DE2933174A1 - Implantat fuer einen teilweisen ersatz einer gleitflaeche eines menschlichen gelenkes - Google Patents
Implantat fuer einen teilweisen ersatz einer gleitflaeche eines menschlichen gelenkesInfo
- Publication number
- DE2933174A1 DE2933174A1 DE19792933174 DE2933174A DE2933174A1 DE 2933174 A1 DE2933174 A1 DE 2933174A1 DE 19792933174 DE19792933174 DE 19792933174 DE 2933174 A DE2933174 A DE 2933174A DE 2933174 A1 DE2933174 A1 DE 2933174A1
- Authority
- DE
- Germany
- Prior art keywords
- partial
- implants
- implant according
- implant
- sliding surface
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Pending
Links
Classifications
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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
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30756—Cartilage endoprostheses
-
- A—HUMAN NECESSITIES
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/32—Joints for the hip
-
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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-
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
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- A61F2/36—Femoral heads ; Femoral endoprostheses
- A61F2/3601—Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices
- A61F2/3603—Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices implanted without ablation of the whole natural femoral head
-
- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0642—Surgical staples, i.e. penetrating the tissue for bones, e.g. for osteosynthesis or connecting tendon to bone
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0647—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks
-
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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- 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
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
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-
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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Landscapes
- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (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)
- Rheumatology (AREA)
- Physical Education & Sports Medicine (AREA)
- Prostheses (AREA)
Description
- Implantat für einen teilweisen Ersatz einer Gleitfläche
- eines menschlichen Gelenkes Die Erfindung betrifft ein Implantat gemäss Oberbegriff von Anspruch 1.
- In neuerer Zeit ist man bestrebt, bei Gelenkflächen, deren Knorpelschicht nur in Teilbereichen beschädigt oder zerstört ist, eine prothetische Versorgung nur in diesen Teilbereichen vorzunehmen. Dabei bereitet es oft Schwierigkeiten, das meist nagelartige, aus einem Verankerungszapfen und einem platten- oder scheibenartigen Kopf bestehende Implantat in Form und Grösse den Teilbereichen der Gelenkfläche anzupassen, in denen die Gleitfläche und insbesondere die Knorpelschicht ersetzt werden müssen.
- Aufgabe der Erfindung ist es daher, Implantate zu schaffen.
- mit denen ein teilweiser Ersatz in - in Form, Grösse und Lage - verschiedenen Bereichen der Gelenkflächen möglich ist. Diese Aufgabe wird erfindungsgemäss mit Hilfe der in Anspruch 1 genannten Merkmale gelöst. Die Teilimplantate der Erfindung erlauben es, mehrere, mit relativ kleinen plattenartigen Köpfen versehene Einzelelemente uihsterartig zusammenzusetzen, um eine dem zu ersetzenden Teilbereich der Gleitfläche des Gelenkes weitgehend angepasste prothetische Oberfläche praktisch beliebiger Form und Grösse zu erhalten; mit Hilfe ihrer Verankerungsmittel können die Teilimplantate auf einfache Weise durch Einschlagen oder Einschrauben in die kortikale und spongiose Schicht des Knochens fixiert werden.
- Die Teilimplantate können dabei mit ihrer plattenartigen Gleitfläche an die Verwendung in bestimmten Gelenken, beispielsweise in einer Hüftgelenkspfanne oder auf den Femur- kondylen, angepasst sein, wobei grössere Platten unter Umständen mit zwei oder mehr Verankerungszapfen ausgerüstet sind. Es ist jedoch auch möglich - falls eine Vielzahl von Teilimplantaten vorhanden ist -, kreisförmige oder elliptische Köpfe unterschiedlicher Grösse bei den einzelnen Teilimplantaten vorzusehen, oder diese als Polygone auszubilden, die mosaikartig zusammengesetzt werden.
- Als Werkstoff für das neue Implantat eignen sich alle bisher in der Implantat-Technik üblichen Materialien, wie Metalle, Metalllegierungen, Biokeramik, pyrolytischer Kohlenstoff und Kunststoff, insbesondere Polyäthylen der Qualitäten HDPE und UHMW.
- Nachfolgend wird die Erfindung anhand von Ausführungsbeispielen im Zusammenhang mit der Zeichnung näher erläutert.
- Fig. 1 zeigt schematisch in einer Aufsicht ein erfindungsgemässes Implantat für eine Hüftgelenkspfanne; Fig. 2 und 3 geben in einer Ansicht von rückwärts und von der Seite ein mehrteiliges Implantat für eine Femurkondyle wieder, wobei Fig. 3 teilweise im Schnitt dargestellt ist; Fig. 4 ist eine Aufsicht auf die Gelenkfläche des Tibiaknochens, die mit zwei unterschiedlichen Ausführungsformen des erfindungsgemässen Implantates versehen sind.
- Fig. 5 ist eine Ansicht eines mit einer Anzahl gleichgrosser Teilimplantate belegten Femurkondyle, während Fig. 6 in einem Ausschnitt aus Fig. 5 die Ansicht eines einzigen Teilimplantates in grösserem Massstab wiedergibt.
- Das Implantat nach Fig. 1, das dazu bestimmt ist, einen Teil der Gleitfläche einer Hüftgelenkspfanne 4 zu ersetzen, setzt sich aus drei einzelnen Teilimplantaten 1 bis 3 zusammen, die unterschiedliche Form und Grösse besitzen; die Teilimplantate sind so aufeinander abgestimmt, dass sie längs der äusseren seitlichen und oberen Bereiche der natürlichen, im Beckenknochen eingebetteten Hüftgelenkspfanne 4 eine praktisch geschlossene künstliche Gleitfläche für den nicht dargestellten Fernurkopf bilden. Jedes Teilimplantat 1- 3 hat als eigenes Verankerungsmittel mindestens einen Verankerungszapfen 5.
- Die in i. 2 und 3 gezeigten Teilimplantate 7 und 8 ersetzen einen Teil der Kondylenfläche eines Femurs 9; sie sind ebenfalls von unterschiedlicher Crösse, bestehen jedoch je aus einer, in ihrer Grundform im wesentlichen gleichartigen, rechteckigen Platte. Jede der Platten weist wiederum mindestens einen Verankerungszapfen 5 auf.
- Die linke Tibia-Gleitfläche 15 nach Fig. 4 ist mit in Form und Grösse gleichen Teilimplantaten 10 mit polygonförmigen Köpfen belegt, die so ineinander eingepasst sind, dass wieder eine praktisch geschlossene, künstliche Gleitfläche entsteht.
- Eine solche, in ihrer Wirkung einer geschlossenen rothesenschale entsprechende, künstliche Gleitfläche lässt sich auch mit zwei oder drei kreisförmigen Teilimplantaten 11 -13 unterschiedlichen Durchmessers erreichen, wie sie auf der rechten Gleitfläche 14 des Tibiaknochens schematisch angedeutet sind.
- Die Gleitfläche des Femurkopfes 21 nach Fig. 5 ist teilweise mit einer Anzahl Teilimplantaten 22 belegt, die, wie Fig. 6 verdeutlicht, eine leicht konvex gekrümmte äussere Oberfläche und kreisförmigen Querschnitt haben, und alle gleich gross sind.
- Alle genannten Teilimplantate werden mit Vorteil so ausgebildet, dass sie zementfrei oder zumindest zementarm in den entsprechenden Knochen eingeschlagen oder eingeschraubt werden. Sie stützen sich dann vorzugsweise auf der relativ dichten und harten, kortikalen Gewebeschicht ab, wie sie in den Fig. 3 und 5 angedeutet ist.
- Im Zusammenhang mit Fig. 6 sei daher ein besonders vorteilhaftes Ausführungsbeispiel für eine Verankerung eines Teilimplantates 22 beschrieben.
- Die Grundform eines Verankerungszapfens 24 besteht in einem dem Kopf des Teilimplantates 22 nahen Teil aus einem konischen Bereich 25, dessen Länge im wesentlichen der Dicke der Kortikalisschicht 26 des Knochens entspricht.
- An die konische Grundform schliesst sich dann zum freien Ende des Zapfens 24 hin ein Bereich 27 mit einer "zylindrischen" Grundform an, deren "erzeugende" Mantellinie parallel zu ihrer Längsachse verläuft. Die Grundform der Bereiche 25 und 27 kann dabei beliebigen Querschnitt aufweisen, also beispielsweise kreisrund, elliptisch oder polygonförmig, z. B. 3-, 4- oder mehr-eckig,sein; es sind dafür aber auch ovale oder andere, nicht einer einfachen geometrischen Fläche entsprechenden Querschnittsflächen denkbar.
- Im Bereich 25 trägt die konische Grundform eine relativ feine Verzahnung 28, die beim Einschlagen nur wenig in das kortikale Gewebe 26 eindringt, jedoch mit ihren feinen Zähnen in dieses Gewebe widerhakenartig eingreift, so dass ein Herauswandern aus dem Gewebe 26 entgegen der Einschlagrichtung sicher verhindert wird.
- Der Bereich 27 des Zapfens 24 ist bei eingeschlagenem Implantat in dem spongiösen Gewebe 29 verankert; er ist daher mit mindestens einem - im gezeigten Beispiel jedoch mehreren -zahnartigen Verdrängungskörper 30 versehen, deren Volumen vorteilhafterweise mindestens etwa 20 % des Volumens der zugehörigen Grundform 27 beträgt. Die Zähne 30 haben die Aufgabe, beim Einschlagen des Zapfens 24 spongiöses Gewebe zu verdrängen, das sich beispielsweise in komprimierter Form jeweils in der "Einkerbung" hinter dem vorausgehenden Zapfen 30 ablagert.
- Wie Fig. 6 erkennen lässt, ist der zylindrische Endbereich 27 an die Uebergangsstelle 31 gegenüber dem Konus 5 stufenförmig abgesetzt. Diese Stufe 11 hat den Zweck, den kleinsten Enddurchmesser des Konus 25 im wesentlichen mindestens so gross zu machen, dass die Verdrängungskörper 30 des zylindrischen Bereichs 27 die konische Crundformbohrung in der Kortikalis 26 beim Einschlagen praktisch frei, d.h. möglichst ohne kortikales Gewebe zu beschädigen, durchdringen.
- Die feine Verzahnung 28 hat, bezogen auf ihre konische Grundform 25, deren Länge mit Vorteil praktisch mit der Dicke der kortialen Gewebeschicht 26 übereinstimmt, ein relativ geringes Volumen, das vorteilhafterweise nur wenige Prozent des Grundformvolumens 25 beträgt. Die durch sie ausgelöste Gewerbeverdrängung in der Kortikalis 26 ist daher erheblich geringer als diejenige in der Spongiosa 29.
- Die Dichteunterschiede zwischen kortikalem und spongiösem Gewebe, die bekanntlich etwa 20 : 1 betragen, kann man in etwa bei der Bemessung der Volumina der Verdrängungskörper 28 und 30 berücksichtigen, wenn das Verhältnis dieser Volumina zueinander mindestens 1 : 10 oder kleiner ist.
- Bei der Verankerung der Teilimplantate wird nach Entfernen der beschädigten und daher zu ersetzenden Knorpelschicht zunächst mit Hilfe eines Formbohrers, der in Grösse und Form den Grundformen der beiden Zapfenbereiche entspricht, der Knochen angebohrt und anschliessend der Zapfen 24 eingeschlagen oder gegebenenfalls eingeschraubt. Die zahnartigen Verdrängungskörper 30 des in die Spongiosa eindringenden Zapfenbereichs 27 verdrängen dabei, wie erwähnt, aufgrund ihres gegenüber dem Volumen ihrer Grundform 27 relativ stark vergrösserten Volumens beim Einschlagen des Zapfens 24 relativ viel des die ausgebohrte Grundform 27 umgebenden Gewebes und verdichten dieses dabei, wodurch bekanntlich das Einwachsen des Zapfens 24 besileunigt undeerbessert wird. Wegen der grösseren Dichte der Kortikalis und des - bezogen auf das zugehörige Grundvolumen 25 - erheblich geringeren Volumens der im konischen Bereich 25 vorhandenen Feinverzahnung 28 ist dieser Effekt im kortikalen Gewebe wesentlich geringer.
Claims (7)
- Patentansprüche Implantat für einen mindestens teilweisen Ersatz einer zusammenhängenden Gleitfläche eines menschlichen Gelenkes, dadurch gekennzeichnet, dass mindestens zwei unabhängige, mit eigenen Verankerungsmitteln (5, 24) versehene, plattenartige Teilimplantate (1 - 3; 7, 8; 10; 11 - 13; 22) für wenigstens den teilweisen Ersatz der Knorpelschicht im betreffenden Gelenkbereich bestimmt sind.
- 2. Implantat nach Anspruch 1, dadurch gekennzeichnet, dass die Teilimplantate (1 - 3; 7, 8; 10; 11 - 13; 22) in Form und Grösse derart aufeinander abgestimmt sind, dass durch Zusammensetzen mindestens einiger von ihnen eine mindestens weitgehend lückenlose Abdeckung des zu ersetzenden, tragenden Teils der Gleitfläche erreicht wird.
- 3. Implantat nach Anspruch 2, dadurch gekennzeichnet, dass die einzelnen Teilimplantate (1 - 3; 7, 8; 10; 11 - 13; 22) Platten unterschiedlicher Form und/oder Grösse sind.
- 4. Implantat nach Anspruch 3, dadurch gekennzeichnet, dass die Teilimplantate (11 - 13) aus einer Anzahl Kreisscheiben unterschiedlichen Durchmessers bestehen.
- 5. Implantat nach Anspruch 3, dadurch gekennzeichnet, dass die Teilimplantate (1 - 3; 7, 8; 10) die Form von Vielecken haben.
- 6. Implantat nach Anspruch S, dadurch gekennzeichnet, dass die Ecken der Vielecke (1 - 3; 7, 8) abgerundet sind.
- 7. Implantat nach Anspruch 1, dadurch gekennzeichnet, dass die Verankerungszapfen (24) der Teilimplantate in einem ersten, dem plattenartigen Kopf (22) nahen, Bereich ihrer Länge eine konische Grundform (25) beliebigen Querschnitts mit einer mindestens auf einem Teil des Umfangs verlaufenden Feinverzahnung (28) aufweisen, und dass ferner der anschliessende, vom konischen Bereich zum freien Ende der Zapfen (24) verlaufenden Bereich eine Grundform (27) beliebigen Querschnitts mit zu ihrer Längsachse parallelen Mantellinie aufweist, und mindestens mit einem, über mindestens einen Teil des Umfangs verlaufenden, zahnartigen Verdrängungskörper (30) versehen ist.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
CH1039078A CH632923A5 (en) | 1978-10-06 | 1978-10-06 | Implant for partial replacement of a sliding surface of a human joint |
CH1039178A CH632922A5 (en) | 1978-10-06 | 1978-10-06 | Anchorage pin for bone implants |
Publications (1)
Publication Number | Publication Date |
---|---|
DE2933174A1 true DE2933174A1 (de) | 1980-04-10 |
Family
ID=25706591
Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
DE19792933174 Pending DE2933174A1 (de) | 1978-10-06 | 1979-08-16 | Implantat fuer einen teilweisen ersatz einer gleitflaeche eines menschlichen gelenkes |
DE2933141A Expired DE2933141C3 (de) | 1978-10-06 | 1979-08-16 | Verankerungszapfen für ein nagelartiges Gleitflächen-Implantat |
Family Applications After (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
DE2933141A Expired DE2933141C3 (de) | 1978-10-06 | 1979-08-16 | Verankerungszapfen für ein nagelartiges Gleitflächen-Implantat |
Country Status (3)
Country | Link |
---|---|
AT (1) | AT370989B (de) |
CH (2) | CH632923A5 (de) |
DE (2) | DE2933174A1 (de) |
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EP0497079A1 (de) * | 1991-01-18 | 1992-08-05 | SULZER Medizinaltechnik AG | Kniegelenkprothese |
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FR2737970A1 (fr) * | 1995-08-23 | 1997-02-28 | Chibrac Jean | Elements de prothese d'articulation et procede de fabrication de ceux-ci |
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1978
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- 1978-10-06 CH CH1039178A patent/CH632922A5/de not_active IP Right Cessation
-
1979
- 1979-08-16 DE DE19792933174 patent/DE2933174A1/de active Pending
- 1979-08-16 DE DE2933141A patent/DE2933141C3/de not_active Expired
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Cited By (115)
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EP0051729A1 (de) * | 1980-11-10 | 1982-05-19 | Waldemar Link (GmbH & Co.) | Alloplastischer Gelenkflächenersatz |
EP0176188A1 (de) * | 1984-08-01 | 1986-04-02 | National Research Development Corporation | Teile für Knochengelenkendoprothesen |
US4662888A (en) * | 1984-08-01 | 1987-05-05 | National Research Development Corporation | Endoprosthetic bone joint components |
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EP0497079A1 (de) * | 1991-01-18 | 1992-08-05 | SULZER Medizinaltechnik AG | Kniegelenkprothese |
US5549700A (en) * | 1993-09-07 | 1996-08-27 | Ortho Development Corporation | Segmented prosthetic articulation |
FR2737970A1 (fr) * | 1995-08-23 | 1997-02-28 | Chibrac Jean | Elements de prothese d'articulation et procede de fabrication de ceux-ci |
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Also Published As
Publication number | Publication date |
---|---|
DE2933141B2 (de) | 1981-03-12 |
CH632923A5 (en) | 1982-11-15 |
CH632922A5 (en) | 1982-11-15 |
ATA591579A (de) | 1982-10-15 |
DE2933141C3 (de) | 1981-12-17 |
AT370989B (de) | 1983-05-25 |
DE2933141A1 (de) | 1980-04-10 |
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