US20170245884A1 - Multiple portal guide - Google Patents

Abstract

The present disclosure relates to a guide assembly. The guide assembly includes a guide having a body having a first set of marks and a joint including at least one through hole, the joint configured for sliding along the length of the body; and a first surgical device having a second set of marks, wherein the guide is coupled to the first surgical device and a longitudinal axis of the through hole is co-radial with a mark of the second set of marks when the joint is located at a mark of the first set of marks. Other guides are also disclosed.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. patent application Ser. No. 12/794,142, filed Jun. 4, 2010, which is a continuation-in-part of U.S. patent application Ser. No. 12/032,168, filed Feb. 15, 2008, now U.S. Pat. No. 8,956,278, which claims the benefit of U.S. Patent Application No. 61/015,811, filed Dec. 21, 2007. This application also claims the benefit of 61/187,797, filed Jun. 17, 2009. The disclosures of each of these are incorporated herein by reference in their entireties for all purposes.
BACKGROUND
• Field of Technology
• The present disclosure relates to medical devices for use in surgery and, more specifically, a guide for use in creating multiple portals during surgery.
• Related Art
• During arthroscopic surgery, the joint areas of the body, such as the hip, knee, shoulder, and other joint areas, are approached via the use of an endoscope. Some joints are harder to access than others. For example, the hip joint differs from other joints in that a much thicker layer of soft tissue, known as the hip capsules, surrounds it. This thick layer makes changing the trajectory of instruments placed into the joint difficult and the importance of placing portals, or tissue passages, more critical than other joints.
• Presently, fluoroscopy is used to place the portals that house the endoscope and the other instruments used during surgery. Multiple x-rays are taken while the surgeon tries various approaches to the joint using a thin needle that may be reinserted several times until the ideal portal placement is found. This process exposes the surgical team to radiation, is time consuming, and can lead to trauma, particularly to the delicate articular cartilage and, in the case of the hip joint, the acetabular labrum.
• There is a need for an apparatus and method that would allow for the creation of multiple portals while substantially reducing the possible harmful effects and the amount of time that is required of the present methods.
SUMMARY
• In one aspect, the present disclosure relates to a guide assembly. The assembly includes a guide including a body having a first set of marks and a joint including at least one through hole, the joint configured for sliding along the length of the body, and a first surgical device having a second set of marks. The guide is coupled to the first surgical device and a longitudinal axis of the through hole is co-radial with a mark of the second set of marks when the joint is located at a mark of the first set of marks.
• In another aspect, the present disclosure relates to a guide assembly. The guide assembly includes a guide having a body having at least one through hole and a first surgical device including an end having a mark. The guide is coupled to the first surgical device and a longitudinal axis of the through hole is co-radial with the mark on the end of the first surgical device.
• Further areas of applicability of the present disclosure will become apparent from the detailed description provided hereafter. It should be understood that the detailed description and specific examples, while indicating the preferred embodiment of the disclosure, are intended for purposes of illustration only and are not intended to limit the scope of the disclosure.
BRIEF DESCRIPTION OF THE DRAWINGS
• The accompanying drawings, which are incorporated in and form a part of the specification, illustrate the embodiments of the present disclosure and together with the written description serve to explain the principles, characteristics, and features of the disclosure. In the drawings:
• FIGS. 1-4 show front views of a first assembly guide of the present disclosure.
• FIG. 5 shows a front view of a second assembly guide of the present disclosure.
• FIG. 6 shows a front view of a third assembly guide of the present disclosure.
• FIG. 7 shows a front view of a fourth assembly guide of the present disclosure.
• FIG. 8 shows an isometric view of a fourth assembly guide of the present disclosure.
• FIG. 9A shows a top view of the lever arm, of the fourth guide assembly, in a first position.
• FIG. 9B shows a top view of the lever arm, of the fourth guide assembly, in a second position.
• FIG. 10 shows a perspective view of the second attachment portion of the fourth guide assembly.
• FIGS. 11A-11D show perspective views of methods for attaching the guides of the present disclosure to an endoscope cannula.
• FIG. 12 shows a front view of the first guide of the present disclosure coupled to an aimer arm.
• FIG. 13 shows a front view of the first guide of the present disclosure coupled to another aimer arm.
• FIG. 14 shows a front view of the fourth guide of the present disclosure coupled to an aimer arm.
• FIGS. 14A shows an expanded view of a distal end of the aimer arm of the guide ofFIG. 14.
DETAILED DESCRIPTION OF THE EMBODIMENTS
• The following description of the preferred embodiment(s) is merely exemplary in nature and is in no way intended to limit the disclosure, its application, or uses.
• FIG. 1 shows aguide10 that includes abody11 having afirst end12, asecond end13, an arc along a length L of thebody11, and at least one throughhole14. Also shown inFIG. 1 is a firstsurgical instrument20, such as an endoscope, that includes afirst end21 and asecond end22. Thesecond end13 of theguide10 is coupled to thefirst end21 of theendoscope20, via acannula40, as further described below, and alongitudinal axis15 of the throughhole14 intersects, or is co-radial with, thesecond end22 of theendoscope20. As also shown inFIG. 1, thebody11 may include multiple throughholes14, each of which includes alongitudinal axis15 that intersects, or is co-radial with, thesecond end22 of theendoscope20.
• During arthroscopic surgery, especially hip arthroscopy, afirst portal31 is created in a relatively safe position, within a patient'sbody32, where damage to internal structures is minimized. Theportal31 may be created via the use of fluoroscopy, as described above, or another method known to know of ordinary skill in the art. Thefirst cannula40 andendoscope20 are then inserted through theportal31, so that a clear view of the inside of the patient'sbody32, especially thearea35 where the surgery is to be performed (i.e. the hip joint and the capsule surrounding the joint), can be seen by the surgeon. This view also shows the surgeon the anatomy that must be avoided and where a safe area for placing other portals is. As will be further discussed below, theendoscope20 is disposed within thefirst cannula40 such that thesecond end22 of theendoscope20 protrudes through asecond end42 of thecannula40. After positioning thesecond end22 of theendoscope20 at anarea36 where the surgeon wishes a second portal (FIG. 4, 33) to be placed, such as the inner surface of the hip capsule, theguide10 is coupled to thefirst end21 of theendoscope20, via the cannula, and the second portal (FIG. 4, 33) is placed relative to thesecond end22 of theendoscope20 by inserting a second surgical device (FIG. 4, 34), such as a second cannula, through one of the throughholes14 and into the patient'sbody32. Since thelongitudinal axis15 of the throughhole14 intersects, or is co-radial with, the second end of22 of theendoscope20, thesecond cannula34 would also be co-radial with thesecond end22 of theendoscope20. Furthermore, and as will be described below, this co-radial relationship between thesecond cannula34 and the second22 of theendoscope20 allows a needle or other surgical instrument that may be placed within thesecond cannula34 and used in thearea35 described above, to intersect thesecond end22 of theendoscope20.
• Having multiple throughholes14 in theguide10 allows for flexibility in the placement of thesecond portal33 so that damage to internal structures can be minimized. However, aguide10 having only one throughhole14 may be used.
• FIG. 2 shows theendoscope20 disposed within thefirst cannula40, as described above, such that thesecond end22 of theendoscope20 protrudes through asecond end42 of thecannula40. Theguide10 is coupled to afirst end41 of thefirst cannula40. Thecannula40 has a pointedtip43, located at thesecond end42, which is offset a distance d from theendoscope20 or in a direction ofview37 of theendoscope20. As shown inFIG. 2 and in subsequent figures, as described below, the distance d is measured from theoptical center23 of theendoscope20. The direction ofview37 of theendoscope20 is located at an angle α, about 70° , relative to alongitudinal axis26 of theendoscope20. Sometimes, the anatomy of the body prevents thesecond end22 of theendoscope20 from being positioned in thearea36, such as the inner surface of the hip capsule as described above, where the surgeon wishes the second portal (FIG. 4, 33) to be placed. When this happens, thecannula40 with the pointedtip43 can be made to intersect, or be co-radial with, the pointedtip43. Rather than using a cannula with a pointed tip, theendoscope20 could be fitted with a pointed tip similar to the pointedtip43 of thecannula40. Theendoscope20 and pointed tip could be introduced into the patient's body via slotted cannula.
• FIG. 3 is similar toFIG. 2 in that alongitudinal axis15 of the throughhole14 intersects with anarea36 that is offset a distance d from theendoscope20 or in a direction ofview37 of theendoscope20. However, rather than using the pointedtip43 of thecannula40 to identify thisarea36, the average distance d between theendoscope20 and the point of intersection witharea36 is determined and an offset, equal to that average distance d, is built into theguide10 so that alongitudinal axis15 of the throughhole14 intersects with thisarea36. For example, during hop arthroscopy, a surgeon may want to introduce a needle into thehip capsule35, but the hip anatomy may prevent thesecond end22 of theendoscope20 from being brought up against theinner surface36 of the hip capsule. Since theendoscope20 may be a distance from the capsuleinner surface36, an error where the needle penetrates the capsule would result. To overcome this problem, the pointedtip43 or the build-in offset d, as described above, could be used. For the purpose of this disclosure, the distance d is about 1 cm. However, the distance d will vary based on the location of theendoscope20 relative toarea36.
• FIG. 4 shows thesecond cannula34 disposed within the throughhole14 andsecond portal33. Thecannula34 includes adepth stop38 that substantially reduces the possibility of a first end39aof a needle39 or other surgical instrument, disposed within thecannula34, from advancing past the second end of theendoscope20 by having a second end39bof the needle39 about asecond end38bof thedepth stop38. Thedepth stop38 may be part of thesecond cannula34 or separate from thesecond cannula34. This allows thesecond cannula34 to be positioned to any depth within the throughhole14, yet still have a fixed depth stop relative to theguide10.
• FIG. 5 shows aguide60 that includes abody61 having afirst end62, asecond end63, and an arc along a length L of thebody61. Theguide60 also includes a joint64 configured for sliding along the length L of thebody61. The joint64 includes at least one throughhole65. Similar to theguide10 disclosed inFIGS. 1-4, guide60 is also coupled to a firstsurgical device20, such as an endoscope. Theendoscope20 may be disposed within afirst cannula40, similar to the first cannula disclosed inFIG. 2 and described above, such that thesecond end22 of theendoscope20 protrudes through asecond end42 of thecannula40. Thecannula40 has a pointedtip43 similar to the pointed tip shown inFIG. 2 and described above. A secondsurgical device34, similar to the second surgical decide show inFIG. 4, is disposed within the throughhole65. Alongitudinal axis66 of the throughhole65, and therefor of the secondsurgical device34, intersects, or is co-radial with, the pointedtip43. However, thelongitudinal axis66 could be made to intersect, or be co-radial with, thesecond end22 of theendoscope20 or with anarea36 that is offset a distance d from theendoscope20, as shown inFIGS. 1 and 3.
• The joint64 may be slid along the length L of thebody61 to decide where to place thesecond portal33 so that damage to internal structures can be minimized. Since thelongitudinal axis66 of the throughhole65 and the second surgical decide34 is co-radial with the pointedtip43, a needle or other surgical instrument disposed within the secondsurgical device34, will intersect the pointedtip43, regardless of where thesecond portal33 is placed. The joint64 and thebody61 may includeopenings67 to make theguide60 lightweight and ensure that the joint64 and thebody61 cool quickly after autoclaving.
• Similar to theguide60 shown inFIG. 5,FIG. 6 shows aguide70 that includes a body71 having afirst end72, and asecond end73. Theguide70 also includes a joint74 configured for sliding along the body71. The joint74 includes at least one throughhole75. Similar to theguide10 disclosed inFIGS. 1-4, guide70 is also coupled to a firstsurgical device20, such as an endoscope, via acannula40. A secondsurgical device34, similar to the second surgical device shown inFIG. 4, is disposed within the throughhole75. Alongitudinal axis76 of the throughhole75, and therefore of the secondsurgical device34, intersects, or is co-radial with, anarea36 that is offset a distance d from theendoscope20. However, thelongitudinal axis76 could be made to intersect, or be co-radial with, apointed tip43 of thecannula40 or thesecond end22 of theendoscope20, as shown inFIGS. 2, 5, 1 and 4.
• As also show inFIG. 5 and described above, the joint74 may be slid along the body71 to vary the distance d based upon the distance between thesecond end22 of theendoscope20 and the capsuleinner surface36. Since the second surgical decide34 is co-radial with thearea36, a needle or other surgical instrument disposed within the second surgical decide34, will intersect thearea36, regardless of where thesecond portal33 is placed. Theguide70 also includes a mechanism77, such as a locking nut, for engaging the joint74 and holding it in a position along the body71. Once the surgeon has determined the position of thesecond portal33, the locking nut77 will be tightened to engage the joint74 and hold it in a position along the body71. The secondsurgical device34 will then be inserted into the throughhole75 and through the patient'sbody32 to make thesecond portal33.
• Similar to theguides60,70 show inFIGS. 5 and 6, theguide80 shown inFIG. 7 includes abody81 having afirst end81a,asecond end81b,and an arc along a length L of thebody81. Theguide80 also include a joint84 configured for sliding along a length L of thebody81. The joint84 includes at least one throughhole85. Similar to theguide10,60,70 disclosed inFIGS. 1-6, guide80 is also coupled to a first surgical decide20, such as an endoscope via thefirst end21 of theendoscope20 and thefirst end41 of thecannula40. A secondsurgical device34, similar to the second surgical decide shown inFIGS. 4-6, is disposed within the throughhole85. Alongitudinal axis86 of the throughhole85, and therefor of the second surgical decide34, intersects, or is co-radial with, thesecond end22 of theendoscope20. However, thelongitudinal axis86 could be made to intersect, or be co-radial with, apointed tip43 of thecannula40 or anarea36 that is offset a distance d from theendoscope20, as shown inFIGS. 4, 5, and 3.
• As also shown inFIG. 7 and described above, the joint84 may be slid along the length L of thebody81 to decide where to place a second portal so that damage to internal structures can be minimized. Since the secondsurgical device34 is co-radial with thesecond end22 of theendoscope20, aneedle90 or other surgical instrument disposed within the secondsurgical device34, will intersect thesecond end22, regardless of where the second portal is placed. Thebody80 includes aslot81cthat runs the entire length L of thebody80 and that houses the joint84. In addition, similar to theguide70 ofFIG. 6, theguide80 includes amechanism87, such as a locking nut, for engaging the joint84 and holding it in a position along thebody81. During surgery, use of the lockingnut87 in creating a second portal occurs in the same manner as described above. After the secondsurgical device34, or second cannula, has been inserted into the patient's body, theneedle90, or other instrument, may be inserted through thecannula34 for use in performing a surgical procedure. Theneedle90 which intersects, or is co-radial with, thesecond end22 of theendoscope20, may include adepth stop90c,at afirst end90aof theneedle90, that abuts afirst end34aof thecannula34 to substantially reduce the possibility of thesecond end90bof theneedle90 from advancing past thesecond end22 of theendoscope20.
• As show inFIGS. 7 and 8, theguide80 includes afirst attachment portion88 and asecond attachment portion89, both of which are configured for coupling thebody81 to the first surgical decide20 via the firstsurgical device20 and thecannula40. Thefirst attachment portion88, which includes an anti-rotation lock, is located at thefirst end81aof thebody81 and extends substantially perpendicular to theaxis26 of theendoscope20. As shown inFIGS. 9A and 9B, theanti-rotation lock88 includes alever arm88clocated between atop surface88aandbottom surface88bof theanti-rotation lock88. Thelever arm88cis coupled to thesurfaces88a,bvia a pivot pin or screw88dand aspring88e.When theendoscope20 is not coupled to theanti-rotation lock88, thelevel arm88cis in a first position, as shown inFIG. 9A, such that thespring88eis in a relaxed state. However, when theendoscope20 is coupled to theanti-rotation lock88, thelever arm88cis in a second position, as shown inFIG. 9B, such that thelever arm88cis pushed against thelight post24 of theendoscope20, and substantially reduces the possiblity of rotation of thelight post24 in a direction that would uncouple thecannula40 from theendoscope20.
• As show inFIGS. 7 and 8, thesecond attachment portion89 is located near thesecond end81bof thebody81 and extends substantially perpendicular to thelongitudinal axis26 of theendoscope20. Theportion89 includes twoprongs89a,b,both of which extend longitudinally from theportion89, and anopening89c,located between theprongs89a,bthat extends longitudinally into theportion89. As shown inFIG. 10, thecannula40 includes a coupling portion45 configured for coupling of thesecond attachment portion89 to thecannula40. The coupling portion45 includes two holes45aand a projection45bthat extends longitudinally from the coupling portion45. Thesecond attachment portion89 is coupled to the coupling portion45 such that theprongs89a,bare disposed with the holes45aand the projection45bis disposed within theopening89c.
• As shown inFIG. 7, thesecond end81bof thebody81 does not extend beyond aplane90, located between thesecond attachment portion89 and alongitudinal axis26 of the firstsurgical device20, and that forms an angle β, about 60° , with thelongitudinal axis26.
• FIGS. 11A-11D show methods for coupling thesecond end13 of theguide10 to thefirst end41 of thecannula40. As shown inFIG. 11A, thesecond end13 includes afirst arm13a,asecond arm13b,and aslot13clocated between the first andsecond arms13a,b.Thefirst end41 of thecannula40 includes a coupling portion46, similar to the coupling portion45 shown inFIG. 10 albeit with channels46ainstead of holes45a.Thesecond end13 of theguide10 is coupled to thefirst end41 of thecannula40 such that the first andsecond arms13a,bare housed within the channels46aand the projection46bis housed within theslot13c.Botharms13a,binclude anedge13a′,13b′, wherein eachedge13a′,13b′, is configured for attaching to the backside46cof the coupling portion46 when theguide10 is coupled to the coupling portion46, therefore creating a snap-fit connection between thearms13a,13b,and the coupling portion46.
• As shown in11B, thesecond end13 of theguide10 includes afirst arm13aand asecond arm13b.Thefirst end41 of thecannula40 includes an adaptor47 that has been slid over thecannula40. The first andsecond arms13a,bof theguide10 are coupled to the adaptor47 such that an interference fit, or a clip-on connection is created between thearms13a,band the adaptor47.
• As show in11C, thesecond end13 of theguide10 includes abase portion13dthat partially surrounds thefirst end41 of thecannula40 and includes ahook13ethat is placed on the irrigation extender50, which is coupled to thecannula40. Shown inFIG. 11D is aguide10 that includes asecond end13 having anarm13fincluding anopening13f″ and aslot13f′ formed in thearm13f.Thefirst end41 of thecannula40 includes a coupling portion49, similar to the coupling portions45,46 shown inFIGS. 10 and 11A, albeit without holes or channels. Thesecond end13 of theguide10 is coupled to thefirst end41 of thecannula40 such that thefirst end41 of thecannula40 is disposed within theopening13f″ and the projection (not shown) is housed with theslot13f′. Theguide10 may be placed onto thefirst end41 by placing theopening13f″ over thefirst end41 and sliding thearm13fand thefirst end41. Other methods of coupling the guide to the cannula may also be used.
• As show inFIG. 12, aguide100, similar to theguide10 inFIGS. 1-4, is coupled to a firstsurgical device200, such as an aimer arm, that includes adistal end200bin the shape of a hook. Thedistal end200bof theaimer arm200 is positioned in theposterior region300bof thehip joint300. A second surgical decide400, such as a cannula, is disposed within the throughhole104 of theguide100. A longitudinal axis401 of thecannula400 is co-radial with the tip B200cB on thedistal end200bof theaimer arm200. This co-radial relationship allows access to theposterior region300bof thehip joint300, via thefemoral neck300a,by a surgical tool, such as a drill (not shown), disposed within thecannula400. Theaimer arm200 may be introduced into thebody32 in the same manner as theendoscope20 is introduced, as described above, or another manner known to one of ordinary skill in the art. Likewise, theguide100 may be coupled to theaimer arm200 in the same manner asguide80 id coupled to thecannula40 inFIG. 7, in the same manner asguide10 is coupled to thecannula40 inFIGS. 11A-11D, or another manner known to know of ordinary skill in the art. Theaimer arm200 may rotate around a longitudinal axis201 of theaimer arm200 via a rotational coupling (as shown) located at the proximal end200aof theaimer arm200.
• As shown inFIG. 13, aguide500, similar to theguide100 inFIG. 12, is coupled to a firstsurgical device600, such as an aimer arm, that includes adistal end600bin the shape of a hook. Thedistal end600bof theaimer arm600 is positioned in theposterior region700bof thehip joint700. A secondsurgical device800, such as a cannula, is disposed within the throughhole504 of theguide500. Alongitudinal axis801 of thecannula800 is co-radial with themark600con thedistal end600bof theaimer arm600. This co-radial relationship allows access to theposterior region700bof thehip joint700, via thefemoral neck700a,by a surgical tool, such as a drill (not shown), disposed within thecannula800. Theaimer arm600 may be introduced into the body in the same manner as theendoscopy20 is introduced, as described above, or another manner know to one of ordinary skill in the art. Likewise, theguide500 may be coupled to theaimer arm600 in the same manner asguide10 is coupled to thecannula40 inFIGS. 11A-11D, or another manner known to know of ordinary skill in the art. Furthermore, themark600c,which may be created by a laser or any other technology that could be used to create the mark, may be located anywhere along thehook600b.Mark600cmay also be a physical feature, such as a bump, a hole, or any other physical feature that may be seen on an X-ray.
• As shown inFIGS. 14 and 14A, aguide100, similar to theguide80 inFIG. 7, is coupled to a firstsurgical device1100, such as an aimer arm, that includes adistal end1100bin the shape of a hook. Thedistal end1100bof theaimer arm1100 is positioned in theposterior region1200bof thehip joint1200. A second surgical decide1300, such as a cannula, is disposed within the throughhole1010aof the joint1010. Theguide1000 includes a first set of marks1020a-1020gand thedistal end1100bofdevice1100 includes a second set of marks1030a-1030g,as more clearly shown inFIG. 14A. A mark of the first set of marks1020a-1020gand a mark of the second set of marks1030a-1030gare co-radial. For example, as shown inFIG. 14, thelongitudinal axis1400 ofdevice1300 is co-radial withmark1030gwhen joint1010 is located atmark1020g.This co-radial relationship allows acces to theposterior region1200bof the hip joint1200, via thefemoral neck1200a,by a surgical tool, such as a drill (not shown), disposed within thecannula1300. During use, the joint1010 is moved to a mark or marker of the first set of marks1020a-1020gand the drill (not shown) is then inserted into thecannula1300.
• Theaimer arm1100 may be introduced into the body in the same manner as theendoscope20 is introduced, as described above, or another manner known to one of ordinary skill in the art. Likewise, theguide1000 may be coupled to theaimer arm1100 in the same manner asguide10 is coupled to thecannula40 inFIGS. 11A-11D, or another manner known to one of ordinary skill in the art. Furthermore, the marks1020,1030 may be created by a laser or any other technology that could be used to create the marks.
• For the purpose of this disclosure, a manual or automatic milling machine is used to create the through holes of the guides described above. Other apparatuses and methods of creating the through holes may also be used. The guides are manufactured from a metal material, such as stainless steel or titanium, by may be manufactured from another material known to one of ordinary skill in the art. In addition, the first and second cannulas and the aimer arm described above are manufactured from another biocompatible material known to one of ordinary skill in the art. Furthermore, for purposes of this disclosure, the guides include a body having an arc along the length of the body, but an arc is not necessary and the body may be straight or incorporate any other shapes known to one of ordinary skill in the art. Although the present disclosure relates to the use of the above described guides for the placement of portals during hip arthroscopy, the basic principles and methods may also be applied to other joint areas of the body.
• As various modifications could be made to the exemplary embodiments, as described above with reference to the corresponding illustrations, without departing from the scope of the disclosure, it is intended that all matter contained in the foregoing description and shown in the accompanying drawings shall be interpreted as illustrative rather than limiting.

Claims (19)

What is claimed is:

1. A guide assembly comprising:

a guide including a body having at least one through hole; and

a first surgical device coupled to the guide and having a distal portion configured to engage a bone surface;

wherein the through hole is configured to receive a second surgical device therethrough;

wherein a longitudinal axis of the through hole is co-radial with an aiming feature defined by the distal portion of first surgical instrument; and

wherein the distal portion of the first surgical instrument intersects with and extends beyond the longitudinal axis of the through hole.

2. The guide assembly ofclaim 1, wherein the first surgical device is an aimer arm.

3. The guide assembly ofclaim 1, wherein the aiming feature is one of a laser mark, a bump, or a hole.

4. The guide assembly ofclaim 1, further comprising one or more depth limiting elements configured to limit movement of a distal end of the second surgical instrument beyond the distal portion of the first surgical instrument.

5. The guide assembly ofclaim 1, wherein the distal portion of the first surgical device is contoured to substantially conform to a curved bone surface.

6. The guide assembly ofclaim 5, wherein the distal portion defines a curved surface, the curved surface configured to correspond with a curvature of a femoral head so as to enable engaging the curved surface with the femoral head.

7. The guide assembly ofclaim 6, wherein the longitudinal axis of the through hole is configured to guide access of the second surgical device to a region of the hip joint via a path through the femoral neck.

8. The guide assembly ofclaim 1, wherein the through hole is defined by a joint which is slidable along a length of the body, wherein a first longitudinal axis of the through hole is defined for a first position of the joint and a second longitudinal axis of the through hole is defined for a second position of the joint, the first and second longitudinal axes of the through hole being co-radial with different aiming features defined by the distal portion of the first surgical device and intersecting with one another at a point in between the guide and the first surgical device, wherein the distal portion of the first surgical instrument intersects with and extends beyond both the first and second longitudinal axis of the through hole.

9. The guide assembly ofclaim 8, wherein the first longitudinal axis of the through hole and the second longitudinal axis of the through hole are configured to guide access of the second surgical device to a region of the hip joint via different paths through a femoral neck when the first surgical device is engaged with a femoral head and the second surgical device is received in the through hole.

10. The guide assembly ofclaim 1, further comprising a second surgical device disposed within the through hole.

11. The guide assembly ofclaim 10, wherein the second surgical device is a cannula.

12. The guide assembly ofclaim 11, wherein the cannula is configured to receive a drill.

13. The guide assembly ofclaim 1, wherein the guide is removably coupled to the first surgical device.

14. The guide assembly ofclaim 7, wherein the longitudinal axis of the through hole is configured to align with an axis of the femoral neck when the first surgical device is engaged with the femoral head.

15. The guide assembly ofclaim 7, wherein the second longitudinal axis of the through hole is configured to be at an angle relative to an axis of the femoral neck when the first surgical device is engaged with the femoral head.

16. The guide assembly ofclaim 1, wherein the distal tip of the first surgical device includes a pointed spike for engaging with the bone.

17. The guide assembly ofclaim 1, wherein the guide includes multiple through holes each through hole defining a longitudinal axis different from the longitudinal axes of the other through holes.

18. The guide assembly ofclaim 17, wherein the longitudinal axes of the through holes are co-radial with respect to a same aiming feature defined by the distal portion of the first surgical device.

19. The guide assembly ofclaim 17, wherein the longitudinal axes of the through holes are co-radial with respect to different aiming features defined by the distal portion of the first surgical device.

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