The present invention relates to a device and a method for limiting movements in one or more anatomical joints, such as a device for limiting movement in the human hip joint after hip replacement surgery.
As the population ages, it has created a greater demand for orthotic management of any hip joint that has been compromised. Following a hip joint replacement, it is important to provide proper post-operative treatment of the patient after arthoplatyies.
Orthotic management of hip joint compromise has been a challenge for orthopaedics, orthotists and therapists when dealing with patients whose hip joints and their associated soft tissues, joint integrity, alignment, and bone and capsular components are compromised. A hip is a multidirectional joint capable of flexion, extension, internal and external rotation, adduction, and abduction (see
One or more muscle groups of the hip joint are compromised when surgical procedures are performed at the hip joint, especially during a hip replacement surgery. A significant problem that occurs when a hip joint has been compromised is dislocation of the hip joint: The femoral head can be driven out of the acetabulum. The hip is most susceptible to posterior dislocation when it is flexed past 90 degrees, internally rotated and adducted (see
An example of a modular, adjustable prophylactic hip orthosis can be found in U.S. Pat. No. 7,048,707. The orthosis provides a substantially rigid pelvic or hip engaging unit that is formed to conform to the contours of the human hip. As disclosed in WO 2009/017949 this orthosis has been further developed with an adjustable extension posterior spinal orthosis with a pair of adjustable shoulder straps connected to the top of the extension orthosis and fastened at the bottom to the rear connector plate, thereby providing an improved control of both extension, flexion and abduction and adduction of the hip joint.
However, this does not remove the discomfort experienced by the user wearing a rigid hip engaging unit. One object of the invention is therefore to provide a more comfortable hip supporting unit to encourage maximum prolonged usage.
This is achieved by a device for limiting movement in the human hip joint comprising: at least a first member adapted to conform to a leg, a second member adapted to engage at least one shoulder, and a third member connecting said at least first member and said second member, wherein the third member is substantially soft and/or flexible and adapted to limit one or more specific movements of said leg by anchoring the tensile load of said movement(s) in the shoulder(s).
In the preferred embodiment of the invention the first member is a collar, preferably adapted to conform to the thigh of a user. Further, the second member is preferably one or more shoulder straps. The third member is preferably at least one band connecting the first member (e.g. leg collar(s)) and the second member (e.g. shoulder strap(s)).
The object of the invention is further achieved by a method for limiting one or more movements in the hip joint of a user by anchoring the tensile load from said one or more hip joint movements in one or both of the shoulders. The tensile load is preferably distributed to the shoulders by means of a soft and/or flexible element. This element may be substantially inelastic. The element is preferably comfortable to wear for the user. Thus, the tensile load may be anchored in one or both shoulders by means of e.g. a band fixed to one or both of said shoulders and one or both legs of the user.
The present invention further relates to the use of the device for preventing hip joint dislocation.
As such the present invention thus may provide a comfortable hip supporting device without components actually located on the hip. In particular the user avoids wearing a rigid shell on the hip where specific hip joint movements are limited partly by the rigidity of the rigid shell and partly by rotary mechanical joint (hinge) between the rigid shell parts. In the present invention one or more specific leg movements are limited by comfortable soft and/or flexible band(s) and straps that limit these movements and distribute the tensile pull of these “limitations” to the shoulder part of the user.
The hip joint is a synovial ball and socket joint that consists of the articulation of the spherical head of the femur with the cup-like shape of the acetabulum. An acetabular labrum attaches to the bony rim of the acetabulum and cups around the head of the femur to hold it firmly in place. Various ligaments add strength to the articulation of the hip joint and a large number of muscles act on the hip joint. The gluteus medius is primarily associated with abduction. Anterior fibers assist with flexion and internal rotation. Posterior fibers assist with extension and external rotation. These muscle groups stabilize the pelvis during a single leg support.
Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Replacing the hip joint consists of replacing both the acetabulum and the femoral head. Such joint replacement orthopaedic surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage as part of hip fracture treatment. Hip replacement is currently the most successful and reliable orthopaedic operation with approx. 97% of patients reporting improved outcome.
In the preferred embodiment of the invention the shoulder engaging member (i.e. the second member) comprises one or more shoulder straps. Further the shoulder strap(s) may comprise one or more closing mechanisms, thereby easing mounting and dismounting of the device. Further, means for adjusting the length of the shoulder strap(s), such as one or more buckles, may be provided, thereby providing the option of adapting the device to the specific physical dimensions of a user. Individual adaptation may further be provided by at least partly elastic shoulder straps.
The third member is provided to distribute the tensile pull provided by hip joint movements to one or both of the shoulders. As previously indicated this may be provided by a band or equivalently a webbing or strop or belt. The band is preferably adapted to extend along at least a part of the back or the chest of a user. Further, the band is preferably adapted to extend further along at least one buttock or groin of a user. The location of the band (back—buttock or chest—groin) depends on which movements the device is supposed to limit. To limit flexion in the hip joint the band is preferably adapted to extend along the back, at least partly along the spinal column, across the hip and the buttock and further on to the back of the thigh where the band connects to the leg conforming member. Accordingly: to limit extension in the hip joint the band is preferably adapted to extend the chest across the hip and the groin and further on to the front of the thigh where the band connects to the leg conforming member. The advantage of using a band is that a band can be soft and flexible and thereby comfortable to wear for the user. Combined with these comfortable features the band may be provided with the necessary resilience towards being extended in the longitudinal direction, such that when the band is pulled it will resist and distribute the tensional load to the second member and the shoulder part and thereby prevent a user from e.g. flexion in the hip joint.
In the preferred embodiment of the invention the third member is substantially inelastic. But the third member may however in other embodiments be provided with a small elasticity, like the elasticity seen in dense textile like twill fabric.
In a further embodiment of the invention the second member is provided with visible distinguishable markings.
Thus, in order to limit flexion or extension it suffers to provide some sort of connection between the leg conforming member and the shoulder engaging member. However, further limitations to hip joint movements may be provided if the band is substantially wide, preferably both substantially flat and wide and elongated. A wide band may further limit abduction, adduction and rotation of the hip joint. However, if the band is too wide it may be uncomfortable to wear and there may further be bacteriological issues if the band is inconvenient during toilet visits. Thus, in one embodiment of the invention the third member is provided with a narrow end adapted to conform to a buttock and a leg of a user. I.e. the third member thereby has a wider part adapted to extend along the back (or chest) of the user and a less wide part adapted to conform to the buttock (or groin) and leg area. The maximum width of the band may be between 0.2 and 1.5 times the maximum diameter of the thigh of the user, such as between 0.3 and 1.4 times the maximum diameter of the thigh of the user, such as between 0.4 and 1.3 times the maximum diameter of the thigh of the user, such as between 0.5 and 1.2 times the maximum diameter of the thigh of the user, such as between 0.6 and 1.2 times the maximum diameter of the thigh of the user, such as between 0.7 and 1.1 times the maximum diameter of the thigh of the user, such as between 0.8 and 1.1 times the maximum diameter of the thigh of the user, such as between 0.9 and 1.1 times the maximum diameter of the thigh of the user.
In one embodiment of the invention the width of the third member is at least 5 cm, such as at least 6 cm, such as at least 7 cm, such as at least 8 cm, such as at least 9 cm, such as at least 10 cm, such as at least 11 cm, such as at least 12 cm, such as at least 13 cm, such as at least 14 cm, such as at least 15 cm, such as at least 16 cm, such as at least 17 cm, such as at least 18 cm, such as at least 19 cm, such as at least 20 cm.
In one embodiment of the invention the maximum width of the third member is between 5 and 30 cm, such as between 7 and 24 cm, such as between 10 and 22 cm, such as between 11 and 21 cm, such as between 12 and 20 cm, such as between 13 and 19 cm, such as between 14 and 18 cm, such as between 15 and 17 cm, such as between 13 and 18 cm, such as between 14 and 19 cm, such as between 15 and 20 cm, such as between 16 and 21 cm, such as between 17 and 22 cm, such as between 18 and 23 cm, such as between 19 and 24 cm, such as between 20 and 25 cm, such as between 21 and 26 cm, such as between 22 and 27 cm, such as between 23 and 28 cm.
In one embodiment of the invention the width of the shoulder straps is between 2 and 12 cm, such as between 3 and 11 cm, such as between 4 and 10 cm, such as between 5 and 9 cm, such as between 6 and 8 cm, such as approx. 7 cm.
In one embodiment of the invention the band is adapted to be substantially taut when the device is worn by a user. This may help to ensure that any hip joint movement is limited, because the taut band applies tension to the collar and the shoulder straps, i.e. the movement of the leg is limited because the taut band distributes the tensional pull to one or more of the shoulders.
The length of the third member, i.e. the connecting member, i.e. preferably a band, can be determined by the height of the user. In the ideal configuration of the device according to the invention the length of the third member substantially corresponds to the distance between a point between the shoulder blades to the midpoint of the thigh of the user. This length is indicated as XY in
In a further aspect of the invention the length of the band is between 40 and 100 cm, such as between 50 and 90 cm, such as between 55 and 85 cm, such as between 60 and 80 cm, such as between 63 and 77 cm, such as between 65 and 75 cm, such as between 67 and 73 cm, such as between 69 and 71 cm.
As hip joint movements originate from movements of the femur it seems reasonable to anchor the device to the thigh. Thus, in the preferred embodiment of the invention the leg conforming member is a collar, preferably this collar is adapted to conform around a thigh, preferably adapted to fit tightly around the lower part of the thigh just above the knee. The leg conforming member may be attached to the thigh at any position, however attachment close to the crotch may be discomforting to a user. The width of the collar is preferably approx. one third of the length of the femur (thigh bone) of the user, such as between 0.3 and 0.4 times the length of the femur of the user, such as between 0.25 and 0.5 times the length of the femur of the user, such as between 0.2 and 0.6 times the length of the femur of the user.
A thigh will typically be thinnest at the knee with a cone like shape from the knee and up. By providing a collar around the lower part of the thigh the natural cone like shape of the thigh will prevent the collar from sliding up and thereby maintain the tension in the device. The device may be more comfortable to the user if the shape of the collar is substantially conical.
The collar may be a closed collar and mounting of the device may be provided by sticking the foot trough the collar and sliding it up to the thigh. However, it may be easier for the user if the collar is provided with at least one closing mechanism, such as fabric hook-and-loop fasteners, such as Velcro, and thereby providing for an individual adaptation to the diameter of the thigh. The collar may be a band extending around the thigh. The width of the collar (equivalent to the height of the collar when worn by a user) is a balancing between comfort for the user and stability of the attachment. A wide collar covering the whole thigh may provide a very firm attachment, however less comfort for the user. A narrow collar may provide more comfort for user but an unstable attachment to the thigh. Thus, in one aspect of the invention the width of a collar may be between 5 and 26 cm, such as between 7 and 24 cm, such as between 10 and 22 cm, such as between 11 and 21 cm, such as between 12 and 20 cm, such as between 13 and 19 cm, such as between 14 and 18 cm, such as between 15 and 17 cm.
Even though the third member is preferably substantially wide and thereby also adapted to limit abduction, adduction, and lateral and medial rotation in the hip joint it may be necessary to provide additional limitations against one or more of these hip joint movements. Thus, in a further embodiment of the invention the device comprises a fourth member attached to the first member and the upper part of the third member. The fourth member is preferably substantially soft and/or flexible and adapted to limit one or more specific movements of said leg by anchoring the tensile load of said movement(s) in the shoulder(s). Further, the fourth member is preferably adapted to extend from the back of a user to the front side of the thigh of the user. Preferably the fourth member is adapted to limit abduction or adduction in one side of the hip joint. The fourth member may be a strap. Preferably the fourth member is substantially inelastic. Thus, the fourth member may be a strap that is attached to the upper part of the third member (preferably where the second member is attached) and that is adapted to extend down, preferably substantially diagonal, along the back of a user and round the outside of the buttock and the thigh down to the lower front part of the thigh where the fourth member is attached to the first member, which may be a collar. If a user then tries to adduct, i.e. cross the legs, the fourth member will help to limit this movement and the tensional load is distributed to the shoulder part via the third member.
The device may be regarded as an orthosis or more specifically a hip orthosis. However, in the device may also be regarded as a bandage.
In the preferred embodiment of the invention the device is adapted to be worn on the skin of the user. However, in some cases it may se suitable to wear the device over some kind of fabric, such as the clothes. Thus, the device is preferably at least partly provided in a biocompatible material, such as cotton. The device may as such be washable.
Selecting the right material for the device is a compromise between different parameters such as comfort, strength, elasticity, biocompatibility and cost. Textile as the primary material has proven to provide such a good compromise. Thus, in one embodiment of the invention the device, or at least the first member and/or the third member, is primarily manufactured in textile selected from the group of fabric, cloth, woven fabric, twill, denim, chino, drill, gabardine, tweed, canvas and serge. First of all users are accustomed to wearing textile, which is important because the device may be worn for 24 hours a day for 3 months. Secondly textile may provide a sufficient strength in order to efficiently oppose the substantial muscle power that may be exerted by users e.g. during flexion or extension in the hip joint. Thirdly textile may be provided as marginally elastic. Too much elasticity may pose a risk when e.g. flexion over 90 degrees must be avoided. And typically textile is biocompatible, washable and cost efficient.
In the preferred aspect of the invention the device limits flexion and/or extension of one or both sides of the hip joint of a user, i.e. when the device is worn by a user. Further, the device may limit abduction and/or adduction of one or both sides of the hip joint of a user. Even further the device may limit lateral rotation and/or medial rotation of one or both sides of the hip joint of a user.
The invention will now be described in more detail with reference to the drawings in which
a-c show photos of the first embodiment of the invention,
d-e are illustrations of the first embodiment,
a-f are illustrations of the hip joint movements,
a-b show prior art hip orthoses,
a-c are illustrations of the tensional forces in the first embodiment of the invention,
a-c show photos of a second embodiment of the invention,
d-e are illustrations of the second embodiment,
a-b show illustrations of a third embodiment of the invention,
a-b show illustrations of a fourth embodiment of the invention,
a-b show illustrations of a fifth embodiment of the invention,
a-b show examples of where shoulder straps may attach to a band,
a-d show photos of a sixth embodiment of the invention,
a-c show close-up photos of the sixth embodiment,
A first embodiment of the invention is shown in
In this case the user has probably received a posterior hip incision in the right side of the hip that necessitates limitation of flexion in the right hip joint. With a posterior incision there is no need to limit extension of the hip joint and the device as shown in
From
From
The first embodiment is also illustrated in
Six different movements of the hip joint are illustrated in
The arrows in
An “unfolded” embodiment of the first embodiment of the device according to the invention is illustrated in
For the device according to the present invention it is typically required that the third member is taut to provide the desired functionality of limiting certain hip joint movements. To account for different height and anatomical measures of different users the device is thereby preferably adjustable, typically by having adjustment means on the second member, e.g. in form of buckles, such that the length of the second member can be adjusted. When tightening the second member the third member can be made taut on a user. The photos in
Number | Date | Country | Kind |
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10163300.6 | May 2010 | EP | regional |
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/EP2011/058146 | 5/19/2011 | WO | 00 | 2/13/2013 |
Number | Date | Country | |
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61346070 | May 2010 | US |