ES2268256T3 - Sistema de recubrimiento de la tibia. - Google Patents
Sistema de recubrimiento de la tibia. Download PDFInfo
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- ES2268256T3 ES2268256T3 ES03026286T ES03026286T ES2268256T3 ES 2268256 T3 ES2268256 T3 ES 2268256T3 ES 03026286 T ES03026286 T ES 03026286T ES 03026286 T ES03026286 T ES 03026286T ES 2268256 T3 ES2268256 T3 ES 2268256T3
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- articular surface
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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
- A61F2/30721—Accessories
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1604—Chisels; Rongeurs; Punches; Stamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1675—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the knee
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1764—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
-
- 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
- A61F2/30721—Accessories
- A61F2/30749—Fixation appliances for connecting prostheses to the body
-
- 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
- A61F2/389—Tibial components
-
- 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
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
- A61F2002/30354—Cylindrically-shaped protrusion and recess, e.g. cylinder of circular basis
-
- 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
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30604—Special structural features of bone or joint prostheses not otherwise provided for modular
-
- 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
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/3085—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with a threaded, e.g. self-tapping, bone-engaging surface, e.g. external surface
-
- 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
- A61F2002/3895—Joints for elbows or knees unicompartimental
-
- 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
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- Public Health (AREA)
- Surgery (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Veterinary Medicine (AREA)
- General Health & Medical Sciences (AREA)
- Dentistry (AREA)
- Molecular Biology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Cardiology (AREA)
- Transplantation (AREA)
- Vascular Medicine (AREA)
- Physical Education & Sports Medicine (AREA)
- Prostheses (AREA)
- Surgical Instruments (AREA)
- Materials For Medical Uses (AREA)
- Orthopedics, Nursing, And Contraception (AREA)
Abstract
Un implante de superficie articular, que comprende un elemento soporte (20) en ángulo, que comprende un miembro cilíndrico que tiene un primer extremo y un segundo extremo, estando dicho primer extremo formado en un ángulo que crea una cara elíptica de dicho primer extremo, caracterizado porque el implante comprende además un elemento de fijación (22) adaptado a enganchar el hueso, y un elemento de montaje intermedio (21) adaptado para acoplar dicho elemento soporte (20) en ángulo a dicho elemento de fijación (22).
Description
Sistema de recubrimiento de la tibia.
El presente invento se refiere generalmente al
campo de la sustitución de articulaciones ortopédicas,
particularmente, al campo de la sustitución de articulaciones
ortopédicas de la rodilla.
En el campo de la sustitución de la articulación
ortopédica de la rodilla, una reciente evolución de la técnica ha
dado lugar a prótesis que requieren menos retirada de material del
hueso que la preparación para la implantación de los dispositivos
protésicos. Esta tendencia en la técnica y diseño de prótesis está
principalmente dirigida a la creación de más opciones para el
cirujano ortopédico cuando se enfrenta al tratamiento de una persona
joven activa con enfermedad de la articulación. Ahora se acepta que
el tratamiento de esta persona con una artroplastia de articulación
total (prótesis) será una forma efectiva de aliviar los síntomas del
dolor, pero este paciente más joven probablemente presentará
demandas sobre su articulación protésica que darán lugar a un
rápido desgaste, aflojamiento, y necesidad de sustitución de
los
implantes.
implantes.
En la rodilla natural, las cargas transmitidas a
las superficies de la articulación durante actividades normales
tales como correr, caminar, y saltar crean situaciones difíciles
para los tejidos articulares superficiales. Estos tejidos
articulares superficiales, que están compuestos por cartílagos de
hialina, desempeñan un papel clave en la distribución de la carga y
en la capacidad de absorción de impactos de la rodilla. El desgaste
y la degradación de estos tejidos es normalmente el estado final,
que origina síntomas de dolor y eventualmente lleva a una persona a
considerar la cirugía de sustitución de la articulación.
Sin embargo, muchas estructuras y tejidos de la
articulación como la musculatura de la pierna desempeñan un papel
complejo en la distribución y utilización de las cargas visto en
último lugar por las superficies articulares. Discutiblemente, una
de las más importantes de éstas es el menisco. El menisco es una
estructura con forma de riñón-judía que se une a la
superficie superior de la articulación de la tibia con dos insertos
de hueso, uno en la parte anterior y otro en la posterior. El
menisco tiene un contorno de forma que se ajusta a la superficie
articular de la tibia en su parte inferior y se ajusta a la curva
convexa de la superficie articular de acoplamiento del fémur en su
lado superior. Está formado por un sistema altamente organizado de
bandas fibrosas que son circunferenciales y dan a la estructura sus
características de resistencia de un aro. En esta capacidad, se
cree que el menisco aumenta significativamente la superficie de
contacto de la articulación, de forma que las cargas se distribuyen
más uniformemente sobre una superficie mayor de las superficies de
los cartílagos de hialina del fémur y de la tibia. Por este motivo,
es muy ventajoso conservar esta estructura.
En las articulaciones de rodilla protésicas una
de las principales causas de fallo se basa en los restos producidos
por desgaste del componente de la tibia. No solamente esto da lugar
al desgaste del componente de la tibia sino que también produce
pequeñas partículas de restos de desgaste que estimulan la
osteolisis, cambios inflamatorios en los tejidos vecinos, y un
eventual aflojamiento del implante.
El moderno diseño de las articulaciones
protésicas se basa en un cuidadoso ajuste del contorno de la tibia,
normalmente compuesto por polietileno de peso molecular ultraalto
(UHMWPE) para el componente del fémur, normalmente compuesto por
aleación de cromo-cobalto (CoCr). La falta de ajuste
de las superficies o la falta de alineación de las superficies
durante la implantación quirúrgica será causa de un desgaste
acelerado y de un pronto fallo de la articulación. Sin embargo,
como una función de la mecánica compleja de la rodilla, incluso en
el caso de ajuste y alineación quirúrgicos perfectos de los dos
componentes, hay todavía articulaciones de la junta protésica que
crean cargas muy concentradas o incluso cargas puntuales entre los
dos componentes, lo que da lugar a la creación de una partícula
producida por cizallamiento en la superficie de UHMWPE.
La patente de EEUU 2001/0039455 A1 explica una
inserción de cartílago que está hecha de material artificial
biocompatible que se usa para rellenar un hueco en un cartílago
natural que ha sido reseccionado debido a lesión traumática de
enfermedad crónica. La inserción de sustitución de forma
generalmente cilíndrica explicada en la cita anteriormente
mencionada tiene superficies extremas de tamaño uniforme y de forma
circular que están conectadas por una única superficie lateral
cilíndrica continua entre las superficies extremas. La superficie
lateral es perpendicular a ambas superficies extremas, con las
superficies lateral y extrema formando ángulos rectos entre sí.
Tales inserciones de sustitución de cartílagos no están diseñadas
para sustitución de la articulación de la rodilla sin necesidad de
retirar el menisco.
Es por tanto un objeto del presente invento
proporcionar un componente protésico de la tibia que pueda ser
implantado sin necesidad de retirar el menisco.
Este objeto se consigue por las características
de la reivindicación 1. Características ventajosas pueden ser
deducidas de las reivindicaciones subordinadas.
El implante de acuerdo con el invento mantiene
en todo lo posible el tejido anatómico normal y su capacidad de
carga en un intento de eliminar las cargas concentradas o cargas en
un punto entre un componente del fémur (como sucede en las
anteriores patentes) y el componente de la tibia descrito.
El presente invento proporciona un implante de
superficie articular que incluye un elemento de soporte en ángulo
que comprende un miembro cilíndrico que tiene un primer extremo y un
segundo extremo. El primer extremo tiene una forma en ángulo que
crea una cara elíptica del primer extremo, y el primer extremo
define una superficie soporte de carga de una superficie
articular.
En todavía otro aspecto, el presente invento
proporciona un implante de superficie articular que incluye un
elemento soporte en ángulo, un elemento de fijación adaptado a
enganchar el hueso, y un elemento intermedio de montaje adaptado a
unir el elemento soporte con el elemento de fijación.
En otros aspectos el presente invento
proporciona un implante de superficie articular que incluye un
elemento soporte en ángulo que comprende un miembro cilíndrico que
tiene un primer extremo y un segundo extremo. El primer extremo
está formado en un ángulo que crea una cara elíptica del primer
extremo, y el primer extremo define una superficie soporte de carga
de una superficie articular. El miembro cilíndrico también incluye
medios formados en él para enganchar el hueso.
Los expertos en la materia observarán que aunque
la siguiente Declaración Detallada proseguirá haciendo referencia a
realizaciones y métodos de uso a modo de ejemplo, se pretende que el
presente invento no esté limitado a estas realizaciones a modo de
ejemplo. Más bien, el presente invento tiene un campo más amplio y
se pretende que esté limitado solamente por lo expuesto en las
reivindicaciones anejas.
Otras características y ventajas del presente
invento se harán evidentes a medida que avance la siguiente
Descripción Detallada, y haciendo referencia a los Dibujos, en los
que números iguales representan partes iguales, y en los que:
La Figura 1 es una vista in situ de una
guía de perforación a modo de ejemplo de acuerdo con el presente
invento;
la Figura 2 es una vista in situ de una
guía de perforación y de un pasador de guía de perforación, a modo
de ejemplo de acuerdo con el presente invento;
la Figura 3 es una vista lateral de una guía de
perforación a modo de ejemplo de acuerdo con el presente
invento;
la Figura 4 es una vista lateral de una guía de
perforación y de un trépano a modo de ejemplo de acuerdo con el
presente invento;
la Figura 5 es una vista lateral de una guía de
perforación y de un buril a modo de ejemplo de acuerdo con el
presente invento;
la Figura 6 es una vista lateral in situ
de una guía de perforación y de un buril a modo de ejemplo de
acuerdo con el presente invento;
la Figura 7 es una vista en despiece ordenado de
un implante a modo de ejemplo de acuerdo con el presente
invento;
la Figura 8 es una vista en despiece ordenado de
un implante a modo de ejemplo de acuerdo con el presente
invento;
la Figura 9 es una vista en despiece ordenado de
un implante a modo de ejemplo de acuerdo con el presente
invento;
la Figura 10 es una vista in situ de un
implante a modo de ejemplo de acuerdo con el presente invento;
la Figura 11 es una vista in situ de un
implante a modo de ejemplo de acuerdo con el presente invento;
la Figura 12 es una vista en despiece ordenado
de otro implante a modo de ejemplo de acuerdo con el presente
invento; y
la Figura 13 es una vista in situ de otro
implante a modo de ejemplo de acuerdo con el presente invento.
La Figura 1 es una vista in situ 100 de
una guía de perforación a modo de ejemplo. Esta figura representa
la parte próxima 102 de la tibia así como la tibia distal 104. La
rodilla contiene un menisco 1A y 1B, tanto en las partes lateral
como media, respectivamente. El menisco está conectado con la
superficie superior de la tibia por medio de una unión de hueso
anterior y posterior 2A y 2B. Por otra parte, el menisco es
relativamente móvil y desliza a lo largo de la parte superior de la
tibia 104 de acuerdo con y como una limitación parcial al cóndilo
del fémur (no mostrado, pero bien comprendido en la técnica).
La guía de perforación 110 incluye generalmente
un anillo focalizador 4, y un brazo en ángulo 8A, una sección de
brazo curvo 3 y una sección de perforación 112. El anillo
focalizador 4 puede tener un espesor que es lo suficientemente
estrecho para ser insertado entre los cóndilos del fémur y la
superficie superior 106 de la tibia. El anillo 4 puede también
estar dimensionado para tener aproximadamente el mismo tamaño y
forma que el implante de forma oval que eventualmente se colocará
en la superficie de la articulación, tal como se describe
posteriormente con más detalle. Sin embargo, ésta no es una
exigencia de lo presente y solamente representa una forma a modo de
ejemplo del anillo.
El anillo 4 está unido a la sección 3 curva del
brazo de la guía mediante un brazo 8A en ángulo que está configurado
para pasar sobre la parte superior del menisco 1B cuando se llega a
la articulación desde una o dos incisiones normales usadas en
cirugía artroscópica, el portal anterior-medio o
anterior-lateral (estas incisiones no están
representadas en la Figura 1, pero son bien conocidas en la
técnica). La guía también contiene una sección de perforación 112
conectada con el brazo 3. En la realización a modo de ejemplo, la
sección de perforación 112 está conectada al brazo de forma que
crea un eje 114 que se extiende hacia atrás a través de un punto
central o cerca del punto central dentro de la parte central 116 del
anillo focalizador oval 4. La sección de perforación 112 incluye un
soporte hueco de mordaza 8B, un casquillo cónico hueco 118 y una
cápsula cilíndrica 5A. La sección de perforación está dimensionada
para recibir la cápsula cilíndrica. La cápsula cilíndrica 5A puede
ser avanzada dentro del soporte hueco de mordaza 8B hasta que haga
contacto con la superficie del hueso de la tibia 104. Para esto, la
cápsula cilíndrica 5A puede incluir dientes 6 para mejorar o
asegurar el contacto con la superficie del hueso de la tibia. Un
trinquete liberable 7 permite el avance de la cápsula cilíndrica 5A
a través del soporte de mordaza 8B y proporciona un mecanismo de
bloqueo para fijar la cápsula cilíndrica 5A en posición para formar
una plataforma estable para pasos posteriores.
La Figura 3 es una vista lateral de otra guía de
perforación 110'. La sección del brazo 3 también puede incluir una
aleta central 11 de refuerzo en las partes curvas del brazo 3.
También puede usarse en la guía una cápsula de alma grande
alternativa 5B. Con una cápsula u otra (5A o 5B) el mecanismo de
trinquete liberable 12 puede incluir un retenedor 13 montado de
forma pivotable en el soporte de mordaza 8B. La cápsula 5A o 5B
puede incluir un soporte 12 definido generalmente como dientes en
la superficie lateral de la cápsula. Una parte del retenedor 14
puede ser cargada para actuar por pivotamiento sobre el retenedor y
desengancharlo del soporte.
La Figura 2 es una vista in situ 120 de
una guía de perforación a modo de ejemplo y de un pasador de guía.
Con la guía 110 en posición, un pasador de guía 9 se inserta a
través de la sección de perforación 112 y se perfora en la tibia
104. Preferiblemente, el pasador de guía es perforado a través de la
tibia a lo largo del eje 114 definido por la posición de la sección
de perforación hasta que el extremo 10 de la guía 9 sea visible en
el centro del anillo focalizador 4.
Con referencia ahora a la Figura 4, y una vez
que el pasador de guía 9 está adecuadamente posicionado, una broca
15 es impulsada sobre el pasador 9. En la Figura 4, las referencias
anatómicas se han retirado por claridad. La broca puede tener un
diámetro ligeramente mayor que el diámetro del implante (descrito
más adelante). En la realización a modo de ejemplo, la broca es
impulsada hasta que alcanza una distancia 16 que puede ser
aproximadamente 2-3 mm por debajo de la superficie
articular 106 de la tibia. Las técnicas para determinar esta
distancia apropiada de perforación basadas en una escala legible, o
en técnicas que incluyen topes de profundidad incorporados en la
guía o eje de perforación están bien descritas en la técnica
ortopédica. La broca utilizada aquí puede ser una broca
convencional para hueso que es bien conocida en la técnica.
A continuación, como se representa en la Figura
5, se introduce un buril cilíndrico 17A en el túnel perforado y se
le hace avanzar hasta el punto en el que hace contacto con el punto
extremo del túnel previamente perforado. El buril de este ejemplo
incluye una configuración del extremo que comprende un corte
transversal 122 en ángulo a través del diámetro del buril. El buril
es esencialmente una estructura tubular alargada, y el corte
transversal 122 en ángulo crea una cara extrema elíptica 18A con la
sección del tubo. Esta geometría elíptica puede corresponder a la
geometría elíptica del implante de tibia que va a colocarse, así
como a la configuración elíptica del anillo focalizador 4 de la
guía de perforación. El buril puede incluir un extremo del tubo
afilado y biselado, como se ha representado. Aunque no se ha
representado en los dibujos, el buril puede incluir marcas o partes
acuñadas, de forma que pueda ser impulsado en la posición de giro
adecuada con relación al anillo focalizador 19. Para esto, la
sección de perforación 112 puede incluir una disposición de cuñas
que se corresponda con la cuña del buril.
Con la guía 110 mantenida firmemente en
posición, el buril es hecho impactar hacia arriba y contra la
superficie inferior del anillo focalizador 4. Para ayudar a la
limpieza del corte de hueso y cartílago, el buril y el anillo
focalizador pueden incluir varias características 18B para ayudar al
alineamiento final o separación de los tejidos comprimidos.
El sitio está ahora preparado para la colocación
del implante. La Figura 7 representa una vista en despiece ordenado
de un implante 130 a modo de ejemplo de acuerdo con el presente
invento. El implante 130 del presente invento es generalmente un
miembro cilíndrico que incluye un elemento soporte en ángulo, que
comprende un primer extremo y un segundo extremo, en el que el
primer extremo está formado en un ángulo que crea una cara elíptica
de dicho primer extremo. El primer extremo define una superficie
soporte de carga de una superficie articular. El implante puede
incluir tres componentes, una superficie 20 de soporte en ángulo, un
montaje intermedio 21, y un elemento 22 de fijación. La superficie
20 de soporte puede estar fijada en el montaje, por ejemplo,
mediante una configuración de enganche a presión o de enganche
rápido entre las partes de acoplamiento 24A, 24B del lado inferior
de la parte de superficie soporte y el montaje intermedio,
respectivamente. Un saliente excéntrico 25A puede estar incluido en
la parte de acoplamiento 24A que se ajusta en un taladro excéntrico
en la parte de acoplamiento 24B de la superficie soporte 20 para
proporcionar un acuñamiento o alineamiento giratorio de los dos
componentes. Naturalmente, el saliente 25A puede igualmente estar
dispuesto en la parte de acoplamiento 24B de la superficie 20 de
soporte. Las personas expertas en la materia reconocerán que se
pueden realizar numerosas modificaciones mecánicas en la superficie
20 de soporte y/o en el montaje intermedio 21 para proveer acuñado
y/o alineación giratoria, y todas esas alternativas se consideran
como dentro del marco del presente invento. Cuando los dos
componentes están unidos, se forma un eje cilíndrico continuo con
los dos componentes.
La Figura 8 representa una vista de la sección
recta en despiece ordenado del implante. El elemento de fijación 22
de estas realizaciones a modo de ejemplo es un tornillo con una
rosca espongiforme 27 y un diámetro de la base que es
aproximadamente el mismo que los diámetros de la superficie soporte
y del montaje. En la realización a modo de ejemplo el diámetro de
la base es del orden de 10-20 mm. El tornillo tiene
un agujero pasante grande 26 en el extremo próximo del tornillo, y
un taladro cónico 26D en el extremo distal del tornillo que coincide
y se enclava con el saliente cónico macho 23 en el extremo próximo
del componente 21 del montaje. Cuando los dos componentes 21, 22 se
aprietan uno contra otro, las superficies cónicas 26D y 23 se
enclavarán formando una conexión rígida entre los dos componentes.
El extremo próximo del tornillo también contiene un taladro
hexagonal 26P adecuado para enganche con un impulsor hexagonal
ortopédico macho grande.
La Figura 9 representa otra vista en despiece
ordenado del implante 130. El componente 20 de la superficie de
soporte puede incluir muescas o anillos 30 para ayudar a la
transferencia mecánica de cargas al hueso circundante, y puede
contener una superficie superior 31 contorneada para hacer coincidir
mejor la superficie articular existente. El montaje intermedio 21
puede también tener características de transferencia 29
similares.
La Figura 10 representa el implante insertado en
el hueso. El extremo próximo del componente del montaje puede
incluir un taladro 28 que permite la inserción de una barra
separadora 35 que trabaja en conjunción con el empujador hexagonal
usado para hacer avanzar el componente del tornillo. La barra
separadora permite que los dos componentes permanezcan ligeramente
separados en la articulación entre los dos dispositivos 33 durante
la impulsión del tornillo. Éste permitirá el ajuste fino de la
profundidad del tornillo para llevar el implante hasta una posición
a nivel o ligeramente rebajada con respecto a la superficie
articular 106 existente de la tibia. Usando la barra separadora 35,
enganchada en el taladro del montaje, el conjunto de la superficie
soporte y del montaje intermedio puede ser hecho girar
independientemente del componente del tornillo para asegurar que
esté correctamente alineado con respecto a la superficie articular
de la tibia. Una vez que todos los alineamientos estén terminados,
una fuerza hacia abajo 36 sobre el componente del montaje intermedio
asentará las piezas cónicas y bloqueará todos los componentes en
una posición fija, tal como se representa en la Figura 11.
Materiales bien conocidos en el campo de la
ortopedia pueden usarse para los componentes del implante. Por
ejemplo, UHMWPE para la superficie de soporte, y aleaciones de
titanio o de cobalto-cromo se usan para el montaje
intermedio y para los elementos de fijación. Sin embargo, como la
causa más común de fallo de tales componentes está relacionada con
los restos de desgaste del UHMWPE, el componente de superficie
soporte puede estar compuesto por materiales alternativos que
podrían proporcionar ventajas clínicas basadas en sus
características hidrofílicas de baja fricción. Por ejemplo,
recientes desarrollos en los campos de los poliuretanos resistentes
y de hidrogeles estructurales aconsejan que estos materiales,
cargados en una base adecuada, podrían ser alternativas eficaces
cuando están rígidamente fijados en el hueso.
La Figura 12 representa una realización
alternativa a modo de ejemplo del implante del presente invento. En
esta realización, el montaje intermedio 21' puede incluir una parte
de cable comprimida y enrollada 38 que puede ser aglutinada en el
taladro 24A' en el montaje intermedio. La parte de cable 38 puede
estar formada por un material similar al material usado para el
montaje intermedio. Esto puede ser ventajoso si la parte de cable y
el montaje se calientan hasta una temperatura cercana a la
temperatura de fusión de los materiales, los componentes pueden
fundirse conjuntamente para formar una masa sólida con tamaño de
poros controlable para incluir una red semicontinua de espacios
abiertos (es decir, material poroso). El material poroso puede
entonces utilizarse como una base y un gel o material elastomérico
puede fundirse en él. Como se muestra en la Figura 13, esto
proporciona un enclavamiento mecánico 41 entre el material fundido y
la base estructural.
Los expertos en la materia admitirán numerosas
alternativas. Por ejemplo, el elemento soporte en ángulo puede
incluir medios de fijación unidos sobre él, de forma que el elemento
soporte esté atornillado directamente en el hueso.
Alternativamente, el sistema de fijación podría incluir un elemento
de soporte en ángulo y un elemento de fijación sin la necesidad de
un miembro de montaje intermedio. Éstas y otras alternativas serán
evidentes a partir de la descripción detallada anterior, y tales
alternativas se consideran dentro del marco del presente invento,
solamente limitado por las reivindicaciones.
Claims (11)
1. Un implante de superficie articular, que
comprende un elemento soporte (20) en ángulo, que comprende un
miembro cilíndrico que tiene un primer extremo y un segundo extremo,
estando dicho primer extremo formado en un ángulo que crea una cara
elíptica de dicho primer extremo, caracterizado porque el
implante comprende además un elemento de fijación (22) adaptado a
enganchar el hueso, y un elemento de montaje intermedio (21)
adaptado para acoplar dicho elemento soporte (20) en ángulo a dicho
elemento de fijación (22).
2. Un implante de superficie articular como el
reivindicado en la reivindicación 1, en el que dicho segundo
extremo comprende una barra (35) que se extiende desde la cara de
dicho segundo extremo, estando dicha barra (35) adaptada para
enganchar dicho montaje intermedio.
3. Un implante de superficie articular como el
reivindicado en la reivindicación 1, en el que dicho segundo
extremo está formado con un ángulo que crea una cara elíptica de
dicho segundo extremo, comprendiendo dicho segundo extremo además
una barra que se extiende desde la cara de dicho segundo extremo,
estando dicha barra (35) adaptada para enganchar dicho montaje
intermedio.
4. Un implante de superficie articular como el
reivindicado en la reivindicación 1, en el que dicho elemento
soporte en ángulo comprende además partes rebajadas que se extienden
a lo largo de al menos una parte de la periferia exterior de él,
estando dichas partes rebajadas adaptadas para enganchar el
hueso.
5. Un implante de superficie articular como el
reivindicado en la reivindicación 1, en el que dicho elemento (21)
de montaje intermedio comprende un primer extremo y un segundo
extremo, teniendo dicho primer extremo una parte de cuña adaptada
en él para enganchar dicho elemento de soporte (20) en ángulo.
6. Un implante de superficie articular como el
reivindicado en la reivindicación 5, en el que dicho extremo
primero está formado en un ángulo que crea una cara elíptica de
dicho primer extremo, comprendiendo dicho segundo extremo una barra
(35) que se extiende desde la cara de dicho segundo extremo, estando
dicha barra (35) adaptada para enganchar dicho elemento de
fijación.
7. Un implante de superficie articular como el
reivindicado en la reivindicación 6, en el que dicha barra (35)
está adaptada para enganchar una herramienta de impulsión para hacer
girar dicho montaje intermedio (21) independiente de dicho elemento
de fijación.
8. Un implante de superficie articular como el
reivindicado en la reivindicación 1, en el que dicho elemento de
soporte (20) y dicho elemento de montaje intermedio (21) está
adaptado a acoplarse conjuntamente, y en el que dicho montaje
intermedio está adaptado para enganchar una herramienta de impulsión
para hacer girar dicho montaje intermedio (21) y dicho elemento
(20) de soporte independiente de dicho elemento de fijación
(22).
9. Un implante de superficie articular como el
reivindicado en la reivindicación 1, en el que dicho elemento de
fijación comprende un extremo primero adaptado para enganchar dicho
montaje intermedio (21) y roscas (27) formadas en al menos una
parte del exterior de dicho elemento de fijación (22), estando
dichas roscas (27) adaptadas para enganchar el hueso.
10. Un implante de superficie articular como el
reivindicado en la reivindicación 1, en el que dicho elemento de
montaje intermedio (21) comprende una base formada por cable
comprimido con que se forma una base porosa, estando dicho elemento
soporte en ángulo formado en dicha base.
11. Un implante de superficie articular como el
reivindicado en la reivindicación 10, en el que dicho elemento de
soporte es de un material de poliuretano y/o hidrogel.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US10/308,718 US7163541B2 (en) | 2002-12-03 | 2002-12-03 | Tibial resurfacing system |
| US308718 | 2002-12-03 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| ES2268256T3 true ES2268256T3 (es) | 2007-03-16 |
Family
ID=32312228
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES03026286T Expired - Lifetime ES2268256T3 (es) | 2002-12-03 | 2003-11-15 | Sistema de recubrimiento de la tibia. |
Country Status (8)
| Country | Link |
|---|---|
| US (2) | US7163541B2 (es) |
| EP (1) | EP1426013B1 (es) |
| JP (2) | JP2004181236A (es) |
| AT (1) | ATE333241T1 (es) |
| AU (1) | AU2003262428B2 (es) |
| DE (1) | DE60306873T2 (es) |
| DK (1) | DK1426013T3 (es) |
| ES (1) | ES2268256T3 (es) |
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| US8617168B2 (en) | 2010-10-25 | 2013-12-31 | Smith & Nephew, Inc. | Oval tibia guide |
| EP3527144B1 (en) | 2010-11-17 | 2023-12-13 | Arthrex Inc | Adjustable suture-button construct for ankle syndesmosis repair |
| EP2455001B1 (en) | 2010-11-17 | 2020-07-22 | Arthrex, Inc. | Adjustable suture-button constructs for ligament reconstruction |
| US8920497B2 (en) | 2011-01-04 | 2014-12-30 | Arthrex, Inc. | Method and instrumentation for acetabular labrum reconstruction |
| US8747478B2 (en) | 2011-02-14 | 2014-06-10 | Imds Corporation | Patellar prostheses and instrumentation |
| EP2572656A1 (en) | 2011-09-21 | 2013-03-27 | ARTHREX MEDIZINISCHE INSTRUMENTE GmbH | Arthroscope guide |
| US9421008B2 (en) | 2011-09-23 | 2016-08-23 | Arthrex, Inc. | Soft suture-based anchors |
| US10245016B2 (en) | 2011-10-12 | 2019-04-02 | Arthrex, Inc. | Adjustable self-locking loop constructs for tissue repairs and reconstructions |
| US9138237B2 (en) | 2011-10-13 | 2015-09-22 | Arthrex, Inc. | Total joint instrumentation and method for use |
| EP2599449B1 (en) | 2011-11-29 | 2015-02-25 | Arthrex, Inc. | Applicator for suture/button construct with positive retention and control |
| US9615821B2 (en) | 2011-12-09 | 2017-04-11 | Arthrex, Inc. | Tensionable knotless anchor systems and methods of tissue repair |
| US20130165954A1 (en) | 2011-12-22 | 2013-06-27 | Arthrex, Inc. | Continuous suture passing instrument |
| US9351722B2 (en) | 2011-12-23 | 2016-05-31 | Arthrex, Inc. | Drive system for tissue repair |
-
2002
- 2002-12-03 US US10/308,718 patent/US7163541B2/en not_active Expired - Lifetime
-
2003
- 2003-11-15 ES ES03026286T patent/ES2268256T3/es not_active Expired - Lifetime
- 2003-11-15 EP EP03026286A patent/EP1426013B1/en not_active Expired - Lifetime
- 2003-11-15 AT AT03026286T patent/ATE333241T1/de not_active IP Right Cessation
- 2003-11-15 DE DE60306873T patent/DE60306873T2/de not_active Expired - Lifetime
- 2003-11-15 DK DK03026286T patent/DK1426013T3/da active
- 2003-11-20 AU AU2003262428A patent/AU2003262428B2/en not_active Expired
- 2003-11-25 JP JP2003394702A patent/JP2004181236A/ja active Pending
-
2007
- 2007-01-16 US US11/623,513 patent/US8523872B2/en active Active
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2009
- 2009-12-28 JP JP2009298376A patent/JP2010099496A/ja not_active Ceased
Also Published As
| Publication number | Publication date |
|---|---|
| US7163541B2 (en) | 2007-01-16 |
| JP2010099496A (ja) | 2010-05-06 |
| EP1426013A1 (en) | 2004-06-09 |
| US20040106928A1 (en) | 2004-06-03 |
| EP1426013B1 (en) | 2006-07-19 |
| ATE333241T1 (de) | 2006-08-15 |
| AU2003262428A1 (en) | 2004-06-24 |
| US20070118136A1 (en) | 2007-05-24 |
| DE60306873D1 (de) | 2006-08-31 |
| JP2004181236A (ja) | 2004-07-02 |
| US8523872B2 (en) | 2013-09-03 |
| AU2003262428B2 (en) | 2009-04-30 |
| DE60306873T2 (de) | 2007-01-18 |
| DK1426013T3 (da) | 2006-10-30 |
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