AU2010269152A1

AU2010269152A1 - Hip joint device and method

Info

Publication number: AU2010269152A1
Application number: AU2010269152A
Authority: AU
Inventors: Peter Forsell
Original assignee: Milux Holding SA
Current assignee: Implantica Patent Ltd
Priority date: 2009-07-10
Filing date: 2010-07-12
Publication date: 2012-03-01
Anticipated expiration: 2030-07-12
Also published as: MX336424B; AU2010269152B2; US20120101588A1; AU2018203460A1; AU2016204364B2; BR112012000643B8; JP5882894B2; WO2011005187A1; AU2020200347A1; MX2012000519A; MX2012000522A; AU2018203460B2; US11103355B2; EP2451390A4; JP2012532659A; AU2016204364A1; AU2020200347B2; EP2451390A1; BR112012000643A2; BR112012000643B1

Abstract

A medical device for implantation in a hip joint of a human patient is provided. The natural hip joint having a ball shaped caput femur as the proximal part of the femoral bone with a convex hip joint surface towards the centre of the hip joint and a bowl shaped acetabulum as part of the pelvic bone with a concave hip joint surface towards the centre of the hip joint. The caput femur has a centrally placed longitudinal extension, extending through the center of the caput and collum femur, aligned with the collum femur, defined as the caput and collum femur center axis. The medical device comprising; an artificial acetabulum, comprising a concave surface towards the centre of the hip joint. The artificial concave acetabulum is adapted to, when implanted, be fixated to the femoral bone of the human patient, and be in movable connection with an artificial caput femur fixated to the pelvic bone of the patient.

Description

WO 2011/005187 PCT/SE2010/050803 HIPeDINT DEVICE AND MEIHOD FE[D OF INVEN'IION [0001] 'The present invention plates generally to a medical device for implantation in 5 a hip joint, and a method of providing said medical device. BACKGIOUND AR? [0002] Ihe hip joint is a synovial joint, joining the pelvis to the proximal portion of the femoral bone. Synovial joints ame the mo st common types of joints in mammals, and ame typical of nearly all limb joints. Ihe contacting surfaces of said the pelvic, the 10 acetabulum, and the contacting surface of the femoral bone, the caput femur, ame smooth and rounded, and covered by articular cartilage. A synovial membrane, encapsulates the joint, forming a hip joint cavity, which contains synovial fluid. Outside the synovial membrane is a fibrous capsule and ligaments, forming an articular capsule. 15 [0003] Ihere ame both natural and pathological processes leading to deteriorated joint function With age and wear, the articular cartilage becomes less effective as a shock absorber and a lubricated surface. Different degenerative joint diseases, such as arthritis, osteoartrithis, or osteoarthrmsis, accelerate the deterioration [0004] Hip joint Osteoarthitis is a syndrome in which low-grade inflammation results 20 in pain in the hip joints, caused by abnormal wearing of the Cartilage that acts as a cushion inside if the hip joint This abnormal wearing of the cartilage also results in a decrease of the joints lubricating fluid called Synovial fluid. Hip joint Osteoarthitis is estimated to affect80% of all people over 65 years of age, in more or less serious fo rms.

WO 2011/005187 PCT/SE2010/050803 [0005] The present tmatment for hip osteoarthitis comprises NSAID drugs, local injections of Hyalumnic acid or Glucocorticoid to help lubricating the hip joint and replacing parts of the hip joint with a prosthesis through hip joint surgery. [0006] The replacing of parts of the hip joint is one of the most common surgeries to 5 date performed at hundreds of thousands of patients in the world every year. The most common method comprises placing a metal prosthesis in Femur and a plastic bowl in Acetabulum. This operation is done through an incision in the hip and upper thigh and thrmugh Fascia Iata and the lateral muscles of the thigh 'I get access to the joint the supporting Capsule attached to Femur and Ilium needs to be penetrated, making it 10 difficult to get a fully functional joint after the surgery. Femur is then cut at the neck with a bone saw and the prosthesis is placed in femur either with bone cement or without Acetabulum is slightly enlarged using an Acetabular meamer, and the plastic bowl is positioned using sews or bone cement [0007] The complications after hip joint surgery includes dislocation of the hip joint 15 and loosening of the prosthesis fim its fixation in the femoral bone. The loosening and/ or dislocation of the prosthesis could be induced by an abnormal strain being placed on the hip joint fim e.g. the patient falling or making a rapid movement of the hip, or by a bodily macrophage reaction 2 WO 2011/005187 PCT/SE2010/050803 SUMMARY [0008] A medical device for implantation in a hip joint of a human patient is provided. The natuml hip joint having a ball shaped caput femur as the proximal part of the femoral bone with a convex hip joint surface towards the center of the hip joint 5 and a bowl shaped acetabulum as part of the pelvic bone with a concave hip joint surface towards the center of the hip joint The caput femur has a centrally placed longitudinal extension, extending thmugh the center of the caput and collum femur, aligned with the collum femur, defined as the caput and collum femur center axis. The medical device comprising; an artificial acetabulum, comprising a concave surface 10 towards the center of the hip joint The artificial concave acetabulumis adapted to, when implanted, be fixated to the femoral bone of the human patient and be in movable connection with an artificial caput femur fixated to the pelvic bone of the patient [0009] According to one embodiment the medical device comprises a fixating 15 portion adapted to be; stabilized by the cortical bone of the caput femur, fim the inside of the caput femur or stabilized by the conical bone of the collum femur fi-om the inside of the collum femur, when atleast one of the caput and collum femur has been surgically modified and opened. [00010] According to one embodiment the medical device comprises a fixating 20 portion adapted to be; stabilized by the cortical bone of the caput femur, substantially fim the proximal side of the cortical bone of the caput femur, or stabilized by the cortical bone of the collum femur substantially fitim the proximal side of the cortical bone of collum femur, when at least one of said caput and collum femur has been surgically mo dified having a cut though corticalis edge of the caput or collum femur 25 supporting said fixating portion. [00011] According to one embodiment the medical device comprises a fixating portion adapted to be; stabilized by the cortical bone of the caput femur, fim the 3 WO 2011/005187 PCT/SE2010/050803 outside of the caput femur or stabilized by the cortical bone of the collum femur, from the outside of the collum femur. [00012] According to yet another embodiment the medical device comprises a fixating portion adapted to be; stabilized by the cortical bone of the caput femur or 5 collum femur, substantially fim the proximal side of a surgically modified cortical bone and fim the inside of the caput femur or the collum femur, when at least one of the caput and collum femur has been surgically modified and opened. [00013] According to yet another embodiment the medical device comprises a fixating portion adapted to be; stabilized by the cortical bone of the caput or collum 10 femur, substantially fim the proximal side of a surgically modified cortical bone and fi-om the outside of the caput or collum femur. [00014] According to yet another embodiment the medical device comprises a fixating portion adapted to be stabilized by the cortical bone of the caput or collum femur, fim the inside of caput or collum femur and fim the outside of the caput or 15 co llum femur. [00015] The fixating portion could comprise atleast one cavity adapted to receive a mechanical fixation element [00016] The medical device could in any of the embodiments herein further comprise a mechanical fixation element adapted to be placed in at least one cavity of the 20 medical device and inside of the cortical bone of the caput or collum femur, when the medical device is implanted. [00017] According to one embodiment the medical device comprises a mechanical fixation element adapted to be placed inside of the cortical bone of the caput or collum femur fi-om the inside of the caput femur and/ or fi-om the outside of the caput 25 femur. 4 WO 2011/005187 PCT/SE2010/050803 [00018] The mechanical fixation element could in any of the embodiments, be adapted to be placed inside of the cortical bone of the caput or collum femur, substantially from the proximal side of the caput femur. [00019] In any of the embodiments, the medical device could comprise a mecess 5 adapted to receive a portion of the femoral bone. [00020] According to one embodiment the mechanical fixating element could be adapted to be placed partially inside of a firstportion of said medical device, on a fist side of said mecess, partially inside of the portion of the femoral bone placed in said mecess, and partially inside of a second portion of said medical device, on a 10 second opposite side of said mecess, for restraining the portion of the femoral bone in said mecess. [00021] According to another embodiment, the medical device further comprises an elongated element adapted to be placed in the collum femur fi-om the proximal side therof to stabilize the medical device. 15 [00022] According to yet another embodiment the medical device comprises an elongated element comprising a threaded portion The threaded portion could be adapted to engage atleast one of: the cortical bone of the collum femur, the cancellous bone of the collum femur, and an artificial material injected into the collum femur. 20 [00023] According to another embodiment, the elongated element could comprise an anchoring portion, and said anchoring portion could be adapted to engage at least one of: the cortical bone of the collum femur, the cancellous bone of the collum femur, and an artificial material injected into the collum femur. [00024] According to yet another embodiment the anchoring portion could have a 25 first and second state, and said anchoring portion could be adapted to, in said second state, further engage atleast one of: the cortical bone of the collum femur, the 5 WO 2011/005187 PCT/SE2010/050803 cancellous bone of the collum femur, and an artificial material injected into the collum femur, for further fixating said medical device to the femoral bone. [00025] According to yet another embodiment, the medical device comprises a fixating portion further comprising atleast one groove adapted to stabilize a loop 5 shaped fixating element along at least one portion therof, when said medical device is implanted. [00026] The loop-shaped fixating element could be adapted to further stabilize the medical device to the femoral bone. The loop shaped fixating element is could be elastic or the medical device could comprise an elastic portion which could be 10 adapted to clasp a portion of the femoral bone and therby fixate the medical device to the femoral bone. [00027] According to yet another embodiment, the medical device is adapted to pass beyond the equator of the artificial caputfemur placed in the medical device when implanted, therby clasping the artificial caput femur. 15 [00028] According to yet another embodimentthe medical device further comprises a locking member adapted to lock an artificial caput femur in the medical device. [00029] According to yet another embodiment, the locking member could comprise an elastic portion which could be an elastic band adapted to encircle the artificial caput femur. 20 [00030] According to yet another embodiment, the medical device has a fist and second state, and the medical device could be adapted to, in said first state, fixate the artificial caput femur to the medical device, and in said second state, release the artificial caput femur frm the medical device. The medical device could be adapted to change from said fist state to said second state when a predetermined strain is placed 25 on said medical device. 6 WO 2011/005187 PCT/SE2010/050803 [00031] The locking member of the medical device could comprise an elastic or flexible portion, and the locking member could be adapted to change the medical device fim the fist to the second state using the elasticity or flexibility of the elastic or flexible portion of the locking member. 5 [00032] According to yetanother embodimentthe medical device comprises a surface adapted to be placed in contact with the cortical or cancellous bone of the femoral bone, when implanted, and said surface could be adapted to adhere to the cortical or cancellous bone using an adhesive. [00033] According to yet another embodiment the medical device comprises a 10 surface adapted to promote in-growth of bone tissue for fixating said medical device to the femoral bone, by means of for example a porous micro or nano structure. [00034] The fixating portion, adapted to stabilize the medical device to the femoral bone, could in any of the embo diments herein be elastic or flexible. [00035] In some embodiments, the medical device comprises an elastic or flexible 15 portion, which could be adapted to clasp a portion of the femoral bone fim the outside of the cortical bone of caput or collum femur and themeby fixate the medical device to the femoral bone. [00036] The fixating portion adapted to clasp atleastone portion of the femoral bone fim the outside of the cortical bone of caput or collum femur and therby at least 20 partly fixate the medical device to the femoral bone. [00037] In some embodiments, the fixating portion is adapted to pass proximal beyond the equator of caput femur aligned with the caput and collum center axis, when implanted and engaging a surgically modified caput femur, therby clasping the surgically modified caput femur to stabilize the medical implant 25 [00038] The surgically modified caput or collum femur comprises a mostproximal portion The fixating portion could be adapted to pass beyond the most proximal 7 WO 2011/005187 PCT/SE2010/050803 portion, on the outside therof, thus partially be placed more distal than the most proximal portion of the surgically modified caput or collum femur. [00039] According to yet another embodiment a portion of the caput or collum femur is placed at a largest distance fiom the caput and collum femur center axis, and 5 wherein a portion of said fixating portion is adapted to be placed at a distance fiim the caput and collum center axis, being shorter than the largest distance fim the caput and collum femur center axis to the caput or collum femur. [00040] 'The fixating portion could according to one embodiment, be adapted to clasp a portion of the caput or collum femur, said fixating portion thereby assisting in 10 the fixation of the medical device to the caput or collum femur. This could be done by the clo sest distance fiom said fixating portion to said caput or collum center axis being shorter than the distance between said cenkr axis and the equator of the caput femur. [00041] According to another embodiment, the medical device further comprises an elastic layer adapted to absorb chocks fi-om the femoral bone. The elastic layer could 15 be placed between the femoral bone and the medical device, when said medical device is implanted, the elastic layer could be an elastic polymer layer. [00042] The elastic polymer layer could for example be an elastic polymer layer selected fiom a group consisting of: polyurethane, silicone, a combination of polyurethane and silicone, parylene coated silicone, parylene coated polyumetlhane, 20 and a parylene coated combination of polyurethane and silicone. [00043] A method of replacing a natural hip joint with an artificial hip joint is further provided. The method comprising the steps of: exposing the caput femur, opening the caput femur, thereby exposing the cortical and cancellous bone of the caput femur, 25 placing a medical device comprises an artificial concave acetabulum surface in the caput femur and fixating the medical device to the caput femur or collum femur. 8 WO 2011/005187 PCT/SE2010/050803 [00044] According to one embodiment the step of fixating the medical device to the caput or collum femur, comprises the step of fixating the medical device to the cortical bone from the inside of the caput or collum femur and/ or fim the outside of the caput or collum femur and/ or fi-om the proximal side of the caput or collum femur and/ or 5 fm [00045] According to yet another embodiment the medical device comprises an elastic portion, and the step of fixating the medical device could further comprise the step of fixating the medical device to the caput femur by the medical device clasping the caput femur using the elastic portion 10 [00046] According to one embodiment the medical device comprises an elongated member, and the step of fixating the medical device comprises placing the elongated member in the collum femur, substantially aligned with the caput and collum femur center axis, the elongated member engaging at least one of: the cancellous bone of the collum femur, the cortical bone of the collum femur and an artificial material placed 15 inside of the collum femur. [00047] The elongated member could comprise a threaded portion, and the step of placing the elongated member in the collum femur could comprise the step of screwing the elongated into the collum femur. [00048] According to yet another embodiment the elongated member could comprise 20 an anchoring portion, and the step of placing the elongated member in the collum femur could comprise the step of placing the anchoring portion such that the anchoring portion engages at least one of: the cancellous bone of the collum femur, the cortical bone of the collum femur and an artificial material placed inside of the collum femur. [00049] According to another embodiment the anchoring portion can be placed in a 25 fist and second state, and said anchoring portion could be adapted to, in the second state, further engage atleast one of: the cancellous bone of the collum femur, the 9 WO 2011/005187 PCT/SE2010/050803 cortical bone of the collum femur and an artificial material placed inside of the collum femur, for further stabilizing the medical device. [00050] In yet another embodiment the medical device further comprises applying an adhesive to a surface of the inside of the caput or collum femur and placing the 5 medical device in contact with said adhesive, such that said adhesive adhemes to the medical device. [00051] According to yet another embodiment, the step of fixating the medical device comprises the step of fixating the medical device using a mechanical fixation element adapted to engage the cortical bone of the caput or collum femur. 10 [00052] hi yet another embodiment, the step of fixating the medical device comprises the step of fixating the medical device using a mechanical fixation element adapted to engage the cortical bone of the caputor collumfemur. [00053] hi yet another embodiment, the step of fixating the medical device could comprise the step of placing a mechanical fixation element in connection with the 15 medical device, clamping the medical device, and thus fixating the medical device to the caput femur. [00054] In other embodiments, the step of placing the mechanical fixation element comprises the step of placing a loop shaped mechanical fixation element sunounding the medical device and caput femur. 20 [00055] hI other embodiments, step of fixating the medical device to the caput or collum femur, comprises fixating the medical device to the cortical bone of caput or collum femur fim at least one of; the outside, the inside and a proximal cut caput or collum femur and operating the device to adjust the fixation to clamp the cortical bone of the caput or collum femur. 25 [00056] According to one embodiment the fixating portion is adapted to be operable to adjust the stabilization of the medical device towards the cortical bone of the caput 10 WO 2011/005187 PCT/SE2010/050803 or collum femur, from at least one of; the inside of caput or collum femur, the outside of the caput or collum femur and a cut prximal side of caput or collum femur. [00057] Rease note that any embodiment or part of embo diment as well as any method or part of method could be combined in any way. All examples herein should 5 be seen as part of the general description and therefore possible to combine in any way in general terms. 11 WO 2011/005187 PCT/SE2010/050803 BRIEFDESCRIPION OFDIRAWINGS The invention is now described, by way of example, with reference to the accompanying drawings, in which fig. la shows the hip jointin section, 5 fig. lb shows the collum femur in section, fig. 2 shows the exposing of the caput femur though an incision in the thigh, fig. 3 shows the step of removing a proximal part of the caput femur, fig. 4 shows the meaming of the collum and caput femur, fig. 5 shows the collum and caput femur when a medical device gas been fixated, 10 fig. 6 shows the meaming of the acetabulun, fig. 7 shows the injecting of an adhesive in the acetabulum, fig. 8 shows the fixation of a medical device in the acetabulum, fig. 9 shows an artificial hip joint when connected, fig. 10 shows a medical device when anchored in the femoral bone, 15 fig. 11 shows a fiontal view of a human patient when incisions have been made in a surgical method, fig. 12 shows a fiontal view of a human patient when incisions have been made in a arthroscopic method, fig. 13 shows the human patient in section when a medical device for crating a hole 20 in the pelvic bone is inserted, fig. 14 shows the hip jointin sectionwhena medical device forcrmating a hole inthe pelvic bone is operating, fig. 15 shows the step of removing a proximal part of the caput femur, fig.16 shows the hip joint in section when a ramer is introduced to a hole in the 25 pelvic bone, 12 WO 2011/005187 PCT/SE2010/050803 fig. 17 shows the hip joint in section when an injecting member injects a fluid through a hole in the pelvic bone. fig 18 shows the step of providing a medical device through a hole in the pelvic bone, fig.19 shows the medical device in further detail, 5 fig. 20 shows the hip joint in section when a medical device has been provided, fig. 21 shows the hip joint in section when a prosthetic part is being provided, fig. 22 shows the hip joint in section when the medical device has been fixated, fig. 23 shows a second approach to reaming the caputfemur, fig. 24 shows the hip joint in section when an injecting member injects a fluid through 10 a hole in the pelvic bone. fig. 25 shows a second approach to placing the medical device in the hip joint fig. 26 shows a second approach to placing the medical device in the hip joint fig. 27 shows the hip joint in section when a prosthetic partis being provided in a second approach, 15 fig. 28 shows the hip joint in section when the medical device has been fixated, fig. 29 shows a schematic view of the concave hip joint surface in section, fig. 30 shows an artificial concave acetabulum surface in section, fig. 31 shows the step of injecting a fluid into an amea of the hip joint or its surnm undings. 20 13 WO 2011/005187 PCT/SE2010/050803 DETA1HD DESCRIPTION [00058] In the following a detailed description of prefered embodiments of the present invention will be given In the drawing figures, like reference numerals designate identical or cormsponding elements throughout the several figures. It will be 5 appreciated that these figures ame for illustration only and ame not in any way restricting the scope of the invention Thus, any references to dinction, such as "up" or "down', ame only refening to the dimnections shown in the figures. Also, any dimensions etc. shown in the figures ame for illustration purposes. [00059] Fbnctional hip movements ame to be understood as movements of the hip that 10 at least partly cormespond to the natuml movements of the hip. On some occasions the natural movements of the hip joint mightbe somewhatlimited or alterd after hip joint surgery, which makes the functional hip movements of a hip joint with artificial surfaces somewhat different than the functional hip movements of a natuml hip joint [00060] The functional position of an implantable medical device or prosthesis is the 15 position in which the hip joint can perform functional hip movements. The final position is to be understood as a functional position in which the medical device needs no further position change. [00061] Arthroscopy is to be understood as key hole surgery performed in a joint since the arthroscopic procedure could be performed in the abdomen of the patient 20 some of the steps of this arthmscopic procedure is more laparoscopic, however for the purpose of this invention the two terms arthimscopy and laparoscopy is used synonymously and for the purpo se of this invention the main purpo se of these methods ame is that they are minimally invasive. [00062] The medical device according to any of the embodiments could comprise at 25 least one material selected fim a group consisting of: polytetrafluoroethylene (PIE), perfluoroalkoxy (FA) and fluoirinated ethylene propylene (FEP). Itis furthermore conceivable that the material comprises a metal alloy, such as cobalt-chromium 14 WO 2011/005187 PCT/SE2010/050803 molybdenum or titanium or stainless steel, or polyethylene, such as cross-linked polyethylene or gas sterilized polyethylene. The use of ceramic material is also conceivable, in the contacting surfaces or the entire medical device such as zirconium or zirconium dioxide ceramics or alumina ceramics. The part of the medical device in 5 contact with human bone for fixation of the medical device to human bone could comprise a pooihouse structure which could be a porous micro or nano-structume adapted to promote the growth-in of human bone in the medical device for fixating the medical device. The porous structure could be achieved by applying a hydroxy-apatite (HA) coating, or a rough open-pored titanium coating, which could be produced by air 10 plasma spraying, a combination comprising a rough open-pored titanium coating and a HA top layer is also conceivable. The contacting parts could be made of a self lubricated material such as a waxy polymer, such as PIHFF A, FEP, PE and UHMWMPE or a powder metallurgy material which could be infused with a lubricant which preferably is a biocompatible lubricant such as a Hyalumnic acid derivate. Itis 15 also conceivable that the material of contacting parts or surfaces of the medical device herein is adapted to be constantly or intermittently lubricated. According to some embodiments the parts or portions of the medical device could comprise a combination of metal materials and/ or carbon fibers and/ or boron, a combination of metal and plastic materials, a combination of metal and carbon based material, a combination of 20 carbon and plastic based material, a combination of flexible and stiff materials, a combination of elastic and less elastic materials, Coirian or acrylic polymers. [00063] Ig. la shows the hip joint of a human patientin section The hip joint comprises a caput femur 5 placed at the very top of collum femur 6 which is the top part of the femoral bone 7. The caput femur is in connection with the acetabulum 8, 25 which is a bowl shaped part of the pelvic bone 9. Both the caput femur surface 10 and the acetabulum surface 11 is covered with articular cartilage 13 which acts as a cushion in the hip joint In patients with hip joint osteoarthritis, this articular cartilage 13 is abnormally worn down due to a low grade inflammation. The hip joint is sunounded by the hip joint capsule 12 which provides support for the joint and 15 WO 2011/005187 PCT/SE2010/050803 hinders luxalion. After conventional hip joint surgery, penetrating the hip joint capsule 12, the capsule 12 is dramatically weakened due to the limited healing possibilities of its ligament tissue. By performing hip joint surgery without damaging the hip joint capsule 12 the patient can fully recover and place equal amount of strain on an 5 artificial joint as is possible on a natuml one. [00064] Hg. lb shows a section A - A of the collum femur, as shown in fig. 1. The section A - A shows the collum femur comprising cortical bone 601, the outer more sclerotic bone, and cancellous bone 602, the inner porous bone located in the bone mar-w 603. Rulher, fig. lb shows a section B- B of the caput femur, perpendicular 10 to the length axis of the collum 6 and caput 5 femur. [00065] Hg. 2 shows a lateral view of a human patient when an incision in the thigh region has been made. The femoral bone 7 comprising the collum femur 6 and the caput femur 5 has been dislocated fiom its usual position in the hip joint in connection with the acetabulun, which is a part of the pelvic bone 9, the caput femur 5 being a 15 part of the hip joint normally being covered by the hip joint capsule. [00066] Hg. 3 shows the proximal part of the caput femur 5 being removed e.g. by means of a bone saw. A surface of a section 102 is thus created perpendicularly to a length axis of the collum femur 6 [00067] Hg. 4a shows the meaning of the collum femur 6 and caput femur 5 using a 20 reamer 40 connecting to an elongated member 21 by a connecting section 101. The meamer 40 crating a hemi-spherical cavity, having a concave surface 103, centrally placed in the caput 5 and collum femur 6. [00068] Hg. 4b shows the step of applying an adhesive 106 to the created hemi spherical cavity in the femoral bone using an injecting member 104 having an 25 injecting nozzle 105. In the embodiment shown in fig. 4b the injecting member is inserted into an amea of the hip joint though a hole 18 in the pelvic bone 9, however 16 WO 2011/005187 PCT/SE2010/050803 it is equally conceivable that the injecting member is inserted though the hip joint capsule 12 or the femoral bone 7. [00069] Hg. 5 shows the femoralbone 7 when a medical device 109 having a concave contacting surface has been provided to the hemi-spherical cavity, centrally 5 placed in the caput 5 and collum femur. An elastic layer 109b adapted to absorb shocks fi-om the femoral bone has been placed between the surface 109c adapted to be in contact with the artificial caput femur surface, and the femoral bone 7, 6. The elastic layer 109b could be an elastic polymer layer, such as a polyurethane or silicone layer. Having a layer absorbing shocks in the hip jointreduces the risk of 10 fastening elements in contact with bone being affected by strains such that the fastening elements ame loosened fim their mspective fastening positions, it also increases the comfort for the patient [00070] Hg. 6a shows the femoral bone 7 when a medical device having a concave contacting surface 110 has been provided to the hemi-spherical cavity, centrally 15 placed in the caput 5 and collum femur. The medical device has been fixated to the femoral bone 7 using sews 121 placed aligned with the caput and collum femur center axis and entering the cortical bone of the caput femur. [00071] Hg. 6b shows the femoralbone 7 when a medical device having a concave contacting surface 110 has been provided to the hemi-spherical cavity, centrally 20 placed in the caput 5 and collum femur. The medical device comprises fixating portions 680 extending on the outside of the surface of a section 102 of the surgically cut caput femur, comprising cortical bone in the periphery therof, therby stabilizing the medical device with the artificial concave acetabulum surface 110 in the surgically cut caput femur. 25 [00072] Hg. 6c shows an alternative embodiment in which the medical device has been fixated to the surgically cut caputfemur using sews 121 entering the cortical bone 601 of the caputfemur. 17 WO 2011/005187 PCT/SE2010/050803 [00073] Hg. 6d shows yet another embodiment in which the medical device is fixated to the femoral bone using fixating portions, in accordance with the embodiment described with reference to fig. 6b, and an elongated member 681. 'The elongated member is according to this embodiment a thmeaded member 681 extending along the 5 collum and caput femur center axis, in the cancellous bone 602 of the collum femur, and entering the cortical bone 601 of the femoral bone, on the inside therof, in the amea of the greater tochanter. The threaded elongated member 681 cmeates an axial force when pulled pressing the medical device towards the surface of a section 102 of the surgically cut caput femur, thereby stabilizing and fixating the medical device in 10 the concave cavity created in the caput femur. [00074] Hg. 6e shows yet an altemative embodiment of the medical device in which the fixating portions 680 are additionally fixated using screws 121 placed frm the outside of the surgically cut caput femur, perpendicularly to the collum and caput femur center axis. 15 [00075] Hg. 7a shows the medical device in an embodiment in which the fixating portions 680 extends beyond the greatest cirumference of the surgically cut caput femur and thereby clasps the medical device to the surgically cut caput femur, fixating the medical device thereon The concave contacting surface 110 is also adapted to travel beyond the equator of an artificial caput femur which is placed in the artificial 20 acetabulum when mounted into a functioning artificial hip joint and clasping the artificial caput femur when mounted therein. [00076] Hg. 7b shows yetanother embodiment where the medical device is additionally fixated using a fixating band 683 encirling the fixating portions of the medical device and thereby further clasping the medical device to the surgically cut 25 caput femur. [00077] Hg. 7c shows three different embodiment of medical devices comprising fixating portions 680 which are slightly tilted towards the collum and caput femur 18 WO 2011/005187 PCT/SE2010/050803 center axis, therby clasping a portion of the surgically cut caput femur for fixating the medical device to the surgically cut caput femur. The three different embo diments shown is fist, without screws 121, second, with sews entering the cortical bone, and third, with sews penetrating the cortical bone and entering the medical device on the 5 inside of the concave cavity, which enables the sews to squeeze a portion of the cortical bone for tight fixation of the medical device. [00078] Hg. 7d shows two embodiments in which the concave contacting surface 110 only comprises the part placed inside of the concave cavity. The fist embodiment shows the acetabulum surface 110 fixated to the concave cavity using sews 121, 10 whereas the second embodiment shows the artificial acetabulum surface fixated without screws, such as using an adhesive. [00079] Hg. 7e shows two embodiments in which the artificial acetabulum surface extends into a portion placed on the surface of a section eated when the caput femur is surgically cut In the fist embodimentthe medical device is fixated using sews 15 entering the cortical bone, whereas in the second embodiment the artificial contacting surface is fixated without sews, such as using an adhesive. [00080] Hg. 7f describes an embodiment in which the medical device is further fixated using an elongated member 681, fixating portions 680, and sews 121 placed between the fixating portions 680 and the inside of the artificial acetabulum 20 contacting surface 110. The elongated member 681 is according to this embodiment a threaded member 681 and the fist fig. disclo ses the prparation of the cancellous bone 602 with a curing fluid 685, such as bone cement, crating a sturdy base for the fixation of the threaded member 681. [00081] Hg. 8 shows the artificial acetabulum surface 110 in further detail when the 25 artificial acetabulum surface comprises a fixating portion 680 extending on the outside of the cortical bone 601. The fixating portion 680 is further fixated using semws 121 placed fom the outside, though a hole in the medical device, penetrting the cortical 19 WO 2011/005187 PCT/SE2010/050803 bone 601 of the surgically cut caput femur and entering the medical device placed in the concave cavity in the caput femur. [00082] Ig. 9 shows a section of the medical device according to the embodiment also described with reference to fig. 7a, in further detail. The medical device 5 according to the embodimentin fig. 9 comprises fixating portions 680 which reaches on the outside of the surgically cut caputfemur and clasps the cortical bone of the caput femur. The medical device clasps the caput femur since a distance 687, between the collum and caput femur center axis CA and the fixating portion in shorter than a distance 686 between the collum and caput femur center axis CA and a portion of the 10 fixating portion placed more proximally when the medical device is implanted. On the inside of the artificial concave acetabulum surface, the surface extends beyond the equator of the artificial caput femur adapted to be placed therein An extending portion 682 clasps the artificial caput femur placed in the artificial acetabulum surface 110 since a distance 688, between the collum and caputfemur center axis CA and 15 the inside of the artificial acetabulum surface 110 is shorter than a distance 689 between the collum and caput femur center axis CA and a point on the inside of the artificial acetabulum contacting surface 110 being more distal when the medical device is implanted. In other embodiments, the fixating portions 680 could be operable or adjustable for further fixating the medical device to the cortical bone. The 20 fixating portions 680 could be operable for example by means of a sew for tightening the fixating portions 680 to the cortical bone, which could squeeze the cortical bone between the fixating portions 680 and the part of the medical device placed inside of the femoral bone. [00083] Ig. 10a shows the step of milling the periphery 690 of the cortical bone of 25 the caput femur after the caput femur has been surgically cut using a milling device 688 adapted therefor. The milling process cmeates a straighter edge which facilitates the fixation of a medical device on the outside of the caput femur. 20 WO 2011/005187 PCT/SE2010/050803 [00084] Hg. 10b shows the milling of the inside of the cortical bone of the caput femur after the caput femur has been surgically cut using a milling device 689 adapted therefor, creating a straighter edge which facilitates the fixation of a medical device on the inside of the caput femur. 5 [00085] Hg. 11 shows an artificial convex caput femur surface 112 adapted to be placed in an artificial acetabulum surface according to any of the embodiments herein After the artificial convex caput femur surface has been placed in the artificial acetabulum surface it is locked using a locking member 116 comprising a surface 117 adapted to be in contact with the artificial convex hip joint surface 112. The locking 10 member 116 further comprises fixating member 115 which arm adapted to assist in the fixation of the locking member 116 to the caput femur 5 or collum femur 6, which in turns fixates the artificial convex hip joint surface 112. The fixating member comprises a fixating portion 680 which travels on the outside of the surgically cut caput femur for radially stabilizing and fixating the locking member to the surgically 15 cut caput femur. The artificial convex hip joint surface 112 is fixated to an attachment rod 113 comprising a thread 114. [00086] Hg. 12 shows the artificial convex caput femur surface 112 as disclosed with reference to fig. 11 when mounted in an artificial acetabulum surface 109 placed in a concave cavity in the femoral bone. Ihe artificial acetabulum surface is according to 20 this embodiment is fixated to the femoral bone using an elongated member 681, heme being a threaded member placed aligned with the collum and caput center axis. [00087] Hg. 13 shows the artificial convex caput femur surface 112 as disclosed with reference to fig. 11 when mounted in an artificial acetabulum surface 109 placed in a concave cavity in the femoral bone. Ihe artificial acetabulum surface is according to 25 this embodiment is fixated using sews 121 entering the cortical bone of the surgically cut caput femur. 21 WO 2011/005187 PCT/SE2010/050803 [00088] Hg. 14 shows the injection of an adhesive 106 in the acetabulum8 in the pelvic bone 9 using an injecting member comprising an injecting nozzle 105, which is a preparation for the fixation of a medical device to the pelvic bone 9. [00089] Hg. 15 shows the placing of a medical device in the meamed acetabulum8 5 surface of the pelvic bone 9. Ihe medical device comprises a convex hip joint surface 112 fixated to a fixation element1301, which in turn is fixated to the acetabulum8 using the injected fluid, which could be assisted or replaced by a mechanical fixation element such as sews. The medical device further comprises a prm-mounted locking member 116 for locking the convex hip joint surface of the concave hip joint surface 10 placed in the caput 5 and collum femur 6 for hindering dislocation of the hip joint when the hip joint is in its functional position. [00090] Hg. 16a shows the step of creating a hole in the pelvic bone 9 fim the acetabulum side of the pelvic bone 9. [00091] Hg. 16b shows the medical device according to an embodimentin which the 15 medical device comprises a fixation element 1301 adapted to fixate the artificial convex caput femur 112 to the pelvic bone 9. The fixation element1301 comprises a fixation surface 1334 which is adapted to fit into the acetabulum 8. The fixation surface 1334 could be adapted to be fixated againstthe acetabulum8 using an adhesive, such as bone cement applied to the fixation surface 1334 and/ or the 20 acetabulum surface 8. The medical device further comprises an elongated element 1310, here being an integrated part of the fixation element 1301. The elongated element 1310 is inserted through the hole in the pelvic bone 9, such that said elongated member 1310 is partially placed on the abdominal side of the pelvic bone 9. Alter insertion of the elongated member 1310, the elongated member 1310 is 25 structurally changed on the abdominal side of the pelvic bone 9, such that said elongated member 1310 fixates the fixation element 1301 to the pelvic bone 9. According to the embodiment of fig. 16b the elongated member 1310 comprises an expandable portion 1311, and the structural change comprises the expandable 22 WO 2011/005187 PCT/SE2010/050803 portion 1311 changing fim a fist, non-expanded state, in which the elongated element 1310 is inserted into the hole in the pelvic bone 9 substantially along a length axis of the elongated element 1310 into an expanded state, in which the expandable portion 1311 is expanded in at least one away frm the length axis, such that said 5 elongated element 1310 is placed in an expanded state, which fixates the fixation element 1301 to the pelvic bone 9. The expandable portion 1311 according to the embodiment shown in fig. 16b comprises a plurality of expanding elements in connection with an anvil member 1312. A threaded member 1313 is placed centrally in the elongated element 1310 and is in one end connected to an anvil member 1312 10 and in the other end connected to a threaded portion 1314 of the artificial caput femur 112. By the connection with the threaded member 1313, the anvil member 1312 is adapted to press on the expanding elements following an action performed fi-om the acetabulum side of the pelvic bone 9, such that said expanding elements expand in at least one direction substantially perpendicular to the length axis of the 15 elongated element 1311. The fixation element shown in fig. 16b further comprises a flange 1315 adapted to extend out of the acetabulum8 and be placed in contact with the pelvic bone 9. [00092] Ig. 16c shows the expandable portion 1311 when the anvil member 1312 has pressed the expandable elements in two dimections perpendicular to the length axis 20 of the elongated element 1310 for fixating the elongated element 1310 and the entire artificial caput femur 112 to the pelvic bone 9. The threaded part 1314, being a portion of the artificial caput femur 112, has been partially inserted into the artificial caput femur 112, and thus the anvil member 1312 is pulled towards the hole in the pelvic bone 9. 25 [00093] Ig. 16d shows the elongated member 1311 in the wholly expanded state fixating the artificial caput femur 112 to the pelvic bone 9. In this state the threaded member 1313 is positioned furtherinto the artificial caputfemur 112 which is rotated to tighten the expandable elongated element 1310. The locking member 116 is 23 WO 2011/005187 PCT/SE2010/050803 according to this embodiment p-mounted onto the artificial caput femur 112 when the artificial caputfemur 112 is implanted, however, according to other embodiments itis equally conceivable thatthe locking member 116 is adapted to be mounted after the artificial caput femur 112 has been implanted in the hip joint 5 [00094] Hg. 16e shows the medical device according to an embodimentin which the implantable medical device comprises an elongated element 1320 comprising a movable locking portion 1321 adapted to have a first and second state, wherein said movable locking portion 1321, in said first state is adapted to be inserted into a hole in the pelvic bone 9, and in said second state is adapted to hinder the elongated 10 element 1320 fim passing though said hole in the pelvic bone 9 by said movable locking portion 1321 contacting the surface of the pelvic bone 9 on the abdominal side. Hg. 8f shows the elongated element 1320 in its fist state after having passed through the hole in the pelvic bone 9. [00095] Hg. 16f shows the movable locking portion 1321 changing fim the firstto 15 the second state at the same time as the artificial caput femur 112, comprising a threaded part 1314, interacts with a corresponding threaded member 1323 being partof the elongated element 1320. 'Ihe movable locking portion 1321 is pivotally arranged at a pivotpoint 1322 and changes fim the firstto the second state using the pivot point 1322. 20 [00096] Hg. 16g shows the medical device according to the embodiment of figs. 16e and 16f when the movable member 1321 is placed in the second state, in which the artificial caput femur 112 is fixated to the pelvic bone 9 by the movable member 1321 being in contact with the abdominal side of the pelvic bone 9. The artificial caput femur 112 has been tightened using the thmaded part 1314 and cormsponding 25 threaded member 1323, such that the entire medical device comprising the artificial caput femur 112 is securely fixated to the pelvic bone 9. Similarto the embodiments shown with reference to figs. 16b - 16d the fixation element 1301 could be further 24 WO 2011/005187 PCT/SE2010/050803 fixated to the acetabulum 8 using an adhesive, such as bone cement applied to the fixation surface and/ or the acetabulum surface 8. [00097] Hg. 16h shows an embodimentin which the fixation element comprises a fixation surface 1334 comprising two holes adapted to receive two mechanical 5 fixation elements 1331. In the embodimentof fig. 8i the mechanical fixation elements 1331 ame expanding fixation elements 1331, such as the expanding fixation elements described with reference to figs. 16b - 16d, however in other embodiments it is equally conceivable that the mechanical fixation elements ame elements adapted to fixate the medical device to the intemal periphery of the holes, such as sews. Similar 10 to the embodiments shown with reference to figs. 16b - 16g the fixation element 1301 could be further fixated to the acetabulum using an adhesive, such as bone cement applied to the fixation surface and/ or the acetabulum surface. Hg. 16h shows an embodimentin which the medical device has a pre-mounted locking member 116, however, in other embodiments it is equally conceivable that the locking member 116 15 is adapted to be mounted after the artificial caput femur 112 has been implanted in the hip joint [00098] Hg. 16i shows the artificial hip joint in section, when the medical device described with reference to fig. 16h has been implanted. Fbrhermome an artificial acetabulum surface 1340 having a concave surface towards the center of the hip joint 20 has been implanted. 'he artificial acetabulum surface 1340 has been fixated to the femoral bone 7, and placed in movable contact with the artificial caput femur surface 112, thus crating a functioning artificial hip joint The locking member 116 has been fixated to the femoral bone 7, thus locking the artificial caput femur 112 in the artificial acetabulum surface 1340. Ihe locking member 116 is according to the 25 embodiment shown in fig. 8j fixated using sews 121, however the sews 121 could be assisted or replaced by an adhesive, such as bone cement [00099] Hg. 17a shows an assembled artificial hip joint with an artificial caput femur surface 112 fixated to the pelvic bone 9 using two fixating members adapted to 25 WO 2011/005187 PCT/SE2010/050803 expand inside of the cortical bone of the pelvic bone 9. The fixating members comprises a sew 121 in connection with an anvil member 1312 affecting an expandable portion 1311 pressing the expandable members in two dimections perpendicular to the length axis of the fixation members for fixating the artificial caput 5 femur 112 to the pelvic bone 9. The artificial acetabulum 1340 is fixated to the femoral bone 7 using an elongated member 13 10b placed in the cancellous bone and aligned with the caput and collum femur center axis. The elongated member comprises an expandable portion 131 lb which is pressed by an anvil member 13 12b connected to a ihreaded member 1313b pressing the expandable members 1311b in 10 two dimections perpendicular to the length axis of the elongated member 13 1Ob for fixating the artificial acetabulum surface to the femoral bone 7. [000100] Hg. 17b shows an embodiment similar to the embodiment shown in fig. 17a with the difference that the artificial acetabulum surface is fixated using an elongated member 13 10c which penetrates the cancellous bone of the collum femur 15 and the cortical bone of the femoral bone in the amea of the greater trochanter 1695. The elongated member comprises a movable locking portion 132 1b, pivotally arranged at a pivotpoint1322b. The movable locking portion 132 lb could change fiom a fist to a second state around the pivot point 1322b. When the movable locking portion 132 lb is placed in the second state itlocks the elongated member on 20 the outside of the femoral bone 7 in the amea of the greater trochanter 1695. [000101] Hg. 17c shows an embodiment similar to the embodiment shown in fig. 17a with the difference that the artificial acetabulum surface is fixated using an elongated member 13 10d which penetrates the cancellous bone of the collum femur and enters the cortical bone of the femoral bone in the amea of the greater trochanter 25 1695 butnever exits the bone butrather is fixated inside of the bone 7. [000102] Hg. 18a shows an embodiment where the artificial acetabulum 1340 is fixated to the femoral bone 7 using fixating portions 680 being part of the locking member 116. The fixating portions 680 comprises portions 680' clasping the 26 WO 2011/005187 PCT/SE2010/050803 surgically cut femoral bone and themeby fixating the artificial acetabulum surface to the femoral bone. [000103] Hg. 18b shows an embodimentsimilarto the embodimentdescribed with reference to fig. 18a with the difference that the locking member is fixated to the 5 surgically cut caput femur using sews 121. [000104] Hg. 19 shows the hip joint in section when the medical device is assembled and in its functional position in the hip joint The artificial caput femur surface 45 or convex hip joint surface 112 is fixated to the fixation part 1301, which in turn is fixated to the acetabulum8, The locking member 116 locks the artificial convex caput 10 femur surface 45 in the artificial concave acetabulum surface in the caput 5 and collum femur 6. [000105] Hg. 20 shows a fiontal view of a human patient when an incision for teaching an ama of the hip joint though the pelvic bone in a surgical method has been performed. According to one embodiment the incision 1 is made in the 15 abdominal wall of the human patient The incision 1 passes though the abdominal wall, preferably rectus abdominis and peritoneum, in to the abdomen of the human patent Ina second embodiment the incision 2 is conducted though the rectus abdominis and in to the pelvic amea, below peritoneum. According to a third embodiment the incision 3 is performed just between Illium and the sunmunding tissue, 20 an incision 3 which could enable the pelvic bone to be dissected with very little penetration of fascia and muscular tissue. According to a fourth embodiment the incision 4 is made in the inguinal channel. In all of the four embodiments the tissue sunounding the pelvic bone 9 in the amea opposite to acetabulumis removed or penetrated which enables the surgeon to reach the pelvic bone 9. Itis obvious that the 25 methods described may both be combined or alterd teaching the same goal to dissect the pelvic bone on the opposite side of the acetabulum. 27 WO 2011/005187 PCT/SE2010/050803 [000106] Hg. 21 shows a fontal view of a human patient when small incisions for reaching an ama of the hip jointthmugh the pelvic bone in a arthroscopic method has been performed. According to a fist embodiment the incisions 14 is made in the abdominal wall of the human patient 'The small incisions enable the surgeon to insert 5 arthroscopic trocars into the abdomen of the human patient According to the first embodiment the incisions 14 passes though the abdomen, preferably rectus abdominis and peritoneum, in to the abdomen of the human patent According to a second embodiment the small incisions 15 is conducted though the rectus abdominis and in to the pelvic amea, below peritoneum. According to a third embodiment the 10 small incisions 16 is performed just between Illium and the surrounding tissue, an incision 16 which could enable the pelvic bone to be dissected with very little penetration of fascia and muscular tissue. According to a fourth embodiment the incision 17 is made in the inguinal channel. In all of the four embodiments the tissue sunounding the pelvic bone 9 in the amea opposite to acetabulum 8 is removed or 15 penetrated which enables the surgeon to rach the pelvic bone 9. [000107] Hg. 22 shows the human patient in section when a medical device for crating a hole 18 in the pelvic bone 9 is inserted though an incision according to any of the embodiments described above. An elongated member 21, which could comprise a part or section adapted to be bent transfers force fiim an operating device 20 (not shown) to the bone contacting organ 22. 'Ihe bone contacting organ 22 is placed in contact with the pelvic bone 9 and cmeates a hole though a drilling, sawing or milling process powered by a rotating, vibrating or oscillating force distributed fiim the elongated member 21. [000108] Hg. 23 shows the hip joint in section after the medical device for crating a 25 hole 18 in the pelvic bone 9 has eated said hole 18. According to this embodiment the hole 18 is heated though the removal of a bone plug 31, however it is equally conceivable that said medical device comprises a bone contacting organ 22 adapted 28 WO 2011/005187 PCT/SE2010/050803 to create small pieces of bone, in which case the medical device could further comprise a system for transport of said small pieces of bone. [000109] Hg. 24 shows how the medical device adapted to create a hole is inserted into the hip joint and placed in contact with the caput femur 5. According to this 5 embodiment the medical device for crating a hole in the pelvic bone 9 and surgically cutting the caput femur 5 is the same medical device, however it is equally conceivable that therm is a second medical device particularly adapted to surgically cut the caput femur 5. [000110] Hg. 25 shows the hip jointin section when a second medical device 604 10 surgically memoves the mostproximal portion of the caputfemur 5. The second medical device 604 comprises a drilling portion in which a cutting member in a folded position 605a is placed. [000111] Hg. 26 shows the second medical device 604 when the drilling portion is positioned inside of the femoral bone, and the cutting member is placed in a cutting 15 position 605b for cutting the proximal portion of the caputfemur 5. [000112] Hg. 27 shows a medical device comprising an artificial convex hip joint surface 112. The artificial convex hip joint surface 112 is adapted to be fixated to the pelvic bone 9, and is adapted to be inserted though a hole 18 in the pelvic bone 9. The medical device comprises a nut 120, comprising thmaads for securely fixating the 20 medical device to the pelvic bone 9. The medical device further comprises a prosthetic part 118 adapted to occupy the hole 18 cmated in the pelvic bone 9 after the medical device has been implanted in the patient 'Ihe prosthetic part 118 comprises supporting members 119 adapted to be in contact with the pelvic bone 9 and assistin the carrying of the load placed on the medical device fim the weight of the human 25 patient in normal use. Normal use is defined as the same as a person would use a natural hip joint Further the medical device comprises a lo king member 116 comprising a surface 117 adapted to be in contact with the artificial convex hip joint 29 WO 2011/005187 PCT/SE2010/050803 surface 112. The locking member 116 further comprises fixating members 115 which ame adapted to assistin the fixation of the locking member 116 to the caput femur 5 or collum femur 6, which in turns fixates the artificial convex hip joint surface 112. The artificial convex hip joint surface 112 is fixated to an attachment rd 113 comprising 5 a thread 114 that correspondsto the thread of the nut 120 in connection with the prosthetic part 118. [000113] Ig. 28 shows the hip joint in section when the artificial convex hip joint surface is fixated in the medical device 109 comprising a concave hip joint surface 110. The convex hip joint surface 112 is secured in place by the locking member 116 10 which is fixated to the caput femur using screws 121. The surface of the locking member 117 and the concave hip joint surface 117 is placed in connection with the convex hip joint surface and could be made of a friction reducing material such as PRE or a self lubricating powder material. However it is also conceivable that the connecting surfaces ame lubricated using an implantable lubrication system adapted to 15 lubricate the medical device after said medical device has been implanted in the human patient [000114] Ig. 29 shows the placing of a prosthetic part:118 adapted to occupy the hole 18 created in the pelvic bone 9. The prosthetic part 118 comprises supporting members 119 adapted to be in contact with the pelvic bone 9 and assistin the 20 carrying of the load placed on the medical device fimom the weight of the human patient According to the embodiment shown in fig. 12 the supporting members 119 ame located on the abdominal side of the pelvic bone 9, however it is equally conceivable the supporting members 119 ame located on the acetabulum side of the pelvic bone 9, in which case they ame preferably displaceable for allowing insertion of 25 the prosthetic part:118 though the hole 18 in the pelvic bone 9. Fbrhermome fig. 12 shows the fixation of a nut 120 to the attachmentrod 113. According to the embodiment shown in fig. 12 the hole 18 in the pelvic bone 9 is adapted to be larger than the medical device allowing the medical device to be inserted in its full functional 30 WO 2011/005187 PCT/SE2010/050803 size. According to other embodiments the hole 18 is smaller in which case the medical device could comprise of several parts adapted to be connected after insertion in the hip joint or the medical device could be expandable for insertion thmugh a hole smaller than the full functional size of the medical device. 'Ihe expandable medical 5 device could be enabled though the elements of the medical device comprising elastic material. [000115] Hg. 30 shows the hip joint in section when all the elements of the medical device has been fixated in the amea of the hip joint or its sur-undings. The prosthetic part 113 adapted to occupy the hole 18 in the pelvic bone 9 is herm fixated with 10 sews 121, however these sews 121 could be assisted or placed by an adhesive which could be applied to the surface S between the prosthetic part and the pelvic bone 9. [000116] Hg. 31 shows the hip jointin sectionwhenthe method of supplying the medical device is conducted according to another embodiment 'The proximal part of 15 the caput femur has been removed along the section crated by the medical device for crating a hole. A naming member 40 adapted to create a concave surface 103 in the caput femur 5 is here applied to a elongated member 206 which is inserted thrmugh a hole 205 going from the lateral side of the thigh, penetrating the cortical bone of the femoral bone 7 propagating along a length axis of the collum femur in the 20 cancellous bone and entering the area of the hip joint The elongated member 206 is operated using an operating device 207 which could be an electrically powered operating device, a hydraulically powered operating device or a pneumatically powered operating device. The reaming in the caput femur and part of the collum femur 6 is mainly performed in the cancellous bone, however that does not exclude the 25 possibility the some of the racing needs to be performed in the cortical bone of the caput femur 5 or the collum femur 6. [000117] Hg. 32 shows the step of applying an adhesive 106 to the concave surface created by the reamer 40. The adhesive 106 is applied by an injecting member 104 31 WO 2011/005187 PCT/SE2010/050803 comprising an injecing nozzle 105. The adhesive 106 is preferably a biocompaible adhesive such as bone cement The injecing member 104 is in this embodiment adapted for introduction through a hole 18 in the pelvic bone 9, through the injecting member 104 being bent 5 [000118] Ig. 33 shows the step of providing a medical device 109 comprising an artificial concave hip joint surface 110. The medical device is according to this embodiment provided with a hole positioned in the length axis of the collum femur 6. The medical device is through the hole adapted to be guided by the elongated member 206 or a guiding rod placed in the hole 205 along a length axis of the 10 collum femur 6. Inserting the medical device into the hip joint while the elongated member 206 or guiding rod runs through the hole of the medical device facilitates the positioning of the medical device and ensums the differntparts of the medical device is centerd for functioning as a unit In the embodiment shown in fig. 33 the medical device 109 is inserted into the hip jointas a single unit however itis equally 15 conceivable that the medical device 109 is inserted in parts (not shown) which ame then connected to form the medical device after implantation in the patient The artificial concave hip joint surface 110 is fixated to the concave surface 103 created in the caput femur 5 and collum femur 6. The medical device 109 comprises a fixation support111 adapted to anchor said artificial concave hip joint surface 110, to at least 20 one of the caput femur 5 and the collum femur 6. The medical device 109 is adapted to be introduced to the hip joint through a hole 18 in the pelvic bone 9 using a manipulation device 122 comprising a gripping member 123. According to this embodiment the manipulation device 122 is bent and therby adapted to operate through a hole 18 in the pelvic bone 9. According to one embodiment the medical 25 device 109 comprises a self lubricating material such as PIHE however it is also conceivable that said medical device comprises: titanium, stainless steel, Corian, PE or other acrylic polymers, in which case the medical device could be adapted to be lubricated after insertion in the hip joint 32 WO 2011/005187 PCT/SE2010/050803 [000119] Hg. 34 shows the hip joint in section when the artificial convex hip joint surface is fixated in the medical device 109 comprising a concave hip joint surface 110, the medical device is guided using the elongated member 206 or a guiding rod. The convex hip joint surface 112 is secured in place by the locking member 116 5 which is fixated to the caput femur using sews 121, the convex hip joint surface is guided using the elongated member 206 or a guiding rod. The surface of the locking member 117 and the concave hip joint surface 110 is placed in connection with the convex hip joint surface and could be made of a fricion reducing material such as PFE or a self lubricating powder material. However it is also conceivable that the 10 connecting surfaces ame lubricated using an implantable lubrication system adapted to lubricate the medical device after said medical device has been implanted in the human patient The elongated member or guiding rod 206 can be adapted to act as a centering rod for centering the at least one artificial hip joint surface inside of the hip joint According to the embodiment shown the elongated member 206 is inserted 15 thrmugh the femoral bone, however according to other embodiments, not shown, the elongated member is positioned inside of the hip joint fim the acetabulum side. [000120] Hg. 35 shows the placing of a prosthetic part118 adapted to occupy the hole 18 created in the pelvic bone 9. The prosthetic part 118 comprises supporting members 119 adapted to be in contact with the pelvic bone 9 and assistin the 20 canying of the load placed on the medical device fim the weightof the human patient Ruthermor fig. 35 shows the fixation of a nut 120 to the attachmentrod 113, which in turn is guided by the elongated member 206 or a guiding rod. [000121] Hg. 36 shows the hip jointin section when all the elements of the medical device has been fixated in the amea of the hip joint or its sunoundings. The prosthetic 25 part 118 adapted to occupy the hole 18 in the pelvic bone 9 is herm fixated with scews 121, however these sews 121 could be assisted or placed by an adhesive which could be applied to the surface S between the prosthetic part and the pelvic 33 WO 2011/005187 PCT/SE2010/050803 bone 9. The elongated member 206 or guiding rod has been miracted though the incision in the thigh. [000122] Hg. 37 shows an embodiment of a locking member 116, wherin the locking member 116 comprises a surface adapted to be in contactwith the artificial 5 convex hip joint surface 1353, the locking member 116 is adapted to, in a first state, lock the artificial caput femur 112 to the artificial acetabulum surface 1340, and in a second state, release said artificial caput femur 112 from said artificial acetabulum 1340. The locking member 116 is adapted to change frm the first to the second state when a prdetermined amount of strain is placed on the locking member 116. The 10 locking member 116 according to the embodiment shown in fig. 37, comprises four elastic portions 1351, and the locking member 116 is adapted to change frm the fist to the second state using the elasticity of the elastic portions 1351. The locking member 116 is adapted to be fixated to the femoral bone 7 using sews adapted to be placed in holes 1352 adapted therefor. 15 [000123] Hg. 38 shows the hip jointin section when a two state locking member 116 locks the artificial caputfemur 112 in the artificial acetabulum 1340. The two state locking member 116 is fixated to the femoral bone 7 using sews 121, and is here shown in its first state in which the locking member 116 locks the artificial caputfemur 112 to the artificial acetabulum 1340. 20 [000124] Hg. 39 shows the hip jointin section according to the embodiment of fig 38, but when the two state locking member 116 is in its second state, in which the locking ring 116 releases the artificial caputfemur 112 frm the artificial acetabulum surface 1340. The construction with the leasing locking ring 116 reduces the risk of strain placed on the artificial joint injuring the fixation points, i.e. the contactwith 25 bone; it further enables the artificial joint to be non-nvasively located in case of luxation. 34 WO 2011/005187 PCT/SE2010/050803 [000125] According to the above mentioned embodiments the medical device is adapted to be inserted through a hole in the pelvic bone, however it is equally conceivable that the medical device according to any of the embodiment above is adapted to be inserted through a hole in the hip joint capsule or the femoral bone of 5 the human patient [000126] Rease note that any embodiment or part of embo diment as well as any method or part of method could be combined in any way. All examples herein should be seen as part of the general description and therefore possible to combine in any way in general terms. 35

Claims

1. A medical device for implantation in a hip joint of a human patient the natuaml hip joint having a ball shaped caput femur as the proximal part of the femoral bone with a convex hip joint surface towards the center of the hip joint and a 5 bowl shaped acetabulum as part of the pelvic bone with a concave hip joint surface towards the center of the hip joint wherein the caput femur has a centrally placed longitudinal extension, extending through the center of the caput and collum femur, aligned with the collum femur, defined as the caput and collum femur center axis, the medical device comprising; an artificial 10 acetabulum, comprising a concave surface towards the center of the hip joint wherein said artificial concave acetabulum is adapted to, when implanted, a. be fixated to the femoral bone of the human patient and b. be in movable connection with an artificial caput femur fixated to the pelvic bone of the patient 15

2. The medical device according to claim 1, wherein said medical device comprises a fixating portion adapted to be; stabilized by the cortical bone of the caput femur, fim the inside of the caput femur or stabilized by the cortical bone of the collum femur fim the inside of the collum femur, when atleast one 20 of the caput and collum femur has been surgically modified and opened.

3. The medical device according to claim 1, wherein said medical device comprises a fixating portion adapted to be; stabilized by the cortical bone of the caput femur, substantially frm the proximal side of the cortical bone of the 25 caput femur, or stabilized by the cortical bone of the collum femur substantially fom the proximal side of the cortical bone of collum femur, when at least one of said caput and collum femur has been surgically modified having a cut though corticalis edge of the caput or collum femur supporting said fixating portion. 36 WO 2011/005187 PCT/SE2010/050803

4. The medical device according to claim 1, wherein said medical device comprises a fixating portion adapted to be; stabilized by the cortical bone of the caput femur, fi-om the outside of the caput femur or stabilized by the cortical bone of the collum femur, fnm the outside of the collum femur. 5

5. The medical device according to claim 3, wherein said medical device comprises a fixating portion adapted to be; stabilized by the cortical bone of the caput femur or collum femur, substantially fiom the proximal side of a surgically modified cortical bone and fim the inside of the caputfemur or the 10 collum femur, when atleast one of the caput and collum femur has been surgically modified and opened..

6. The medical device according to claim 3, wherein said medical device comprises a fixating portion adapted to be; stabilized by the cortical bone of 15 the caput or collum femur, substantially fi-om the proximal side of a surgically modified cortical bone and fim the outside of the caput or collum femur.

7. The medical device according to claim 2, wherein said medical device comprises a fixating portion adapted to be stabilized by the cortical bone of the 20 caput or collum femur, fi-om the inside of caput or collum femur and fi-om the outside of the caput or collum femur.

8. The medical device according to any one of claims 2 -7, wherein said fixating portion comprises at least one cavity adapted to receive a mechanical fixation 25 element

9. The medical device according to claim 8, wherein said medical device further comprises a mechanical fixation element adapted to be placed in said at least 37 WO 2011/005187 PCT/SE2010/050803 one cavity of the medical device and inside of the cortical bone of the caput or collum femur, when the medical device is implanted.

10. 'The medical device according to claim 9, wherein said mechanical fixation 5 element is adapted to be placed inside of the cortical bone of the caputor co llum femur fn m the inside of the caput femur.

11. The medical device according to claim 9, wherein said mechanical fixation element is adapted to be placed inside of the cortical bone of the caputor 10 collum femur from the outside of the caput femur.

12. The medical device according to claim 9, wherein said mechanical fixation element is adapted to be placed inside of the cortical bone of the caputor collum femur, substantially frm the proximal side of the caput femur. 15

13. The medical device according to any one of claims 1 - 12, wherein said medical device comprises a mecess adapted to receive a portion of the femoral bone. 20

14. The medical device according the claim 13, further comprising a mechanical fixating element adapted to be placed partially inside of a fist portion of said medical device, on a first side of said mecess, partially inside of the portion of the femoral bone placed in said mecess, and partially inside of a second portion of said medical device, on a second opposite side of said 25 mecess, for restraining the portion of the femoral bone in said mecess.

15. The medical device according to any one of claims 1 - 14, wherein said medical device further comprises an elongated element adapted to be placed in the collum femur frm the proximal side therof to stabilize the medical device. 30 38 WO 2011/005187 PCT/SE2010/050803

16. The medical device according to claim 15, wherein said elongated element comprises a threaded portion, and wherein said threaded portion is adapted to engage at least one of: the cortical bone of the collum femur, the cancellous bone of the collum femur, and an artificial material injected into the collum 5 femur.

17. The medical device according to claim 15, wherein said elongated element comprises an anchoring portion, and wherein said anchoring portion is adapted to engage atleast one of: the cortical bone of the collum femur, the 10 cancellous bone of the collum femur, and an artificial material injected into the co llum femur.

18. The medical device according to claim 17, wherein said anchoring portion can be in a fist and second state, and wherein said anchoring portion is 15 adapted to, in said second state, further engage atleast one of: the cortical bone of the collum femur, the cancellous bone of the collum femur, and an artificial material injected into the collum femur, for further fixating said medical device to the femoral bone. 20

19. The medical device according to any one of the preceding claims, wherein said fixating portion further comprises at least one groove adapted to stabilize a loop-shaped fixating element along atleast one portion thermof, when said medical device is implanted. 25

20. The medical device according to any one of the preceding claims, wherein said medical device further comprises a loop-shaped fixating element adapted to further stabilize the medical device to the femoral bone.

21. The medical device according to claim 20, wherein said loop shaped 30 fixating element is elastic. 39 WO 2011/005187 PCT/SE2010/050803

22. The medical device according to any one of the preceding claims, wherein said medical device comprises an elastic portion 5

23. The medical device according to claim 22, wherein said elastic portion is adapted to clasp a portion of the femoral bone and therby fixate the medical device to the femoral bone.

24. The medical device according to claim 23, wherein the medical device is 10 adapted to pass beyond the equator of the artificial caput femur placed in the medical device when implanted, therby clasping the artificial caput femur.

25. The medical device according to any one of the preceding claims, wherein the medical device further comprises a locking member adapted to lock an 15 artificial caput femur in the medical device.

26. The medical device according to claim 25, whemein said locking member comprises an elastic portion. 20

27. The medical device according to claim 26, whemein said elastic portion is an elastic band adapted to encircle said artificial caput femur.

28. The medical device according to any one of the preceding claims, wherein said medical device has a fist and second state, and wherein said medical 25 device is adapted to, in said first state, fixate the artificial caput femur to the medical device, and in said second state, release the artificial caput femur from the medical device.

29. The medical device according to claim 26, wherein the medical device is 30 adapted to change from said fist state to said second state when a predetermined strain is placed on said medical device. 40 WO 2011/005187 PCT/SE2010/050803

30. The medical device according to claim 29, wherein said medical device comprises a locking member comprising an elastic or flexible portion, and wherein said locking member is adapted to change said medical device fiim 5 said fist to said second state using the elasticity or flexibility of said elastic or flexible portion of said locking member.

31. The medical device according to claim 30, wherein said elasic portion is an elastic band adapted to, in said first state, encircle said artificial caput 10 femur.

32. The medical device according to any one of the preceding claims, wherein said medical device comprises a surface adapted to be placed in contact with the cortical or cancellous bone of the femoral bone, when implanted, and 15 wherein said surface is adapted to adhere to the cortical or cancellous bone using an adhesive.

33. The medical device according to any of the preceding claims, wherein said medical device comprises a surface adapted to promote in growth of bone 20 tissue for fixating said medical device to the femoral bone.

34. The medical device according to any one of claims 32 and 33, wherein said surface comprises a porous mico structure. 25

35. The medical device according to any one of the preceding claims, wherein said fixating portion, adapted to stabilize the medical device to the femoral bone, is elastic or flexible.

36. The medical device according to any one of the preceding claims, wherein 30 said medical device comprises an elastic or flexible portion 41 WO 2011/005187 PCT/SE2010/050803

37. The medical device according to claim 36, whemin said elastic or flexible portion is adapted to clasp a portion of the femoral bone fim the outside of the cortical bone of caput or collum femur and therby fixate the medical device to 5 the femoral bone.

38. The medical device according to claim 4, wherin the fixating portion is adapted to clasp atleastone portion of the femoral bone fim the outside of the cortical bone of caput or collum femur and therby at least party fixate the 10 medical device to the femoral bone.

39. The medical device according to claim 38, wherin the fixating portion is adapted to pass proximal beyond the equator of caput femur aligned with the caput and collum center axis, when implanted and engaging a surgically 15 modified caput femur, therby clasping the surgically modified caput femur to stabilize the medical implant

40. The medical device according to claim 4, wherin the surgically modified caput or collum femur comprises a most proximal portion, and wherein said 20 fixating portion is adapted to pass beyond the most proximal portion, on the outside therof, thus partially be placed more distal than the most proximal portion of the surgically modified caput or collum femur.

41. The medical device according to claim40, wherein a portion of the caput 25 or collum femur is placed at a largest distance fi-om the caput and collum femur center axis, and wherin a portion of said fixating portion is adapted to be placed at a distance fim the caput and collum center axis, being shorter than the largest distance fi-om the caput and collum femur center axis to the caput or co llum femur. 30 42 WO 2011/005187 PCT/SE2010/050803

42. The medical device according to any one of claims 40 and 41, wherein said fixating portion is adapted to clasp a portion of the caput or collum femur, said fixating portion therby assisting in the fixation of the medical device to the caput or collum femur. 5

43. The medical device according to claim42, wherein the closest distance fiom said fixating portion to said caput or collum center axis is shorter than the distance between said center axis and the equator of the caput femur. 10

44. The medical device according to any one of the preceding claims, wherein said medical device further comprises an elastic layer adapted to absorb chocks fnim the femoral bone.

45. The medical device according to claim 43, wherein said elastic layer is 15 placed between the femoral bone and the medical device, when said medical device is implanted.

46. The medical device according to claim 45, wherein said elastic layer is an elastic polymer layer. 20

47. The medical device according to claim 46, wherein said elastic polymer layer is an elastic polymer layer selected fi-om a group consisting of: a. polyurethane 25 b. silicone c. a combination of polyumthane and silicone d. parylene coated silicone e. parylene coated polyurethane, and f. a parylene coated combination of polyurethane and silicone. 30 43 WO 2011/005187 PCT/SE2010/050803 MEIOD

48. A method of replacing a natural hip joint with an artificial hip joint, the method comprising the steps of: 5 g. exposing the caputfemur, h opening the caput femur, thereby exposing the cortical and cancellous bone of the caputfemur, i. placing a medical device comprises an artificial concave acetabulum 10 surface in the caput femur, and j. fixating the medical device to the caput femur or collum femur.

49. The method according to claim 48, wherin the step of fixating the medical device to the caput or collum femur, comprises fixating the medical device to the 15 cortical bone from the inside of the caput or collum femur.

50. The method according to claim 48, wherin the step of fixating the medical device to the caput or collum femur, comprises fixating the medical device to the cortical bone fom the outside of the caput or collum femur. 20

51. The method according to claim 48, whemein the step of fixating the medical device to the caput or collum femur, comprises fixating the medical device to the cortical bone from the proximal side of the caput or collum femur. 25

52. The method according to claim 49, wherin the step of fixating the medical device further comprises fixating the medical device to the cortical bone fom the outside of the caput or collum femur. 44 WO 2011/005187 PCT/SE2010/050803

53. 'The method according to claim 49, wherin the step of fixating the medical device further comprises fixating the medical device to the cortical bone fiim the proximal side of the caput or collum femur. 5

54. The method according to claim 50, wherin the step of fixating the medical device further comprises the step of fixating the medical device to the cortical bone fm the proximal side of the caput or collum femur.

55. The method according to claim 48, wherein the medical device comprises 10 an elastic portion, and wherein the step of fixating the medical device comprises fixating the medical device to the caput femur by said medical device clasping the caput femur using the elastic portion

56. The method according to any one of claims 48 -55, wherein the medical 15 device further comprises an elongated member, and wherein the step of fixating the medical device comprises placing the elongated member in the collum femur, substantially aligned with the caput and collum femur center axis, said elongated member engaging atleast one of: the cancellous bone of the collum femur, the cortical bone of the collum femur and an artificial material placed 20 inside of the collum femur.

57. Ihe method according to claim 56, wherein the elongated member comprises a threaded portion, and wherein the step of placing the elongated member in the collum femur comprises the step of screwing the elongated into 25 the collum femur.

58. The method according to claim 56, wherin the elongated member comprises an anchoring portion, and wherein the step of placing the elongated member in the collum femur comprises the step of placing the anchoring portion 30 such thatthe anchoring portion engages atleast one of: the cancellous bone of 45 WO 2011/005187 PCT/SE2010/050803 the collum femur, the cortical bone of the collum femur and an artificial material placed inside of the collum femur.

59. The method according to claim 58, wherein the anchoring portion can be 5 placed in a fist and second state, and whemein said anchoring portion is adapted to, in the second state, further engage atleast one of: the cancellous bone of the collum femur, the cortical bone of the collum femur and an artificial material placed inside of the collum femur, for further stabilizing the medical device. 10

60. The method according to claim 48, wherin the step of fixating the medical device further comprises applying an adhesive to a surface of the inside of the caput or collum femur and placing the medical device in contact with said adhesive, such that said adhesive adhers to the medical device. 15

61. The method according to claim 48, wherin the step of fixating the medical device comprises the step of fixating the medical device using a mechanical fixation element adapted to engage the cortical bone of the caput or collum femur. 20

62. The method according to claim 48, wherin the step of fixating the medical device comprises the step of fixating the medical device using a mechanical fixation element adapted to engage the cortical bone of the caput or collum femur. 25

63. The method according to claim 48, wherin the step of fixating the medical device comprises placing a mechanical fixation element in connection with the medical device, clamping the medical device, and thus fixating the medical device to the caput femur. 30 46 WO 2011/005187 PCT/SE2010/050803

64. 'The method according to claim 63, wherein the step of placing the mechanical fixation element comprises the step of placing a loop shaped mechanical fixation element sur-unding the medical device and caput femur. 5

65. The method according to claim 48, wherin the step of fixating the medical device to the caput or collum femur, comprises fixating the medical device to the cortical bone of caput or collum femur fim at least one of; the outside, the inside and a proximal cut caput or collum femur and operating the device to 10 adjust the fixation to clamp the cortical bone of the caput or collum femur.

66. The medical device according to claim 2-7, wherein said fixating portion is adapted to be operable to adjust the stabilization of the medical device towards the cortical bone of the caput or collum femur, fim at least one of; the 15 inside of caput or collum femur, the outside of the caput or collum femur and a cut proximal side of caput or collum femur. 20 47