FR2718014A1 - Anchor screw assembly for joint prosthesis cup implant - Google Patents

Anchor screw assembly for joint prosthesis cup implant Download PDF

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Publication number
FR2718014A1
FR2718014A1 FR9404341A FR9404341A FR2718014A1 FR 2718014 A1 FR2718014 A1 FR 2718014A1 FR 9404341 A FR9404341 A FR 9404341A FR 9404341 A FR9404341 A FR 9404341A FR 2718014 A1 FR2718014 A1 FR 2718014A1
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FR
France
Prior art keywords
screw
cup
thread
head
screwing
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Withdrawn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
FR9404341A
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French (fr)
Inventor
Chagneau Francis
Feron Franck
Levasseur Michel
Rolland Jean Jacques
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Individual
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Individual
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Publication date
Application filed by Individual filed Critical Individual
Priority to FR9404341A priority Critical patent/FR2718014A1/en
Publication of FR2718014A1 publication Critical patent/FR2718014A1/en
Withdrawn legal-status Critical Current

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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
    • A61F2/32—Joints for the hip
    • A61F2/34—Acetabular cups
    • 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
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A61B17/1746—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip for the acetabulum
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8605—Heads, i.e. proximal ends projecting from bone
    • 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
    • A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
    • A61B17/8042—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being a cover over the screw head
    • A—HUMAN NECESSITIES
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
    • A61B17/8057—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded the interlocking form comprising a thread
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4637—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for connecting or disconnecting two parts of a prosthesis
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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
    • 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
    • A61F2002/30405—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
    • 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
    • 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
    • A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30495—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism using a locking ring
    • 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
    • A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/305—Snap connection
    • 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
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    • 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
    • A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/30538—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting angular orientation
    • A61F2002/3054—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting angular orientation about a connection axis or implantation axis for selecting any one of a plurality of radial orientations between two modular parts, e.g. Morse taper connections, at discrete positions, angular positions or continuous positions
    • 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
    • A61F2002/30617—Visible markings for adjusting, locating or measuring
    • 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
    • A61F2/30767—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
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30774—Apertures or holes, e.g. of circular cross section internally-threaded
    • 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
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    • 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
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30784—Plurality of holes
    • A61F2002/30787—Plurality of holes inclined obliquely with respect to each other
    • 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
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    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30841—Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
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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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    • A61F2002/3401—Acetabular cups with radial apertures, e.g. radial bores for receiving fixation screws
    • 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
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    • A61F2002/3482—Two hemispherical halves having completely different structures
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    • 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
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    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
    • A61F2250/0097—Visible markings, e.g. indicia

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Neurology (AREA)
  • Cardiology (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Dentistry (AREA)
  • Prostheses (AREA)

Abstract

The screw (4) suitable for spongy bone material has a thread (6) of large pitch along its shaft and a finer thread (10) around its head or proximal end. The implant cup (1) is formed with a number of screw passage holes which include a thread (3) on their inner edge faces corresponding to that of the screw heads. The threads on the cup hole edges also correspond to a thread on a drill guide (5) which may be temporarily screwed into the hole while a guide hole for the screw is formed in the spongy bone tissue. The bone screws may alternatively have smooth shafts (7), and the edges of the cap holes may only be partially threaded.

Description

La présente invention concerne un dispositif de fixation d'une cupule prothétique de forme hémisphérique dans la cavité cotyloïdienne du bassin. Cette fixation est mécanique, afin de préserver la repousse osseuse ultérieure et un éventuel démontage. The present invention relates to a device for fixing a prosthetic cup of hemispherical shape in the acetabular cavity of the pelvis. This fixation is mechanical, in order to preserve subsequent bone regrowth and possible disassembly.

Elle concerne plus précisément la solidarisation complète ou partielle, d'une vis ou d'une pointe implantée dans l'os spongieux, avec la cupule prothétique.It relates more precisely to the complete or partial attachment of a screw or a point implanted in the cancellous bone, with the prosthetic cup.

La pose d'une prothèse totale de hanche, est devenue de nos jours une opération courante dans le monde, et les progrès accomplis en médecine et en biomécanique assurent à ces implants, en règle générale, une bonne stabilité dans le temps. La liaison os-implant est assurée par un ciment chirurgical. The fitting of a total hip prosthesis has nowadays become a common operation in the world, and the progress made in medicine and biomechanics assure these implants, as a rule, good stability over time. The bone-implant connection is ensured by surgical cement.

Cela est particulièrement vrai pour la pièce fémorale. This is especially true for the femoral piece.

Pour la fixation de la cupule prothétique, si l'utilisation d'un ciment, déposé entre la prothèse métallique et l'os du bassin, assure une stabilité immédiate, cette stabilité est parfois remise en cause au bout d'une dizaine d'années. For the fixation of the prosthetic cup, if the use of a cement, deposited between the metallic prosthesis and the pelvic bone, ensures immediate stability, this stability is sometimes called into question after ten years .

Une technique plus actuelle consiste à assurer une liaison mécanique plus naturelle, en utilisant le fait qu'unie repousse osseuse peut envahir les pores de la surface externe, non lisse, d'un implant métallique. I1 convient dans ce cas d'assurer, seulement d'une manière temporaire, la stabilité de l'implant dans la structure osseuse. A more current technique consists in ensuring a more natural mechanical connection, by using the fact that a bone regrowth can invade the pores of the external surface, not smooth, of a metal implant. In this case, it is advisable to ensure, only temporarily, the stability of the implant in the bone structure.

Pour la pièce fémorale cette stabilité temporaire peut être assurée, en fabriquant des queues de prothèse fémorale, dites anatomiques, épousant d'une manière quasi-parfaite la géométrie du canal médullaire. For the femoral part, this temporary stability can be ensured by manufacturing tails of the femoral prosthesis, called anatomical, which conform almost perfectly to the geometry of the medullary canal.

Pour la cupule hémisphérique non cimentée, la stabilité immédiate dans la cavité cotyloïdienne est plus délicate. Si l'os du bassin le permet, un fraisage profond de diamètre légèrement inférieur au diamètre extérieur de la cupule, assure un serrage, ou effet "press fit", suffisant. Mais dans la plupart des cas, le praticien doit assurer par un artifice la stabilité du couple oscupule, en attendant la repousse osseuse. I1 utilise alors, généralement, une ou deux vis. Toutefois, pour assurer une bonne repousse osseuse, le fraisage initial doit mettre la prothèse en contact direct avec l'os spongieux. Cette nécessité biologique a un inconvénient sur le plan mécanique, car l'os spongieux présente une moindre résistance que l'os cortical fraisé par le praticien. For the uncemented hemispherical cup, the immediate stability in the acetabular cavity is more delicate. If the pelvic bone allows it, deep milling with a diameter slightly smaller than the outside diameter of the cup provides sufficient tightening, or "press fit" effect. But in most cases, the practitioner must ensure by an artifice the stability of the oscillating couple, while awaiting bone regrowth. I1 then generally uses one or two screws. However, to ensure good bone regrowth, the initial milling must put the prosthesis in direct contact with the cancellous bone. This biological necessity has a mechanical disadvantage, since the cancellous bone has less resistance than the cortical bone milled by the practitioner.

Une légère impaction survient donc lors de la remise en charge du patient. Cette impaction de la cupule dans le spongieux n'est en elle-même pas dangereuse, mais les vis elles, bien ancrées dans le bassin par suite de leurs larges filets ne peuvent suivre cette impact ion, et leur tête initialement placée dans un logement adapté, peut ressortir de ce logement vers l'extérieur de la cupule. Or, à l'intérieur de la cupule se trouve une autre cupule, en polyéthylène, dans laquelle vient s'articuler la tête de l'implant fémoral. Les vis en ressortant de leur logement peuvent détériorer le noyau de polyéthylène. La seule solution est alors de resserrer les vis ce qui nécessite une nouvelle intervention chirurgicale très préjudiciable pour le patient.A slight impaction therefore occurs when the patient is put back in charge. This impaction of the cup in the cancellous is not in itself dangerous, but the screws themselves, well anchored in the pelvis due to their large threads can not follow this impact ion, and their head initially placed in a suitable housing , can come out of this housing towards the outside of the cup. However, inside the cup is another cup, made of polyethylene, in which the head of the femoral implant is articulated. The screws coming out of their housing can damage the polyethylene core. The only solution is then to tighten the screws which requires a new surgical procedure which is very detrimental for the patient.

La présente invention vise à assurer une fixation temporaire par vissage, tout en permettant une légère migration dans le temps de la cupule dans la cavité cotyloidienne.  The present invention aims to provide temporary fixing by screwing, while allowing a slight migration over time of the cup in the acetabular cavity.

Cela est rendu possible en assurant une liaison permanente entre la tête de la vis et la cupule et en permettant au corps de la vis de migrer radialement dans l'os du bassin comme le ferait un clou. This is made possible by ensuring a permanent connection between the head of the screw and the cup and by allowing the body of the screw to migrate radially into the pelvic bone as a nail would.

Ce résultat est atteint conformément à l'invention par le fait que le dispositif de solidarisation comprend
- des têtes de vis ou des têtes de pointes comportant
quelques filets d'un pas de vis
- des trous dans la cupule, comportant le même pas de vis,
où viennent se visser les têtes précédentes
- un guide de perçage, venant se visser initialement dans le
filetage des trous de la cupule, pour assurer le
positionnement axial de la vis ou de la pointe.This result is achieved in accordance with the invention by the fact that the securing device comprises
- screw heads or tip heads comprising
a few threads with a thread
- holes in the cup, having the same pitch,
where are the previous heads screwed
- a drilling guide, originally screwed into the
thread of the cup holes, to ensure the
axial positioning of the screw or tip.

Selon une version voisine, où les trous du cotyle ne comportent qu'une portion de filet, la solidarisation peut alors être partielle, en ce sens que l'inclinaison peut varier, mais le déplacement lui ne peut se faire radialement. According to a neighboring version, where the holes in the acetabulum comprise only a portion of thread, the connection may then be partial, in the sense that the inclination may vary, but the displacement cannot be effected radially.

Enfin dans une dernière version, la solidarisation est assurée par une rondelle vissée ou par un anneau élastique. Finally in a last version, the connection is ensured by a screwed washer or by an elastic ring.

D'autres caractéristiques et avantages de l'invention apparaîtront de la description et des dessins annexés qui en présentent un mode de réalisation préférentiel. Other characteristics and advantages of the invention will appear from the description and the attached drawings which show a preferred embodiment.

Sur ces dessins,
- la figure 1 représente une vue générale,
- les figures 2 et 3 représentent une section méridienne
agrandie,
- les figures 4 et 5 représentent la fixation par pointe,
- la figure 6 représente le canon de perçage,
- la figure 7 représente une fixation non radiale,
- la figure 8 représente une variante du mode de
solidarisation ne comportant qu'une portion sectorielle de
filets,
- la figure 9 représente une variante de la tête de la vis.In these drawings,
FIG. 1 represents a general view,
- Figures 2 and 3 show a meridian section
enlarged,
- Figures 4 and 5 show the point fixing,
FIG. 6 represents the drilling barrel,
FIG. 7 represents a non-radial attachment,
- Figure 8 shows a variant of the mode of
solidarity comprising only a sectoral portion of
nets,
- Figure 9 shows a variant of the screw head.

- les figures 10 et 11 représentent une variante par anneau
élastique.- Figures 10 and 11 show a variant per ring
elastic.

Le dispositif représenté sur ces dessins est destiné à solidariser les vis, fixées dans le spongieux, à la cupule prothétique. The device shown in these drawings is intended to secure the screws, fixed in the cancellous, to the prosthetic cup.

Décrivons maintenant la technique employée pour la pose du dispositif lors d'une arthroplastie de la hanche.  Let us now describe the technique used for fitting the device during a hip replacement.

La pose d'une cupule (1) nécessite, après extraction de la tête fémorale, un fraisage important de la cavité cotyloïdienne. The installation of a cup (1) requires, after extraction of the femoral head, a significant milling of the acetabular cavity.

Ce fraisage a bien sûr un diamètre identique ou légèrement inférieur à la cupule qu'il va recevoir.This milling has of course an identical or slightly smaller diameter than the cup it will receive.

Une fois la cupule mise en place, il s'avère nécessaire, d'assurer temporairement sa fixation dans l'os spongieux (2) sousjacent. Once the cup is in place, it proves necessary to temporarily secure it in the cancellous bone (2) below.

Dans un premier temps on visse dans les trous filetés (3) de la cupule, aux emplacements prévus pour le passage des vis (4) un canon de perçage (3) guidant la pénétration ultérieure du foret. Firstly, a drilling barrel (3) is screwed into the threaded holes (3) of the cup, at the locations provided for the passage of the screws (4), guiding the subsequent penetration of the drill.

Le diamètre du foret correspond au diamètre à fond de filet du corps (6) de la vis ou au diamètre, soit égal, soit légèrement inférieur de la tige (7) de la pointe (8). The diameter of the drill bit corresponds to the diameter at the bottom of the thread of the body (6) of the screw or to the diameter, either equal or slightly smaller, of the rod (7) of the tip (8).

Le praticien retire après perçage d'un trou (9) le canon et introduit la vis de fixation. The practitioner withdraws after drilling a hole (9) the barrel and introduces the fixing screw.

Cette vis comporte deux filetages
- un premier filetage de type spongieux à pas large pour le
corps (6),
- un second filetage de type mécanique pour la tête (10)
dont le diamètre à fond de filet est supérieur au diamètre
maximal de son corps.,
La tête de la vis peut comporter une empreinte à 6 pans creux, permettant le vissage dans l'os spongieux avec une clé appropriée. Le trou (9) percé initialement dans l'os spongieux, assure la direction requise pour la vis, et évite tout effort excessif.This screw has two threads
- a first spongy type thread with a wide pitch for the
body (6),
- a second mechanical type thread for the head (10)
whose diameter at the bottom of the thread is greater than the diameter
maximum of his body.,
The head of the screw may include a hexagon socket impression, allowing screwing into the cancellous bone with an appropriate key. The hole (9) initially drilled in the cancellous bone provides the direction required for the screw, and avoids excessive effort.

Lorsque la tête de la vis (10) arrive près de la paroi interne de la cupule (1), elle va d'elle-même, vu la concentricité du perçage initial, se visser dans la paroi filetée du trou (3) de la cupule. Le pas de vis plus faible de la tête par rapport au corps assure en même temps un rapprochement ferme du cotyle (1) sur le spongieux (2). Ce vissage de la tête, solidarise la vis et le cotyle, assurant un véritable encastrement. Cet encastrement évite, en particulier, tout risque de bascule dans le plan méridien de la cupule. When the head of the screw (10) arrives near the internal wall of the cup (1), it will of itself, given the concentricity of the initial drilling, be screwed into the threaded wall of the hole (3) of the cup. The weaker thread of the head compared to the body ensures at the same time a firm approximation of the acetabulum (1) on the cancellous bone (2). This screwing of the head, secures the screw and the cup, ensuring a real embedding. This embedding avoids, in particular, any risk of tilting in the meridian plane of the cup.

Cette rigidité mécanique permet de simplifier la vis initiale, en supprimant les filets du corps de vis destinés au spongieux. This mechanical rigidity makes it possible to simplify the initial screw, by removing the threads from the body of the screw intended for the cancellous bone.

Les essais mécaniques montrent qu'une tige lisse enfoncée dans le spongieux, et dont la tête est vissée dans la cupule assure une meilleure stabilité au cisaillement dans la cavité cotyloidienne que des vis classiques à tête non filetée. Mechanical tests show that a smooth rod pressed into the cancellous tube, the head of which is screwed into the cup, ensures better shear stability in the acetabular cavity than conventional screws with a non-threaded head.

La pose de ces pointes (8) filetées en tête (10) se révèle des plus faciles, et simplifie donc la technique opératoire. The installation of these points (8) threaded at the head (10) proves to be very easy, and therefore simplifies the operating technique.

Une variante directionnelle sur la figure 7 montre que le système peut s'adapter à des directions (12) de fixation non radiales. I1 suffit que le vissage (3) dans la cupule se fasse dans un plan dont la normale est inclinée par rapport à l'axe radial (13). A directional variant in FIG. 7 shows that the system can adapt to non-radial fixing directions (12). I1 suffices that the screwing (3) in the cup takes place in a plane whose normal is inclined relative to the radial axis (13).

Une variante sur la fixation de la tête, figure 8, permet au praticien de travailler sans canon de perçage. En effet, une portion d'un secteur (14) de quelques filets seulement, permet de fixer la tête de la vis qui comporte de son côté un filetage complet. Dans ce cas, la direction de vissage, initiale du corps de la vis dans le spongieux peut être non radiale, ce qui laisse une marge de positionnement de la vis suffisante pour la plupart des cas, tout en assurant le blocage longitudinal de la vis sur la cupule. A variant on the fixing of the head, FIG. 8, allows the practitioner to work without a drilling gun. Indeed, a portion of a sector (14) of only a few threads makes it possible to fix the head of the screw which, for its part, has a complete thread. In this case, the direction of screwing, initial of the body of the screw in the cancellous can be non-radial, which leaves a margin of positioning of the screw sufficient for most cases, while ensuring the longitudinal blocking of the screw on the cup.

Naturellement après la pose d'une première vis le praticien procède, s'il le souhaite et de la même manière à la pose d'autres vis ou d'autres pointes.  Naturally after the installation of a first screw the practitioner proceeds, if he wishes and in the same way to the installation of other screws or other points.

Deux pointes posées radialement permettent d'obtenir un montage mécanique très stable, comme le confirment des essais mécaniques comparatifs. Two points laid radially make it possible to obtain a very stable mechanical assembly, as confirmed by comparative mechanical tests.

Enfin en conservant les vis ou les pointes classiques, on peut assurer encore un blocage suffisant à l'aide d'une petite pièce supplémentaire telle qu'une rondelle, vissée dans la partie supérieure de l'alésage des trous de la cupule. Finally, by retaining the conventional screws or points, it is still possible to ensure sufficient blocking using a small additional piece such as a washer, screwed into the upper part of the bore of the holes in the cup.

L'utilisation de cette rondelle implique une déformation dans la sphéricité de la cupule, afin de créer un logement suffisant pour contenir la tête de la vis et la rondelle. The use of this washer implies a deformation in the sphericity of the cup, in order to create a housing sufficient to contain the head of the screw and the washer.

I1 est possible selon une variante, figure 10, de remplacer cette pièces vissée par un anneau élastique (17) venant s'encastrer dans une gorge (18). I1 is possible according to a variant, Figure 10, to replace this screwed parts by an elastic ring (17) coming to be embedded in a groove (18).

Cet anneau pour en faciliter sa pose peut avantageusement être précontraint dans un tube (19) muni d'un piston (20) : en ajustant le tube au bord de la gorge préexistante dans le cotyle, figure 11), une simple poussée sur le piston assure alors sa mise en place. This ring to facilitate its installation can advantageously be prestressed in a tube (19) provided with a piston (20): by adjusting the tube at the edge of the pre-existing groove in the acetabulum, figure 11), a simple push on the piston then ensures its implementation.

L'ensemble peut naturellement comporter un index (21) donnant l'orientation de l'ouverture de l'anneau élastique. Cet index permet donc de disposer l'anneau, selon la direction la plus favorable, à une éventuelle extraction. The assembly can naturally include an index (21) giving the orientation of the opening of the elastic ring. This index therefore makes it possible to arrange the ring, in the most favorable direction, for possible extraction.

Le système est aisément démontable.  The system is easily removable.

Claims (8)

supérieure élargie d'un filetage de pas plus fin (10). upper widened with a thread of no finer (10). comportant un filetage à grand pas, et munie dans sa partie comprising a thread with large pitch, and provided in its part - Une vis (4) avec un corps de vis (6) pour os spongieux - A screw (4) with a screw body (6) for cancellous bone caractérisé par le fait qu'il comprend characterized by the fact that it includes REVENDICATIONS 1) Dispositif d'ancrage de vis sur une cupule prothétique, CLAIMS 1) Device for anchoring screws on a prosthetic cup, correspond au filetage de la partie supérieure de la vis. corresponds to the thread of the upper part of the screw. de chaque alésage prévu pour le passage des vis. Ce filetage of each bore provided for the passage of the screws. This thread - Une cupule (1) munie d'un filetage pariétal (3) à l'intérieur - A cup (1) provided with a parietal thread (3) inside l'os spongieux (2). cancellous bone (2). perçage radial (13) ou dans une direction bien définie dans radial drilling (13) or in a direction well defined in momentanément se visser dans la cupule, afin d'assurer un momentarily screw into the cup to ensure que la partie supérieure (10) de la vis. Ce canon vient than the upper part (10) of the screw. This cannon comes - Un canon de perçage (5) muni à son embase du même filetage - A drilling barrel (5) provided at its base with the same thread 2) Dispositif selon la revendication 1 caractérisé en ce que le2) Device according to claim 1 characterized in that the corps de vis (6) pour os spongieux est remplacé par une tige screw body (6) for cancellous bone is replaced by a rod lisse (7). smooth (7). 3) Dispositif selon les revendications 1 et 2 caractérisé en ce3) Device according to claims 1 and 2 characterized in that que le filetage des alésages de la cupule n'est constitué que that the threads of the bores of the cup are made only d'une portion sectorielle de filet (14). of a sectoral portion of net (14). 4) Dispositif selon les revendications 1 à 3 caractérisé en ce que4) Device according to claims 1 to 3 characterized in that la tête de la vis est constituée d'un élément intermédiaire se the head of the screw consists of an intermediate element vissant en bout du corps de vis, laissant le choix entre une screwing at the end of the screw body, leaving the choice between a tête de vis classique non filetée (15) et une tête filetée (16) conventional unthreaded screw head (15) and a threaded head (16) se vissant dans la cupule prothétique. screwing into the prosthetic cup. 5) Dispositif selon les revendications 1 à 4 caractérisé en ce que5) Device according to claims 1 to 4 characterized in that le vissage dans la cupule est remplacé par un encliquetage.  the screwing in the cup is replaced by a snap. 6) Dispositif selon les revendications 1 à 4 caractérisé en ce que6) Device according to claims 1 to 4 characterized in that le blocage par vissage de la tête de la vis ou de la pointe, se blocking by screwing the head of the screw or the point, trouve remplacé par une pièce ou une rondelle supplémentaire found replaced by an additional part or washer disposée par dessus la tête précédente, et venant se visser arranged over the previous head, and coming to screw dans la paroi du cotyle. in the cup wall. 7) Dispositif selon la revendication 6 caractérisé en ce que la7) Device according to claim 6 characterized in that the rondelle vissée est remplacée par un anneau élastique ouvert screwed washer is replaced by an open elastic ring (17) venant s'encastrer dans une gorge (18) préusinée dans le (17) coming to be embedded in a groove (18) pre-machined in the cotyle. acetabulum. 8) Dispositif selon la revendication 7 caractérisé en ce que8) Device according to claim 7 characterized in that l'anneau élastique se trouve précontraint dans un tube (19) the elastic ring is prestressed in a tube (19) muni d'un piston (20). L'extrémité distale du tube est conçue fitted with a piston (20). The distal end of the tube is designed pour venir s'emboîter parfaitement jusqu'au bord supérieur de to come to fit perfectly to the upper edge of la gorge. Le maniement du piston dont la course est the throat. The handling of the piston whose stroke is prédéterminée, assure la mise en place de l'anneau dans la predetermined, ensures the positioning of the ring in the gorge. Un index (21) permet d'orienter cet anneau.  throat. An index (21) makes it possible to orient this ring.
FR9404341A 1994-04-05 1994-04-05 Anchor screw assembly for joint prosthesis cup implant Withdrawn FR2718014A1 (en)

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US6342057B1 (en) 2000-04-28 2002-01-29 Synthes (Usa) Remotely aligned surgical drill guide
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