CN104207863A - Moment-introduced whole-joint replacing prosthesis - Google Patents

Moment-introduced whole-joint replacing prosthesis Download PDF

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Publication number
CN104207863A
CN104207863A CN201410410460.1A CN201410410460A CN104207863A CN 104207863 A CN104207863 A CN 104207863A CN 201410410460 A CN201410410460 A CN 201410410460A CN 104207863 A CN104207863 A CN 104207863A
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China
Prior art keywords
insert
tibial
prosthetic
tibial tray
mobilizable
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CN201410410460.1A
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CN104207863B (en
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理查德·D·科米斯泰克
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DePuy Ireland ULC
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DePuy Ireland ULC
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Priority to CN201410410460.1A priority Critical patent/CN104207863B/en
Priority claimed from CNA2006800544752A external-priority patent/CN101431967A/en
Publication of CN104207863A publication Critical patent/CN104207863A/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

The invention relates to a moment-introduced whole-joint replacing prosthesis. A prosthesis shin insert comprises a shin disk insert, wherein the shin disk insert comprises a stabilizing pillar, and a center line of the stabilizing pillar shifts from at least one center line of the front-rear center line of the prosthesis shin disk insert and the inner-outer center line of the prosthesis shin disk insert. An axial rotating method comprises the step of shifting an axial rotating axis between a shin prosthesis and another shin prosthesis in at least one mode, namely, shifting the stabilizing pillar relative to a shin insert, thereby increasing the radius of a container on the inner side of the shin insert of the shin prostheses and increasing the adaptability between the container on the inner side of the shin insert and the internal condyle.

Description

Introduce the total joint replacement prosthese of moment
The application is the divisional application of Chinese invention patent application of application number 200680054475.2, March 21 2006 applying date, the denomination of invention total joint replacement prosthese of moment " introduce ".
Technical field
The present invention relates to implanting prosthetic device, and relate more specifically to the implanting prosthetic joint of the natural biological mechanics imitating native mammalian joint.The present invention is also included in implanting prosthetic intraarticular and introduces the method for moment and the implanting prosthetic device containing introducing moment.
Background technology
Previous research proves, the amount of spin occurred in knee in walking and highly bending active procedure such as stands between those knees of total knee arthroplasty (TKA) different greatly at natural knee (previously do not done operation and do not had the history of clinical deformity) and operation correction knee.In the process of natural knee bends, femur rotates pattern relative to the axial stock shin of tibia and causes tibia relative to the inward turning of femur, and causes tibia relative to the outward turning of femur when knee extension.To be part caused by the anatomical variations on the length in ligamentum cruciatum and collaterial ligament and tension force and middle and side direction femur and tibial condyle size this inward turning mechanism.
Real axial stock shin after KTA rotates pattern and is still not clear, but has illustrated and change to a great extent.Some suppose TKA after axial rotation reduce may with the removing or to change and/or accurately can not to copy the geometry of inside and outside femur and tibial condyle relevant of ligamentum cruciatum, but most people supposes that the motion of this minimizing is caused by the condyle geometry that not reproducible is correct.
Polycentric load-bearing kinematics analysis in vivo proves to be worth similar with the average axial rotation in relative heavy burden movable TKA prosthese in the fixing TKA prosthese of heavy burden.But, bearing a heavy burden in movable TKA prosthese about exact position (tibia insert that tibia insert is higher or relative is lower) the existence dispute of axial rotation.Some fixing and movable TKA prostheses that bear a heavy burden prove that axial rotation obviously reduce, and other then proves that TKA patient often stands contrary rotation pattern, in this mode tibia outside gusset rotate around femur, wherein knee bends degree increases.
Summary of the invention
The present invention relates to the implanting prosthetic device imitating native mammalian joint natural biological mechanics.One exemplary embodiment of the present invention described herein comprises implantable prosthetic component, and described parts introduce moment to make the rotational motion between joint component in implantable prosthetic joint.The present invention also comprises the implantable prosthesis joint containing the Exemplary prosthesis parts introducing moment, and for introducing moment to make to rotate between implantable IA complementary prosthetic component.
A first aspect of the present invention provides tibial prosthetic insert, it comprises the inner side and outer side container for holding a pair femoral prosthesis condyle, prosthetic tibial tray insert also comprises stability column, and wherein the centrage of stability column is from least one disalignment the front-rear center line of prosthetic tibial tray insert and the medial-lateral centerline of prosthetic tibial tray insert.
In the more specific embodiment of first aspect, stability column offsets to the inside from the medial-lateral centerline of prosthetic tibial tray insert.Also in another more detailed embodiment, stability column offsets laterally from the medial-lateral centerline of prosthetic tibial tray insert.In the embodiment that another is detailed, stability column is from the front-rear center line biased forwards of prosthetic tibial tray insert.But in another specific embodiment, stability column offsets after the front-rear center alignment of prosthetic tibial tray insert.In more detailed embodiment, prosthetic tibial tray insert comprises the recess being suitable for holding ridge, and described ridge protrudes from prosthetic tibial tray implant, and prosthetic tibial tray insert can rotate relative to prosthetic tibial tray implant around it.In a more detailed embodiment, prosthetic tibial tray insert comprises and is suitable for being accommodated in the ridge in prosthetic tibial tray implant recess, and prosthetic tibial tray insert can rotate relative to prosthetic tibial tray implant around it.In another more detailed embodiment, prosthetic tibial rotates along the first rotation axis in the first plane relative to prosthetic tibial tray implant, prosthetic tibial tray insert rotates along the second rotation axis in the first plane relative to femoral prosthesis, and the first rotation axis and the second rotation axis disalignment.Also in another more detailed embodiment, stability column is circular at rear side.
A second aspect of the present invention provides tibial prosthetic insert, it comprises the isolated inner side and outer side container for holding a pair femoral prosthesis condyle, prosthetic tibial tray insert also comprises stability column, wherein stability column is along at least one the centrage orientation in the front-rear center line of prosthetic tibial tray insert and the medial-lateral centerline of prosthetic tibial tray insert, wherein prosthetic tibial tray insert is suitable for rotating around the rotation axis perpendicular to prosthetic tibial tray insert relative to the prosthetic tibial tray implant of immobilized patients tibia, wherein rotation axis at least one disalignment from the front-rear center line and medial-lateral centerline of prosthetic tibial tray insert.
In the more specific embodiment of second aspect, rotation axis offsets to the inside from the medial-lateral centerline of prosthetic tibial tray insert.Also in another more detailed embodiment, rotation axis offsets laterally from the medial-lateral centerline of prosthetic tibial tray insert.In the embodiment that another is detailed, rotation axis is from the front-rear center line biased forwards of prosthetic tibial tray insert.But in another specific embodiment, rotation axis offsets after the front-rear center alignment of prosthetic tibial tray insert.In more detailed embodiment, prosthetic tibial tray insert comprises the recess being suitable for holding ridge, and described ridge protrudes from prosthetic tibial tray implant, and prosthetic tibial tray insert can rotate relative to prosthetic tibial tray implant around it.In a more detailed embodiment, prosthetic tibial tray insert comprises and is suitable for being accommodated in the ridge in prosthetic tibial tray implant recess, and prosthetic tibial tray insert can rotate relative to prosthetic tibial tray implant around it.In another more detailed embodiment, prosthetic tibial tray insert rotates along the first rotation axis in the first plane relative to prosthetic tibial tray implant, prosthetic tibial tray insert rotates along the second rotation axis in the first plane relative to femoral prosthesis, and the first rotation axis and the second rotation axis disalignment.Also in another more detailed embodiment, stability column is circular at rear side.
In a third aspect of the present invention, tibial prosthetic insert comprises outside for holding a pair femoral prosthesis condyle and medial condyle receivers, prosthetic tibial tray insert has lateral condyle receiver, the shape that this container has is convex shape or at least one shape from front to back in tilted shape, prosthetic tibial tray insert also has medial condyle, this medial condyle has the concave shape of the protrusion medial condyle for holding femoral prosthesis, the combination of lateral condyle receiver and medial condyle produces the moment around rotation axis, to make to horizontally rotate between prosthetic tibial tray insert and femoral prosthesis condyle.
In the more detailed embodiment of the third aspect, prosthetic tibial tray insert comprises the recess being suitable for holding ridge, and described ridge protrudes from prosthetic tibial tray implant, and prosthetic tibial tray insert can rotate relative to prosthetic tibial tray implant around it.In a more detailed embodiment, prosthetic tibial tray insert comprises and is suitable for being accommodated in the ridge in prosthetic tibial tray implant recess, and prosthetic tibial tray insert can rotate relative to prosthetic tibial tray implant around it.In another more detailed embodiment, prosthetic tibial tray insert rotates along the first rotation axis in the first plane relative to prosthetic tibial tray implant, prosthetic tibial tray insert rotates along the second rotation axis in the first plane relative to femoral prosthesis, and the first rotation axis and the second rotation axis disalignment.Also in another more detailed embodiment, rotation axis offsets from the medial-lateral centerline of prosthetic tibial tray insert.In another specific embodiment, rotation axis offsets from the front-rear center line of prosthetic tibial tray insert.
In a fourth aspect of the present invention, provide knee prostheses, comprising: (a) femoral prosthesis; And (b) comprises the prosthetic tibial of prosthetic tibial tray insert, this prosthetic tibial tray insert comprises the isolated inner side and outer side container for holding a pair femoral prosthesis joint, prosthetic tibial tray insert also comprises stability column, and wherein the centrage of stability column is from least one disalignment the front-rear center line of prosthetic tibial tray insert and the medial-lateral centerline of prosthetic tibial tray insert.
In the more specific embodiment of fourth aspect, stability column offsets to the inside from the medial-lateral centerline of prosthetic tibial tray insert.Also in another more detailed embodiment, stability column offsets laterally from the medial-lateral centerline of prosthetic tibial tray insert.In the embodiment that another is detailed, stability column offsets after the front-rear center alignment of prosthetic tibial tray insert.But in another specific embodiment, stability column is from the front-rear center line biased forwards of prosthetic tibial tray insert.In more detailed embodiment, prosthetic tibial tray insert comprises the recess being suitable for holding ridge, and described ridge protrudes from prosthetic tibial, and prosthetic tibial tray insert can rotate relative to prosthetic tibial around it.In a more detailed embodiment, prosthetic tibial tray insert comprises and is suitable for being accommodated in the ridge in prosthetic tibial recess, and prosthetic tibial tray insert can rotate relative to prosthetic tibial around it.In another more detailed embodiment, prosthetic tibial tray rotates along the first rotation axis in the first plane relative to prosthetic tibial, prosthetic tibial tray insert rotates along the second rotation axis in the first plane relative to femoral prosthesis, and the first rotation axis and the second rotation axis disalignment.Also in another more detailed embodiment, stability column is circular at rear side, and femoral prosthesis comprises the cam be supported on stability column, and wherein cam offset is to mate with the skew of stability column.
A fifth aspect of the present invention provides knee prostheses, and it comprises: (a) is suitable for the femoral prosthesis being installed to patient's natural femur, b () is suitable for the prosthetic tibial being installed to patient's natural tibia, and (c) prosthetic tibial tray insert, prosthetic tibial tray insert comprises the isolated inner side and outer side container for holding a pair femoral prosthesis joint, prosthetic tibial tray insert also comprises stability column, wherein stability column is along at least one the centrage orientation in the front-rear center line of prosthetic tibial tray insert and the medial-lateral centerline of prosthetic tibial tray insert, wherein prosthetic tibial tray insert is suitable for rotating around the rotation axis perpendicular to prosthetic tibial tray insert relative to prosthetic tibial, wherein rotation axis at least one disalignment from the front-rear center line and medial-lateral centerline of prosthetic tibial tray insert.
In more specific embodiment in the 5th, rotation axis offsets to the inside from the medial-lateral centerline of prosthetic tibial tray insert.Also in another more detailed embodiment, rotation axis offsets laterally from the medial-lateral centerline of prosthetic tibial tray insert.In the embodiment that another is detailed, rotation axis is from the front-rear center line biased forwards of prosthetic tibial tray insert.But in another specific embodiment, rotation axis offsets after the front-rear center alignment of prosthetic tibial tray insert.In more detailed embodiment, prosthetic tibial tray insert comprises the recess being suitable for holding ridge, and described ridge protrudes from prosthetic tibial, and prosthetic tibial tray insert can rotate relative to prosthetic tibial around it.In a more detailed embodiment, prosthetic tibial tray insert comprises and is suitable for being accommodated in the ridge in prosthetic tibial recess, and prosthetic tibial tray insert can rotate relative to prosthetic tibial around it.In another more detailed embodiment, prosthetic tibial tray insert rotates along the first rotation axis in the first plane relative to prosthetic tibial, prosthetic tibial tray insert rotates along the second rotation axis in the first plane relative to femoral prosthesis, and the first rotation axis and the second rotation axis disalignment.Also in another more detailed embodiment, stability column is circular at rear side, and femoral prosthesis comprises the cam be supported on stability column, and wherein cam offset is to mate with the skew of stability column.
A sixth aspect of the present invention provides knee prostheses, and it comprises: (a) is suitable for the femoral component being installed to patient's natural femur; B () is suitable for the tibial component being installed to patient's natural tibia, tibial component comprises outside for holding a pair femoral prosthesis condyle and medial condyle receivers, the shape that lateral condyle receiver has is convex shape or at least one shape from front to back in tilted shape, medial condyle has the concave shape of the protrusion medial condyle for holding femoral prosthesis, the combination of lateral condyle receiver and medial condyle produces the moment around rotation axis, to make to horizontally rotate between prosthetic tibial tray insert and femoral prosthesis condyle.
In more specific embodiment in the 6th, tibial component comprises prosthetic tibial tray insert, this prosthetic tibial tray insert comprises cam face, and prosthetic tibial tray insert comprises the recess being suitable for holding ridge, described ridge protrudes from the prosthetic tibial tray implant of tibial component, and prosthetic tibial tray insert can rotate relative to tibial tray implant around it.In a more detailed embodiment, tibial component comprises prosthetic tibial tray insert, prosthetic tibial tray insert comprises cam face, and prosthetic tibial tray insert comprises and is suitable for being accommodated in the ridge in the prosthetic tibial tray implant recess of tibial component, prosthetic tibial tray insert can rotate relative to prosthetic tibial tray implant around it.In another more detailed embodiment, prosthetic tibial tray insert rotates along the first rotation axis in the first plane relative to prosthetic tibial tray implant, prosthetic tibial tray insert rotates along the second rotation axis in the first plane relative to femoral prosthesis, and the first rotation axis and the second rotation axis disalignment.Also in another more detailed embodiment, rotation axis offsets from the medial-lateral centerline of prosthetic tibial tray insert.In a more detailed embodiment, at least one medial-lateral centerline from prosthetic tibial tray insert in the first rotation axis and the second rotation axis offsets.
A seventh aspect of the present invention provides mobilizable knee prostheses that bears a heavy burden, it comprises: (a) is for implantation into the tibial prosthesis in receptor tibia, tibial prosthesis comprises tibial tray and is fixed to the tibia insert of tibial tray, tibia insert is rotatable relative to tibial tray reorientates, to introduce moment around the run-on point offset with the medial-lateral centerline of tibial tray of tibial tray, tibial tray comprises medial condyle receivers and tibial receiver; And (b) is for implantation into the femoral component in receptor femur, femoral component comprises the medial condyle be contained in the medial condyle receivers of tibial tray, and the lateral condyle be contained in tibial tray lateral receiver, at least one wherein in tibial tray and femoral component comprises stability column, to prevent femoral component from exceeding vertical rotation relative to tibial prosthesis, wherein the medial-lateral centerline of stability column and tibial tray offsets.
In more specific embodiment in the 7th, tibial tray comprises the stability column offset with the medial-lateral centerline of tibial tray.Also in another more detailed embodiment, stability column is towards the offset inboard of tibial tray.In the embodiment that another is detailed, stability column towards tibial tray about 0.1 millimeter to about 20 millimeters of offset inboard between.Also in the embodiment that another is detailed, be circular after stability column.In more detailed embodiment, femoral component comprises the cam being suitable for being rotatably supported on after stability column, and the surface configuration of its cam is bending spill, to hold the circular rear face of stability column.
A eighth aspect of the present invention provides the fixing knee prostheses that bears a heavy burden, it comprises: (a) is for implantation into the tibial prosthesis in receptor tibia, tibial prosthesis comprises medial condyle receivers and tibial receiver, and (b) is for implantation into the femoral prosthesis in receptor femur, femoral prosthesis comprises the medial condyle be contained in the medial condyle receivers of tibial tray, and the lateral condyle be contained in tibial tray lateral receiver, at least one wherein in tibial prosthesis and femoral prosthesis comprises post, to prevent femoral prosthesis from exceeding vertical rotation relative to tibial prosthesis, the medial-lateral centerline of wherein said post and femoral prosthesis offsets.
In the more detailed embodiment of eighth aspect, tibial prosthesis comprises tibial tray and is fixed to the tibia insert of tibial tray.Also in another more detailed embodiment, tibial tray comprises cam member, the inside and outside neutral point deviation of this cam member and tibial tray.In the embodiment that another is detailed, cam member is towards the lateral offset of tibial tray.Also in the embodiment that another is detailed, cam member towards tibial tray about 2 millimeters to about 20 millimeters of lateral offset between.In the embodiment that another is detailed, be circular after stability column.In a more detailed embodiment, femoral component comprises the cam being suitable for being rotatably supported on after stability column, and the surface configuration of its cam is bending spill, to hold the circular rear face of stability column.
A ninth aspect of the present invention provides the method making prosthetic joint axial rotation, described method comprises rotation axis between two main bodys around prosthetic joint and produces moment, make to carry out axial rotation between two main bodys, produce the action of moment to comprise and make the some interfaces between two main bodys spaced apart with different distances from anterior posterior midline, such rotation axis does not overlap with anterior posterior midline.
A tenth aspect of the present invention provides the method making prosthetic joint axial rotation, described method comprises the axial-rotation journal offset by providing following at least one mode to make between the tibial prosthesis of prosthetic knee joints and femoral prosthesis, namely by making stability column offset about the anterior posterior midline of the tibia insert of tibial prosthesis, the radius of the tibia insert medial condyle receivers of tibial prosthesis is made to be increased to the degree larger than femoral prosthesis medial condyle radius, and the adaptability (conformity) between the medial condyle receivers of the tibia insert of increase tibial prosthesis and medial condyle.
In more specific embodiment in the tenth, the present invention also comprises the axial-rotation journal offset made between the tibial prosthesis of prosthetic knee joints and femoral prosthesis, comprise the skew of posterior stabilization post about the anterior posterior midline of the tibia insert of tibial prosthesis, and wherein stability column to offset laterally from the anterior posterior midline of the tibia insert of tibial prosthesis.Also in another more detailed embodiment, the present invention also comprises and makes the axial-rotation journal offset between the tibial prosthesis of prosthetic knee joints and femoral prosthesis comprise the skew of posterior stabilization post about the anterior posterior midline of the tibia insert of tibial prosthesis, and stability column offsets to the inside from the anterior posterior midline of the tibia insert of tibial prosthesis.In more detailed embodiment, the present invention also comprises the journal offset making the axial-rotation between the tibial prosthesis of prosthetic knee joints and femoral prosthesis by making the anterior posterior midline of the rotation axis between the tibia insert of tibial prosthesis and tibia implant and tibia insert offset.
A eleventh aspect of the present invention provides the method making implantable prosthetic joint axial rotation, the rotation axis that described method comprises between two main bodys around prosthetic joint produces moment, make to carry out axial rotation between two main bodys, produce the action of moment to comprise and make the some interfaces between two main bodys spaced apart with different distances from anterior posterior midline, such rotation axis does not overlap with anterior posterior midline.
A twelveth aspect of the present invention provides the method making prosthetic joint axial rotation, described method comprises: (a) axial-rotation journal offset by providing following at least one mode to make between the tibial prosthesis of prosthetic knee joints and femoral prosthesis, namely by making stability column offset about the anterior posterior midline of the tibia insert of tibial prosthesis, make stability column about the front and back midline shift of the tibia insert of tibial prosthesis, the radius of the tibia insert medial condyle receivers of tibial prosthesis is made to be increased to the degree larger than femoral prosthesis medial condyle radius, make to become circle after the stability column that is associated with the tibia insert of tibial prosthesis, make to become circle before the cam that is associated with femoral prosthesis, and (b) increases the adaptability between the medial condyle receivers of the tibia insert of tibial prosthesis and medial condyle.
A thirteenth aspect of the present invention provides the method making prosthetic joint axial rotation, described method comprises around the rotation axis generation moment between the stability column and the cam of femoral prosthesis of tibial prosthesis, to make axial-rotation between two prostheses, produce the action of moment comprise following one of at least, namely make becoming circle below and making the cam of femoral prosthesis become recessed of tibial prosthesis stability column.
A fourteenth aspect of the present invention provides the method making prosthetic joint axial rotation, described method comprises around the rotation axis generation moment between the stability column and the cam of femoral prosthesis of tibial prosthesis, to make axial-rotation between two prostheses, produce the action of moment comprise following one of at least, namely the stability column of tibial prosthesis tibia insert is made to offset with the medial-lateral centerline about tibia insert, the stability column of tibial prosthesis tibia insert is offset with the front-rear center line about tibia insert, cam is offset from the medial-lateral centerline about femoral prosthesis, and cam is offset from the front-rear center line about femoral prosthesis.
A fifteenth aspect of the present invention provides the method making prosthetic joint axial rotation, described method comprises around the rotation axis generation moment between tibial prosthesis and femoral prosthesis, to make axial-rotation between two prostheses, the action producing moment comprises the medial condyle receivers making the medial condyle of femoral prosthesis effectively be fixed to tibial prosthesis, and prepare the lateral condyle of femoral prosthesis, to have the surface of substantially flat, the substantially flat of this surface and the lateral bearing surface of tibial prosthesis or substantially protrude surface interface and contact.
A sixteenth aspect of the present invention provides the method making prosthetic joint axial rotation, described method comprises around the rotation axis generation moment between prosthetic tibial and tibial prosthetic insert, produce the action of moment to comprise the run-on point between prosthetic tibial and tibial prosthetic insert offset, the skew of wherein said run-on point is from one of at least generation medial-lateral centerline and front-rear center line.
A seventeenth aspect of the present invention provides knee prostheses, comprise: (a) has the femoral prosthesis of a pair condyle (being separated by cam), at least one disalignment in the medial-lateral centerline of cam and femoral prosthesis and the front-rear center line of femoral prosthesis; And (b) comprises the prosthetic tibial of prosthetic tibial tray insert, prosthetic tibial tray insert comprises the isolated inner side and outer side container for holding a pair femoral prosthesis condyle, prosthetic tibial tray insert also comprises the stability column with circular rear face, and wherein the centrage of stability column is from least one disalignment the front-rear center line of prosthetic tibial tray insert and the medial-lateral centerline of prosthetic tibial tray insert.
A eighteenth aspect of the present invention provides knee prostheses, comprising: (a) has the femoral prosthesis of a pair condyle (being separated by cam); And (b) comprises the prosthetic tibial of prosthetic tibial tray insert, prosthetic tibial tray insert comprises the isolated inner side and outer side container for holding a pair femoral prosthesis condyle, prosthetic tibial tray insert also comprises the stability column with circular rear face, and this circular rear face is suitable for contacting with the cam interface of femoral prosthesis.
A nineteenth aspect of the present invention provides knee prostheses, comprising: (a) has the femoral prosthesis of a pair condyle (being separated by the concave cam bent); And (b) comprises the prosthetic tibial of prosthetic tibial tray insert, prosthetic tibial tray insert comprises the isolated inner side and outer side container for holding a pair femoral prosthesis condyle, prosthetic tibial tray insert also comprises the stability column with circular rear face, and this circular rear face is suitable for contacting with the cam interface of the bending spill of femoral prosthesis.
A twentieth aspect of the present invention provides tibial prosthetic insert, and it comprises prosthetic tibial tray insert,
Prosthetic tibial tray insert comprises the isolated inner side and outer side container for holding a pair femoral prosthesis condyle, prosthetic tibial tray insert also comprises the stability column with circular rear face, this circular rear face is suitable for the rotation promoting femoral prosthesis, and wherein the centrage of stability column is from least one disalignment the front-rear center line of prosthetic tibial tray insert and the medial-lateral centerline of prosthetic tibial tray insert.
21 aspect of the present invention provides tibial prosthetic insert, it comprises prosthetic tibial tray insert, prosthetic tibial tray insert comprises the isolated inner side and outer side container for holding a pair femoral prosthesis condyle, prosthetic tibial tray insert also comprises stability column, and wherein the centrage of stability column is from about 0.1 millimeter to about 20 millimeters of at least one disalignment the front-rear center line of prosthetic tibial tray insert and the medial-lateral centerline of prosthetic tibial tray insert.
In more specific embodiment in the 21, stability column offsets about 0.1 millimeter to about 5 millimeters from the medial-lateral centerline of prosthetic tibial tray insert.
22 aspect of the present invention provides the method making prosthetic joint axial rotation, described method comprises around the rotation axis generation moment between prosthetic tibial and tibial prosthetic insert, produce the action of moment to comprise the run-on point between prosthetic tibial and tibial prosthetic insert is offset, the described skew of at least one centrage wherein from the medial-lateral centerline and front-rear center line of tibial prosthetic insert is about 0.1 millimeter to about 20 millimeters.
23 aspect of the present invention provides the method making prosthetic joint axial rotation, described method comprises around the rotation axis generation moment between femoral prosthesis and tibial prosthetic insert, produce the action of moment to comprise the run-on point between femoral prosthesis and tibial prosthetic insert is offset, the described skew of at least one centrage wherein from the medial-lateral centerline and front-rear center line of tibial prosthetic insert is about 0.1 millimeter to about 20 millimeters.
Accompanying drawing explanation
Fig. 1 is the free body diagram of the cylinder B of contact platform A;
Fig. 2 is the figure illustrating that condyle of femur bends as linear segment, and the amount of corresponding contact linear segment in knee joint bending process is shown;
Fig. 3 is the top view of the mobilizable full knee joint transposing prosthesis insert of heavy burden of the posterior stabilization of prior art, and this insert has the polyethylene post aimed on center of rotation;
Fig. 4 is the top view of the full knee joint transposing prosthesis insert of the posterior stabilization that the heavy burden of prior art is fixed, and this insert has the polyethylene post that the anterior posterior midline along polyethylene insert is located;
Fig. 5 is the top view that prior art posterior cruciate ligament retains full knee joint transposing prosthesis insert;
Fig. 6 is the rear side figure of full knee joint transposing prosthesis first example of the movable posterior stabilization of heavy burden according to introducing moment of the present invention;
Fig. 7 is the top view of full knee joint transposing prosthesis insert first example of the movable posterior stabilization of heavy burden according to introducing moment of the present invention;
Fig. 8 is the figure that the polyethylene tibia insert of prior art carries out relative to the time rotating, described polyethylene tibia insert has post and the run-on point at polyethylene tibia insert center, and the rotation that the new moment basic display of the heavy burden of posterior stabilization mobilizable full knee joint transposing prosthesis insert introducing is larger;
Fig. 9 is the back side view according to stable full knee joint transposing prosthesis insert first example of the heavy burden fixed rear portion of introducing moment of the present invention;
Figure 10 is the top view according to stable full knee joint transposing prosthesis insert first example of the heavy burden fixed rear portion of introducing moment of the present invention;
Figure 11 is the inner side and outer side side view for the exemplary variations for exemplifying prosthetic insert on medial condyle adaptability and increase lateral condyle rear portion gradient;
Figure 12 (a) is the figure with the lateral femur condyle PCRTKA prosthese of circular convex shape representing prior art;
Figure 12 (b) and 12 (c) are the figure representing exemplary MITKAPCR prosthese, and this prosthese has the femoral radius being suitable for more smooth lateral condyle, and this lateral condyle contacts with convex surface downward in tibial component rear direction or inclined-plane;
Figure 13 is the top view of full knee joint transposing prosthesis insert first example of the movable posterior stabilization of heavy burden according to introducing moment of the present invention;
Figure 14 (a) and (b) are the diagram profiles representing exemplary MITKA posterior cruciate ligament reservation TKA, and it has the adaptability of the increase between knee flexion medial condyle in various degree and tibia insert medial condyle receivers;
Figure 14 (c) and (d) are the diagram profiles representing exemplary MITKA posterior cruciate ligament reservation TKA, and it has the increase gradient between knee flexion lateral condyle in various degree and tibia insert;
Figure 14 (e) and (f) are the diagram profiles representing exemplary MITKA posterior cruciate ligament reservation TKA, and it has outside convex shape, is supported on the place in various degree of knee bends along described outside convex shape lateral condyle;
Figure 15 is the three dimensional top perspective view with the TKA prosthese cam/post mechanism of flat guiding surface of prior art;
Figure 16 is the elevational perspective view of exemplary MITKA posterior stabilized prosthetic insert; And
Figure 17 is the elevational perspective view of exemplary MITKA posterior stabilized prosthetic device.
Detailed description of the invention
The following describes and explain and exemplary embodiment of the present invention is described, so that the interior method introducing moment of the prosthetic joint being included in implantation, and containing introducing the implantable prosthesis joint of moment.Certainly, for those skilled in the art, preferred embodiment described below is exemplary in itself, and re-starts repacking when not departing from the scope of the invention and spirit.But in order to clear and accurately, the exemplary embodiment discussed below can comprise those skilled in the art should think optional step, method and the feature that whether must fall in the scope of the invention.
The law of basic major control machinery is from Newton's law: (A) each object under at the uniform velocity state is tending towards keeping this kinestate, unless external force is applied on it; (B) pass between quality m, its acceleration a and exerted forces F of object is F=ma; And (C) exists equal to opposite effect power for each active force.Described mechanical law is suitable for the external force being applied to system, but when the power in plane is applied on the object with ability movement, and if when applied force is larger than resistance (gravity, frictional force etc.), object is mobile by starting.Complete in knee bends process, be no matter walking in paces or in the degree of depth is bending, the ligamentum cruciatum of natural knee forces tibia in inward turning, props femur relative to tibia.Confirm that disappearance ligamentum cruciatum causes axial rotation to reduce.
For total knee replacement (TKA) prosthese, can apply three main power thereon: (1) applied force, this power produces by striding across kneed muscle; (2) the bearing surface contact power produced between the femur and tibia at contact point place and between the femur and Patella at contact point place; And the restraining forces that (3) are produced by the ligament of opposing active force.But the generation of the usual axial rotation of knee prostheses and magnitude mode control by introducing moment arm, and only introduce rotation by introducing relative to the moment arm of the caused rotation of power.In exemplary system, vectorial V has distance D, and wherein position is by the starting point P of vectorial V.Vector V has the feature of following equation about the moment M of a P: equation #1:M=RxV; Wherein R is the position vector from a P to the second point along vectorial V.
Before torque analysis is carried out for any TKA prosthese, the understanding determined and understand the magnitude acted on knee and direction should be known.Most effectual way for muscle of deriving, area supported and ligament forces simultaneously passes through mathematical modeling technique.Verified, under correct understanding knee mechanism, the equation determining intravital power may be derived.Although know that the strength level being applied to knee is important, determine that the direction that these apply power is of equal importance.The moment guaranteed around institute's reconnaissance is correctly sued for peace by the correct direction acting on the contact force at strand shin and plate-like bone interface place.Therefore, to determine on femur with the velocity attitude of the point of tibia contact (some FT) it is important, the described direction of the bearing surface contact power determining to occur between FT and TF that will allow, some TF is the point contacted with femur on tibia.
In natural knee, such to any mechanical system with any two objects being in contact, three possible situations can occur, and it causes the situation different greatly at contact point place between two objects.These three kinds of situations are: (1) pure rolling; (2) simple sliding; And the combination that (3) are rotated and slided.
With reference to Fig. 1, exemplary free body diagram 100 comprises the cylinder (main body A) 102 with radius R, and this cylinder 102 moves relative to the usually smooth platform (main body B) 104 be fixed in Newtonian reference system.In this simple example, limit two referentials for each object 102,104, wherein " A > " and " B > " direction is the opposite direction of gravity.Contact point between object 102,104 is limited mutually by two points: the some AB on the platform 104 and some BA on cylinder 102.Three other P1, P2, P3 are around the side face spaced at equal intervals of cylinder 102, and wherein longitudinal center is limited by a BO.Point P1 on A1 > direction and on A2 > direction with a BA spacing distance R.Point P2 on-A1 > direction and on-A2 > direction with a BA spacing distance R.Point P3 on A2 > direction with a BA spacing distance 2R.
Under pure rolling condition, we can suppose velocity vector V_BO_A=A1 >, wherein: radius R=1; And cylinder equals-A3 > relative to platform referential around the angular velocity omega of A3 > axis.So can utilize equation #2-#5 to determine a speed of P1, P2, P3 and BO:
Equation #2:V_P1_A >=V_BO_A >+ω _ B_A > xP_BO_P1 >
V_P1_A＞＝A1＞+-A3＞xA1＞
V_P1_A＞＝A1＞+-A2＞
Equation #3:V_BA_A >=V_BO_A >+ω _ B_A > xP_BO_BA >
V_BA_A＞＝A1＞+-A3＞x-A2＞
V_BA_A＞＝A1＞-A1＞＝0＞
Equation #4:V_P2_A >=A1 >+A2 >
Equation #5:V_P3_A >=2A1 >
Therefore, under pure rolling state, the speed of some BA must equal the speed of an AB.Be " fixing " due to platform 104 and do not move in Newtonian reference system that platform has a little null speed.This simple analysis illustrates that speed cylinder 102 being put BA under pure rolling state equals zero.
Under simple sliding condition, the speed being suitable for this identical systems is in FIG different for the every bit along cylinder 102.The simple practical ways of sliding of description is the automobile on ice.If coefficient of friction equals zero, tire will rotate, but maintenance is stablized by automobile.Therefore, in knee, under simple sliding state, V_BO_A=0 >, and be similar to example shown in FIG, radius R=1, ω=-A3 >.So can utilize equation #6-#9 to determine a speed of P1, P2 and P3:
Equation #6:V_P1_A >=V_BO_A >+ω _ B_A > xP_BO_P1 >
V_P1_A＞＝0＞+-A3＞xA1＞
V_P1_A＞＝-A2＞
Equation #7:V_BA_A >=V_BO_A >+ω _ B_A > xP_BO_BA >
V_BA_A＞＝0＞+-A3＞x-A2＞
V_BA_A＞＝-A1＞
Equation #8:V_P2_A >=A2 >
Equation #9:V_P3_A >=A1 >
Therefore, under simple sliding state, the speed of some BA equals-A1 >, and velocity attitude is contrary with the direction of the rear portion femoral rollback of condyle of femur in knee.Although supposed that the velocity vector of contact point between condyle of femur and tibia highland will in a rearward direction in simple sliding process, the correct direction of velocity vector has been in forward direction and has been in backward directions in stretching process in BENDING PROCESS.Although described pure rolling and simple sliding, when can suppose in vivo, " only having " pure rolling or " only having " simple sliding state can not occur.
With reference to Fig. 2, the side face distance 200 of femoral prosthesis condyle 202 can be represented by smooth line 204.Under pure rolling state, femoral prosthesis condyle 202 is only advanced along the path of flat line 204, and the distance in this path is larger than the front/rear size of tibial prosthetic insert (not shown).Former analysis to confirm that for natural knee the amount of seesawing can in the scope between 10 to 25 millimeters for lateral condyle, and for TKA prosthese, and this motion can in forward direction 10 millimeters or 15 millimeters backward.Like this, in TKA prosthese, the motion at first that the contact point place between condyle of femur 202 and tibia insert occurs is slided.
Referring again to Fig. 1, can carry out analyzing determining when exist simultaneously slide and rotate time on cylinder 102 in the speed at BA, AB place, area supported interface.In this analysis, we can suppose V_BO_A=A1 >, radius R=1, and cylindrical angular velocity omega=-2A3 >.Therefore equation #10-#13 can be utilized determine a speed of P1, P2, P3 and BA:
Equation #10:V_P1_A >=V_BO_A >+ω _ B_A > xP_BO_P1 >
V_P1_A＞＝A1＞+-2A3＞xA1＞
V_P1_A＞＝A1＞-2A2＞
Equation #11:V_BA_A >=V_BO_A >+ω _ B_A > xP_BO_BA >
V_BA_A＞＝A1＞+-2A3＞x-A2＞
V_BA_A＞＝A1＞-2A1＞＝-A1＞
Equation #12:V_P2_A >=A1 >+2A2 >
Equation #13:V_P3_A >=A1 >+2A2 >=3A2 >
In all three kinds of situations (slide, rotate or combination), an important information is the speed of a BA.In pure rolling process, the speed of some BA equals zero, but in our example, when simple sliding and rotation and slip combination, this speed is not equal to zero.In simple sliding, the direction of speed BA is on the direction of-A1 >, contrary with the direction of the rear portion femoral rollback of condyle of femur, when rotating and sliding combination, in our example, the direction of this velocity vector V_BA_N > is on the direction of-A1 >, and the direction of this V_BA_N > is same contrary with the direction of the contact point BA on AB.The magnitude of V_BA_N > can change along with the speed of BO in Newtonian reference system and the angular velocity of main body B, but described magnitude is always on the direction of-A1 >.Therefore, assuming that it is disadvantageous that the power acting on the BA point place on AB in knee bends process designs full knee joint transposing prosthesis on the direction of A1 > (backward directions).On the contrary, on-A1 > direction applying power should to be designed in knee bends process and in knee extension process, on A1 > direction, applies the full knee joint transposing prosthesis of power, be similar to the velocity vector direction acting on this some place.In addition, be to be further noted that the speed of contact point BA in pure rolling situation in BENDING PROCESS equals zero, and in simple sliding situation the speed of contact point BA in forward direction (-A1 >).Therefore, in knee bends process, V_BA_N > is not in backward directions.
Current, all known TKA prostheses contact point place be disposed between femoral component and tibial component carries out equalization to power and distributes.Therefore, these TKA prostheses do not introduce the moment for generation of axial rotation.In surgical procedures, the object of surgeon is the gap in order to produce same isostension between condyle of femur and tibia insert/highland.If the strength acted between medial condyle and tibia insert equals the power acted between lateral condyle and tibia insert, the distance that it is expected to due to medial condyle and lateral condyle distance tibia insert center is also identical, and so femoral component can not obtain the axial rotation relative to tibia insert.If two masterpieces are used in system, and two power are identical in magnitude, and the moment arm be applied to these power from fixing point is equal, and so the moment of this system will equal zero.
With reference to Fig. 3, heavy burden mobilizable TKA prosthese 300 of common posterior stabilization provides five main contact forces: (1) (F in the vertical direction n m) on medial condyle power 302; (2) direction (F in a front/back t m) on medial condyle power 304; (3) (F in the vertical direction n l) on lateral condyle power 306; (2) direction (F in a front/back t l) on lateral condyle power 308; And (5) are applied to the power 310 (Fp) on post by cam.Point O represents the run-on point of polyethylene insert 312 relative to tibia implant (not shown), sues for peace around it to moment.Also comprise the distance r between an O to medial condyle contact force 1and the distance r between some O to lateral condyle 2.
If carry out moment summation around an O to the movable TKA prosthese 300 of heavy burden on T3 > (perpendicular to T1 > and T2 > direction), represent moment equation by equation #14:
Equation #14: ∑ MoT3 >=1 α T3 >
We can suppose that the angular acceleration (α) that polyethylene insert 312 implants parts relative to tibia on T3 > direction can be ignored, and can be set as equalling zero.Therefore, this hypothesis substituted into, equation #14 is simplified to equation #15:
Equation #15: ∑ Mo=0 on T3 > direction.
∑Mo·T3＞＝-r 1·T2＞xF T M·T1＞+r 2·T2＞xF T L·T1＞
Wherein know following information, distance r 1=r 2=r, and power F m=F l=F, equation #15 can be simplified to equation #16 further:
Equation #16: ∑ MoT3 >=-rF (-T3 >)+rF (-T3 >),
∑Mo·T3＞＝0。
As shown in by equation #16, if the distance r from the run-on point O of the movable TKA prosthese 300 that bears a heavy burden to inner side and outer side condyle 1, r 2identical, moment and equalling zero.Like this, polyethylene insert 312 does not rotate around tibial component.The In vivo analysis of movable TKA prosthese 300 of bearing a heavy burden proves that the object of 7/9 stands to be less than the axial rotation of 2.0 degree.
With reference to Fig. 4, the fixing TKA prosthese 400 of common heavy burden comprises and is fixed to the tibia insert 402 (being generally polyethylene) that tibia implants parts (be generally metal tibial dish, not shown its).The TKA prosthese 300 of the movable posterior stabilization of the heavy burden unlike Fig. 3, tibia insert 402 is fixed to tibia and implants parts, and such insert is not implanted parts relative to tibia and rotated.Act on the power of bearing a heavy burden on fixing posterior stabilization insert 402 and be similar to those power that the TKA prosthese 300 of the movable posterior stabilization of the heavy burden of Fig. 3 is limited.
The moment of bearing a heavy burden on fixing polyethylene insert 402 that acts on around qualified point O can be sued for peace.Main Differences between Fig. 4 point O and Fig. 3 point O is the selected some O run-on point not in representative graph 4, but the fixed physical point on the tibia insert 402 at Shang Zhu center, T2 > direction.Represent that the moment around an O is sued for peace by equation #14:
Equation #14: ∑ MoT3 >=I α T3 >
Be similar to the movable TKA prosthese 300 of heavy burden of Fig. 3, we can suppose that the angular acceleration (α) of femur relative to tibia insert 402 on T3 > direction is little, and can be set as equalling zero.Therefore, this hypothesis substituted into, equation #14 is simplified to equation #15:
Equation #15: ∑ Mo=0 on T3 > direction.
∑Mo·T3＞＝-r 1·T2＞xF T M·T1＞+r 2·T2＞xF T L·T1＞
Wherein know following information, distance r 1=r 2=r, and power F m=F l=F, equation #15 can be simplified to equation #16 further:
Equation #16: ∑ MoT3 >=-rF (-T3 >)+rF (-T3 >)
∑Mo·T3＞＝0。
As fruit polyethylene post 404 is positioned at the center of tibia insert 402 on T1 > and T2 > direction, so for the contact force be applied to by femoral component on tibia insert, the moment on T3 > direction and equalling zero.TKA prosthese analysis in vivo in the past determines that all TKA prostheses obtain the axial rotation fewer than natural knee, and most of TKA receptor can obtain the finally kneed axial rotation be less than twice, and these receptors of about 1/3 stand the axial rotation pattern contrary with natural knee.
With reference to Fig. 5, rear cross keeps TKA prosthese 500 (no matter being bear a heavy burden movable or bear a heavy burden fixing) to allow posterior cruciate ligament to keep, and there is not the cam/post mechanism 404 existed in the TKA prosthese 400 of the posterior stabilization of Fig. 4.Those the analysis that cam/post mechanism causes being very similar to the described TKA prosthese to posterior stabilization is lacked in rear cross maintenance TKA prosthese 500.Because the cam/post mechanism being suitable for the TKA prosthese of current posterior stabilization is in the center of tibia insert, cam/post power does not apply moment.Therefore, when cam/post mechanism does not introduce rotation, except the resistance of posterior cruciate ligament, torque analysis for the movable posterior cruciate TKA500 that bears a heavy burden will be similar to the torque analysis of movable posterior stabilization TKA prosthese 300 (see Fig. 3), and will be similar to for the torque analysis of heavy burden fixed rear portion cross TKA500 the torque analysis that fixed rear portion stablizes TKA prosthese 400 (see Fig. 4).In other words, retain for TKA prosthese 500 for these posterior cruciate ligaments, moment and equalling zero for the contact force be applied to by femoral component on tibia insert.
With reference to Fig. 6, bear a heavy burden total knee replacement (MITKA) prosthetic insert 600 of movable introducing moment of exemplary posterior stabilization is fixed to prosthese tibial post 606, and this prosthese tibial post 606 is preferably implanted in patient's tibia (not shown).Insert 600 is included side upwards from the post 602 that the anterior posterior midline 608 of insert 600 offsets, there is provided the rotation axis 605 between insert and femoral component (not shown) and the rotation axis between tibial post 606 and insert 600 604, rotation axis 604 upwards offsets from anterior posterior midline 608 in outside.
With reference to Fig. 7, the torque analysis of exemplary MITKA prosthetic insert 600 comprises around the moment summation of run-on point O on T3 > direction.Moment equation is represented by equation #17:
Equation #17: ∑ MoT3 >=-r 1t2 > xF t mt1 >-r 3t2 > xF pt1 >+r 2t2 > xF t lt1 >
Wherein know following information, distance r 1=2r, r 2=r 3=r, and power F t m=F t l=F, equation #17 can be simplified to equation #18 further:
Equation #18: ∑ MoT3 >=-2rF (-T3 >)-rF (-T3 >)+rF (-T3 >)
∑Mo·T3＞＝2rF·T3＞+rF·T3＞-rF·T3＞
∑Mo·T3＞＝2rF·T3＞
In the summation of this exemplary moment, the moment introduced by exemplary MITKA prosthetic insert 600 equals 2rF, its usual axial rotation causing tibia insert (to be looked down) in the clockwise direction.
Unlike the TKA prosthese 300 (such as seeing Fig. 3) of movable posterior stabilization of bearing a heavy burden at present, as following result be suitable for the tibia insert 600 of MITKA will in the clockwise direction (looking down) rotate, namely produce the distance of run-on point O to tibia insert 600 (by r 3the distance represented), increase from run-on point O to medial condyle contact force F t m(by r 1represent distance) distance, and reduce from run-on point O to lateral condyle contact force F t l(by r 2the distance represented) distance, allow lateral condyle to be similar to natural knee sample and to move more backward.
The side-play amount produced between post 602 and the run-on point O of MITKA prosthetic insert 600 causes tibia insert to increase relative to the axial rotation on tibia implantation parts (not shown) in the clockwise direction (T3 > direction).The strength (see Fig. 8) depending on patient weight, knee balanced degree and be applied to by cam on post, exemplary mathematical model determination post 602 offsets 3 millimeters in the inward direction from the centrage inward-outward direction and run-on point O offsets 3 millimeters of usual axial rotation causing 5 to 13 to spend in an outward direction from the centrage inward-outward direction.Utilize exemplary mathematical model to carry out the second analysis, its center pillar 602 offsets 6 millimeters in the inward direction, and run-on point O offsets 6 millimeters in an outward direction.The strength depending on patient weight, knee balanced degree equally and be applied to by cam on post, the usual axial rotation of this analysis result display polyethylene insert is increased to the scope of 10 to 22 degree.3rd analyzes, and its center pillar 602 offsets 10 millimeters in the inward direction and run-on point O offsets 10 millimeters of usual axial rotation causing polyethylene insert in the clockwise direction within the scope of 20 to 35 degree in an outward direction.In the larger skew inwardly and on outward direction also within the scope of the invention, such as inwardly nonrestrictive or skew 0.01 to 20 millimeters laterally.
With reference to Fig. 9, bear a heavy burden total knee replacement (MITKA) prosthetic insert 900 of fixing introducing moment of exemplary posterior stabilization according to the present invention comprises in an outward direction from cam/post mechanism 902 that center 904 inside and outside tibia insert offsets.Be appreciated that the respective cams of femoral component also can offset in an outward direction to coordinate the tibial post of skew.
With reference to Figure 10, the torque analysis that PSMITKA prosthese 900 is fixed in exemplary heavy burden comprises sues for peace to the moment around run-on point O on T3 > direction.Moment equation is represented by equation #19:
Equation #19: ∑ MoT3 >=-r1T2 > xF t mt1 >+r2T2 > xF t lt1 >
Wherein know following information, distance r1=2r, r2=r, and power F t m=F t l=F, equation #19 can be simplified to equation #20 further:
Equation #20: ∑ MoT3 >=-2rF (-T3 >)+rF (-T3 >)
∑Mo·T3＞＝2rF·T3＞-rF·T3＞
∑Mo·T3＞＝rF·T3＞
In the summation of this exemplary moment, the moment introduced by exemplary MITKA prosthetic insert 900 equals 2rF, its usual axial rotation causing femur (to be looked down) in the clockwise direction relative to tibia insert.
The side-play amount produced between post 902 and the run-on point O of MITKA prosthetic insert 900 causes tibia insert to increase relative to the axial rotation on tibia implantation parts (not shown) in the clockwise direction (T3 > direction).The strength depending on patient weight, knee balanced degree and be applied to by cam on post, exemplary mathematical model determination post 902 offsets 3 millimeters in the inward direction from the centrage inward-outward direction and causes the rotation of femoral component within the scope of 2 to 8 degree.If post 902 offsets 6 millimeters in an outward direction, femoral component amount of spin be increased to 5 to 13 degree scopes, and if post 902 offset 10 millimeters in an outward direction, axial rotation amount be again increased to 9 to 25 spend scopes.In the larger skew inwardly and on outward direction also within the scope of the invention, such as inwardly nonrestrictive or skew 0.01 to 20 millimeters laterally.
As mentioned above, cam/post mechanism can be used in the TKA prosthese of posterior stabilization, to produce rotation by producing from run-on point to the moment arm of the movable TKA post that bears a heavy burden, or by making post offset laterally, increase to produce from post to the moment arm of medial condyle shearing force and rotate, mainly through skew run-on point and the adaptability set up between femoral radius and spill tibia insert radius and introduce moment.
With reference to Figure 11, exemplary MITKA posterior cruciate ligament according to the present invention retains medial condyle receivers 1104 and the lateral receiver 1106 that (PCR) heavy burden fixed fae body insert 1100 comprises medial condyle and the lateral condyle being suitable for holding femoral prosthesis (not shown) respectively.In order to make tibia insert 1100 clockwise (looking down) rotate, insert 1100 is included in the larger adaptability between medial condyle on inside tibia insert and medial condyle receivers 1104.In this one exemplary embodiment 1100, the radius of the radius ratio medial condyle of medial condyle receivers 1104 is large, allows front/rear translation occurs between medial condyle and medial condyle receivers.If the upper surface especially outside tibia insert 1100 is smooth or in convex shape situation, increase adaptability between medial condyle receivers 1104 and medial condyle causes the shearing force being applied to the increase on the medial condyle receivers of polyethylene insert by medial condyle, cause clockwise moment to produce, described smooth or convex shape coordinates with the more even shape of the lateral condyle being suitable for femoral prosthesis.
The run-on point 1202 (and rotation axis) utilizing contour line between insert 1200 and condyle of femur 1206,1208 to implant center 1204 movement of substrate (not shown) in an outward direction relative to tibia is comprised with reference to Figure 12 and Figure 13, the exemplary MITKA movable PCR prosthetic insert 1200 that bears a heavy burden.On outside, lateral receiver 1208 downward-sloping (see Figure 12 (b)) or the protrusion (see Figure 12 (c)) in the longitudinal direction of lateral femur condyle 1206 more smooth (being similar to the shape of dugout canoe) and tibia insert.On inner side, medial femoral condyle have with tibia insert 1200 inside on the larger adaptability of medial condyle receivers 1210.Therefore, when shearing force between condyle of femur and tibia insert increases, shear strength by larger on inner side and introduce rotating clockwise of tibia insert, reason is: (1) increases adaptability; And (2) are larger to the moment arm of lateral condyle power from run-on point to the moment arm of inboard shear power ratio from run-on point.
For total knee arthroplasty, for obtaining, to increase a main purpose bending of load-bearing be can in the ability of lateral condyle that rearward to move up.In normal knee, describedly can be realized by the axial rotation of two condyles or translation.But due in normal knee, medial condyle average movement in backward directions is no more than 10 millimeters, and this amount is less than 5 millimeters, and lateral condyle obtains back contacts by stock shin axial rotation.In MITKA, introduce moment, so normal axial rotation can occur, and lateral condyle can obtain the larger back contacts having and increase knee bends.The TKA of this moment introducing posterior stabilization more easily realizes, and cam/post power wherein can be used to drive the rotation clockwise or prop the power of medial condyle relative to post.Keep in TKA at posterior cruciate ligament, more relevant to the ability introducing moment.MITKA posterior cruciate ligament maintenance knee utilizes the increase adaptability between the medial condyle receivers of medial condyle and polyethylene insert.In addition, the bending radius being suitable for the increase of lateral condyle (dugout canoe shape) allows lateral condyle contact point mobile in the 1 of knee bends the degree in backward directions.Therefore, obtain with the object of lateral condyle back contacts by introducing moment and can keeping realizing in TKA at MITKA posterior cruciate ligament by the geometry changing condyle of femur by the knee bends increased.In like fashion, the rotation axis that MITKA bears a heavy burden between movable PCR prosthetic insert 1200 and femoral prosthesis can from the medial-lateral centerline of insert 1200 (and also CB) skew in the past, and the rotation axis that MITKA bears a heavy burden between movable PCR prosthetic insert 1200 and prosthetic tibial tray (not shown) simultaneously can offset from the medial-lateral centerline of insert 1200 (and also from the front-rear center line of insert 1200).
Although on the inner face of tibia polyethylene insert and more smooth lateral condyle, increase adaptability between medial condyle and container, keep being described the rear portion inclination of contact polyethylene insert or the outside of convex shape before this for TKA for posterior cruciate frame, these configuration features can be used in any TKA prosthesis type.Described configuration variation can be used to increase axial rotation in PSTKA type, and can be used in anterior and posterior cruciate ligament reservation TKA type to guarantee normal axial rotation.
In Exemplary prosthesis insert of the present invention, medial condyle can play an important role relative to the effective dose of the medial condyle receivers of tibia insert.Can play an important role in axial rotation, cause the said increase of axial rotation amount or the additive factors of minimizing be when surgical operation condyle balance.Be appreciated that, in the ligament balance process of inner side operation, the mathematical model of reference combines equal inner side and outer side condyle curved slot and causes medial condyle contact force to equal lateral condyle contact force in aforementioned discussion.If medial condyle contact force is greater than lateral condyle contact force, those values that normal axial amount of spin will increase above by the mathematical model prediction of described reference.On the contrary, if lateral condyle contact force is greater than medial condyle contact force, axial rotation amount is by by below those values of model prediction.
With reference to Figure 14, exemplary MITKA posterior cruciate ligament reservation TKA prosthese comprises the increase adaptability between the medial condyle receivers of medial condyle and tibia insert (polyethylene), to introduce the clockwise moment (normal axial rotation) (see Figure 14 (a) and (b)) of femur relative to tibia.In addition, owing to causing the contact position Rapid Variable Design from full extension to 30 degree of knee bends in the more smooth condyle geometry at full extension place, lateral condyle will obtain larger rear motion.This rear portion change being suitable for the contact position of lateral condyle can be assisted further by the convex shape (see Figure 14 (e) and (f)) of the increase rear portion gradient of polyethylene insert (see Figure 14 (c) and (d)) or polyethylene insert.
With reference to Figure 15, all cams/post mechanism in current TKA prosthese 1400 comprises flat surfaces.These flat surfaces cause hypothesis contact area comparatively greatly, can be applied to stress less on post 1404 thus by cam 1402.Unfortunately, if femoral component (cam) 1402 produces relative to tibia insert (post) 1404 and rotates in the stable TKA prosthese of heavy burden fixed rear portion, be oppositely correct, and the contact area 1406 between femoral cam and tibial post become very little.The factor that between smooth cam 1402 on the smooth post of major effect 1404, contact area reduces is edge loading, causes heavily stressed, the described heavily stressed tibia insert premature failure caused at post place.
With reference to Figure 16 and Figure 17, the TKA prosthetic appliance 1500 according to exemplary MITKA posterior stabilization of the present invention comprises the tibia insert 1502 with tibial post 1504, and tibial post 1504 has circular posterior face 1506.The rounded back section surface 1506 of this post 1502 is suitable for interacting with the circular femoral cam 1508 of femoral prosthesis parts 1510.The radius R and the circular cam 1508 that are suitable for the rounded back section surface 1506 of post 1504 are similar, but the selected radius R being suitable for the stable prosthetic appliance 1500 of MITKA heavy burden fixed rear portion will depend on desired amount of spin.If the prosthetic appliance 1500 of MITKA posterior stabilization is configured to comprise minimum stock shin axial rotation, if the value being suitable for R that the prosthetic appliance 1500 than MITKA posterior stabilization is arranged to be suitable for larger axial rotation by the value being so suitable for R is higher.
Utilize although aforementioned the tibial component with integral post (being suitable for contacting with the cam interface of femoral prosthesis parts) to explain the prosthese of the MITKA posterior stabilization expressing plasticity, post has been incorporated in femoral component and cam is incorporated into tibia insert and also fall within the scope of the present invention.Utilized the tibial component with integral post (being suitable for and the cavity interracial contact in tibia insert) to explain the prosthese expressing plasticity although aforementioned, but be incorporated in tibia insert by post and also fall within the scope of the present invention, wherein said post is by the cavity that is correspondingly contained in tibia implant.
Although explain that clear preceding example MITKA bears a heavy burden movable POR prosthese by offset pillars between insert and tibial component and run-on point, should be appreciated that those skilled in the art only can make post offset or only make run-on point offset to produce moment described herein.Although the run-on point between insert and tibial component (dish) will offset with anterior posterior midline, one exemplary embodiment will comprise POR prosthetic appliance, and this prosthetic appliance has the post along anterior posterior midline alignment.On the contrary, although post will offset with anterior posterior midline, exemplary POR prosthetic appliance can have the run-on point along anterior posterior midline alignment.
In addition, the contact point of post or run-on point are offset forward or backward also fall within the scope of the present invention.The movable knee prostheses insert of heavy burden of prior art always has along anterior posterior midline and the run-on point that centers along front and back center line.By contact point or the run-on point of the Centre position deviation post from prior art, if the contact point of post and run-on point disalignment, then introduce moment.
Those skilled in the art will readily appreciate that exemplary inserts of the present invention is applicable to comprise the prosthetic knee joints of tibia and femoral component.One exemplary embodiment of the present invention can containing or replaceable many tibia implant and femoral implant can not all list.
Sum up from described description and invention, although those skilled in the art should understand that method and apparatus described here forms one exemplary embodiment of the present invention, but the present invention being included in this is not limited to this exact embodiment, and can change described embodiment without departing from the present invention, wherein invention scope is limited by claim.In addition, should be appreciated that the present invention be defined by the claims and this not intention will be incorporated as to describe at this and that example embodiment proposes require arbitrarily any restriction or the parts of parts, unless clearly set forth this restriction or parts to explain.Be understandable that in addition, even if described advantage is not clearly discussed at this, but because the present invention is defined by the claims, and because intrinsic and/or unforeseen advantage of the present invention can exist, so there is no necessity and meet disclosed herein to fall into the clear and definite advantage of the present invention in any right or object.

Claims (38)

1. a tibial prosthetic insert, comprising:
Bear a heavy burden mobilizable tibial tray insert, described heavy burden mobilizable tibial tray insert comprises the isolated medial condyle with lateral condyle receiver, the mobilizable tibial tray insert of described heavy burden also comprises stability column, wherein said heavy burden mobilizable tibial tray insert is suitable for around a substantially vertical rotation axis rotation, described substantially vertical rotation axis offsets laterally from stability column, described substantially vertical rotation axis from described heavy burden mobilizable tibial tray insert-outer centrage offsets laterally, described stability column from described heavy burden mobilizable tibial tray insert-outer centrage offsets to the inside.
2. tibial prosthetic insert according to claim 1, wherein:
Described rotation axis is from the anterior-posterior centrage biased forwards of the mobilizable tibial tray insert of described heavy burden.
3. tibial prosthetic insert according to claim 1, wherein:
Described rotation axis offsets backward from the anterior-posterior centrage of the mobilizable tibial tray insert of described heavy burden.
4. according to the tibial prosthetic insert described in claim 1, wherein:
Described stability column from described heavy burden mobilizable tibial tray insert-outer centrage offsets about 0.1 millimeter to about 20 millimeters to the inside.
5. tibial prosthetic insert according to claim 1, wherein:
Described stability column offsets about 0.01 millimeter to about 20 millimeters to the inside relative to described substantially vertical rotation axis.
6. according to the tibial prosthetic insert described in claim 1, wherein:
Described lateral condyle receiver comprises convex shape or at least one shape from front to back in continuous tilt shape; And described medial condyle has the concave shape of the protrusion medial condyle for holding femoral prosthesis.
7. according to the tibial prosthetic insert described in claim 1, wherein:
The rear of described stability column is circular.
8. according to the tibial prosthetic insert described in claim 1, wherein:
Described stability column is from the anterior-posterior centrage biased forwards of the mobilizable tibial tray insert of described heavy burden.
9. according to the tibial prosthetic insert described in claim 1, wherein:
Described stability column offsets backward from the anterior-posterior centrage of the mobilizable tibial tray insert of described heavy burden.
10., according to the tibial prosthetic insert described in claim 1, also comprise:
Be suitable for the tibial tray being operatively coupled to the mobilizable tibia insert of described heavy burden, wherein said heavy burden mobilizable tibial tray insert rotates around described substantially vertical rotation axis relative to described tibial tray.
11. tibial prosthetic insert according to claim 10, wherein:
The mobilizable tibial tray insert of described heavy burden comprises the recess being suitable for holding the ridge protruded from prosthetic tibial tray implant, and the mobilizable tibial tray insert of described heavy burden can rotate relative to prosthetic tibial tray implant around it.
12. tibial prosthetic insert according to claim 10, wherein:
Described heavy burden mobilizable tibial tray insert comprises the ridge being suitable for being held by the recess of described prosthetic tibial tray implant, and the mobilizable tibial tray insert of described heavy burden can rotate relative to prosthetic tibial tray implant around it.
13. tibial prosthetic insert according to claim 10, wherein:
Described substantially vertical rotation axis from described heavy burden mobilizable tibial tray insert-outer centrage offsets laterally.
14. tibial prosthetic insert according to claim 10, wherein:
Described rotation axis is from the anterior-posterior centrage biased forwards of the mobilizable tibial tray insert of described heavy burden.
15. tibial prosthetic insert according to claim 10, wherein:
Described rotation axis offsets backward from the anterior-posterior centrage of the mobilizable tibial tray insert of described heavy burden.
16. tibial prosthetic insert according to claim 10, wherein:
Described stability column from described heavy burden mobilizable tibial tray insert-outer centrage offsets about 0.1 millimeter to about 20 millimeters to the inside.
17. tibial prosthetic insert according to claim 10, wherein:
Described stability column offsets about 0.01 millimeter to about 20 millimeters to the inside relative to described substantially vertical rotation axis.
18. tibial prosthetic insert according to claim 10, wherein:
Described lateral condyle receiver comprises convex shape or at least one shape from front to back continuously in rake shape; And
Described medial condyle comprises the concave shape of the protrusion entocondyle for holding femoral prosthesis.
19. tibial prosthetic insert according to claim 10, wherein: the rear of described stability column is circular.
20. tibial prosthetic insert according to claim 10, wherein:
Described stability column is from the anterior-posterior centrage biased forwards of the mobilizable tibial tray insert of described heavy burden.
21. tibial prosthetic insert according to claim 10, wherein:
Described stability column offsets backward from the anterior-posterior centrage of the mobilizable tibial tray insert of described heavy burden.
22. tibial prosthetic insert according to claim 10, also comprise:
Femoral component, described femoral component comprises medial condyle and lateral condyle.
23. tibial prosthetic insert according to claim 22, wherein:
Described heavy burden mobilizable tibial tray insert rotates around a rotation axis relative to described femoral component; And
Described rotation axis and described substantially vertical rotation axis depart from.
24. tibial prosthetic insert according to claim 23, wherein:
Described rotation axis from described heavy burden mobilizable tibial tray insert-outer centrage offsets laterally.
25. tibial prosthetic insert according to claim 23, wherein:
Described lateral condyle receiver comprises convex shape or at least one shape from front to back in inclined in two-way shape; And
Described medial condyle comprises the concave shape of the convex interior condyle for holding femoral prosthesis.
26. tibial prosthetic insert according to claim 22, wherein:
Described femoral component comprises the cam be placed on described stability column, and wherein said cam moves with the shifted matching with described stability column; And
Circular by the rear of the described stability column of described cam contact.
27. tibial prosthetic insert according to claim 22, wherein:
The mobilizable tibial tray insert of described heavy burden comprises the recess being suitable for holding the ridge protruded from prosthetic tibial tray implant, and the mobilizable tibial tray insert of described heavy burden can rotate relative to prosthetic tibial tray implant around it.
28. tibial prosthetic insert according to claim 22, wherein:
Described heavy burden mobilizable tibial tray insert comprises the ridge being suitable for being held by the recess of described prosthetic tibial tray implant, and the mobilizable tibial tray insert of described heavy burden can rotate relative to prosthetic tibial tray implant around it.
29. tibial prosthetic insert according to claim 22, wherein:
Described substantially vertical rotation axis from described heavy burden mobilizable tibial tray insert-outer centrage offsets laterally.
30. tibial prosthetic insert according to claim 22, wherein:
Described rotation axis is from the anterior-posterior centrage biased forwards of the mobilizable tibial tray insert of described heavy burden.
31. tibial prosthetic insert according to claim 22, wherein:
Described rotation axis offsets backward from the anterior-posterior centrage of the mobilizable tibial tray insert of described heavy burden.
32. tibial prosthetic insert according to claim 22, wherein:
Described stability column from described heavy burden mobilizable tibial tray insert-outer centrage offset to the inside about 0.1 milli art to about 20 millimeters.
33. tibial prosthetic insert according to claim 22, wherein:
Described stability column offsets approximately relative to described substantially vertical rotation axis to the inside: 0.01 millimeter to about 20 millimeters.
34. tibial prosthetic insert according to claim 22, wherein:
Described lateral condyle receiver comprises convex shape or at least one shape from front to back in continuous tilt shape; And
Described medial condyle comprises the concave shape of the protrusion entocondyle for holding femoral prosthesis.
35. tibial prosthetic insert according to claim 22, wherein:
The rear of described stability column is circular.
36. tibial prosthetic insert according to claim 22, wherein:
Described stability column is from the anterior-posterior centrage biased forwards of the mobilizable tibial tray insert of described heavy burden.
37. tibial prosthetic insert according to claim 22, wherein:
Described stability column offsets backward from the anterior-posterior centrage of the mobilizable tibial tray insert of described heavy burden.
38. tibial prosthetic insert according to claim 22, wherein: the rear of described stability column is circular.
CN201410410460.1A 2006-03-21 2006-03-21 Introduce the total joint replacement prosthese of torque Active CN104207863B (en)

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US5639279A (en) * 1995-02-09 1997-06-17 Intermedics Orthopedics, Inc. Posteriorly-stabilized prosthetic knee
US6039764A (en) * 1997-08-18 2000-03-21 Arch Development Corporation Prosthetic knee with adjusted center of internal/external rotation
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US20050197710A1 (en) * 2004-02-26 2005-09-08 Hjs Gelenk System Gmbh Tibia plateau for a replacement joint

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US5413604A (en) * 1992-12-24 1995-05-09 Osteonics Corp. Prosthetic knee implant for an anterior cruciate ligament deficient total knee replacement
US5639279A (en) * 1995-02-09 1997-06-17 Intermedics Orthopedics, Inc. Posteriorly-stabilized prosthetic knee
US6039764A (en) * 1997-08-18 2000-03-21 Arch Development Corporation Prosthetic knee with adjusted center of internal/external rotation
US6299646B1 (en) * 1997-09-23 2001-10-09 Tornier Sa Knee prosthesis with a rotational plate
US20050197710A1 (en) * 2004-02-26 2005-09-08 Hjs Gelenk System Gmbh Tibia plateau for a replacement joint

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN104814815A (en) * 2015-05-22 2015-08-05 北京爱康宜诚医疗器材股份有限公司 Bone joint prosthesis

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