FR2732891A1 - Femoral prosthesis used in orthopaedics - Google Patents

Femoral prosthesis used in orthopaedics Download PDF

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Publication number
FR2732891A1
FR2732891A1 FR9504617A FR9504617A FR2732891A1 FR 2732891 A1 FR2732891 A1 FR 2732891A1 FR 9504617 A FR9504617 A FR 9504617A FR 9504617 A FR9504617 A FR 9504617A FR 2732891 A1 FR2732891 A1 FR 2732891A1
Authority
FR
France
Prior art keywords
rod
base
fin
femoral prosthesis
prosthesis according
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
FR9504617A
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French (fr)
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FR2732891B1 (en
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Individual
Original Assignee
Individual
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Publication date
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Priority to FR9504617A priority Critical patent/FR2732891B1/en
Publication of FR2732891A1 publication Critical patent/FR2732891A1/en
Application granted granted Critical
Publication of FR2732891B1 publication Critical patent/FR2732891B1/en
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A61B17/1753—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip for fixing pins through femoral hip prostheses
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30721—Accessories
    • A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30721—Accessories
    • A61F2/30739—Devices connected to the proximal part of an endoprosthetic femoral shaft for reinforcing or replacing the trochanters, e.g. the greater trochanter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3662—Femoral shafts
    • A61F2/367—Proximal or metaphyseal parts of shafts
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/36—Femoral heads ; Femoral endoprostheses
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • A61F2002/30113—Rounded shapes, e.g. with rounded corners circular
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30433—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
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    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
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    • A61F2002/3054—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting angular orientation about a connection axis or implantation axis for selecting any one of a plurality of radial orientations between two modular parts, e.g. Morse taper connections, at discrete positions, angular positions or continuous positions
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    • A61F2002/30576—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30904—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves serrated profile, i.e. saw-toothed
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A—HUMAN NECESSITIES
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    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A—HUMAN NECESSITIES
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
    • A—HUMAN NECESSITIES
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
    • A—HUMAN NECESSITIES
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0075—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements sutured, ligatured or stitched, retained or tied with a rope, string, thread, wire or cable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • A61F2230/0006—Rounded shapes, e.g. with rounded corners circular

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Public Health (AREA)
  • Vascular Medicine (AREA)
  • Cardiology (AREA)
  • Transplantation (AREA)
  • Surgery (AREA)
  • Dentistry (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Prostheses (AREA)

Abstract

The prosthesis consists of a shank (1) designed to fit into the medullary canal of a femur, having a shoulder (14) at its upper end equipped with a joint ball. The outer surface of the shoulder is equipped with a detachable wing (19) which can be of variable height, according to requirements, with the top of the wind situated above the level of the portion of the shoulder in line with the axis of the shank. The wing (19) has a lower transverse face shaped to fit against the outer surface of the shoulder, which is generally semi-circular in shape, while the thickness of the wing is basically constant at the top and tapers towards the bottom. It is equipped with a lug (20) designed to engage with a recess in the upper surface of the shoulder and made with a hole for a fixing bolt (16).

Description

La présente invention a pour objet une prothèse fémorale de reconstruction et un ancillaire pour sa pose. The present invention relates to a femoral reconstruction prosthesis and an ancillary device for its installation.

Une prothèse fémorale comprend, de façon connue, une tige destinée à être engagée dans le canal médullaire d'un fémur, après résection de la tête du fémur, et dont l'extrémité supérieure est équipée d'une embase, elle-même munie d'une rotule. Cette rotule est destinée à venir pivoter à l'intérieur de la cavité cotyloïdienne, après implantation éventuelle d'une cupule. A femoral prosthesis comprises, in a known manner, a rod intended to be engaged in the medullary canal of a femur, after resection of the head of the femur, and the upper end of which is equipped with a base, itself provided with 'a ball joint. This patella is intended to pivot inside the acetabular cavity, after possible implantation of a cup.

Chez des personnes âgées, il peut se produire une certaine fragilisation des os qui, accompagnée d'une usure d'une prothèse déjà en place nécessite le retrait de cette prothèse et son remplacement par une prothèse de reconstruction. Le plus souvent la fragilisation osseuse est due au descellement de la prothèse. In elderly people, there can be a certain weakening of the bones which, accompanied by wear of a prosthesis already in place requires the removal of this prosthesis and its replacement by a reconstruction prosthesis. Most often the weakening of the bone is due to the loosening of the prosthesis.

Les prothèses de reconstruction sont destinées à être implantées dans des fémurs de mauvaise qualité, dans lesquels la paroi osseuse présente une faible épaisseur, et est déminéralisée. Pour réaliser un ancrage le plus satisfaisant possible d'une telle prothèse, il convient généralement d'utiliser une tige de grande longueur pour profiter de la plus grande longueur possible de la partie encore saine de la diaphyse comme moyen d'ancrage mécanique dans le fémur. Dans la mesure où cet ancrage mécanique est fermement assuré, il est possible d'espérer une reconstruction osseuse dans la partie métaphysaire. Dans cette partie métaphysaire, il n'est pas rare que le grand trochanter soit détérioré, ce qui pose des problèmes de tenue de la partie haute de la prothèse, ainsi que des problèmes d'attache de certains muscles, notamment des fessiers. The reconstruction prostheses are intended to be implanted in poor quality femurs, in which the bone wall has a small thickness, and is demineralized. To achieve the most satisfactory possible anchoring of such a prosthesis, it is generally advisable to use a very long rod to take advantage of the greatest possible length of the still healthy part of the diaphysis as a mechanical anchoring means in the femur. . Insofar as this mechanical anchoring is firmly ensured, it is possible to hope for bone reconstruction in the metaphyseal part. In this metaphyseal part, it is not uncommon for the greater trochanter to be deteriorated, which poses problems of holding the upper part of the prosthesis, as well as problems of attachment of certain muscles, in particular of the glutes.

Le but de l'invention est de fournir une prothèse fémorale de reconstruction qui permette de pallier une insuffisance de solidité de la partie métaphysaire du fémur. The object of the invention is to provide a femoral reconstruction prosthesis which makes it possible to compensate for an insufficient solidity of the metaphyseal part of the femur.

A cet effet, dans la prothèse qu'elle concerne, L'embase est munie sur sa face tournée vers l'extérieur, c'est-à-dire du côté opposé à la rotule, d'un aileron profilé, fixé de façon amovible et de taille variable selon les cas. L'extrémité supérieure de l'aileron est située plus haut que la zone de la paroi supérieure de l'embase se trouvant dans l'axe de la tige. To this end, in the prosthesis to which it relates, the base is provided on its face facing outwards, that is to say on the side opposite to the ball joint, with a profiled fin, removably fixed. and of variable size depending on the case. The upper end of the fin is located higher than the area of the upper wall of the base located in the axis of the rod.

Cet aileron a pour but soit de recentrer le grand trochanter à sa place, soit d'assurer une fixation très solide. II sert d'appui à la partie osseuse constituant le grand trochanter, mais qui peut être détériorée.  The purpose of this fin is either to center the greater trochanter in its place, or to ensure a very solid fixation. It serves as a support for the bone part constituting the greater trochanter, but which may be deteriorated.

Suivant une forme d'exécution l'aileron possède, vu en coupe transversale, une face inférieure de profil complémentaire de celui de la face extérieure de l'embase et une face extérieure de forme générale semicirculaire. According to one embodiment, the fin has, seen in cross section, a lower face with a profile complementary to that of the outer face of the base and an outer face of generally semicircular shape.

En outre l'épaisseur de l'aileron est sensiblement constante dans sa partie supérieure et diminue dans sa partie inférieure, au fur et à mesure que l'on se rapproche de la tige. In addition the thickness of the fin is substantially constant in its upper part and decreases in its lower part, as one approaches the rod.

Cette forme permet de s'adapter le mieux possible à la forme du grand trochanter restant. This shape makes it possible to adapt as best as possible to the shape of the remaining greater trochanter.

Selon une caractéristique de l'invention l'aileron comporte, d'une part à sa partie supérieure, une patte destinée à être positionnée dans un évidement ménagé dans la face supérieure de l'embase et à être fixée dans celui-ci par vissage, et d'autre part en-dessous de la patte, au moins un ergot, destiné à être engagé dans un trou, ménagé dans l'embase sensiblement perpendiculairement à l'axe de la tige. According to a characteristic of the invention, the fin comprises, on the one hand at its upper part, a tab intended to be positioned in a recess formed in the upper face of the base and to be fixed therein by screwing, and on the other hand below the tab, at least one lug, intended to be engaged in a hole, formed in the base substantially perpendicular to the axis of the rod.

Suivant une forme avantageuse de réalisation de cette prothèse, dans le cas où la tige et l'embase sont indépendantes et fixées l'une à l'autre par vissage à l'aide d'une vis traversant l'embase et vissée dans un trou fileté ménagé à l'extrémité supérieure de la tige, la patte que comporte l'aileron est sensiblement perpendiculaire à l'axe de la tige et est fixée dans l'évidement ménagé à cet effet dans 'embase, par la vis d'assemblage de la tige et de l'embase. According to an advantageous embodiment of this prosthesis, in the case where the rod and the base are independent and fixed to each other by screwing using a screw passing through the base and screwed into a hole threaded at the upper end of the rod, the tab that the fin comprises is substantially perpendicular to the axis of the rod and is fixed in the recess provided for this purpose in the base, by the assembly screw of the rod and the base.

Cette structure est intéressante car limitant le nombre de pièces constitutives de la prothèse, et permettant, à l'aide d'une seule vis de réaliser l'assemblage de plusieurs pièces dont les fonctions sont distinctes. This structure is advantageous because it limits the number of constituent parts of the prosthesis, and makes it possible, using a single screw, to assemble several parts whose functions are distinct.

En outre, L'aileron comporte des trous traversants horizontaux. In addition, the fin has horizontal through holes.

Ces trous permettent soit l'attache du grand trochanter restant, soit l'attache de greffons osseux permettant la canalisation ultérieure du grand trochanter.These holes allow either the attachment of the remaining greater trochanter, or the attachment of bone grafts allowing subsequent canalization of the greater trochanter.

Selon une autre caractéristique de l'invention, cette prothèse comporte des moyens de réglage de l'antéversion du col constitués par des crans dépassant de la face supérieure de la tige destinés à coopérer dans plusieurs positions angulaires avec des encoches ménagées dans la face inférieure de l'embase.  According to another characteristic of the invention, this prosthesis comprises means for adjusting the anteversion of the neck constituted by notches protruding from the upper face of the rod intended to cooperate in several angular positions with notches formed in the lower face of the base.

Afin de favoriser la tenue de la prothèse à l'intérieur du fémur la partie métaphysaire de la tige et/ ou la partie inférieure de l'embase comportent des gorges annulaires disposées dans des plans perpendiculaires à l'axe de la tige. In order to promote the holding of the prosthesis inside the femur, the metaphyseal part of the rod and / or the lower part of the base have annular grooves arranged in planes perpendicular to the axis of the rod.

L'ancrage de la tige et de l'embase à l'intérieur du fémur peut être amélioré en revêtant ces pièces d'hydroxyapatite de calcium qui favorise la repousse osseuse. The anchoring of the rod and the base inside the femur can be improved by coating these pieces of calcium hydroxyapatite which promotes bone regrowth.

Avantageusement, la partie diaphysaire de la tige comporte au moins un trou transversal traversant destiné à loger une vis traversant le fémur. Advantageously, the diaphyseal part of the rod has at least one transverse through hole intended to accommodate a screw passing through the femur.

Une telle vis permet d'assurer un blocage de la tige notamment en rotation, ce qui évite les risques de mobilité de cette dernière. Such a screw makes it possible to secure the rod in particular in rotation, which avoids the risks of mobility of the latter.

L'invention concerne également un ancillaire pour la pose de cette prothèse qui est caractérisé en ce qu ' il comprend deux branches parallèles reliées par une branche supérieure transversale, les deux branches parallèles ayant des longueurs différentes, celle la plus courte comportant, à son extrémité libre, des moyens de positionnement et d'appui sur la face supérieure de la partie métaphysaire de la tige, et celle la plus longue comportant des orifices transversaux qui, situés dans l'alignement des trous transversaux de la tige, servent au guidage d'un outil pour le perçage transversal du fémur dans l'axe du ou des trous transversaux de la tige. The invention also relates to an ancillary device for fitting this prosthesis, which is characterized in that it comprises two parallel branches connected by a transverse upper branch, the two parallel branches having different lengths, the shorter one having, at its end free, positioning and support means on the upper face of the metaphyseal part of the rod, and the longer one comprising transverse orifices which, located in alignment with the transverse holes in the rod, serve to guide a tool for the transverse drilling of the femur in the axis of the transverse hole (s) of the rod.

De toute façon l'invention sera bien comprise à l'aide de la description qui suit, en référence au dessin schématique annexé représentant, à titre d'exemple non limitatif, une forme d'exécution de cette prothèse, et une forme d'exécution d'un ancillaire pour sa pose
Figure 1 est une vue en élévation de cette prothèse dont les pièces principales sont représentées en position éclatée
Figure 2 est une vue de face de cette même prothèse en position assemblée, et partiellement en coupe longitudinale
Figure 3 est une vue de profil de cette prothèse, du côté opposé à la rotule
Figure 4 est une vue en coupe transversale et à échelle agrandie de l'aileron;
Figure 5 est une vue en élévation d'un ancillaire pour la pose de cette prothèse.In any case, the invention will be better understood with the aid of the description which follows, with reference to the appended schematic drawing representing, by way of nonlimiting example, an embodiment of this prosthesis, and an embodiment an ancillary for its installation
Figure 1 is an elevational view of this prosthesis whose main parts are shown in exploded position
Figure 2 is a front view of the same prosthesis in the assembled position, and partially in longitudinal section
Figure 3 is a side view of this prosthesis, on the side opposite the patella
Figure 4 is a cross-sectional view on an enlarged scale of the fin;
Figure 5 is an elevational view of an ancillary for the installation of this prosthesis.

La figure 1 représente une prothèse fémorale comportant une tige 2 présentant deux parties principales, une partie inférieure diaphysaire 3, de section cylindrique, et sensiblement constante, dont la face extérieure comporte des rainures longitudinales 4. Dans la partie diaphysaire 3 est ménagé un trou traversant 5, ou plusieurs suivant les tailles, destiné au passage d'une vis 6, engagée, depuis l'extérieur, à travers le fémur pour assurer la retenue de la tige dans le canal médullaire et éviter notamment sa rotation. La tige 2 présente également une partie supérieure métaphysaire 7 dont la section décroît de haut en bas, qui présente une section aplatie, comportant deux plats 8 sur ses deux faces latérales. La partie métaphysaire comporte des gorges 9 annulaires situées dans des plans perpendiculaires à l'axe de la tige.Ces gorges 9 résultent de la présence de plusieurs tronçons tronconiques successifs de section diminuant depuis le haut de la partie métaphysaire vers le bas de celle-ci. FIG. 1 represents a femoral prosthesis comprising a rod 2 having two main parts, a lower diaphyseal part 3, of cylindrical section, and substantially constant, the external face of which has longitudinal grooves 4. In the diaphyseal part 3 is provided a through hole 5, or more depending on the size, intended for the passage of a screw 6, engaged from the outside, through the femur to ensure the retention of the rod in the medullary canal and in particular to avoid its rotation. The rod 2 also has a metaphyseal upper part 7 whose section decreases from top to bottom, which has a flattened section, comprising two dishes 8 on its two lateral faces. The metaphyseal part comprises annular grooves 9 located in planes perpendicular to the axis of the stem. These grooves 9 result from the presence of several successive frustoconical sections of section decreasing from the top of the metaphyseal part towards the bottom thereof. .

A son extrémité supérieure, la partie métaphysaire est équipée d'un cône 10 dans lequel est ménagé axialement un perçage taraudé 12. Ce cône 10 est destiné à être engagé dans un évidement conique complémentaire 13, ménagé dans une embase 14. L'embase présente pour sa part un trou axial 15 pour le passage d'une vis 16 d'assemblage de la tige et de l'embase. L'embase 14 est équipée de façon connue d'un cône 17 sur lequel est destinée à être montée de façon connue une rotule, non représentée au dessin. Dans la face supérieure de l'embase 14, et plus précisément dans la partie dans laquelle débouche la vis 1 6 est ménagé un évidement 18 délimitant une surface perpendiculaire à l'axe de la tige, dans laquelle débouche le trou 1 5 pour le passage de la vis.At its upper end, the metaphyseal part is equipped with a cone 10 in which an internally threaded hole 12 is formed. This cone 10 is intended to be engaged in a complementary conical recess 13, formed in a base 14. The base has for its part an axial hole 15 for the passage of a screw 16 for assembling the rod and the base. The base 14 is equipped in a known manner with a cone 17 on which is intended to be mounted in a known manner a ball joint, not shown in the drawing. In the upper face of the base 14, and more precisely in the part in which the screw 1 6 opens, a recess 18 is formed delimiting a surface perpendicular to the axis of the rod, in which the hole 1 5 opens for the passage of the screw.

Cette prothèse comporte également une pièce 19 en forme d'aileron destinée à être fixée sur l'embase 14, du côté opposé à la rotule. This prosthesis also comprises a part 19 in the form of a fin intended to be fixed to the base 14, on the side opposite to the ball joint.

A cet effet, L'aileron 19 comporte une patte 20 horizontale et présentant un trou traversant, destinée à venir prendre appui dans l'évidement 18 sur la face supérieure de l'embase 14. L'aileron 19 comporte également un ergot 22 destiné à venir s'engager dans un trou 23 orienté sensiblement perpendiculaire à l'axe de la tige, et ménagé dans l'embase 14. L'aileron 19 étant positionné avant assemblage de la tige 2 et de l'embase 14 par la vis 16, cette dernière traverse la patte 20 et assure l'immobilisation de l'aileron sur l'embase. A cet effet, L'aileron présente une surface 24, tournée du côté de l'embase 14, qui est de forme complémentaire de la surface extérieure de l'embase.Comme montré au dessin, la hauteur de l'aileron 19 est telle que son extrémité supérieure est située sensiblement au-dessus de l'extrémité supérieure de l'embase 14 dans la zone de celleci recevant la vis 16. En outre, L'aileron 19 possède une forme profilée, sa surface extérieure 25 présentant une section sensiblement semi-circulaire, et son épaisseur diminuant, dans sa zone inférieure 26, au fur et à mesure que l'on se rapproche de la tige 2. Cette forme de l'aileron 19 permet de soutenir la partie osseuse de l'extrémité métaphysaire du fémur correspondant au grand trochanter, voire de remplacer le grand trochanter.For this purpose, the fin 19 comprises a horizontal tab 20 and having a through hole, intended to come to bear in the recess 18 on the upper face of the base 14. The fin 19 also comprises a lug 22 intended to come and engage in a hole 23 oriented substantially perpendicular to the axis of the rod, and formed in the base 14. The fin 19 being positioned before assembly of the rod 2 and the base 14 by the screw 16, the latter crosses the tab 20 and immobilizes the fin on the base. For this purpose, the fin has a surface 24, turned towards the side of the base 14, which is of shape complementary to the external surface of the base. As shown in the drawing, the height of the fin 19 is such that its upper end is located substantially above the upper end of the base 14 in the region of this receiving the screw 16. In addition, the fin 19 has a profiled shape, its outer surface 25 having a substantially semi-section -circular, and its thickness decreasing, in its lower zone 26, as one approaches the rod 2. This shape of the fin 19 makes it possible to support the bone part of the metaphyseal end of the femur corresponding to the greater trochanter, or even to replace the greater trochanter.

L'aileron 19 comporte un certain nombre de trous traversant 27 horizontaux permettant l'attache de muscles, ou le montage de liens pour ligaturer des parties osseuses ou des greffons. Des trous 28 possédant la même fonction sont ménagés dans l'embase 14. Il existe plusieurs tailles de l'aileron 19 permettant une latéralisation optimum du grand trochanter.The fin 19 has a certain number of horizontal through holes 27 allowing the attachment of muscles, or the mounting of links for ligating bone parts or grafts. Holes 28 having the same function are provided in the base 14. There are several sizes of the fin 19 allowing optimum lateralization of the greater trochanter.

Afin de permettre le réglage de l'antéversion du col, la partie supérieure de la tige 2 comporte deux crans 29 diamétralement opposés faisant saillie vers le haut, et destinés à coopérer avec deux séries d'encoches 30 ménagées dans le bord inférieur de l'embase 14 dans différentes positions angulaires, par exemple décalées de 10 les unes par rapport aux autres. Enfin, et comme montré à la figure 3, la partie diaphysaire qui peut être de différentes longueurs afin de s'adapter à différents cas, est incurvée dans le sens antéropostérieur, le centre de la courbure étant tourné vers l'arrière. In order to allow the anteversion of the neck to be adjusted, the upper part of the rod 2 has two diametrically opposite notches 29 projecting upwards, and intended to cooperate with two series of notches 30 formed in the lower edge of the base 14 in different angular positions, for example offset by 10 relative to each other. Finally, and as shown in FIG. 3, the diaphyseal part which can be of different lengths in order to adapt to different cases, is curved in the anteroposterior direction, the center of the curvature being turned towards the rear.

L'invention concerne également un ancillaire pour la pose de cette prothèse comprenant deux branches parallèles 32 et 33 reliées par une branche transversale supérieure 34. La branche 32 la plus courte est équipée de moyens de positionnement sur la face supérieure de la tige 2, et d'immobilisation sur cette dernière à l'aide d'une vis 35 actionnée par une molette 36. La branche longue 33 qui suit la courbure de la partie diaphysaire 3 de la tige 2 comporte des orifices transversaux 37 alignés avec les trous 5 ménagés dans la tige 2. Ces orifices 37 servent au passage d'un outil 38 utilisé pour percer le fémur en regard du ou des trous 5 afin de permettre la mise en place de la ou des vis 6. The invention also relates to a device for fitting this prosthesis comprising two parallel branches 32 and 33 connected by an upper transverse branch 34. The shorter branch 32 is equipped with positioning means on the upper face of the rod 2, and immobilization on the latter using a screw 35 actuated by a thumb wheel 36. The long branch 33 which follows the curvature of the diaphyseal part 3 of the rod 2 has transverse holes 37 aligned with the holes 5 formed in the rod 2. These orifices 37 serve for the passage of a tool 38 used to pierce the femur opposite the hole or holes 5 in order to allow the placement of the screw or screws 6.

Comme il ressort de ce qui précède, I'invention apporte une grande amélioration à la technique existante en fournissant une prothèse de reconstruction possédant une structure permettant le soutien ou la reconstruction du grand trochanter, permettant grâce à son caractère modulaire d'associer différentes longueurs de tiges à un même type d'embase, et de monter la tige sur l'embase avec une possibilité de réglage de l'antéversion. As is clear from the above, the invention brings a great improvement to the existing technique by providing a reconstruction prosthesis having a structure allowing the support or the reconstruction of the greater trochanter, allowing thanks to its modular character to associate different lengths of rods to the same type of base, and to mount the rod on the base with the possibility of adjusting the anteversion.

Comme il va de soi, I'invention ne se limite pas à la seule forme d'exécution de cette prothèse décrite ci-dessus à titre d'exemple, elle en embrasse au contraire toutes les variantes. C'est ainsi notamment que les moyens de fixation de l'aileron sur l'embase pourraient être différents sans que l'on sorte pour autant du cadre de l'invention.  It goes without saying that the invention is not limited to the sole embodiment of this prosthesis described above by way of example, on the contrary, it embraces all of its variants. Thus, in particular, the means of fixing the fin on the base could be different without departing from the scope of the invention.

Claims (11)

REVENDICATIONS 1. Prothèse fémorale de reconstruction, du type comprenant une tige (2), destinée à être engagée dans le canal médullaire d'un fémur, et dont l'extrémité supérieure est équipée d'une embase (14) elle-même munie d'une rotule, caractérisée en ce que l'embase (14) est munie sur sa face tournée vers l'extérieur, c'est-à-dire du côté opposé à la rotule, d'un aileron profilé (19), fixé de façon amovible, et de taille variable suivant les cas. 1. Femoral reconstruction prosthesis, of the type comprising a rod (2), intended to be engaged in the medullary canal of a femur, and the upper end of which is equipped with a base (14) itself provided with a ball joint, characterized in that the base (14) is provided on its face facing outward, that is to say on the side opposite the ball joint, with a profiled fin (19), fixed in such a way removable, and of variable size depending on the case. 2. Prothèse fémorale selon la revendication 1, caractérisée en ce que l'extrémité supérieure de l'aileron (19) est située plus haut que la zone de la paroi supérieure de l'embase (14) se trouvant dans l'axe de la tige (2). 2. femoral prosthesis according to claim 1, characterized in that the upper end of the fin (19) is located higher than the area of the upper wall of the base (14) lying in the axis of the rod (2). 3. Prothèse fémorale selon l'une quelconque des revendications 1 et 2, caractérisée en ce que l'aileron (19) possède, vu en coupe transversale, une face inférieure (24) de profil complémentaire de celui de la face extérieure de l'embase et une face extérieure (25) de forme générale semi-circulaire. 3. Femoral prosthesis according to any one of claims 1 and 2, characterized in that the fin (19) has, seen in cross section, a lower face (24) of profile complementary to that of the outer face of the base and an outer face (25) of generally semi-circular shape. 4. Prothèse fémorale selon la revendication 3, caractérisée en ce que l'épaisseur de l'aileron (14) est sensiblement constante dans sa partie supérieure et diminue dans sa partie inférieure (26), au fur et à mesure que l'on se rapproche de la tige (2). 4. femoral prosthesis according to claim 3, characterized in that the thickness of the fin (14) is substantially constant in its upper part and decreases in its lower part (26), as one is closer to the rod (2). 5. Prothèse fémorale selon l'une quelconque des revendications 1 à 4, caractérisée en ce que l'aileron (14) comporte, d'une part à sa partie supérieure, une patte (20) destinée à être positionnée dans un évidement (18) ménagé dans la face supérieure de l'embase (14) et à être fixée dans celui-ci par vissage, et d'autre part en-dessous de la patte, au moins un ergot (22), destiné à être engagé dans un trou (23), ménagé dans l'embase sensiblement perpendiculairement à l'axe de la tige (2). 5. Femoral prosthesis according to any one of claims 1 to 4, characterized in that the fin (14) comprises, on the one hand at its upper part, a tab (20) intended to be positioned in a recess (18 ) formed in the upper face of the base (14) and to be fixed therein by screwing, and on the other hand below the tab, at least one lug (22), intended to be engaged in a hole (23), formed in the base substantially perpendicular to the axis of the rod (2). 6. Prothèse fémorale selon la revendication 5, caractérisée en ce que dans le cas où la tige (2) et 'embase (14) sont indépendantes et fixées l'une à l'autre par vissage à l'aide d'une vis (16), traversant l'embase (14) et vissée dans un trou fileté (12), ménagé à l'extrémité supérieure de la tige (2), la patte (20) que comporte l'aileron (19) est sensiblement perpendiculaire à l'axe de la tige et est fixée dans l'évidement (18) ménagé à cet effet dans 'embase, par la vis (16) d'assemblage de la tige et de 'embase.  6. femoral prosthesis according to claim 5, characterized in that in the case where the rod (2) and 'base (14) are independent and fixed to each other by screwing with a screw ( 16), passing through the base (14) and screwed into a threaded hole (12), formed at the upper end of the rod (2), the tab (20) which comprises the fin (19) is substantially perpendicular to the axis of the rod and is fixed in the recess (18) formed for this purpose in 'base, by the screw (16) for assembling the rod and' base. 7. Prothèse fémorale selon l'une quelconque des revendications 1 à 6, caractérisée en ce que l'aileron (19) comporte des trous (27) traversants horizontaux. 7. Femoral prosthesis according to any one of claims 1 to 6, characterized in that the fin (19) has horizontal through holes (27). 8. Prothèse fémorale selon la revendication 6, caractérisée en ce qu'elle comporte des moyens de réglage de l'antéversion du col constitués par des crans (29) dépassant de la face supérieure de la tige (2) destinés à coopérer dans plusieurs positions angulaires avec des encoches (30) ménagées dans la face inférieure de l'embase (14). 8. Femoral prosthesis according to claim 6, characterized in that it comprises means for adjusting the anteversion of the neck constituted by notches (29) protruding from the upper face of the rod (2) intended to cooperate in several positions angular with notches (30) formed in the underside of the base (14). 9. Prothèse fémorale selon l'une quelconque des revendications 1 à 8, caractérisée en ce que la partie métaphysaire (7) de la tige (2) etl ou la partie inférieure de l'embase (14) comportent des gorges annulaires (9) disposées dans des plans perpendiculaires à l'axe de la tige (2). 9. Femoral prosthesis according to any one of claims 1 to 8, characterized in that the metaphyseal part (7) of the rod (2) and the lower part of the base (14) have annular grooves (9) arranged in planes perpendicular to the axis of the rod (2). 10. Prothèse fémorale selon l'une quelconque des revendications 1 à 9, caractérisée en ce que la partie diaphysaire (3) de la tige (2) comporte au moins un trou transversal (5) traversant destiné à loger une vis (6) traversant le fémur. 10. Femoral prosthesis according to any one of claims 1 to 9, characterized in that the diaphyseal part (3) of the rod (2) comprises at least one transverse hole (5) passing through intended to accommodate a screw (6) passing through the femur. 11. Ancillaire pour la pose d'une prothèse fémorale selon la revendication 10, caractérisé en ce qu'il comprend deux branches parallèles (32, 33) reliées par une branche supérieure transversale (34), les deux branches parallèles ayant des longueurs différentes, celle (32) la plus courte comportant, à son extrémité libre, des moyens de positionnement et d'appui sur la face supérieure de la partie métaphysaire (7) de la tige (2), et celle (33) la plus longue comportant des orifices transversaux (37) qui, situés dans l'alignement des trous transversaux (5) de la tige, servent au guidage d'un outil (38) pour le perçage transversal du fémur dans l'axe du ou des trous transversaux (5) de la tige.  11. Ancillary device for fitting a femoral prosthesis according to claim 10, characterized in that it comprises two parallel branches (32, 33) connected by a transverse upper branch (34), the two parallel branches having different lengths, that (32) the shortest comprising, at its free end, positioning and support means on the upper face of the metaphyseal part (7) of the rod (2), and that (33) the longest comprising transverse holes (37) which, located in alignment with the transverse holes (5) of the rod, serve to guide a tool (38) for the transverse drilling of the femur in the axis of the transverse hole (s) (5) of the stem.
FR9504617A 1995-04-12 1995-04-12 FEMALE RECONSTRUCTION AND ANCILLARY PROSTHESIS FOR ITS INSTALLATION Expired - Lifetime FR2732891B1 (en)

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EP1374803A1 (en) * 2002-06-21 2004-01-02 Biomet, Inc. Hip joint having a variety of trochanteric flange sizes
FR2892922A1 (en) * 2005-11-08 2007-05-11 Ortho I D Sarl Trochanteric implant for forming femoral prosthesis, has hooks that allow fixation of femoral tuberosity part on implant by using encircling devices and with pin and throat respectively, where one of hooks enclose encircling devices
US20130274889A1 (en) * 2010-03-05 2013-10-17 Biomet Manufacturing Corp. Modular Lateral Hip Auguments
WO2014031535A1 (en) * 2012-08-20 2014-02-27 Vargas Joseph R Trochanter attachment device
US8876837B2 (en) 2010-03-05 2014-11-04 Biomet Manufacturing, Llc Method and apparatus for implanting a modular femoral hip
US8979940B2 (en) 2012-12-14 2015-03-17 Biomet Manufacturing, Llc Modular attachment mechanism in prosthetic implants
US9138273B2 (en) 2010-03-05 2015-09-22 Biomet Manufacturing, Llc Guide assembly for lateral implants and associated methods
US9314287B2 (en) 2010-03-05 2016-04-19 Biomet Manufacturing, Llc Assembly tool for modular implant and associated method
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US9615942B2 (en) 2010-03-05 2017-04-11 Biomet Manufacturing, Llc Method and apparatus for trialing and implanting a modular femoral hip
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EP1197182A2 (en) * 2000-09-09 2002-04-17 Aesculap AG & Co. KG Modular endoprosthesis with adjusting device and drill-guide
EP1197182A3 (en) * 2000-09-09 2002-04-24 Aesculap AG & Co. KG Modular endoprosthesis with adjusting device and drill-guide
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FR2892922A1 (en) * 2005-11-08 2007-05-11 Ortho I D Sarl Trochanteric implant for forming femoral prosthesis, has hooks that allow fixation of femoral tuberosity part on implant by using encircling devices and with pin and throat respectively, where one of hooks enclose encircling devices
US9339318B2 (en) 2010-03-05 2016-05-17 Biomet Manufacturing, Llc Method and apparatus for preparing a proximal femur
US9615942B2 (en) 2010-03-05 2017-04-11 Biomet Manufacturing, Llc Method and apparatus for trialing and implanting a modular femoral hip
US8876837B2 (en) 2010-03-05 2014-11-04 Biomet Manufacturing, Llc Method and apparatus for implanting a modular femoral hip
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US9138273B2 (en) 2010-03-05 2015-09-22 Biomet Manufacturing, Llc Guide assembly for lateral implants and associated methods
US9314287B2 (en) 2010-03-05 2016-04-19 Biomet Manufacturing, Llc Assembly tool for modular implant and associated method
US20130274889A1 (en) * 2010-03-05 2013-10-17 Biomet Manufacturing Corp. Modular Lateral Hip Auguments
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WO2014031535A1 (en) * 2012-08-20 2014-02-27 Vargas Joseph R Trochanter attachment device
US9730743B2 (en) 2012-08-20 2017-08-15 Zimmer, Inc. Trochanter attachment device
US8979940B2 (en) 2012-12-14 2015-03-17 Biomet Manufacturing, Llc Modular attachment mechanism in prosthetic implants
US20210169655A1 (en) * 2018-10-25 2021-06-10 Revision Technologies Llc Interconnected implants and methods

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