opened by separating the tendon of the patient’s triceps muscle. 40. The method according to § 39, in which the tendon of the triceps muscle is labeled for subsequent re-attachment. 41. The method according to any one of claims 35-40, wherein in step a), the capsule is excised to expose the femoral neck. 42. The method according to any one of claims 35-41, wherein the patient’s leg is held at approximately 45 ° from the vertical during at least some stages of the operation. 43. The method according to § 42, in which the position of the legs is held by the leg holder. 44. The method according to any one of claims 35-43, further comprising a notch in the neck of the femur on the side of the femoral head where the osteotomy is made. 45. The method according to any one of claims 35-44, wherein e) place the guide wire in the channel of the body of the femur of the patient, ί) use a guide wire to guide the flexible reamer to drill a hole in the femoral canal, and e) insert the prosthesis of the femoral leg into the aforementioned hole so that the first end of the femoral leg protrudes from the end of the body of the femur. 46. The method according to item 45, in which additionally 11) place the aforementioned first end in the acetabulum of the patient, ί) insert spacers between the end of the body of the femur and the acetabulum, _)) use a spacer to determine the control points on the acetabulum of the patient, and k) use control points as a guide when expanding the acetabulum. 47. The method according to item 46, in which additionally l) place a test prosthesis of the head on said first end, r) place a test acetabular cup in the expanded acetabulum, o) place the test prosthesis of the head in the test acetabular cup and - 14 007729 o) inserting spacers between the end of the femur and the test cup of the acetabulum until the necessary fit between the test prosthesis of the head and the test cup of the acetabulum is reached, and p) correlate the number or size of the spacers with the required size of the prosthesis component. 48. A method for performing a hip arthroplasty operation on a patient, the method comprising ί) expose the greater trochanter and neck of the patient's femur, i) an osteotomy of the femoral head is performed, ίίί) a prosthetic femoral leg or test femoral leg is inserted into the body of the patient’s femur so that the first end of the femoral leg protrudes beyond the end of the femur, ίν) the first end is placed in the acetabulum of the patient, ν) apply one or more spacers to the first end of the femoral pedicle, νί) use the mentioned one or more spacers to determine the reference positions on the acetabulum, and νίί) use the reference positions to direct the expansion of the acetabulum. 49. The method of claim 48, wherein said struts have labels to indicate control positions. 50. The method according to p. 48 or 49, in which at step ν центр) determine the center of the control positions and use this center as the center of expansion. 51. A method for performing a hip arthroplasty operation on a patient, the method comprising A) expose the greater trochanter and neck of the femur, B) produce an osteotomy of the femoral head, C) insert the femoral leg prosthesis or test femoral leg into the body of the patient's femur so that the first end of the femoral leg protrudes beyond the end of the femur body, ϋ) insert the acetabular cup prosthesis or test acetabular cup into the patient's expanded acetabulum, E) impose one or more spacers on the first end of the femoral leg until the required tissue tension in the patient’s hip joint is achieved, and E) correlate the number or size of the spacers with the required size of the prosthesis component. 52. The method according to § 51, in which the required size of the prosthesis component relates to the neck length of the neck prosthesis component and the femoral head. 53. A method for performing a hip arthroplasty operation on a patient, the method comprising A) expose the greater trochanter and neck of the femur, B) produce an osteotomy of the femoral head, C) insert the femoral leg prosthesis or test femoral leg into the body of the patient's femur so that the first end of the femoral leg protrudes beyond the end of the femur body, ϋ) insert the acetabular cup prosthesis or test acetabular cup into the patient's expanded acetabulum, E) apply one or more spacers to the first end of the femoral leg to determine the desired orientation of the acetabulum relative to the femoral leg.