EP2916776A1 - Prothèse de trapèze - Google Patents

Prothèse de trapèze

Info

Publication number
EP2916776A1
EP2916776A1 EP13853306.2A EP13853306A EP2916776A1 EP 2916776 A1 EP2916776 A1 EP 2916776A1 EP 13853306 A EP13853306 A EP 13853306A EP 2916776 A1 EP2916776 A1 EP 2916776A1
Authority
EP
European Patent Office
Prior art keywords
mounting element
implant
prosthesis
tendon
trapezium
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.)
Withdrawn
Application number
EP13853306.2A
Other languages
German (de)
English (en)
Other versions
EP2916776A4 (fr
Inventor
Michael Wayne Solomons
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of EP2916776A1 publication Critical patent/EP2916776A1/fr
Publication of EP2916776A4 publication Critical patent/EP2916776A4/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
    • 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
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30518—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts
    • A61F2002/3052—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts unrestrained in only one direction, e.g. moving unidirectionally
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
    • A61F2002/4271—Carpal bones
    • A61F2002/4274—Distal carpal row, i.e. bones adjacent the metacarpal bones
    • A61F2002/4276—Trapezium

Definitions

  • This invention relates to a prosthesis, and more particularly, to a trapezium prosthesis.
  • CMC carpometacarpal
  • the CMC joint interconnects a metacarpal bone of the thumb and a trapezium bone of the wrist.
  • the CMC joint is held in place by means of ligaments which also serve to form a joint capsule around the CMC joint.
  • Articular cartilage on the CMC joint surface facilitates relative displacement or articulation between the thumb metacarpal and trapezium bones. When the articular cartilage wears out, the joint may develop a painful type of arthritis known as osteoarthritis.
  • the trapezium bone is also configured to articulate with the scaphoid, index metacarpal and trapezoid bones of the hand.
  • a recess is defined in the trapezium bone for receiving a flexor Carpi radialis (FCR) tendon complementally therein, the recess further allowing the FCR tendon to be displaceable relative thereto.
  • FCR flexor Carpi radialis
  • One accepted surgical procedure to overcome this problem includes the excision and replacement of the trapezium bone with a rolled up slip of tendon.
  • Another accepted surgical procedure includes the complete or partial replacement of the trapezium bone with a prosthetic implant such as the Wright Orthosphere. Although the above procedures have been successful, dislocation of the implant may still occur because of the inherent instability of the trapezeo metacarpal joint.
  • One or more embodiments of the present invention provides a prosthesis comprising a trapezium implant, where the trapezium implant includes at least one bore hole and a retaining formation within the bore hole; and a mounting element, where the mounting element includes a complementary retaining formation that interacts with said retaining formation within the bore hole to thereby at least partially secure the mounting element within the bore hole.
  • a prosthesis comprising a trapezium implant and a mounting element adapted to slidably attach the trapezium implant to a flexor carpi radialis tendon of the patient.
  • Still other embodiments of the present invention provides a method for replacing a trapezium bone, the method comprising excising a trapezium to be replaced to form an open joint capsule, inserting the mounting element into the capsule and guiding at least a portion of the mounting element around a flexor radialis tendon, providing a trapezium implant, and securing the mounting element to the implant in a manner that will slidably retain the tendon between the mounting element and the implant while allowing the tendon to move longitudinally with respect to the implant and the mounting element.
  • Figure 1 is a schematic representation of bones forming a portion of a hand
  • Figure 2 is a sectioned schematic view of a prosthesis in accordance with the invention.
  • Figures 3 to 5 are sectioned schematic views of the progressive stages followed during implanting of the prosthesis
  • Figure 6 is an enlarged sectioned view of a part of the prosthesis;
  • Figure 7 is a three-dimensional schematic view of a further embodiment of a partially implanted prosthesis in accordance with the invention.
  • Figure 8 is a sectioned view of the prosthesis shown in Figure 7 in an operative mounted condition.
  • Figure 9 is a plan view of a prosthesis incorporating a bearing member and connecting means in accordance with the invention.
  • Figure 10 is a perspective view of a prosthesis incorporating a formable mounting element pursuant to one or more embodiments of the invention.
  • Figure 11 is a cross-sectional view of a prosthesis incorporating a formable mounting element pursuant to one or more embodiments of the invention.
  • Embodiments of the invention are based, at least in part, on the discovery of a trapezium prosthesis having a mounting element adapted to slidably mount the prosthesis to the FCR tendon and thereby suitably maintain the position of the prosthesis relative to other bones within the hand while allowing movement between the prosthesis and the FCR tendon longitudinally along the length of the FCR tendon.
  • the mounting element and/or mode of attachment allows for axial displacement of the tendon relative to both the implant and the mounting element.
  • the prior art teaches trapezium prosthesis and the securing of these prosthesis to soft tissue within the hand, the prior art does not contemplate attachment to the FCR tendon and does not suggest attachment in a manner that permits the FCR tendon to move relative to the prosthesis in a direction along the length of the FCR tendon. It has unexpectedly been discovered that by allowing movement between the prosthesis and the FCR tendon longitudinally along the length of the FCR tendon, patient recovery times can be improved. Further, the mounting elements employed in one or more embodiments of the present invention offer significant advantages in ease of installation.
  • practice of this invention is advantageous because the implant is attached to the FCR tendon, which is extremely strong and not prone to degenerate or rupture, and therefore the likelihood of dislocation of the implant is greatly reduced.
  • the prosthesis includes an implant that is configured to imitate or replicate the anatomic characteristics and functions of a trapezium bone to be replaced, and a mounting element adapted to secure the implant on a flexor carpi radialis ("FCR") tendon of a patient thereby to inhibit dislocation of the implant in use.
  • prosthesis 10.1 includes an implant 12.1, which is configured to imitate or replicate the anatomic characteristics and functions of a trapezium bone, and a mounting element 16 for mounting the implant 12.1 on a FCR tendon 18 of a patient.
  • the implant may be contoured and/or dimensioned to facilitate engagement with and/or articulation of the trapezoid, scaphoid, index metacarpal, and thumb metacarpal bones.
  • the implant may be sized and dimensioned according to the trapezium bone to be replaced.
  • implant 12.1 is formed for insertion in a CMC joint capsule 20.
  • implant 12.1 is contoured and/or dimensioned to facilitate engagement with and/or articulation of the trapezoid 22, scaphoid 24, index metacarpal 26, and thumb 28 metacarpal bones as shown in Fig. 1.
  • implant 12.1 is sized and dimensioned according to the trapezium bone to be replaced.
  • the implant may also be adapted to receive, and thereby be retained by, the mounting element.
  • the adaptations to implant 12.1 can be numerous and the type of adaptation may hinge on the type of mounting element employed.
  • implant 12.1 includes one or more bore holes for receiving the mounting element.
  • implant 12.1 may include a bore hole 34.
  • implant 12.1 is prepared from known suitable synthetic materials, such as plastics, or metallic materials. As is known in the art, these materials should be inert within the human body.
  • the plastics material may be any one or more of a selection of high density polyethylene (HDPE), low density polyethylene (LDPE), polyethylene terephthalate, polyvinyl chloride (PVC), polyurethane, polycarbonate urethane (e.g. BionateTM), nylon polyamide (e.g. a nylon), or polytetrafluoroethylene (a.k.a.PTFE such as TeflonTM).
  • the implant may be formed from any suitable metallic material that is inert within the human body.
  • the metallic material may include copper, nickel, stainless steel, titanium, cobalt chrome or silicon.
  • the mounting element includes a hook portion that is adapted to hook around (and thereby captivate) a part of a FCR tendon and an extension portion that extends from the hook portion.
  • a bore may be defined in the implant for receiving at least a portion of the extension portion coaxially therein.
  • a recess may be defined in the implant for receiving a free end of the hook portion to facilitate retention of the FCR tendon between the hook portion and the implant in an operative mounted or retaining condition of the prosthesis.
  • prosthesis 10.1 includes mounting element 16.
  • Mounting element 16 includes a hook portion 30 that is adapted to hook around a part of the FCR tendon 18 and a shaft portion 32 that is dimensioned to be received in register a bore 34 defined in the implant 12.1.
  • a recess 36 is defined in a base 38 of the implant 12.1 for receiving a free end 40 of the hook portion 30 to facilitate retention of the FCR tendon 18, and with it the implant 12.1, between the hook portion 30 and the implant 12.1 in an operative mounted or retained condition of the prosthesis 10.1.
  • a guide portion 42 for guiding the shaft portion 32 in to the bore 34 of the implant 12.1 and towards the operative retained condition is detachably connectable to the shaft portion 32 via an axially aligned screw threaded pin-and-socket arrangement 44.
  • a retaining means or retaining element in the form of a fixing screw 46 is provided to retain the shaft receiving portion in position in the bore 34 of the implant 12.1 in the operative inserted condition.
  • a recessed shoulder formation 48 is defined in the entrance 50 of the bore 34 to receive a head 52 of the screw 46 complementary therein.
  • the mounting element is adapted to allow movement of the FCR tendon in a direction along the length of the FCR tendon (i.e. longitudinally), relative to the implant and/or the hook.
  • the mounting element confines or shackles the FCR tendon to thereby secure the implant in place, the ability to move relative to the FCR tendon and the implant, in a direction along the length of the tendon, is maintained.
  • Various factors can impact, either alone or in combination, the ability to maintain a degree of longitudinal movement between the mounting element and the FRC tendon after mounting.
  • these factors can include the relative thickness of mounting element relative to the thickness of the FRC tendon, the cross-sectional shape of mounting element, the smoothness of the surface of mounting element adjacent to FRC tendon after mounting, and the material composition of mounting element.
  • Other complementary factors include the shape of implant in the location where implant contacts or is proximate to FRC tendon after mounting.
  • Still other complementary factors include the manner in which the mounting element engages the implant and its impact on the degree of force that the mounting element impinges on the FRC tendon.
  • the mounting element prevents lateral movement of the tendon relative to the prosthesis while allowing longitudinal movement.
  • the mounting element allows both lateral and longitudinal movement of the tendon relative to the prosthesis.
  • mounting element 16 which, as discussed above, includes hook portion 30, can have one or more features that allow movement of prosthesis 10.1 relative to FRC tendon 18 along the length of tendon 18 once installed.
  • mounting element 16 can be adapted in one or more ways to provide axial movement of the tendon relative to the prosthesis.
  • hook portion 30 can be fabricated from relatively rigid material, which material will substantially maintain its shape when subjected to forces in the direction of the length of the FRC tendon. By substantially maintaining its shape, hook portion 30 can slide along FRC tendon 18 without binding and/or FRC tendon 18 can slide between hook portion 30 and implant 12.1 without binding.
  • mounting element 16 included one or more sutures, they would not maintain their shape when subject to forces in the direction of the length of the FRC tendon and would thereby cause implant 10.1 to bind against FRC tendon 18 and restrict its movement.
  • the gap 31 between tendon-contacting portion 30.9 of hook portion 30 and tendon-contacting portion 12.9 of implant 12, is maintained at a sufficient size to allow movement of FCR tendon 18 relative to prosthesis 10.
  • tendon-contacting portion 30.9 is the location of hook portion 30 where hook portion 30 contacts tendon 18 when properly installed.
  • tendon-contacting portion 12.9 of implant 12.1 is the location of implant 12.1 that contacts tendon 18 when properly installed.
  • the surface of hook portion 30 at and/or proximate to tendon-contacting portion 30.9 is relatively smooth, which will facilitate movement of prosthesis 10.1 longitudinally along the FRC tendon.
  • an appropriate smoothness for contacting portion 30.9 can be selected without undue experimentation.
  • the skilled person may select a geometry for contacting portion that includes rounded edges.
  • the skilled person may select a surface that is devoid of any protrusions that may impinge upon FRC tendon and prevent or inhibit movement along the length of the FRC tendon.
  • the implant may also be adapted to facilitate movement of the prosthesis along the tendon.
  • implant 12.3 includes a notch 12.5, which may also be referred to as recess 12.5, at tendon-contacting portion 12.9, which as noted above is the portion where the implant contacts FRC tendon when mounted.
  • the notch is generally configured to extend between two terminal points of implant 12.1 in a direction that will complement and receive FRC tendon 18.
  • tendon-contacting portion 12.9 is relatively smooth.
  • tendon-contacting portion 30.9 of hook portion 30 the skilled person, once armed with the teachings herein, can configure contacting surface 12.9 of implant 12.1 to be relatively smooth, which will facilitate longitudinal movement of prosthesis 10.1 along the FRC tendon.
  • mounting element 16 may also include a retaining element (e.g., fixing screw 46) that fixes the position of mounting element 16 relative to implant 12 for purposes of mounting prosthesis 10.1 to the FRC tendon.
  • fixing screw 46 fixes the position of hook portion 30 relative to implant 12 in all directions of movement.
  • the fixing screw 46 allows for one or more directions of movement between hook portion 30 and implant 12 while maintaining a shackle around the FRC tendon.
  • retaining element 46 may be positioned to allow for limited movement along the bore axis but prevents a degree of movement that will allow the FRC tendon to be disengaged from hook portion 30.
  • mounting element 16 may be formed from any suitable synthetic material, such as plastic material, that is inert within the human body.
  • the plastics material may be any one or more of a selection of high density polyethylene (HDPE), low density polyethylene (LDPE), polyethylene terephthalate, polyvinyl chloride (PVC), polyurethane, preferably poly carbonate urethane (e.g. BionateTM), polyamide (e.g. a nylon) or polytetrafluoroethylene (a.k.a. PTFE such as Teflon).
  • the mounting element may be formed from any suitable metallic material that is inert within the human body.
  • Exemplary metallic materials include any one or more of a selection of copper, nickel, stainless steel, titanium, cobalt chrome or silicon.
  • mounting element 16.2 includes an elbow portion 54 that is configured to hook around a part of the FCR tendon, and arms 56 that extend from the elbow portion 54 and are dimensioned to be received in complementary registering bores 58 defined in an implant 12.2.
  • a retaining element in the form of an interference or friction fitting annular bush 60 is provided to retain the arms 56 in position in the bores 58 of the implant 12.2 in the operative retaining condition, as shown in Figure 8.
  • the annular bush 60 is configured to be received co-axially the free end regions of the arms and to span a space between the arms 56 and an inner surface of the bores 58. As shown in Figure 8, the ends of the arms 56 are cut to size following implanting of prosthesis 12.2, so as not to protrude substantially beyond the surface of implant 12.2.
  • mounting element 56 is adapted to allow movement of the FCR tendon, in a direction along the length of the FCR tendon (i.e. longitudinally), relative to implant 12.2 and/or the elbow 54.
  • elbow portion 54 can be fabricated from relatively rigid material, which material will substantially maintain its shape when subjected to forces in the direction of the length of the FRC tendon.
  • the gap 61, between tendon-contacting portion 54.9 of elbow portion 54 and tendon-contacting portion 12.9 of implant 12.2 is maintained at a sufficient size to allow movement of FCR tendon 18 relative to the prosthesis 10.2.
  • tendon-contacting portion 54.9 is the location of elbow portion 54 where elbow portion 54 contacts tendon 18 when properly installed.
  • tendon-contacting portion 12.9 of implant 12.2 is the location of implant 12.2 that contacts tendon 18 when properly installed.
  • the mounting element includes one or more retaining formations that interact with complementary retaining formations on or within the implant to secure the mounting element to the implant.
  • the retaining formations may be in the form a ratchet arrangement that interacts with a gear rack or other coinciding teeth or interlocking receivers to retain the mounting element.
  • mounting element 16.3 includes a formable mounting element 72.
  • implant 12.3 includes first and second bore holes 74, 75, which are adapted to receive mounting element 16.3 and thereby mount prosthesis 10.3 to the FCR tendon.
  • This configuration is advantageous since it facilities installation of prosthesis 10.3 and it allows for movement of the prosthesis longitudinally along the length of the FCR tendon while securing prosthesis 10.3 relative to the bones within the hand and thereby inhibit dislocation of the implant during use.
  • the mounting element allows for longitudinal movement of the prosthesis while preventing deleterious lateral movement of the prosthesis relative to the tendon. In other embodiments, the mounting element allows for longitudinal and lateral movement of the prosthesis relative to the tendon.
  • mounting element 16.3 includes an elongate body 77 and at least one portion 78 for securing mounting element 16.3 to implant 12.3.
  • mounting element 16.3 includes a first and an optional second securing portion for independently securing each of first and second portions to implant 12.3.
  • first, and optionally second, securing portions are independently adapted to be retained by implant 12.3 and thereby prevent movement of mounting element 16.3 through implant 12.3 in at least one direction when securing portion 78 is engaged with implant 12.3.
  • mounting element 16.3 includes first securing portion 78 in the form of a gear rack or one or more teeth, which may be referred to as gear rack 78 or receivers 78.
  • First securing portion 78 is adapted to interact with one or more ratchets or teeth 82 on or within implant 12.3 and thereby prevent movement of mounting element 16.3 in at least one direction when engaged.
  • ratchet 82 is located within bore hole 74.
  • first securing portion 78 includes one or more ratchets or teeth that are adapted to interact with receivers or a gear rack on or within implant 12.3.
  • a gear rack may be located within bore hole 74.
  • mounting element 16.3 includes a second securing portion 88 in the form of a head, which may be referred to as head 88, which is larger in diameter than bore 75 of implant 12.3 through which mounting element 16.3 may be placed.
  • Head 88 is adapted to preclude movement of mounting element 16.3 in at least direction A once head 88 engages implant 12.3, while maintaining movability in a direction opposite A.
  • implant 12.3 is adapted, such as by way of a recess 86 within implant 12.3, for receiving head 88. This may be advantageous because head 88 can be housed within recess 86 and thereby not alter the overall configuration or shape of implant 12.3 due to protrusions caused by mounting element 16.3.
  • mounting element is permanently affixed at second portion to the implant.
  • second portion may be molded or welded directly to the implant at a location where the device shown in Fig. 11 is inserted into bore hole 75.
  • mounting element 16.3 may include a formable mounting element 72.
  • the term formable refers to the property of at least being flexible while having a degree of rigidity such that the shape of formable mounting element 72 will not undergo deformation when subjected to relatively minor forces (e.g. forces of gravity acting on a portion of formable mounting element 72).
  • formable mounting element 72 will have a degree of rigidity that will allow formable mounting element 72, particularly at a location 79 where formable mounting element 72 partially circumscribes the FCR tendon, to resist deformation while implant 12.3 moves or slides along the length of the FCR tendon. This rigidity will inhibit binding the FCR tendon between formable mounting element 72 and implant 12.3.
  • formable mounting element 72 will have a degree of flexibility that is sufficient to allow formable mounting element 72 to at least partially circumscribe FCR tendon during installation of prosthesis 10.3.
  • Formable mounting element 72 should therefore be easily distinguished from articles such as sutures, which although they are flexible, they do have sufficient rigidity to retain their shape when subjected to relatively minor forces.
  • mounting element 16.3 is flexible along its entire length.
  • mounting element is only flexible in formable portion 72, which may also be referred to as formable mounting element 72.
  • formable mounting element 72 is fabricated from a synthetic polymer such as a high molecular weight synthetic polymer. These polymers may include thermoplastic resins as well as thermosetting resins.
  • thermoplastic materials that may useful in this regard include, but are not limited to, high density polyethylene (HDPE), low density polyethylene (LDPE), polyethylene terephthalate, polyvinyl chloride (PVC), polyurethane, preferably polycarbonate urethane (e.g. BionateTM), polyamide (e.g. a nylon) or polytetrafluoroethylene (a.k.a. PTFE such as Teflon).
  • HDPE high density polyethylene
  • LDPE low density polyethylene
  • PVC polyvinyl chloride
  • polyurethane preferably polycarbonate urethane (e.g. BionateTM), polyamide (e.g. a nylon) or polytetrafluoroethylene (a.k.a. PTFE such as Teflon).
  • the prosthesis 10 further includes a bearing member 62 which is configured and dimensioned to replace a base of a thumb metacarpal 28 and to permit complementary engagement or interdigitation with the implant 12.
  • the bearing member 62 is connected to a thumb metacarpal 28 via a connecting means in the form of a conventional morse taper 64.
  • the us of the bearing member is believed to be advantageous since the bearing member serves to reduce pain caused by direct engagement between the thumb metacarpal and the implant.
  • the procedure of replacing the trapezium bone 14 involves a first step of opening the joint capsule 20 surrounding the CMC joint and excising the trapezium bone at the base of the thumb metacarpal 28. The surgeon may then install the prosthesis using one or more of the following techniques.
  • the surgeon may insert mounting element, which includes the guide portion 42, into the capsule 20 and hook the hook portion 30 around the FCR tendon 18 as shown in Fig. 3. Thereafter, the surgeon slides the implant 12.1 down the guide portion 42 towards the shaft portion 32 until a position is reached wherein the tendon 18 is held captive between the hook portion 30 and the base 38 as shown in Figs 4-5. Once the guide portion 42 is screw threadedly detached from the shaft portion 32, the fixing screw 46 is screwed into a complementary screwed threaded socket formation defined in the free end of the shaft portion 32 to retain the tendon 18 in the captive condition.
  • the bearing member may be installed according to the following procedure. Following excising of a part of a base of the thumb metacarpal 28, a longitudinally extending bore is drilled into the thumb metacarpal for receiving complimentally, the morse taper 64. The bearing member 62, at the end of the morse taper 64, is then manipulated into mating engagement with the implant 12 to permit interdigitation or displacement therebetween. The capsule 20 and surrounding soft tissue are then sutured closed.
  • the mounting element includes one or more retaining formations that interact with complementary retaining formations on or within the implant to secure the mounting element to the implant, as shown by way of example in Figs. 10-11, the surgeon may first insert mounting element 16.3 into bore hole 75, and then insert mounting element 16.3 into the capsule 20 and bend mounting element 16.3 around FCR tendon 18. Where mounting element 16.3 is already fixed to implant 12.3, the step of inserting the element into the first bore hole can be eliminated. Once inserted around the FCR tendon, the free end of mounting element 16.3 can then be inserted into bore hole 74 for engagement of the complementary retaining formations (e.g. ratchet and gear rack).
  • the complementary retaining formations e.g. ratchet and gear rack
  • mounting element 16.3 engages and or restrains FCR tendon 18 can be increased by pulling on the free end of mounting element 16.3. The surgeon may therefore tighten the shackle around the FCR tendon to maintain the prosthesis in its desired position while maintaining the desired mobility (i.e. slidable mobility along the length of the tendon). In one or more embodiments, excess portion of mounting element is cut flush with implant 12.3. In one or more embodiments, mounting element 16.3 is adapted with a stop or other impediment to prevent the surgeon from tightening mounting element too tight such that the desired slidable mobility is not jeopardized.

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)
  • Prostheses (AREA)

Abstract

L'invention concerne une prothèse (10) comprenant un implant de trapèze (12) et un élément de montage (16) conçu pour fixer de façon coulissante l'implant de trapèze (12) à un tendon fléchisseur radial du carpe (18) du patient.
EP13853306.2A 2012-11-09 2013-11-11 Prothèse de trapèze Withdrawn EP2916776A4 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US201261724452P 2012-11-09 2012-11-09
PCT/ZA2013/000083 WO2014075114A1 (fr) 2012-11-09 2013-11-11 Prothèse de trapèze

Publications (2)

Publication Number Publication Date
EP2916776A1 true EP2916776A1 (fr) 2015-09-16
EP2916776A4 EP2916776A4 (fr) 2016-06-29

Family

ID=50685259

Family Applications (1)

Application Number Title Priority Date Filing Date
EP13853306.2A Withdrawn EP2916776A4 (fr) 2012-11-09 2013-11-11 Prothèse de trapèze

Country Status (3)

Country Link
EP (1) EP2916776A4 (fr)
WO (1) WO2014075114A1 (fr)
ZA (1) ZA201503997B (fr)

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US3924276A (en) * 1975-02-18 1975-12-09 Richard E Eaton Surgically implantable trapezium prosthesis and method of reconstructing the thumb carpometacarpal joint
US5702468A (en) * 1995-03-09 1997-12-30 Uresil Corporation Carpal bone biaxially restrained prosthesis
US20050251265A1 (en) * 2004-05-07 2005-11-10 Calandruccio James H Trapezium implant for thumb and method
US20070021839A1 (en) * 2005-07-21 2007-01-25 William Lowe Trapezium prosthesis and method
WO2008070881A1 (fr) * 2006-12-07 2008-06-12 Michael Wayne Solomons Prothèse de trapèze
US9119613B2 (en) * 2008-01-07 2015-09-01 Extremity Medical Llc System and method for trapezium bone replacement
FR2928831B1 (fr) * 2008-03-19 2011-04-29 Xavier Renard Implant prothetique pour suspensoplastie apres une trapezectomie et procede pour realiser un tel implant.
US8167952B2 (en) * 2008-09-03 2012-05-01 The Cleveland Clinic Foundation Arthroplastic implant with shield for basilar joint and related methods

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EP2916776A4 (fr) 2016-06-29
ZA201503997B (en) 2017-11-29
WO2014075114A1 (fr) 2014-05-15

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