JP2002510223A - Modular prosthesis - Google Patents

Abstract

Abstract: A kit for making a modular prosthesis (10) is provided, the kit comprising a prosthesis member (12) having a cavity such as a hole (14) formed therein, and A clamp (30) releasably clamped in the cavity (14). A clamp (30), which may be a rod having an axial hole (32) throughout a portion of its length, is subjected to a stretching force to provide sufficient clamping (30) to be received in cavity (14). , Reduce the diameter of the clamp (30). When the stimulus is released, the clamp (30) returns to its initial configuration, and thereby expands against the walls of the cavity (14). The second prosthesis member (16) can be formed to accommodate a portion of the first member, such that expansion of the clamp (30) in the cavity (14) of the first member (12) is simultaneously performed. The member (12) is expanded into contact with the second member (16) and the members (12, 16) are clamped together.

Description

DETAILED DESCRIPTION OF THE INVENTION                          Modular prosthesisField of the invention   The present invention relates to the field of medical prostheses, and in particular to morbid or damaged joints. For a prosthesis for use as a substitute for a prosthesis.Background of the Invention   Prostheses for joint replacement generally have two surfaces with surfaces joining each other. One part and a structure for fixing the part to the bone. Natural joint structure Prosthesis parts are carefully molded and dimensioned to replicate Must be determined and by the surgeon with respect to each other and the patient's solution It must be properly oriented with respect to the anatomy.   To achieve a good surgical result, the surgeon should use a prosthesis during the surgical implantation. Have as free a procedure as possible to change the shape, dimensions and orientation of parts Should. Primarily for these reasons, various elements of the prosthesis are individually selected And the prosthesis can be assembled according to the needs of the patient's anatomy And a modular prosthesis that can be oriented Efforts have been made to provide.   Modularized prostheses for hip joints are known, for example, from U.S. U.S. Pat. No. 5,080,685; U.S. Pat. U.S. Pat. No. 4,995,883; Le Mans U.S. Pat. No. 5,002,578; And U.S. Pat. No. 4,693,724 to Renter et al. Mainly Prostheses like to work together to taper connections of parts Includes a number of parts held together in one form or otherwise by the locking screw No. Some freedom of choice is provided by previous modular prostheses However, the use of threaded fixed screws and tapered connections May lead to loose goods and other problems. Physical and chemical corrosion Due to the weakening of the prosthesis and the biological response to corroding debris and by-products, considerable May be a problem. Yakov, J .; J. etc,Biological Activity of Parti culate Chromium-Phosphate Corrosion Products , Collected Paper of the 21s t Annual Meeting of the Society for Biomaterials, March 18-2, 1995 2, p. 398 and Urban, Robert M .; etc,Corrosion Products Fro m Modular-Head Femoral Stems of Different Desighs and Material Couples , Collected Papers of the 21st Annual Meeting of the Society for Biomateri als, March 18-22, 1995, page 326. Phase between adjacent surfaces Erosive corrosion caused by opposing motion leads to the production of debris, which in turn The manufacture of the joints results in accelerated attrition between the joints of the prosthesis, Can lead to dissolution. When a gap is created between adjacent surfaces of a prosthesis component, Oxidation leads to the formation of an acidic environment and therefore chemical attack of the surface (usually crevice corrosion and Referenced. ).   Can be freely selected and oriented by the surgeon in the operating room And also requires screw fasteners or tapered connections that are tied together With elements that can be strongly and firmly fixed to each other without having to It would be desirable to provide a modified prosthesis kit.Summary of the Invention   The present invention is capable of being firmly clamped to a prosthesis member and having a modular Can be used to securely clamp selected parts of the Make use of clamps. The clamp applies physical stress to the clamp At the same time, in a second direction perpendicular to the first direction. Has a "stationary" configuration with dimensions in one direction, where the lamp expands, The clamp can be accommodated in the cavity of the prosthesis. Physical applied Upon release of the stress, the clamp attempts to return to its "stationary" configuration, and in one direction The size of the clamp increases and the clamp pushes against the walls of the cavity, forcing the prosthesis member Start to clamp.   Therefore, in one aspect, the invention includes a first member having a wall defining a cavity; , And a clamp comprising a clamp releasably releasable within said cavity. Related to the Rotation kit. The clamp has a predetermined dimension in a first direction, Also, in response to the applied physical stress, the smaller dimension in the first direction is reduced. Has a second configuration with dimensions increased in a second direction perpendicular to the first direction at the same time Having a stationary configuration that allows the clamp to be at least partially received within the cavity. Place The fixed dimensions are such that the release of the applied physical stress causes the clamp to return to its resting form. Back, and at the same time, in its first direction, enough to clamp strongly on said member. Are selected to increase the size of   In another aspect, the invention features a first prosthesis member having a wall defining a cavity And a clamp releasably clampable in said cavity, for assembly And a modular prosthesis kit that includes The clamp is in the first direction Has a first stationary configuration having predetermined dimensions. The device is in the first direction A stretching force is applied to the clamp in a second vertical direction to cause the clamp to To reduce said dimension in the first direction enough to be accommodated in the cavity Be prepared for. The specified dimensions are such that the removal of the stretching force causes the clamp to return to its resting form. Return, and consequently, enough to clamp strongly to the first prosthesis member, It is such that its dimensions in the first direction increase. In a preferred embodiment In the prosthesis kit, at least a portion of the first member is A second member shaped to receive the second member. The cavity wall of the first member is clamped Returns to its stationary form and secures the second member in a predetermined direction with respect to the first member. Shaped to extend into clamp contact with the second member when supported I have.   Preferably, said clamp in its rest position is extended in a second direction, The cavity also has an inner wall similarly formed to receive the clamp, The pump has a distal end sized to be partially received in the cavity. Power May be exerted on the distal end of the clamp, which is oriented inside the cavity. The hollow wall is clad As it fits at any point along the pump and its length to resist insertion of the clamp, A continuous force on the distal end of the clamp causes the distal end and cavity to mate A tension is created in the area between the point and the area is extended, resulting in a cavity wall Reduce the width of the clamp at the point of mating. Second, this reduction in width hollows the clamp To be able to move further inside. The force exerted on the distal end of the clamp is opposite Direction, resisted by essentially equal forces applied to the cavity, the latter force The ramp is transmitted to the clamp along its length fitted by the cavity. In this aspect, the device mates the distal end of the clamp with the first prosthesis member. It is preferably provided as follows.   In yet a further aspect, the invention relates to assembling a component of a modular prosthesis. About the method. The first prosthesis member is provided with walls defining a cavity, and The pump is provided with a first stationary configuration having a predetermined dimension in a first direction. . The clamp receives a physical tension and clamps in a second direction perpendicular to the first direction. The dimensions expand, while the clamp dimensions in the first direction decrease and the clamps become hollow. Inside. This means that, as described above, Desirably achieved by applying force to the distal end of the clamp housed therein. It is. The tension is then released and the clamp returns to its first resting state, resulting in In the first direction enough to clamp strongly to the first prosthesis member. Its size increases.   In a preferred embodiment, the clamp and the cavity of the first prosthesis member comprise a clamp To provide substantially surface-to-surface contact between the clamp and the first member. Having a facing clamping surface that conforms to the prosthesis and the facing surface Have substantially no gap between them. Similarly, the second prosthesis member houses the first member And then become clamped to the first member, preferably these members The clamping surface is a surface-surface between the clamping surfaces of the first and second members. Substantially adapted to provide inter-contact, and wherein the prosthesis is There is substantially no gap. Such surface-to-surface contact can be caused by the clamping surface Facilitates even loading along.BRIEF DESCRIPTION OF THE FIGURES   FIG. 1 is a side view in partial cross section of a portion of a hip prosthesis according to the present invention. And   FIG. 2 is an exploded view of a cross section taken along line 2-2 of FIG.   FIG. 3 is a schematic front view of the shin of the knee joint according to the present invention;   FIG. 4 is a partial cross-sectional view of a portion of another hip prosthesis similar to that of FIG. FIG.   FIG. 5 shows components of an instrument for use in assembling the hip prosthesis of FIG. FIG.   FIG. 6 is a view of the assembled parts of FIG. 5;   FIG. 7 is an illustration of the assembly of FIG. 6 with a manual force generator;   FIG. 8 is an exploded view of a cross section showing another embodiment of the present invention;   9A, 9B and 9C show a preferred hip prosthesis stem, book It is a side view of a body member and a clamp member,   FIG. 10 shows a hip joint prosthesis comprising the elements represented in FIGS. 9A, 9B and 9C. It is a side view in a partial cross section of a part of Z   FIG. 11 is a side view of an improved stem of a hip joint;   FIG. 12 illustrates the positioning of the body element with respect to the stem, of the prosthesis of FIG. It is a schematic top view,   FIGS. 13A, 13B and 13C illustrate the assembly of clamping members and equipment. FIG.   FIG. 14 is a partial cross-section of a prosthesis of the present invention during a step in its assembly. And it has been removed,   FIG. 15 is a perspective view of an instrument useful in assembling the prosthesis of the present invention;   FIG. 16 illustrates another alternative that can be used in assembling the prosthesis of the present invention. It is a schematic diagram of the equipment, and   FIG. 17 shows an improvement that can be used in assembling the prosthesis of the present invention. FIG.Detailed description of preferred embodiments   Referring initially to FIG. 1, a modular hip prosthesis is designated at 10; A length dimensioned to be housed in the intramedullary canal of the surgically created femur An extended stem 12 is included. A shaft hole 14 is formed in stem 12. Body member 1 6 is provided with a hole 18 dimensioned to closely accommodate the stem 12, The body member has a generally triangular shape when viewed from the side, and includes a femoral intramedullary canal. Shaped to fit the surgically engraved proximal end. Proximal to body member 16 is Neck having a bore 21 dimensioned to closely accommodate the upper end of the stem 12 20 is located, the neck member includes a deflected extension 22 which is a pelvic crotch ball. Properly dimensioned and formed cavity prosthesis (shown) Not. ) Ends in a spherical member 24 sized to join.   Clamp 30 extends from its proximal end portion 34 to the distal end portion 38 of the clamp. FIG. 1 shows an elongated metal rod having an axial hole 32 extending to an inaccessible bottom 36. Is represented by Near its upper end, the shaft bore 32 has a locator as described below. A distal finish adapted to accommodate the machine.   The clamp 30, when unconstrained in the stem, has a diameter that is equal to the diameter of the stem at body temperature. 14 are formed and dimensioned to be slightly larger than the diameter of 14. On the other hand, the neck The diameter 21 of the hole in the shaped member and the diameter 18 of the hole in the body member are essentially The outer diameter is the same as the outer diameter, i.e., the stem is The hole 18 is slidably but slidably open so that it can be moved over without difficulty. , 21.   Prior to being inserted into the stem hole 14, the clamp 30 has a diameter It must first be changed to be slightly smaller than the diameter. This means that Physically extending the clamp in the longitudinal or axial direction, the clamp is Achieved by reducing the diameter of the clamp enough to allow insertion Is done. The clamp can be made of various metals, such as: Metals undergo a reversible martensitic phase transition when applied in their superelastic state. A shape memory alloy such as nitinol. From nitinol The clamp 30 is stretched as described above, and the temperature is Stay substantially higher than the final temperature (the temperature at which the alloy is completely in its austenitic form). When carried, a transformation from the austenitic phase to the martensitic phase occurs. This is known as stress-induced martensitic morphology and can be pseudoelastic or super-elastic. It is the basis of a phenomenon known as elasticity. Shape memory alloy maintains external stress At least partially remains in the martensitic phase. However Furthermore, the removal of stress causes the clamp 30 to return to the austenite phase and its original state. Return to shape and dimensions. However, the clamp is constrained within the dimensions of the bore 14 Therefore, the original shape and dimensions cannot be completely restored. As a result Thus, clamp 30 exerts a continuous force on bore 14 of stem 12. That is, When externally applied stress is released, clamp is referred to as "stationary" There is a tendency to return to a form that can be done. The stationary form of the clamp is slightly smaller than the lateral dimension of the shaft hole. Has a large lateral dimension (diameter for a rod with a circular cross section), and consequently The clamp pushes the shaft hole outward and firmly clamps into the shaft hole. Become.   1, the wall 42 of the clamp fits and pushes the hole 14 outward. It has an outer surface 44. When in place, the outer wall 44 of the clamp is Of the body member 16 and then the inner wall 26 of the body member 16 And likewise is pushed outwardly into contact with the inner surface 28 of the neck 20.   Preferably, the outer surface of clamp 30 is generally cylindrical and the surface of bore 14 Make substantial surface-to-surface contact with the substrate. In addition, the stem wall indicates that these holes The outer wall of the stem, even when slightly different in It is flexible enough to be expandable to contact both holes. Advantages of the present invention A feature of the preferred embodiment is the clamping surface, i.e. the facing of the clamp and the first member. Surfaces and the opposing surfaces of the first and second members are in surface-to-surface contact. And distribute the compressive force quite evenly over the clamped surface, Preferably, gaps between facing surfaces are avoided. As used herein The term "gap" refers to a slightly spaced prosthesis when assembled. Thin empty space formed between the surfaces, e.g., a long with a screw at one end FIG. 4 illustrates the space formed between the elongated smooth wall bar and the hole that receives the bar. Clan If the pump is a cylinder with a circular cross section and the cavity is a circular hole, the clamp The compression clamping force exerted on the walls of the Is substantially uniform along its length. If desired, clamps (and prosthesis members) When) Change the concentration of compressive force during clamping by changing the shape of the surface to be clamped I can make it. For example, if the cross-section of the clamp and recess is elliptical rather than circular, Compression clamping force goes at longer lateral dimensions than at shorter lateral dimensions It is expected to be big.   The invention in another aspect is depicted in FIG. Is firmly fixed to the deflected neck extension 22. Spherical member 24 and The neck 20 (from which the deflected extension 22 extends) generally comprises a subunit The sub-unit is then assembled with the body member as described above. And stem.   As shown in FIG. 2, the deflected extension 22 has only one opening at one end. It has an inner hole 50 closed at one end 52. The holes 50 are shown in FIGS. Extends downwardly and laterally, and opens into hole 28. side The distal end of the facing neck has a tapered bore 60 formed in the spherical member 24. It has a tapered head 54 housed therein. In this embodiment, the deflected neck The ridge 22 functions not only as part of the prosthesis but also as a clamp. side A deflected neck to securely and securely connect the spherical member 24 to the oriented neck Are first extended in the manner described above with respect to clamp 30. Ball head 54 Extension of the neck 22 which is deflected enough to allow for a tight fit in the neck Thus, the stretching force applied by the instrument is released, and the neck 22 Returning to the conventional "stationary" configuration, the outer wall of the head 54 pushes outwardly the wall formed by the hole 60. Thus, the spherical member is firmly clamped to the deflected neck member. Referring to FIG. 50 is more fully secured by its open end prior to securing the neck 20 to the stem 12. It is noted that it is accessible. Similarly, clamps and cavities have cross sections Despite being circular and making surface-to-surface contact with each other, rather than cylinders It is noted that tapers can change the shape of the clamps and cavities. Ruka is explained.   Referring to FIG. 3, the shin tray component is generally represented as 70 and is also known in a known manner. A step adapted to be accommodated in the intramedullary canal created in the tibia surgery at And a memory 72. The stem terminates in a metal tray 74, which then rises above its top. Supports a stem receiving insert 76 made of high molecular weight polyethylene or the like. The latter is all In a known manner, a condyle at the distal end of the femur, or a prosthetic femoral implant Joint with the condyle. Proximate to the upper end of the stem, which was created during surgery on the intramedullary canal of the tibia A shoulder 78 is located which fits into the end and serves to support the upper end of the stem. You.   Such a clamp is designated at 80 in FIG. Preferably in section At body temperature, a cylinder slightly larger than the diameter of the hole 82 formed in the stem 72 in the axial direction. is there. Clamp 80 is mounted in the same manner as described for clamp 30 of FIG. Can be inserted. When the stretching force is released, the clamp returns to its "stationary" configuration. And the wall pushes the wall of the stem 72 outward, and then the stem is To the wall of the hole 84.   A slightly improved hip prosthesis is described as 100 in FIG. The prosthesis has a stem 112 adapted for insertion into the intramedullary canal of the femur. An axial bore 114 is formed in the stem and a wall of the stem near its proximal end. May have a longitudinal slot 116 formed therein. In order to avoid the stress concentration range, the process ends at the circular hole 118. Slot 116 Make the stem wall more easily expandable and evenly spaced around the circumference of the stem Separate. Four slots can be used. The body member 120 has a stem The body member is provided with a bore 122 dimensioned to accommodate the A spherical member 124 similar to the spherical member 24 is provided. Above or near body member 120 The distal end extends slightly beyond the proximal end 126 of the stem.   Hollow tubular clamp similar to the clamp 30 shown in FIG. 1 in the stem 130 are accommodated. The clamps 130 are all represented in FIG. Extending beyond the proximal end 126 of the stem, but more preferably the hole in the body member Proximal outer threaded end retained in the proximal end portion of 122 It has a portion 132.   FIGS. 5-7 show the tension applied to the clamp shown as 130 in FIG. Describe the equipment for applying the force. 140 is the proximal end of the clamp Open distal end internally threaded to accommodate external threads of section 132 A tubular gripper having a portion 142. A square screw is preferably used. Opening Portion 144 is formed in gripper device 140 proximate its distal end portion 142. . An elongated push rod 150 is received in the hollow clamp and faces the clamp. Distal end shaped to mate with distal end wall 134 in surface-to-surface contact It has a portion 152. The proximal end 154 of the push rod is best represented in FIG. As such, it is accessible through opening 144 and has a recessed end surface 156. You. The proximal end wall 146 of the tubular gripper has a recess facing the recessed end surface 156 of the rod. It is noted that it also has a salient surface 148.   FIG. 7 describes the assembly of FIG. 6 with a manual pliers-like force generator 170, The device includes a handle 172 and an opposed nose that can be accommodated in an opening in the gripper machine. And a pivot axis positioned to provide substantial mechanical convenience to the nose portion 176. The nose 174 may be depressed and depressed, as shown in FIG. Pressing each depressed surface of the gripper and compressing the handles together requires a rod 15 0, resulting in the application of a substantial force to Extend sufficiently to allow insertion into the bore of the stem. Known design and hand Tooth and pawl mechanisms 178 commonly used in surgical instruments are provided at the end of the handle. Obtained, keeping them together, and therefore in an elongated form under stress Maintain the stem. Various other that transmit substantial force to allow the clamp to stretch The equipment is used using a number of all mechanical, pneumatic and hydraulic fluid means. obtain.   In use, referring again to FIGS. 4-7, the push rod or shaft 150 is Inserted into a suitable clamp 130 and the proximal end of the clamp is Screwed into the end of 40 to form the assembly shown in FIG. Force generator The nose 174 of the device 170 is provided with a recessed surface on each of the push and grasp devices. Inserted through openings 144 to make contact and handles are facing each other Squeezed and secured by mechanism 178, thus clamping the clamp to its extended Keep in the form. Body member 120 is received through the stem and is used during the implantation procedure. In the meantime, it is desirably located along the stem by the surgeon. Once the stem and And the body members are properly oriented with respect to each other, and the body members are moved into the intramedullary canal. When properly pushed by the clinician, the clamp is inserted into the shaft bore. Mechanism 17 8 is then released, releasing the pressure of the nasal element on the push and gripper device It will be. Since the clamp 130 expands to its stationary configuration, the clamp is substantially The walls of the stem with a strong force and tightly connect these walls with the walls of the holes formed in the body member. Make contact. Of course, the gripper is then removed, and the open proximal end of the clamp is Appropriately covered if desired.   Of particular benefit is the stem 30 of the prosthesis of FIG. To eliminate the clamp. Here, the proximal end of the stem is 6. The same externally threaded gripper screw as 140 It can be internally threaded to accommodate the cut distal end. Gripper and push The rod is longer than that represented in the figure and is gripped on the threaded end of the stem Prior to joining the devices, it may be possible to install the neck and body members beyond the gripper.   By appropriately shaping the gripper 140, the proximal portion of the stem can be Position the neck member 20 and body member 16 loosely on the gripper before extending I can do it. The push rod 150 is placed in the hole of the stem, and the gripper connects on the stem. Can come off. Once the stem 12 is extended by operation of the force generator and the femur When properly positioned in the cavity, the neck and body members are positioned over the nose. Is lowered around the stem and is desirably located within the intramedullary canal.   Desirably, the various parts of the prosthesis of the present invention that are clamped together Stainless steel, cobalt chrome steel, titanium alloy, etc. It consists of the metal used. The clamp can also be a shape memory alloy or Consist of any metal exhibiting an initial ratio relationship between stress and tension (within effectiveness) obtain. Various metals and metal alloys, including stainless steel, meet this requirement. Idiomatic Transverse to longitudinal or axial tension, which refers to Poisson's ratio The transverse tensile ratio is between 0,0 and 0, depending on the material and its conditions. 2 to 0. 5 of Can be range. For example, Poisson's ratio for stainless steel is about 0. 28.   The clamp according to the invention is preferably made of a shape memory alloy such as Nitinol. You. Nitinol is about 0.1%. Shows a Poisson's ratio of 3, but this ratio is a shape memory alloy Is stretched beyond its initial elastic limit, i.e., of stress-induced martensite. When formation begins to occur, about 0. Clearly increases by 5 or more. Nitinol Is a pseudoelastic material, that is, a material that exhibits superelasticity at room temperature. Many shape memory alloys , Are known to exhibit superelastic / pseudoelastic recovery properties, and Or deformation from austenitic crystal structure to stress-induced martensite structure at body temperature Generally, due to their ability to return to an austenitic state when stress is removed Has been evaluated. Alternating crystal structures impart superelastic or pseudoelastic properties to alloys .   A nitinol clamp of the type referred to above with respect to FIGS. 1 and 3 is shown in FIG. Easily extended to 8% or more by use of equipment as represented in Can be 0. Using Nitinol, which exhibits a Poisson's ratio of 3, When the clamp as represented in FIG. 6 is extended by 8%, about 2 in diameter . Expected to shrink by 4%. When the initial diameter of the clamp is around 1/2 inch The reduction in diameter is 0. 012 inches. The inner hole of the stem And for other prosthetic parts, the tolerance is ± 0. Easily within 002 inches 0. 0 in the clamp diameter as it can be sagged. 012 inch change is dimension Gives substantial room for design changes in However, if the clamp When stretched in the longitudinal direction, e.g. by 8%, the diameter of the shaft hole is the outer diameter of the clamp It is generally preferred that they are only very slightly larger.   The surgeon can select the desired dimensions of the stem, body member and head, Also, the same can be assembled during a surgical procedure. The size represented in FIG. Referring to the femoral implant, an appropriately sized articulating spherical member 124 is selected, Then, it is fixed to the neck member 120 as described above. Then, clamp 13 A zero femoral prosthesis is assembled. Assembling is performed according to the desired dimensions and The angle of each of the prosthesis components is determined by measurement or by using a trial prosthesis component. This can be done away from the patient if it is known exactly in advance, as in Step The prosthesis itself is located in the patient's intramedullary canal, with the exact Can be assembled. Referring to FIGS. 4-7, once the part is placed Once clamped and desirably oriented in the intramedullary canal, clamp 130 is 40, the push rod 150 and the use of the force generator 170 reduce its diameter. And then gently placed into the hole in the stem. Clan When the tension on the pump is released, the clamp will ”Immediately expands into a configuration, thereby clamping itself to the stem and The stem 112 is clamped to the main body member 120. The resulting prosthesis becomes loose. It is noted that desirably does not have a scoured fastener. The tension is While maintained in the pump, the body member 120 may be suitable for the surgeon in a particular patient. Individual positioning in the axial and rotational directions on the stem, as if it were Can be done. Disassembly reverses the process in the same way that assembly is performed. And can be done by   As with the prosthesis of FIG. 3, once the shoulder 78 and the stem 72 are Once desirably secured to the distal end of the tibia and oriented with respect to each other, the The pump 80 is inserted into the hole 82 and is expandable to its "stationary" configuration. Can be This in turn pushes the stem wall outwards, and the stem and shoulder The holes 84 in the shoulder 78 are brought into contact so as to secure the members together.   The clamp of the present invention is a hollow rod having one open end and one closed end. Although described above, it is understood that various clamp configurations may be used. Should. Similarly, the clamp is housed in or on the outer surface and hole of the clamp The inner surface of the hole is smooth and uniform to make good surface-to-surface contact. However, in practice, the outer surface of the clamp may be corrugated or rough if desired. Facing or longitudinal grooving or other shaping may be provided.   Further, as noted above, the clamp of the present invention is circular in cross section It need not be and need not have uniform dimensions across the longitudinal axis. As desired The outer surface of the clamp may have a larger lateral dimension in some areas than in others. For example, referring to FIG. 1, the lateral dimensions of the clamp are such that the clamped stem portion is Near the top of the clamp, where it pushes the hole in the body member or vice versa. Can be larger.   Desirable clamps have a hollow or tubular design. Referring to FIG. The head 54 of the extension 22 of the material is provided with a skirt 182 extending outward at its open end. It can be formed with a thimble shaped clamp 180 having. Clamp 180 The attached head 54 is inserted into the hole 60 of the spherical member (the end of the clamp 180 and the hole 60). When extruded (leaving a gap 62 with the bottom of the A plate 182 is encountered and the wall of the clamp is extended. Open head 60 with opening 60 Due to the release of the pressure pushing in, the wall of the clamp increases slightly in thickness, The spherical member is wedged on the head 54 and the opening 60 is sealed. Head 54 and club The contact surface 61 with the pump 180 is also sealed.   In a preferred embodiment, the facing walls of the clamp and the cavity are So that any sliding between them will push the clamp deeper into the cavity Can be formed. For example, clamps or cavities or both facing walls may be Having a shoulder or tapered surface or other shape that provides the clamp with For repeated sliding between facing surfaces in one direction rather than the opposite Act to preferentially promote movement or "walking" in . Referring to FIG. 4, for example, the diameter of the holes in clamp 130 and stem 112. Is slightly larger near the distal end of stem 112 than near the proximal end The clamp and stem through repeated sliding of the stem hole Movement or “walk” pushes the clamp distally within the stem, and the proximal end of the stem 126 expanded and threaded at the proximal end of the clamp to contact 126 You will inhale.   9A and 9B describe an improved form of the hip joint of the present invention. Stem 2 00 is a stem extending bore through its length and open at its proximal end The hole wall includes a pair of diametrically opposed slots 204. Each Slot has two small holes 20 which serve to relieve stress at the end of the slot. 6 are formed. Body member 210 accommodates proximal portion of stem without gap A circular hole 212 is provided, and the body member has a neck portion of the type shown in FIG. Have. The proximal end of the stem has an outer threaded portion 208 of reduced diameter. Have. As shown in FIG. 10, when the stem is housed in the body member , The threaded proximal end of the stem is smaller than that of hole 212 in the body member Diameter and threaded inside a tubular device (as represented by 216 in FIG. 14). The cut end can be threaded over the end of the stem. Tubular vessel Machine Is designed with an outer diameter that allows it to pass through holes 212 in its body I have.   Referring to FIGS. 9C, 10 and 14, preferably Nitinol or other similar The elongated hollow clamp 220 made of super-elastic alloy is accommodated in the shaft hole 202. Have been. The clamp is of the type indicated at 42 in FIG. With ends or clamps as shown in FIG. 9C It can open through its length. Extend the clamp and thereby extend the clamp Reduce its lateral dimension enough to allow the pump to be accommodated in the shaft bore 202. For this purpose, the distal end of the clamp (222 in FIG. 9C and FIG. 1) 38), must be subjected to forces which tend to stretch or extend the clamp. I have to. FIGS. 6 and 7 show that pusher 150 pushes it close to the clamp. Mating at the ends, i.e. tension is applied to the proximal and distal ends of the clamp Fits the close end of the clamp, how the proximal end of the clamp is Generally represents that it can be threaded and grasped. Referring to FIG. On the other hand, the tapered head 54 is pivoted into the hole formed in the joining spherical member. In the direction, suck the thimble shaped clamp 180, and Extend the clamp when the interaction between them inhibits the axial movement of the clamp You. This feature is also used in the embodiments of FIGS.   Returning now to FIG. 14, some of the suitable equipment for pushing the clamp into the bore is 216, this portion is tubular and the stem 200 is threaded Internally threaded distal end 21 adapted to be rigidly connected to end 208 8 Sliding axially within the tubular member 216 is a clamp at its distal end. A shaft or push 224 that fits tightly with the distal end 222 of the pump. FIG. As can be seen, the shaft 224 is distal with respect to the stem 200, i.e., In the figure, when extruded downward, part of the clamp 220 in the stem is subject to tensile stress. Provided. The distal end 222 of the clamp 220 has its end formed in the stem 200. At its end so that it can be easily accommodated in the rim 214 of the bore formed Tapered slightly inward. In this way, the distal end 222 of the clamp is closed. The lamp can be partially housed within the proximal end of the hole without deformation. Thereafter, the force pushing shaft 224 distally on the distal end 222 of the clamp is: This end of the clamp is pushed inside the hole 202. Clamp outer wall As the insertion proceeds, it comes into contact with the inner wall of the hole, and this contact Slow insertion of the pump. However, the continuous The application of force causes the wall to come into contact with the wall of the hole, ie, Extend the clamp at the point where it "clogs" and keep pushing the clamp inside the hole The Rukoto. Nitinol is used as a clamp and cobalt chrome steel or When the stem is made from titanium, the insertion of the clamp in the hole increases smoothly. Proceed substantially without a sudden push due to interference.   Referring again to FIGS. 9-12 and 14, the prosthesis represented herein is a first prosthesis. Stem 200 as a rotation member, and body as a second prosthesis member The member 210 is included. In this embodiment, the clamp 220 is adapted to engage the hole 20 in the first member. 2 is received in the cavity formed by the second member and 212. Here, the wall of the first member (stem 200) is in its stationary state. When the returning clamp 220 pushes radially outwardly on the inner wall 202 of the stem, It can expand outward to contact the hole 212. Generally two or four axes Elongated slots 204 can be spaced around the circumference of the stem The slot terminates in the hole 206 to avoid stress concentration at the end of the slot. same Such a concept is represented in FIG. 11, in which a pair of diametrically opposed slots (Represented as 205) extends proximally from the stress relief holes 207 and then , 209, turn in the middle where they meet, so the slot It defines a "tongue" shaped portion of the stem wall that can be more easily moved outwards.   Preferred clamps 220 are represented in FIGS. 13A, 13B and 13C. Said before As such, the distal end 222 of the clamp is desirably slightly inward as shown. To allow the clamp to enter the outer rim 214 at the proximal end of the bore 202 Function. The sacrifice or shaft 224 has a tapered distal portion 227 (FIG. 13). Terminates distally at the reduced diameter portion with C) and the wall converges distally . At the end of portion 227 is a button 228 of increased diameter. Extensible rings Shaped collar 230 has a substantially cylindrical outer surface 232 and preferably a shaft 2 The tapered bore 234 (FIG. 1) matches the taper at the end portion 227 of the H.24. 3A). The wall of the collar 230 extends axially as necessary. Tapered distal portion of the shaft 224 can be provided. When 227 is pushed axially in the distal direction with respect to the collar, the collar Will be extended.   Referring to FIG. 13A, when color 230 is set for end button 228, The unexpanded collar can slide through the inner diameter of the hollow clamp 220 . Use a hard material such as steel to wedge the collar into the distal end of the clamp. Block 236 can be utilized, the block being shaped through its thickness. It has a hole 238 formed. The hole 238 is large enough to allow the button 228 to pass through. It has a diameter but is not large enough to pass through the collar 230. FIG. 13B The clamp has its distal end relative to block 238 as represented in , And a button 228 extending into the hole. Shaft 224 is distal ( When extruded (in the direction of arrow F in FIG. 13B), The interaction between the parched portion and the collar will cause the clamp 230 to close near its distal end. Expand the collar to fit tightly with the inner wall. After inserting the clamp into the stem The shaft 224 can stay in place, or withdraw the proximal rod Can be removed. 13B from where the shaft is represented in FIG. 13C. The wall of the collar is squashed inwards and pulled out Of the shaft 224 and the collar 230 as a unit Can be removed by   FIG. 12 illustrates how the body member 210 of the prosthesis of the present invention relates to the stem. FIG. 4 illustrates that a direction can be determined. Angle and direction between appropriate stem and body member The orientation can be initially determined by the surgeon, and these factors are described above. It can be fixed in place by such a clamping element. Stem and body members If it becomes necessary to reorient, the clamps are again placed under tension and The body member can be movable with respect to the stem.   FIG. 15 illustrates a clamp, such as represented at 30 in FIG. 1 represents a mechanical device that can be used to suitably extend within a sinus. 240 The instrument itself, designated by, is internally threaded which is connected to the proximal end of the clamp Includes a tubular member 216 having a distal end. Device 240 includes side walls 246 and ends. An undeformed frame 244 having a wall 248, wherein the side walls and end walls are Are connected so as not to be deformed. Near its distal end, the device is Swivel bar 250 which is guided and allows a small axial movement of clamp 30 Having. A pair of elongated compression bars 252 are located inside frame 244 and The bars can pivot relative to the proximal end wall 248 and the distal pivot bar 250, respectively. Having an outer end. At their adjacent ends, the compression bar is pivotable to the yoke 254 Attached to. The yoke is threaded with a threaded actuation handle 256 A threaded end for receiving the end, the end of the screw being adjacent to the side wall 246; push. As represented in FIG. 15, the compression bar 252 is The rotation causes the yokes 254 to be slightly pushed out to the left in this drawing, Extend at a slight angle, the compression bars are more aligned with each other and push the pivot bar distally. Put out. The end of the compression bar swiveling on the end wall and the swivel bar are Properly shaped so that they cannot "move" beyond the heart, but instead they It is limited to a form that is qualitatively aligned.   The swivel bar 250 is configured to operate in all of the above modes when the device of FIG. 15 is operated. Proximal end of the pusher 150 such that the pusher moves distally with respect to the clamp 30. Contact with parts.   Another force generator is shown in FIG. Here, the stem 200 is a tubular member. Externally threaded attached to the internally threaded distal end of 216 It is represented again with its proximal end. In this embodiment, having a piston rod 264 A piston 260 is installed in a cylinder 262 and a distal end of the piston rod 264. The portion comes into contact with the proximal end of shaft 224. In this embodiment, the class The pump 266 has a closed distal end fitted by the distal end of the shaft 244. Having a part.   On the other side of the piston 260, a cylinder defines a high pressure chamber 268 You. The hydraulic fluid used in the present high pressure chamber is preferably a sterile physiological solution or Other biologically compatible fluids. Sterile saline passes through valve port 270 , The fluid is supplied to the second high-pressure chamber 274 through the one-way valve 272, Two high pressure chambers have a diameter much smaller than the diameter of high pressure chamber 268 You. The piston rod 276, which itself acts as a piston, is 74. Movement of the piston rod 276 distally increases sterile saline. From the pressure chamber 274 through the one-way valve 278 and Extrude into 8. Next, the piston rod 276 is moved axially in the low pressure chamber 282. Is activated by the moving Biston 280. The chamber 282 and its chamber The downstream side 284 of the chamber is a suitable switch, represented schematically at 286 in FIG. The use of a pool valve provides a source of gas under pressure or air or nitrogen Connected.   During operation of the apparatus of FIG. 16, air or other gas under pressure And withdrawn from the chamber 284, with the piston 280 distally Lower, and place a second high pressure chamber in the piston rod 276 of even smaller diameter. Compress the saline in 274. Next, the high-pressure physiological saline is supplied to the chamber 26. 8 to bring the piston 260 and the piston rod 264 into contact with the shaft 224. And push it down. When piston 280 reaches the bottom in chamber 284 When air or other gas flows, remove the piston rod proximally and remove sterile saline. The water is inverted to accommodate the high pressure chamber 274. One-way valve 278 Maintain the pressure in the chamber 268. The process moves the piston 280 back and forth Sometimes then it repeats with piston 260 moving distally through the instrument You. Properly sizing the cross-sectional area of pistons 280, 276 and 260 More low pressure air is used to generate a very high compression force in piston rod 264. Can be done. The seal for piston 260 and piston rod 276 A high pressure seal that can withstand the substantial pressure generated. Piston rod 26 4 and the tube 214 need not be particularly tight, and the distal chamber 26 7 can be easily leaked. If desired, the leak can be May be provided.   A similar operating device is represented in FIG. 17, in which the stem 200 has at its upper end Attached to tube 216 via screws. FIG. 16 (similar numbering Used to specify parts. ) In the same manner as described in And the piston rod 264 is then inserted into a rod (table) contained in a clamp of the type described above. It has not been. ) Has its distal end in contact. The piston rod passes through the pipe 216 Extending from the piston 260 into the high pressure cylinder 268 and down, preferably The high pressure cylinder contains a biologically compatible fluid, such as sterile saline. The upper chamber 282 contains a high pressure source of gas such as nitrogen. A one-way valve 290 is provided. The piston operates in cylinder 282 , The piston 292 connects the gas side of the cylinder 282 with a physiological diet represented by 294. Operates as a diaphragm to separate from the salt water side. Supply nitrogen gas The operation of this embodiment by means of, for example, Saline under substantially the same pressure in chamber 294 passes through flow control valve 296. Into a cylinder 268 where the piston 260 and its biston Acts to push rod 264 distally.   Various force generators can be used in the present invention. Noted above As such, the clamping element is generally placed under substantial tensile stress, and the stress-generating element Shall avoid harm to the patient or medical staff in the event of any material destruction. Preferably, it is shaped and arranged in such a way. The device of FIGS. 16 and 17 Using an incompressible fluid in a high pressure chamber adjacent to the prosthesis stem Give the advantage. A slight increase in the volume given to the fluid, e.g. Any material destruction that causes even a slight increase in the dimensions of the member The pressure in the chamber can be released substantially completely. Further, FIGS. Sealing the clamp during assembly, as represented in the embodiments of 6 and 17, And by activating the shaft, a large amount of shaft or clamp Damage from destruction is largely avoided.   Although preferred embodiments of the present invention have been described, various changes, adaptations, and improvements may be made to the present invention. It is understood that this can be done without departing from the spirit of the invention and the scope of the appended claims. Should be understood.

[Procedure of Amendment] Article 184-8, Paragraph 1 of the Patent Act [Submission date] August 23, 1999 (1999.8.23) [Correction contents]                                The scope of the claims 1. A kit for a modular prosthesis, wherein the kit is elongated. Member having a wall defining a closed cavity; and a releasably clampable resilient member within the cavity. An axially extending hollow clamp made of an elastic alloy, wherein the hollow clamp is perpendicular to the axis. A stationary configuration having predetermined dimensions in the direction, and at least a part in the cavity. A clamp having a distal end shaped to be segregated, and axially Device for applying the stretching force of the above to the clamp, which is housed in a hollow clamp. An instrument including a shaft capable of interacting with the distal end; and To extend the pump in the axial direction to allow further accommodation of the clamp in the cavity. With a moderate force, a force is generated that pushes the shaft axially within the clamp with respect to the member A kit containing the raw means. 2. The instrument includes a shaft extending into the clamp, and mounting the instrument to the clamp. Mounting means for attaching, the device comprising grip force receiving means, and said force Responsive to the application of a gripping force to the receiving means, the insertion of the clamp into the elongated cavity is reduced. Mechanical means for transmitting sufficient axial stretching force to said shaft to permit A kit for a modular prosthesis according to claim 1, comprising: 3. The instrument includes a shaft extending into the clamp and mounting the instrument to a member. And mounting means for gripping, said gripping force receiving means, and said force receiving means. Enables insertion of clamps in the elongated cavity in response to the application of grip force to the means Mechanical convenient means for transmitting an axial stretching force to the shaft sufficient to A kit for a modular prosthesis according to claim 1. 4. The force transmitted to the shaft is at least 10 times the force applied to the force receiving means. 4. The kit according to claim 2, wherein the kit is 0-fold. 5. The instrument comprises a piston and a cylinder in which the piston moves, As well as a source of fluid for actuating a piston in a cylinder under pressure. One of the tons and the cylinder has a fluid supply to said cylinder The shaft is operably mounted on the shaft so as to push it out during clamping. A kit for a modular prosthesis according to claim 1. 6. The other of the piston and the cylinder is adjacent to another end Control to extend the clamp by supplying fluid to the cylinder. The modular prosthesis of claim 5 operatively mounted. Kit for. 7. The other of the piston and the cylinder is provided with a syringe Operably mounted to propel the clamp into the cavity by supplying fluid to the A kit for a modular prosthesis according to claim 5, wherein the kit is a modified prosthesis. 8. The member includes an elongated stem that can be received in the bone marrow cavity of a long bone, 8. The method of claim 1, wherein the stem has an axial hole forming the cavity. A kit for a modular prosthesis according to any one of the preceding claims. 9. Check that the distal end of the shaft is secured to the distal end of the clamp. A key for a modular prosthesis according to any one of claims 1 to 8. To 10. Conveniently receives and faces at least a portion of the surface of the first member A further member having a wall defining an opening shaped so as to extend axially The release of the stretching force returns the clamp to its resting state, A surface-to-surface contact between the wall and the outer surface of the clamp and the first and second members When the facing surfaces are brought into surface-to-surface contact and the members are strongly clamped together Claim 1 not sufficiently including a member whose size increases in one direction to a sufficient extent. 10. A kit for a modular prosthesis according to any one of claims 9 to 9. 11. The shaft has a distal end mateable with a distal end of a clamp; The distal end of the shaft is closed at its distal end when the clamp is received in the member. Grasp the ramp and move the clamp and the distal end of the shaft in their respective axial movements Claim 1 to Claim 9, including grasping means for preventing A kit according to any one of the preceding claims. 12. The gripping means is provided at the distal end of the shaft and is associated with a collar. Expandable expansion to make firm contact with the clamp in response to distal movement of the shaft 12. The kit of claim 11, consisting of a possible color. 13. The distal end of the shaft is tapered so that its width decreases as it becomes distal. The axial movement of the shaft in the collar distal to the shaft. 13. The method of claim 12, wherein the collar is expanded to make firm contact with the clamp. Kit. 14． a. Comprising a member having a wall defining a cavity; b. A clamp having a first stationary configuration having a predetermined dimension in a first direction; , c. Subjecting the clamp to a physical stress to reduce the dimension in the first direction; Sometimes extending the clamp dimensions in a second direction perpendicular to the first direction, d. Inserting a clamp into the cavity while maintaining the physical stress; and e. Releasing said physical stress and returning the clamp to its first resting state, Sufficient to clamp strongly into and into the cavity of the prosthesis member Increasing its dimensions in the first direction, A method of assembling a modular prosthesis comprising: 15. Prior to the release of the physical stress, at least a portion of the member is further protected. Housed in the opening of the housing member, the relative direction between the first and second members being Adjusting, and releasing the stress to the clamp in its first stationary configuration Allowing the return of the clamp, wherein the movement of the clamp When returning to the rest position, the second member is expanded to be in clamp contact with the second member, The second member is fixedly supported in a predetermined direction with respect to the material. The method of assembling a modular prosthesis according to claim 14, comprising the step of: 16. The first and second members are provided when the first member is clamped to the second member. Having an opposing surface shaped to come into surface-to-surface contact 16. A method for assembling a modular prosthesis according to claim 15. 17． The clamp extends axially in the second direction and provides Claim 14 wherein the application of the mechanical stress causes an axial extension of the clamp. 17. A method of assembling a modular prosthesis according to claim 16. .

────────────────────────────────────────────────── ─── Continuation of front page    (81) Designated countries EP (AT, BE, CH, DE, DK, ES, FI, FR, GB, GR, IE, IT, L U, MC, NL, PT, SE), OA (BF, BJ, CF) , CG, CI, CM, GA, GN, ML, MR, NE, SN, TD, TG), AP (GH, KE, LS, MW, S D, SZ, UG), EA (AM, AZ, BY, KG, KZ , MD, RU, TJ, TM), AL, AM, AT, AU , AZ, BA, BB, BG, BR, BY, CA, CH, CN, CU, CZ, DE, DK, EE, ES, FI, G B, GE, HU, IL, IS, JP, KE, KG, KP , KR, KZ, LC, LK, LR, LS, LT, LU, LV, MD, MG, MK, MN, MW, MX, NO, N Z, PL, PT, RO, RU, SD, SE, SG, SI , SK, TJ, TM, TR, TT, UA, UG, US, UZ, VN, YU

Claims (1)

[Claims] 1. A kit for making a modular prosthesis, wherein the kit comprises: A first member having a wall defining a cavity, and releasably clamped within the cavity Consists of a possible clamp, said clamp having predetermined dimensions in a first direction Having a first stationary form, and by applying physical stress, in said first direction Have smaller dimensions and at the same time increased dimensions in a second direction perpendicular to said first direction The clamp can be at least partially accommodated in the cavity with a second shaped configuration Wherein the predetermined dimension is determined by the release of the applied physical stress. The clamp returns to its resting state and consequently clamps strongly against said member. A kit whose size in the first direction is increased by a sufficient amount. 2. The cavity has a surface that matches the surface of the clamp housed in the cavity, and The kit of claim 1, wherein the kit provides surface-to-surface contact of the clamp to the sinus. 3. The clamp has an axial dimension and a lateral dimension that increases as said axial dimension decreases Consists of a metal rod and the cavity is shaped to accommodate the rod in the axial direction The kit of claim 1, wherein 4. The metal rod is shaped for axial bore and for accommodation in the cavity. 4. The kit of claim 3 including a distal end. 5. A device for clamping the rod to the first member, the device comprising: Pushing the distal end sufficiently to allow the rod to be accommodated in the cavity. 5. The kit of claim 4 including means insertable into said aperture to extend the pad. 6. The prosthesis includes at least a portion of the first member in any direction. A second member shaped to receive the first member; The clamp returns to its stationary configuration and the second member in a predetermined direction with respect to the first member. When fixedly supported, it is shaped to expand and make clamp contact with the second member. The kit of claim 1 wherein the kit is used. 7. The device releasably grips a manual compression element including a handle and a first member. And a shaft at the distal end of the rod in response to compression of the handle. 6. The key of claim 5 including means for transmitting a directional force to extend said rod. To 8. The clamp is made of a shape memory alloy having superelastic properties at body temperature. The kit of claim 1. 9. A kit for making a modular prosthesis, wherein the kit comprises: A first member having a wall defining a cavity having an inner surface, and a stem and an outer surface Consisting of a clamp consisting of a superelastic hollow metal rod with a surface, A first stationary configuration having a predetermined dimension in a direction transverse to the axial direction; and In response to the stress-induced axial extension, a smaller dimension in said lateral direction A second shape having the rod at least partially accommodated in the cavity The predetermined lateral dimension is reduced by the release of stresses that tend to extend the rod. The rod returns to its resting state, and as a result, the clamp is forced into the member. Surface-to-surface contact between the inner surface of the cavity and the outer surface of the rod so as to clamp A kit whose size in said lateral direction is increased enough to . 10. A kit for making a modular prosthesis, wherein the kit comprises A first member having a wall defining an elongated cavity, and at least a portion of the first member Defining an opening shaped to receive and confront the surface of the Member having a hollow wall and a hollow axially elongated super-elastic body having an outer surface Consisting of a clamp made of a conductive metal rod, the rod being transverse to its axis. A first stationary configuration having predetermined dimensions and being axially stretchable. The rod to a second part having a second shape having a smaller dimension in the lateral direction. At least partially accommodated in the cavity of the material, said predetermined lateral dimension being externally Release of the stimulus returns the clamp to its resting state, and consequently Bringing the wall and the outer surface of the rod into surface-to-surface contact and in front of the first and second members; When the facing surfaces are brought into surface-to-surface contact and the members are strongly clamped together Sufficient to increase its dimensions in one direction, said kit comprising Applying an axial stretching force sufficient to allow insertion of the rod into the cavity. Kit containing equipment for applying to rods. 11. The instrument extends into the rod and is secured to a distal end of the rod. A shaft having a distal end, the device comprising: a grip receiving means; Enables insertion of the rod into the cavity in response to the application of grip force to the receiving means Mechanical convenient means for transmitting sufficient axial stretching force to said shaft to The device attaches to the rod adjacent to the other end of the rod and connects to the device. Claims including mounting means for extending said rod in response to the application of a grip force Item 11. The kit according to Item 10. 12. The instrument extends within the rod and is secured to a distal end of the rod. A shaft having a distal end, and for attachment of the device to a first member. The device includes attachment means, the device comprising: grip force receiving means; and grip force on the force receiving means. Axial direction sufficient to allow insertion of the rod into the cavity in response to the application of 11. A mechanical expedient for transmitting a stretching force to the shaft. The kit as described. 13. The instrument extends into the rod and is secured to a distal end of the rod. A shaft having a distal end, the instrument comprising a piston and a piston therein. A cylinder in which the ton moves, and the piston in the cylinder under pressure A source of fluid for operating the one of the piston and the cylinder So that the fluid supply to the cylinder pushes the shaft into the clamp. The kit of claim 10 operably mounted on a shaft. 14． The other of the piston and the cylinder has a flow to the cylinder. Operable on the rod adjacent to the other end to extend the rod by body supply 14. The kit according to claim 13, wherein the kit is attached to a noh. 15. The other of the piston and the cylinder has a flow to the cylinder. Operablely mounted on the first member to propel the rod into the cavity by body feeding The kit of claim 13, wherein 16. The first member includes an elongated stem that can be received in the bone marrow cavity of a long bone. The stem of claim 1, wherein said stem has an axial bore defining said cavity. Kit. 17． A kit for a modular prosthesis, the kit comprising: A first prosthesis member having a wall defining a recessed cavity, and releasing within the cavity An axially elongated hollow clamp made of a super-elastic alloy that can be clamped A stationary form having a predetermined dimension in a direction perpendicular to the axis, and A claw having a distal end shaped to be at least partially received within the cavity. A lamp and a device for applying an axial stretching force to the clamp, A shaft receivable within the hollow clamp and matable with the distal end; An instrument including a fixture that can be attached to the first element, and the clamp in the axial direction. With sufficient force to extend and allow further accommodation of the clamp in the cavity, Force for pushing the shaft in a clamp and axially with respect to the first element A kit including a generating means. 18. The force generating means includes a piston and a syringe in which the piston moves. And a fluid supply for actuating the piston in the cylinder under pressure. Including a source, one of the piston and the cylinder operated on the shaft And the other of the piston and the cylinder is Operatively attached to the first member, the fluid supply to the cylinder being controlled by the shaft 18. The kit according to claim 17, wherein said kit is extruded into said clamp. 19. The force generating means includes a grip force receiving means and a grip force applied to the force receiving means. In response to the application, at least the grip force applied to the grip force receiving means is applied to the shaft. 18. The key according to claim 17, further comprising a mechanical expedient for transmitting 100 times the force. To 20. The shaft has a distal end mateable with a distal end of a clamp; The distal end of the shaft has a distal end when the clamp is received within the first member. Hold the clamp at the end and separate the distal end of the clamp and shaft 2. A method according to claim 1, further comprising a grasping means for preventing the movement in the axial direction. 9. The kit according to 9. 21. The gripping means is provided at the distal end of the shaft and is associated with a collar. Expandable to make firm contact with the clamp in response to distal movement of the shaft 21. The kit of claim 20, comprising an expandable collar. 22. The distal end of the shaft is tapered so that its width decreases as it becomes distal. Axial movement of the shaft within the collar distal to the shaft. 22. The method of claim 21 wherein the collar expands the collar into firm contact with the clamp. The kit as described. 23. a. Comprising a first prosthesis member having walls defining a cavity; b. A clamp having a first stationary configuration having a predetermined dimension in a first direction; , c. Subjecting the clamp to physical stress to reduce the dimension in the first direction; Simultaneously expanding the clamp dimensions in a second direction perpendicular to the first direction, d. Inserting the clamp into the cavity while maintaining the physical stress; and And e. Releasing the physical stress and returning the clamp to its initial first resting configuration And, as a result, strongly clamped into and within the cavity of the first prosthesis member. Increasing its dimensions in the first direction enough to be A method of assembling a modular prosthesis comprising: 24. Prior to the release of the physical stress, at least a part of the first member is protected by the second protector. Housed in the opening of the housing member, the relative direction between the first and second members being Adjusting, and releasing the stress to the clamp in its first stationary configuration Return, said first member returning the movement of said clamp to its rest position When fixing and supporting the second member in a predetermined direction with respect to the first member, Expanding and shaped to clamp and contact the second member. A method according to claim 23. 25. a. A first prosthesis member having a wall defining an elongated cavity thing, b. Long axial extension with a distal end shaped for partial containment within the cavity A clamp having a predetermined dimension in a direction transverse to its axis. Having a stationary form having c. Inserting the distal end of the clamp into the cavity; d. Extending the clamp in the axial direction to reduce the dimension in the first direction and With sufficient force to allow further accommodation of the clamp in the cavity. Applying a force to the distal end of a pump to urge the clamp into the cavity; and e. Releasing the force to return the clamp to its first resting configuration, and consequently Sufficient to clamp strongly in and within the cavity of the first prosthesis member. Increasing its dimensions in the first direction, How to assemble a modular prosthesis consisting of: 26. Accommodating at least a portion of the first member in the opening of the second prosthesis member Adjusting the relative orientation between the first and second members and the stress To allow the clamp to return to its first stationary configuration, The member is positioned relative to the first member when the movement of the clamp returns to its rest position. The second member is fixed and supported in a predetermined direction, and expanded to 26. The method of claim 25, comprising the step of being shaped to make contact with the pump. 27. The first and second members are provided when the first member is clamped to the second member. Having an opposing surface shaped to come into surface-to-surface contact 27. The method according to any one of claims 24 and 26.