CA2247053A1 - The anatomic replacement prosthesis system in the hand and wrist - Google Patents
The anatomic replacement prosthesis system in the hand and wrist Download PDFInfo
- Publication number
- CA2247053A1 CA2247053A1 CA 2247053 CA2247053A CA2247053A1 CA 2247053 A1 CA2247053 A1 CA 2247053A1 CA 2247053 CA2247053 CA 2247053 CA 2247053 A CA2247053 A CA 2247053A CA 2247053 A1 CA2247053 A1 CA 2247053A1
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- articular surface
- articular
- prosthesis
- radial
- modul
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Abstract
In the treatment of distal radial fractures. the involvement of the articular surface of the radius may in some case cause serious problems. Because the anatomic reduction of seriously damaged and displaced fragments of the articular surface can not be always reconstructed. As a result of that, in follow-up, the patient can have progressive degenerative changes all over the wrist joint including articular surfaces of the carpal bones which might have been undamaged after the original trauma. At this point, the treatment alternatives are the fusion of the joint and total replacement arthroplastic.
Unfortunately, the current status of the total wrist replacement arthroplastic is not so successful as some other joints.
Consequently, total wrist arthroplastic is a kind of option which surgeons usually try to avoid. Here a new conceptual approach to wrist replacement arthroplastics has been brought to the agenda which permits the surgeon the partial and/or hermipartial joint replacement. In case of necessity, this partial arthroplastic can be converted to total joint replacement, and can be used in tumors, traumatic degenerative and rheumatismal conditions of this joint.
Unfortunately, the current status of the total wrist replacement arthroplastic is not so successful as some other joints.
Consequently, total wrist arthroplastic is a kind of option which surgeons usually try to avoid. Here a new conceptual approach to wrist replacement arthroplastics has been brought to the agenda which permits the surgeon the partial and/or hermipartial joint replacement. In case of necessity, this partial arthroplastic can be converted to total joint replacement, and can be used in tumors, traumatic degenerative and rheumatismal conditions of this joint.
Description
CA 022470~3 1998-08-21 THE ANATOMIC REPLACEMENT PROSTHESIS SYSTEM IN THE H~ND
AND WRIST.
Currently, the wrist prosthesis are the applications which replaces both radial s and carpal components of this joint. In such prosthesis the amount of carpal resection is quite considerable and the resultant changes in the wrist biome-~h:sni-~ leads to some di~sS~ti~f~rtion which ends in limited application and as so as delate the timing of the operation till the highly advanced degenerative joints.
10 CUI . ~..lly, the wrist biomechanic is not ve~ well understood yet. Especially the kin~ ~tics of the skafoid and the lunatum present semifree kind of movements from each other. However, in current practice the carpal component is either fixed to both of these bones or, applicated after the resection o~ the alleged ones.
Beyond that, in tumor cases, affecting articular surface located in the distal radius, when trauma or a kind of rhumatoid disease spear the carpa3 bones, but seriously affects articular surface of the radius, until today a joint replacement system which can only reconstruct the damaged radial part of the wrist has not yet described.
The cu- .~nt status of the prosthetic app1ications in hand surgery can be checked 20 from thelast publication of operative Hand Surgery of David P. Green- (ISBN 0-443-08803-9 Churchill Livingstone Publications page 143-187 ), and also the Journal of ~n--, ;can Hand Surgery could be investigated.
It is obvious that all kinds of current prosthesis forces the surgeon to change the wholeof the joint inevitably. When in case of the normal carpal side cartilage to 2s be obligated to apply prosthesis to the carpal side of the joint increse the risk of co~p!iration and be~me q "too ,...uch treatment".
In applications of the total wrist prosthesis, loosening seen particularly in carpal ~ component and the stabilit~ lost due to the wide carpal resec~ion are still unsolved problem. Therefore, many surgeons keep away from total wrist 30 prrosthesis surgery and prefer artrotdesis or delate the ~ur~ until extreme deformity occurs. Here mentioned, new concept enables the prosthetic repl ~c~. -c..t of only the damaged part of the joint (t~ tieS tumoral, degc..c. ~ive and so on). Likewise with the assistance of the limited replacement CA 02247053 l998-08-2l W O 97/31S93 PCTrrR97/00004 arthroplastie r~inf~in~ the original biomechanic of the wrist joint and provides a sort of profilactic surgery with conservation of wrist ligaments and undamaged parts of the joint. In daily practice, the phenemenons which disturb the morphologic and functional wholeness of such as introarticular r ~.elul~s, giantcell tumors. Generally happens within the distal radius . In such cases, on arthroplastie which reconstruct to only the radial part of thc joint is not described . Certainly, the prosthetic material in question will be in different types according to the location and the stage of the pathology. For instance, incase of benign tumors, a design possesing a massive stem (body) in order to be applied 10 with bone cement ( Methilmetakrilat) is preferable. On the other hand, in a case of introarticular fractures the application of cementless design will be choosen as a low profile one to leave sufficient bone tack.
With the new concept which we have been introduced here, new horizons might possibly be lied beforestarted and with the re~ t:~ of ru~ -r experimental 15 and clinical studies prototype designs will undoubtly developed. Similarly, the fact that the distal radial joint is affected or not will modify the choise of required design.
Following the arthroscopic MRI and operative findings, only if the carpal bones'articular surfaces are found degenerated, sugeon may be contend with only the 20 rep~ nt of degenerated surfaces. Moreover, if only a part of radial articular surface is found degenerated ~Skafoid or Ulnar fossa), again the limited rep!~ce~c~lt of degenerated parts maty be choosen as a hemi-partial prosthetic application an dspare the rest of the joint. The insertion of the radial component may either be realized by a trans- radial -stiloid approach which is not published 25 yet, in case of distal radiovulnar joint degeneration the t~ k moAifi~~tion approach for capanji procedure ( resection of distal ulnar) or finally current dorsal approach used regularlt in wrist replacement arthroplastie . ~ the last one, especially the hemi-partial application9.
Whether TFCC (Triangular fibrocartilage complex) is infact or not, and the 30 carpal instability added or not, may imply little mo~ tions in the design is prefered.
In accordance with the abovementioned principles, partial surface rep~ac- cnt prosthetic applications are nor described and realised for fimger joints. Till today CA 022470~3 1998-08-21 surgeons exherted arthrothesis in case of introarticular fractures or benign tumors located adjusted to finger joints. Thus the joint is sacrificed, even one of the joint surface is compeletly intact. Furthermore, only the fracture which ho1ds one articular surface of MP or PIP joint may imply a contradiction for reviscularisaffon or replantation of the finger. Therefore, a simple partial surface replacement can change the destiny of the whole finger. Also in corpometacorpal an intercarpal joints only the damaged surfaces' anatomic replacement can be used.
Synthetic surface may be in metal or plastic in nature. May be covered with plastic or other material or as a measure the injection of some chemicals in thejoint space between the prosthetic material and opposing normal articular surface can be made.
Practice might be by cement or not. Bone graft, porous-coated, hidrok~ip~tit inpregrinated surface, bone-ongrowth, bone-ingrowth phenemenonstaken in to consideration when de~igning prosthesis. Modular system; style articular surfacestem and body components may be fabricated to construct the assembly outside of the body: or inside with different surgical approach with each of these.
Arthroscopic ~cs;~t~nce may probably be required. With the plate and the screw application, additional primary stability can be obtained. Variations of plate and screw applications can be fixedor assembled over the material.
To increase the primary stability, the stem and the body components, may be manufactured as "expension type~'. In the be~- nin~ the proyotype model will possess an exten~i~n screw system, in the case of ~ -cesi,ily this will be modified.
~istal radial articular surface inclination angle is given generally in two different plans as 23 and ~1 degree. However, we have seen considerable mo~ ons in our mea~u~ ~.e.~ts. Ideally we anticipate to accomadate the angle of the articular surface in comparison with the other wrist, to other wrist of the patient. Either modular and compact system ~vill be designed to allow this accomadation.
~ 30 It is ohvious that, this prosthetic system will be applied with the help of an instrument set to provide to find the correct size, position, and the fixation of the implant. To fasciii~t~te the insertion of the prosthesis some distraction will probably be needed. Thus a Icind of externa~ fixation device will be utilized in CA 02247053 l998-08-2l addition to this, multiple raspes, osteotoms and specially designed insertion devices are indispensable for this goal. These irlstruments will be developed inexperimental studies and in following days newly ~le~i~ cd versions will be invented. Incase of necessity custom made prosthetis will be provided.
s Variations allows the fixation of the prosthesis to the bone with the help of several devices.
In the stem and or the body of the prosthesis, a rectangular area to fill with the bone graft to be taken with a special instrument may be helpful to contribute tothe stability of the device.
~o In the above mentioned radial styloid approach, the main concern is to protect volar and dorsal ligaments, thus the stability of the joint. This is a new approach not described elsewhere.
Scaphoid and lunate bones articular surfaces may be reconstructed with the help of synthetic materials primarily or later. In the case of the scapho-lunate rupture 15 with difficulty to repair, special design to embody this area may be .Itili7e.1 As it is seen, with the help of the new conceptual approach to the prosthetic surgery in the hand, it will only be possible to reconstruct the limited damagedpart of the wrist joint with an anatomically flçsigned prosthetic device, healthy parts will be left intact, then only in the case of necessity other parts of the joint 20 will be changed to convert to total wrist prosthesis. While doing this, any of the previously applicated prosthetic component will not be removed as much as possible if it will be expressed through the help of a parable this modular reconstruction is similar to a modular r..l if..re group available commercially. In following fl~$ign~, main details have been mentioned on the radial prosthetic 2s component shown in approximately natural dimensions. It must be kept in mind that necessary mo~lific~tions will be realized in detai!s.
ILLU~TRATION 1: Appearence in face 1. Joint surface commponent 2. The alar process of the intermediate part to be hold within the spongois bone 3.The hole for bone graft 4and 6. Tlhe groove of 30 screws which help to fixation of the bone. 5. Distal stem component which has the property of expansion. 7. The intermediate component ~part) 8. The groove for the fixation of Triangular fibrocartilage complex.
W O 97/31S93 PCTrrR97/00004 IELUSTRATION 2:
Profile: 9. The hole for the scre v to fix the articular component and the intermediate component in desired position. 10. Alar process of the distal stem.11. Expansion screw hole in distal stem.
s Since the explanations in the text are suffl~icnt for the description of the prosthetic devices except the radial component further illustrations are being thought to be unnecesary. However the concept of anatomic surface replacement which is the cardinale concept in the design of these is to be remembered.
AND WRIST.
Currently, the wrist prosthesis are the applications which replaces both radial s and carpal components of this joint. In such prosthesis the amount of carpal resection is quite considerable and the resultant changes in the wrist biome-~h:sni-~ leads to some di~sS~ti~f~rtion which ends in limited application and as so as delate the timing of the operation till the highly advanced degenerative joints.
10 CUI . ~..lly, the wrist biomechanic is not ve~ well understood yet. Especially the kin~ ~tics of the skafoid and the lunatum present semifree kind of movements from each other. However, in current practice the carpal component is either fixed to both of these bones or, applicated after the resection o~ the alleged ones.
Beyond that, in tumor cases, affecting articular surface located in the distal radius, when trauma or a kind of rhumatoid disease spear the carpa3 bones, but seriously affects articular surface of the radius, until today a joint replacement system which can only reconstruct the damaged radial part of the wrist has not yet described.
The cu- .~nt status of the prosthetic app1ications in hand surgery can be checked 20 from thelast publication of operative Hand Surgery of David P. Green- (ISBN 0-443-08803-9 Churchill Livingstone Publications page 143-187 ), and also the Journal of ~n--, ;can Hand Surgery could be investigated.
It is obvious that all kinds of current prosthesis forces the surgeon to change the wholeof the joint inevitably. When in case of the normal carpal side cartilage to 2s be obligated to apply prosthesis to the carpal side of the joint increse the risk of co~p!iration and be~me q "too ,...uch treatment".
In applications of the total wrist prosthesis, loosening seen particularly in carpal ~ component and the stabilit~ lost due to the wide carpal resec~ion are still unsolved problem. Therefore, many surgeons keep away from total wrist 30 prrosthesis surgery and prefer artrotdesis or delate the ~ur~ until extreme deformity occurs. Here mentioned, new concept enables the prosthetic repl ~c~. -c..t of only the damaged part of the joint (t~ tieS tumoral, degc..c. ~ive and so on). Likewise with the assistance of the limited replacement CA 02247053 l998-08-2l W O 97/31S93 PCTrrR97/00004 arthroplastie r~inf~in~ the original biomechanic of the wrist joint and provides a sort of profilactic surgery with conservation of wrist ligaments and undamaged parts of the joint. In daily practice, the phenemenons which disturb the morphologic and functional wholeness of such as introarticular r ~.elul~s, giantcell tumors. Generally happens within the distal radius . In such cases, on arthroplastie which reconstruct to only the radial part of thc joint is not described . Certainly, the prosthetic material in question will be in different types according to the location and the stage of the pathology. For instance, incase of benign tumors, a design possesing a massive stem (body) in order to be applied 10 with bone cement ( Methilmetakrilat) is preferable. On the other hand, in a case of introarticular fractures the application of cementless design will be choosen as a low profile one to leave sufficient bone tack.
With the new concept which we have been introduced here, new horizons might possibly be lied beforestarted and with the re~ t:~ of ru~ -r experimental 15 and clinical studies prototype designs will undoubtly developed. Similarly, the fact that the distal radial joint is affected or not will modify the choise of required design.
Following the arthroscopic MRI and operative findings, only if the carpal bones'articular surfaces are found degenerated, sugeon may be contend with only the 20 rep~ nt of degenerated surfaces. Moreover, if only a part of radial articular surface is found degenerated ~Skafoid or Ulnar fossa), again the limited rep!~ce~c~lt of degenerated parts maty be choosen as a hemi-partial prosthetic application an dspare the rest of the joint. The insertion of the radial component may either be realized by a trans- radial -stiloid approach which is not published 25 yet, in case of distal radiovulnar joint degeneration the t~ k moAifi~~tion approach for capanji procedure ( resection of distal ulnar) or finally current dorsal approach used regularlt in wrist replacement arthroplastie . ~ the last one, especially the hemi-partial application9.
Whether TFCC (Triangular fibrocartilage complex) is infact or not, and the 30 carpal instability added or not, may imply little mo~ tions in the design is prefered.
In accordance with the abovementioned principles, partial surface rep~ac- cnt prosthetic applications are nor described and realised for fimger joints. Till today CA 022470~3 1998-08-21 surgeons exherted arthrothesis in case of introarticular fractures or benign tumors located adjusted to finger joints. Thus the joint is sacrificed, even one of the joint surface is compeletly intact. Furthermore, only the fracture which ho1ds one articular surface of MP or PIP joint may imply a contradiction for reviscularisaffon or replantation of the finger. Therefore, a simple partial surface replacement can change the destiny of the whole finger. Also in corpometacorpal an intercarpal joints only the damaged surfaces' anatomic replacement can be used.
Synthetic surface may be in metal or plastic in nature. May be covered with plastic or other material or as a measure the injection of some chemicals in thejoint space between the prosthetic material and opposing normal articular surface can be made.
Practice might be by cement or not. Bone graft, porous-coated, hidrok~ip~tit inpregrinated surface, bone-ongrowth, bone-ingrowth phenemenonstaken in to consideration when de~igning prosthesis. Modular system; style articular surfacestem and body components may be fabricated to construct the assembly outside of the body: or inside with different surgical approach with each of these.
Arthroscopic ~cs;~t~nce may probably be required. With the plate and the screw application, additional primary stability can be obtained. Variations of plate and screw applications can be fixedor assembled over the material.
To increase the primary stability, the stem and the body components, may be manufactured as "expension type~'. In the be~- nin~ the proyotype model will possess an exten~i~n screw system, in the case of ~ -cesi,ily this will be modified.
~istal radial articular surface inclination angle is given generally in two different plans as 23 and ~1 degree. However, we have seen considerable mo~ ons in our mea~u~ ~.e.~ts. Ideally we anticipate to accomadate the angle of the articular surface in comparison with the other wrist, to other wrist of the patient. Either modular and compact system ~vill be designed to allow this accomadation.
~ 30 It is ohvious that, this prosthetic system will be applied with the help of an instrument set to provide to find the correct size, position, and the fixation of the implant. To fasciii~t~te the insertion of the prosthesis some distraction will probably be needed. Thus a Icind of externa~ fixation device will be utilized in CA 02247053 l998-08-2l addition to this, multiple raspes, osteotoms and specially designed insertion devices are indispensable for this goal. These irlstruments will be developed inexperimental studies and in following days newly ~le~i~ cd versions will be invented. Incase of necessity custom made prosthetis will be provided.
s Variations allows the fixation of the prosthesis to the bone with the help of several devices.
In the stem and or the body of the prosthesis, a rectangular area to fill with the bone graft to be taken with a special instrument may be helpful to contribute tothe stability of the device.
~o In the above mentioned radial styloid approach, the main concern is to protect volar and dorsal ligaments, thus the stability of the joint. This is a new approach not described elsewhere.
Scaphoid and lunate bones articular surfaces may be reconstructed with the help of synthetic materials primarily or later. In the case of the scapho-lunate rupture 15 with difficulty to repair, special design to embody this area may be .Itili7e.1 As it is seen, with the help of the new conceptual approach to the prosthetic surgery in the hand, it will only be possible to reconstruct the limited damagedpart of the wrist joint with an anatomically flçsigned prosthetic device, healthy parts will be left intact, then only in the case of necessity other parts of the joint 20 will be changed to convert to total wrist prosthesis. While doing this, any of the previously applicated prosthetic component will not be removed as much as possible if it will be expressed through the help of a parable this modular reconstruction is similar to a modular r..l if..re group available commercially. In following fl~$ign~, main details have been mentioned on the radial prosthetic 2s component shown in approximately natural dimensions. It must be kept in mind that necessary mo~lific~tions will be realized in detai!s.
ILLU~TRATION 1: Appearence in face 1. Joint surface commponent 2. The alar process of the intermediate part to be hold within the spongois bone 3.The hole for bone graft 4and 6. Tlhe groove of 30 screws which help to fixation of the bone. 5. Distal stem component which has the property of expansion. 7. The intermediate component ~part) 8. The groove for the fixation of Triangular fibrocartilage complex.
W O 97/31S93 PCTrrR97/00004 IELUSTRATION 2:
Profile: 9. The hole for the scre v to fix the articular component and the intermediate component in desired position. 10. Alar process of the distal stem.11. Expansion screw hole in distal stem.
s Since the explanations in the text are suffl~icnt for the description of the prosthetic devices except the radial component further illustrations are being thought to be unnecesary. However the concept of anatomic surface replacement which is the cardinale concept in the design of these is to be remembered.
Claims (9)
1.The prosthesis is a modular partial or total articular surface replacement device used in different pathology of the distal radial articular surface.
2.This is a systhem according to claim 1. And is constituted from three main part ,namely the tail part (tail module) Fig 1, body part ( colar module) formed by two hemi-part Fig 2 and articular part (articular module) Fig 3. The tail part helping to fix the prosthesis in the medullary cavity of the bone having a couple sulcus (1) or wings to prevent the movements after the insertion and integration in the os or cement and a cylindrical shape (4)fitting the medullary cavity holding distally a spherical protuberence (2) helping to connect with other parts(modules)
3.The body part,also may be named the colar,has two quasi symmetrical hemi-parts fixed to each other with a screw (6) during the application of the prosthesis. The body part helps to connect the articular surface modul and the tail modul and fix both to each other in a desired position according to the medullar shape pattern and the inclination of the distal radial articular surface proper to each patient. Fig.4. This fixation(locking) occurs with a help of the central screw(6)wich connect the two hemi-parts of the body(colar)modul while holdig between two hemi-parts the spherical connection protuberences of the tail and articular moduls. The body modul fits the the metaphizeal region of the radius and has two spherical cavity (7)to recive the cylindrical protuberences of the other two moduls. Moreover in each hemi-cylindrical cavity of the radial site hemi-part of the body module a hole fore a screw may be pierced for additional stability to fixation.(8)
4.The articular surface modul (Fig 3)is a systhem according to the claim no 1 and has constituted by the articular surface (9) and the connecting proximal spherical protuberence (10). The articular surface has the anatomic shape of the distal radial articular surface and it is in the configurational harmony with the contours of the corresponding proximal carpal bones( lunate and scaphoid).
The larger site is the radial border of this modular element and may have a threaded hole( 12) to manipulate with a holding device fitting here.
The larger site is the radial border of this modular element and may have a threaded hole( 12) to manipulate with a holding device fitting here.
5.This is a systhem according to claims 1,2,3,4. In each module it is possible to add some screw holes to fix the prosthesis directly to the bone with the help of screws .Also each modular part may have wings or connected plates for additional screws fixation.
6.The prosthesis can be fabricated in different sizes or may be custom made for the patient considered.
7.In the case when the only scaphoid fossa of the radial articular surface is damaged the prosthesis will be modified to made taking into consideration the claims 1,2,3,4,5,6 and the articular part having only the scaphoid (radial part)of the articular modul .The body modul also will be reduced to fit only the radial partof the radius and the spherical connection of the tail modul will also be displaced radially to fit the off-set body part (Fig .5)
8.In the case when the only damaged part is the lunate fossa of the radial articular surface the prosthesis will be modified taking always into consideration claims 2,5,6 and the articular surface reconstruction concept but this time the prosthesis will be compact(monobloc) holding the articular surface and body and tail parts fitting the lunar articular surface of the radius andthe ulnar part of the distal radius and fixed with screws and/ or cement (13)which cross the body into the bone Fig 6
9.In designs created for finger joints the device is composed of the stem and the articular part. The stem fits the medullar cavity of the tubular bones of the hand. The particularity is that the articular surface is exactely anatomic thus can be applied as a partial replacement prosthesis without any intervention need to the healthy opposing articular surface.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| TR96/00163 | 1996-02-29 | ||
| TR9600163 | 1996-02-29 | ||
| PCT/TR1997/000004 WO1997031593A1 (en) | 1996-02-29 | 1997-02-20 | The anatomic replacement prosthesis system in the hand and wrist |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2247053A1 true CA2247053A1 (en) | 1997-09-04 |
Family
ID=29422576
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA 2247053 Abandoned CA2247053A1 (en) | 1996-02-29 | 1997-02-20 | The anatomic replacement prosthesis system in the hand and wrist |
Country Status (1)
| Country | Link |
|---|---|
| CA (1) | CA2247053A1 (en) |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112137772A (en) * | 2019-06-28 | 2020-12-29 | 青岛大学附属医院 | Artificial scaphoid of bonding type ball socket joint formula |
| CN114129310A (en) * | 2021-11-22 | 2022-03-04 | 中国人民解放军联勤保障部队第九二〇医院 | Wrist part scaphoid replacement prosthesis |
-
1997
- 1997-02-20 CA CA 2247053 patent/CA2247053A1/en not_active Abandoned
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112137772A (en) * | 2019-06-28 | 2020-12-29 | 青岛大学附属医院 | Artificial scaphoid of bonding type ball socket joint formula |
| CN112137772B (en) * | 2019-06-28 | 2023-02-24 | 青岛大学附属医院 | Artificial scaphoid of bonding type ball socket joint formula |
| CN114129310A (en) * | 2021-11-22 | 2022-03-04 | 中国人民解放军联勤保障部队第九二〇医院 | Wrist part scaphoid replacement prosthesis |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| EEER | Examination request | ||
| FZDE | Dead |