FR2722398A1 - One=piece cotyloid implant for hip prosthesis - Google Patents
One=piece cotyloid implant for hip prosthesis Download PDFInfo
- Publication number
- FR2722398A1 FR2722398A1 FR9408814A FR9408814A FR2722398A1 FR 2722398 A1 FR2722398 A1 FR 2722398A1 FR 9408814 A FR9408814 A FR 9408814A FR 9408814 A FR9408814 A FR 9408814A FR 2722398 A1 FR2722398 A1 FR 2722398A1
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- France
- Prior art keywords
- implant
- ring
- angle
- rings
- anteversion
- 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.)
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
- A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
- A61B5/1071—Measuring physical dimensions, e.g. size of the entire body or parts thereof measuring angles, e.g. using goniometers
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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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
- A61F2/32—Joints for the hip
- A61F2/34—Acetabular cups
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- 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
- A61F2/4657—Measuring instruments used for implanting artificial joints
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- A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
- A61B2562/16—Details of sensor housings or probes; Details of structural supports for sensors
- A61B2562/17—Comprising radiolucent components
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- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
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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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- A61F2/30724—Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity
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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
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2/4609—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of acetabular cups
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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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- A61F2002/30003—Material related properties of the prosthesis or of a coating on the 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
- A61F2002/30535—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
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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
- A61F2/30767—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
- A61F2002/30795—Blind bores, e.g. of circular cross-section
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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
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
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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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- 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
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
- A61F2002/30891—Plurality of protrusions
- A61F2002/30894—Plurality of protrusions inclined obliquely with respect to each other
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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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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- 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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- A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
- A61F2250/0098—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers radio-opaque, e.g. radio-opaque markers
Abstract
Description
La présente invention a pour objet un implant cotyloïdien monobloc pour prothèse de hanche, du type en un matériau radiotransparent tel qu'un matériau plastique, destiné à être cimenté dans une cavité cotylot- dienne, ainsi qu'un procédé de détermination de l'angle d'antéversion ou de rétroversion de cet implant après sa pose sur un patient. The present invention relates to a monobloc acetabular implant for hip prosthesis, of the type made of a radiolucent material such as a plastic material, intended to be cemented in an acetabular cavity, as well as a method for determining the angle. anteversion or retroversion of this implant after its placement on a patient.
Lors de la pose d'un implant cotyloidien, le chirurgien doit orienter celui-ci de façon tridimensionnelle en respectant notamment un angle dit d'antéversion (c'est à dire une inclinaison vers l'avant selon un angle précis par rapport à un plan de référence). Or, ce positionnement angulaire est relativement difficile a vérifier après la pose complète de l'implant. De plus, si dans le temps post-operatoire, l'implant bascule vers l'arrière, l'angle d'antéversion peut devenir ce qui sera appelé ci-après angle de "rétroversion", susceptible de nécessiter une intervention correctrice. When placing an acetabular implant, the surgeon must orient it three-dimensionally, in particular by respecting an angle known as anteversion (i.e. an inclination towards the front at a precise angle relative to a plane reference). However, this angular positioning is relatively difficult to verify after the complete placement of the implant. In addition, if in the postoperative time, the implant tilts backwards, the anteversion angle can become what will be called hereinafter the "retroversion" angle, likely to require corrective intervention.
L'invention a donc pour but de proposer un implant cotyloïdien réalisé de façon à permettre un repérage aisé de son orientation tridimensionnelle après la pose. The invention therefore aims to provide an acetabular implant produced so as to allow easy identification of its three-dimensional orientation after installation.
Conformément à 1 invention, l'implant cotyloidien est équipé de moyens de repérage radiographique tridimensionnel pour déterminer son orientation après sa pose. In accordance with the invention, the acetabular implant is equipped with three-dimensional radiographic tracking means to determine its orientation after it has been placed.
Conformément à un mode de réalisation de l'invention, lesdits moyens de repérage radiographique comprennent un premier et un second anneaux métalliques tronqués, de diamètres différents, le second anneau ayant un diamètre supérieur à celui du premier anneau, logés dans des gorges formées sur la surface externe de l'implant, parallèlement entre elles et à un plan équatorial dudit implant, positionnées de manière que, sur une image radiographique, à une longueur mesurée du petit axe d'une ellipse formée sur cette image par le second anneau, corresponde un angle d'antéversion ou de rétroversion détermine de l'implant. According to an embodiment of the invention, said radiographic tracking means comprise first and second truncated metal rings, of different diameters, the second ring having a diameter greater than that of the first ring, housed in grooves formed on the external surface of the implant, parallel to each other and to an equatorial plane of said implant, positioned so that, on an X-ray image, at a measured length of the minor axis of an ellipse formed on this image by the second ring, corresponds to a anteversion or retroversion angle determines the implant.
Ainsi pour chaque taille de l'implant, c'est à dire pour chaque diamètre de la calotte sensiblement hémisphérique constituant celui-ci, chaque longueur mesurée du petit axe de l'ellipse précitée correspond à un angle donné d'antéversion ou de rétroversion. Cela permet de réaliser une abaque donnant directement l'angle recherché en fonction de la longueur mesurée sur l'image radiographique pour une taille d'implant donnée. Thus for each size of the implant, that is to say for each diameter of the substantially hemispherical cap constituting the latter, each length measured of the minor axis of the abovementioned ellipse corresponds to a given angle of anteversion or retroversion. This makes it possible to produce an abacus giving directly the desired angle as a function of the length measured on the radiographic image for a given implant size.
D'autres particularités et avantages de l'invention apparaitront au cours de la description qui va suivre, faite en référence aux dessins annexés qui en illustrent une forme de réalisation à titre d'exemple non limitatif. Other features and advantages of the invention will appear during the description which follows, given with reference to the accompanying drawings which illustrate an embodiment thereof by way of nonlimiting example.
La figure 1 est une vue en élévation latérale, sensiblement à l'échelle, d'une forme de réalisation de l'implant cotyloïdien selon l'invention. Figure 1 is a side elevational view, substantially to scale, of an embodiment of the acetabular implant according to the invention.
La figure 2 est une vue de dessus, à l'échelle, de l'implant de la figure 1. Figure 2 is a top view, to scale, of the implant of Figure 1.
La figure 3 est une vue de dessous de l'implant des figures I et 2, du côté de son plan equatorial. Figure 3 is a bottom view of the implant of Figures I and 2, from the side of its equatorial plane.
La figure 4 est une vue en coupe diamétrale de l'implant des figures 1 à 3. FIG. 4 is a diametrical sectional view of the implant of FIGS. 1 to 3.
La figure 5 est une vue en coupe partielle à échelle agrandie dans le plan de la figure 4. FIG. 5 is a partial section view on an enlarged scale in the plane of FIG. 4.
La figure 6 est une vue schématique en perspective de 1; implant et de ses deux anneaux de repérage radiographiques, dans une position angulaire donnée de l'implant. Figure 6 is a schematic perspective view of 1; implant and its two radiographic locating rings, in a given angular position of the implant.
La figure 7 est un croquis resultant de la superposition d'une radiographie d'un implant posé, montrant les anneaux et d'un calque transparent de repérage sur le grand anneau de l'antéversion ou de la rétroversion. FIG. 7 is a sketch resulting from the superposition of an x-ray of an implant placed, showing the rings and a transparent tracing layer on the large anteversion or retroversion ring.
La figure 8 est une vue en perspective des deux anneaux dans une position angulaire particulière. Figure 8 is a perspective view of the two rings in a particular angular position.
La figure 9 est une abaque de détermination de l'angle d'orientation de l'implant cotyloidien. FIG. 9 is an abacus for determining the angle of orientation of the acetabular implant.
L'implant cotyloïdien 1 représenté aux dessins est destiné à une prothèse de hanche et est du type destiné à être cimente sur la paroi osseuse d'une cavité cotylodienne d'un os iliaque non représenté. The acetabular implant 1 shown in the drawings is intended for a hip prosthesis and is of the type intended to be cemented on the bone wall of an acetabular cavity of an iliac bone not shown.
Cet implant cotyloïdien 1 est constitué en une matière plastique appropriée, telle que le polyéthylène de très haut poids moléculaire. L'implant 1 a une forme extérieure approximativement hémisphérique, d'épaisseur convenable, dans laquelle est ménagée une cavite centrale hemispherique 2 de réception d'une tête d'articulation non représentée d'une prothèse fémorale. This acetabular implant 1 is made of a suitable plastic material, such as very high molecular weight polyethylene. The implant 1 has an approximately hemispherical external shape, of suitable thickness, in which is provided a central hemispherical cavity 2 for receiving a joint head not shown of a femoral prosthesis.
Sur la surface extérieure de l'implant 1, sont ménagées une série de gorges circulaires 3, 4, 5... On the outer surface of the implant 1, a series of circular grooves 3, 4, 5 ... are provided.
9 parallèles entre elles et au plan équatorial 11 de l'implant. La première gorge 3 est séparée du plan équatorial 11 par des épaulements annulaires 12, 13 et un chanfrein circulaire 13a, tandis que la dernière gorge 9, de plus petit rayon, entoure le pôle 14. Un premier anneau métallique 15 tronqué est logé dans la gorge 8 et comporte une extrémité coudée 15a (figure 6) qui vient se loger dans un alésage 16 ménage radialement dans le cotyle 1, et dont l'axe OX passe par le centre O du cotyle 1 et de sa cavite 2. Un second anneau tronqué métallique 17, de diamètre supérieur à celui de l'anneau tronqué 15, est disposé dans l'une des autres gorges, a savoir la gorge 5 dans l'exemple illustré aux dessins.9 parallel to each other and to the equatorial plane 11 of the implant. The first groove 3 is separated from the equatorial plane 11 by annular shoulders 12, 13 and a circular chamfer 13a, while the last groove 9, of smaller radius, surrounds the pole 14. A first truncated metal ring 15 is housed in the groove 8 and has a bent end 15a (Figure 6) which is housed in a bore 16 housed radially in the cup 1, and whose axis OX passes through the center O of the cup 1 and its cavity 2. A second ring truncated metal 17, of diameter greater than that of the truncated ring 15, is disposed in one of the other grooves, namely the groove 5 in the example illustrated in the drawings.
L'anneau 17 se termine par une extrémité coudée 17a qui vient s'engager dans un second alésage 18, afin de retenir l'anneau dans la position choisie sur l'implant 1.The ring 17 ends with a bent end 17a which engages in a second bore 18, in order to retain the ring in the position chosen on the implant 1.
L'alésage d'entrée 18 de l'anneau 17 est formé de deux parties, à savoir une première partie 19 s'étendant radialement et dont l'axe OY passe par le centre 0 de l'implant, et une seconde partie 21 s'étendant suivant un angle aigu A entre son axe ZZ' et l'axe
OY. Les deux axes OX et OY délimitent entre eux un angle au centre (C) qui peut etre variable, mais est de préférence de 30 environ, pour une raison qui sera explicitée ci-après.The inlet bore 18 of the ring 17 is formed of two parts, namely a first part 19 extending radially and whose axis OY passes through the center 0 of the implant, and a second part 21 s 'extending at an acute angle A between its axis ZZ' and the axis
OY. The two axes OX and OY define between them an angle at the center (C) which can be variable, but is preferably about 30, for a reason which will be explained below.
Par ailleurs, les alésages 16 et 18, et par conséquent les extrémités coudées respectives 15a, 17a des anneaux 15, 17 sont décales angulairement de façon que, les anneaux etant vus en perspective avec une orientation déterminée (Fig. 6), le petit anneau 15 traverse l'intervalle angulaire séparant l'extrémité coudée 17d et l'autre extrémité 17t du grand anneau 17. Furthermore, the bores 16 and 18, and consequently the respective bent ends 15a, 17a of the rings 15, 17 are angularly offset so that, the rings being seen in perspective with a determined orientation (Fig. 6), the small ring 15 crosses the angular interval separating the bent end 17d and the other end 17t of the large ring 17.
Des rainures ou cannelures méridiennes 22 sont agencées à intervalles angulaires convenables sur la surface externe de l'implant 1 en intersectant une partie des gorges 3 à 9 en fonction de leur longueur. Ces cannelures 22 forment un système anti-rotatoire pour l'implant 1, une fois remplies de ciment. L'implant est aussi pourvu d'une série de plots 23 interrompant à leur emplacement les gorges correspondantes et faisant saillie de la surface de l'implant 1. Dans l'exemple représenté, cinq plots sont ainsi réalisés entre le second anneau 17 et le pâle, ce dernier étant lui même surmonte d'un plot 23. Bien entendu, le nombre de plots et leurs emplacements peuvent largement varier, ces plots étant destinés, comme les gorges 3-9 et les rainures 22, à favoriser l'ancrage osseux de l'implant 1 dans la cavite cotylol- dienne, ainsi qu'une meilleure répartition du ciment. Meridian grooves or grooves 22 are arranged at suitable angular intervals on the external surface of the implant 1 by intersecting part of the grooves 3 to 9 as a function of their length. These grooves 22 form an anti-rotary system for the implant 1, once filled with cement. The implant is also provided with a series of studs 23 interrupting at their location the corresponding grooves and projecting from the surface of the implant 1. In the example shown, five studs are thus produced between the second ring 17 and the pale, the latter itself being surmounted by a stud 23. Of course, the number of studs and their locations can vary widely, these studs being intended, like the grooves 3-9 and the grooves 22, to promote bone anchoring of implant 1 in the acetabular cavity, as well as a better distribution of the cement.
Le pourtour de la cavité 2 comporte un bord antiluxation 24 raccordé à un chanfrein 25. Le bord antiluxation 24 s'étend de préférence sur un secteur angulaire d'environ 90 , c'est à dire sur un quadrant. The periphery of the cavity 2 has an anti-luxation edge 24 connected to a chamfer 25. The anti-luxation edge 24 preferably extends over an angular sector of approximately 90, that is to say on a quadrant.
D'autre part, deux trous 26 de positionnement d'éléments de préhension d'un ancillaire non représenté, sont ménagés sur la face équatoriale 11 de l'implant 1, de préférence chacun au voisinage d'une extrémité du bord antiluxation 24. Les deux trous 26 peuvent etre séparés par un intervalle angulaire B variable, par exemple de 110 si le bord antiluxation 24 forme un quadrant comme représenté.On the other hand, two holes 26 for positioning gripping elements of an ancillary not shown, are formed on the equatorial face 11 of the implant 1, preferably each in the vicinity of one end of the antiluxation edge 24. two holes 26 can be separated by a variable angular interval B, for example 110 if the anti-luxation edge 24 forms a quadrant as shown.
Les anneaux 15,17 sont de préférence posi tionnés angulairement, dans des plans parallèles au plan equatorial de l'implant, comme représenté à la figure 3 : les anneaux sont places de manière à couvrir chacun la zone angulaire occupée par le bord antiluxation 24. Les intervalles entre leurs extrémités coudées 15a, 17a et leurs extrémités libres respectives 15b et 17h sont situés en dehors de ladite zone angulaire du bord antiluxation 24, et les ergots constitués par leurs extrémités coudées 15d, 17a, sont distants angulairement de préférence d'environ 90". The rings 15, 17 are preferably positioned angularly, in planes parallel to the equatorial plane of the implant, as shown in FIG. 3: the rings are placed so as to each cover the angular zone occupied by the antiluxation edge 24. The intervals between their bent ends 15a, 17a and their respective free ends 15b and 17h are situated outside said angular zone of the anti-luxation edge 24, and the lugs formed by their bent ends 15d, 17a, are angularly separated by preferably about 90 ".
Gracie à ce positionnement des anneaux 15,17, on évite que leurs extrémités puissent se trouver derrière la rotule de la prothèse fémorale, et donc invisibles sur les clichés radiographiques. Thanks to this positioning of the rings 15,17, we avoid that their ends can be behind the kneecap of the femoral prosthesis, and therefore invisible on radiographic images.
Les deux anneaux métalliques 15 et 17 constituent des moyens de repérage radiographique pour déterminer, d'après l'image radiographique de l'implant posé dans la cavité cotyloidienne, son orientation tridimensionnelle et en particulier son angle d'antéversion ou de rétroversion. En effet, en raison de l'inclinaison de l'implant 1 dans la cavité cotyloidienne, les anneaux 15, 17 apparaissent sur l'image radiographique comme des ellipses qui s'interpénètrent plus ou moins en fonction de l'inclinaison de l'implant, comme visible à la figure 7. The two metal rings 15 and 17 constitute radiographic tracking means for determining, from the radiographic image of the implant placed in the acetabular cavity, its three-dimensional orientation and in particular its anteversion or retroversion angle. In fact, due to the inclination of the implant 1 in the acetabular cavity, the rings 15, 17 appear on the radiographic image as ellipses which interpenetrate more or less depending on the inclination of the implant. , as shown in Figure 7.
La figure 7 résulte de la superposition par transparence d'un cliché radiographique et de l'implant cotyloïdien 1, sur lequel on voit les anneaux 15,17 et l'os iliaque 20, et d'un calque transparent sur lequel ont été inscrits une série de traits concourants 25, 26, 27, 28 délimitant entre eux des angles de différentes valeurs. Chaque droite 25, 26... porte des repères en forme d'ergots incurvés de manière similaire aux ergots 15a,17a de retenue des anneaux 15,17, l'un de ces repères correspondant à une position horaire déterminée d'antéversion, tandis que l'autre correspond à une position anti-horaire déterminée de rétroversion de l'implant cotyloïdien, après sa pose sur le patient. Ainsi, les droites 25 et 27 portent deux repères mais les droites 26 et 28 en portent trois. Par exemple, la droite 25 représentée en trait plus fort que les autres, porte un premier repère horaire référencé 1H30 R et un second repère horaire référencé 1H30 A, R signifiant rétroversion et A signifiant antéversion. De même, la droite 28 est associée à deux repères de rétroversion correspondant aux positions horaires 12H et 6H et d'un repère d'anteversion correspondant à la position horaire 3H. FIG. 7 results from the superimposition by transparency of an X-ray photograph and of the acetabular implant 1, on which we see the rings 15,17 and the iliac bone 20, and of a transparent layer on which a series of concurrent lines 25, 26, 27, 28 delimiting between them angles of different values. Each straight line 25, 26 ... carries markers in the form of curved lugs in a similar manner to the lugs 15a, 17a for retaining the rings 15,17, one of these markers corresponding to a determined hourly anteversion position, while that the other corresponds to a determined anti-clockwise position of retroversion of the acetabular implant, after its placement on the patient. Thus, the lines 25 and 27 carry two marks but the lines 26 and 28 carry three. For example, the straight line 25 shown in a stronger line than the others, carries a first time marker referenced 1:30 hours R and a second time marker referenced 1:30 hours A, R meaning retroversion and A meaning anteversion. Similarly, the straight line 28 is associated with two retroversion marks corresponding to the 12H and 6H hour positions and an anteversion mark corresponding to the 3H hour position.
On établit ainsi une série de calques dont chacun correspond à l'un des deux anneaux 15,17, à une prothèse de hanche gauche ou droite et à un angle détermine d'orientation de l'implant cotyloïdien, soit d'antéversion soit de rétroversion, plus une abaque telle que celle représentée dans la figure 9 comme cela sera explicite ci-après. A series of layers is thus established, each of which corresponds to one of the two rings 15,17, to a left or right hip prosthesis and to a determined angle of orientation of the acetabular implant, either anteversion or retroversion , plus an abacus such as that shown in Figure 9 as will be explained below.
Sur la figure 7, le calque portant les repères horaires correspond au grand anneau 17 d'un implant posé sur une prothèse de hanche gauche et à un angle d'antéversion ou de rétroversion de 20 . Le rôle de cette abaque superposée au cliché radiographique est de permettre de déterminer si l'angle en question correspond à une rétroversion ou à une antéversion de l'implant 1. In FIG. 7, the layer bearing the time markers corresponds to the large ring 17 of an implant placed on a left hip prosthesis and to an anteversion or retroversion angle of 20. The role of this abacus superimposed on the radiographic image is to make it possible to determine whether the angle in question corresponds to a retroversion or an anteversion of the implant 1.
La détermination de cet angle d'orientation (antéversion ou rétroversion) de l'implant 1 posé s'effectue conformément au procédé suivant. The determination of this orientation angle (anteversion or retroversion) of the implant 1 placed is carried out in accordance with the following process.
a) on réalise une radiographie de face de l'implant cotyloïdien 1 en visant le centre du grand anneau 17, et on obtient une radiographie telle que celle illustrée à la figure 7. Cette radiographie établit ainsi une projection dans un plan des anneaux. a) an X-ray of the acetabular implant 1 is taken from the front, aiming at the center of the large ring 17, and an X-ray such as that illustrated in FIG. 7 is obtained. This X-ray thus establishes a projection in a plane of the rings.
b) sur la radiographie, on mesure la longueur 1 du petit axe de l'ellipse du grand anneau 17, ou éventuellement du petit anneau 15, en s'aidant de graduations 30 sur la droite 27. b) on the radiography, the length 1 of the minor axis of the ellipse of the large ring 17, or possibly of the small ring 15, is measured, using graduations 30 on the right 27.
c) à l'aide d'une abaque preétablie, telle que celle illustrée à la figure 9, on lit l'angle de rétroversion ou d'antéversion sur cette abaque, pour une taille donnée (diamètre externe) de l'implant cotyloidien 1 en fonction de la longueur 1 mesurée. c) using a pre-established abacus, such as that illustrated in FIG. 9, we read the angle of retroversion or anteversion on this abacus, for a given size (external diameter) of the acetabular implant 1 depending on the length 1 measured.
Cette abaque est un tableau à double entrée comportant d'une part les diamètres externes des implants en progression régulière, et d'autre part, les angles d'antéversion. I1 convient de préciser que les chiffres remplissant partiellement ce tableau sont arbitraires et fournis uniquement à des fins explicatives de l'utilisation de cette abaque. This abacus is a double entry table comprising on the one hand the external diameters of the implants in regular progression, and on the other hand, the anteversion angles. It should be noted that the figures partially filling this table are arbitrary and provided only for explanatory purposes of the use of this chart.
On voit sur la figure 9, que pour chaque taille d'implant, par exemple un diamètre externe de 46 mm pour un implant pourvu ou non de plots 23, à chaque longueur du petit axe de l'ellipse du grand anneau 15 lue dans l'une des cases du tableau, correspond un angle d'orientation donné. Ainsi, pour un diamètre externe de 46 mm d'un implant et une longueur correspondant à la référence 36, l'angle d'antéversion ou de rétroversion est de 13Q. A ce stade, le chirurgien ignore encore s'il s'agit d'un angle d'antéversion ou de rétroversion, détermination qui fait l'objet de l'étape suivante. We see in Figure 9, that for each size of implant, for example an external diameter of 46 mm for an implant with or without studs 23, at each length of the minor axis of the ellipse of the large ring 15 read in the 'one of the boxes in the table corresponds to a given orientation angle. Thus, for an external diameter of 46 mm of an implant and a length corresponding to the reference 36, the anteversion or retroversion angle is 13Q. At this stage, the surgeon still does not know whether it is an anteversion or retroversion angle, a determination which is the subject of the next step.
d) On choisit le calque dont l'angle trouvé en antéversion ou rétroversion est le plus proche ainsi que le côté de hanche considéré, et l'anneau sur lequel on veut faire la mesure en fonction de sa lisibilité sur la radiographie. On positionne l'un des traits, a savoir le trait fort 25 sur le grand axe du grand anneau 17 du cliché radiographique placé sous le calque, on centre ce dernier à l'aide des graduations 30 marquées sur la droite 27 perpendiculaire à la droite 25, sur le petit axe de l'ellipse constituée par le grand anneau 17 (si le calque correspond à cet anneau). Le calque se trouve alors dans la position représentée à la figure 7 par rapport aux anneaux 15,17. d) We choose the layer whose angle found in anteversion or retroversion is the closest as well as the hip side considered, and the ring on which we want to make the measurement according to its legibility on the radiography. One of the lines is positioned, namely the strong line 25 on the long axis of the large ring 17 of the radiographic photograph placed under the layer, we center the latter using the graduations 30 marked on the right 27 perpendicular to the right 25, on the minor axis of the ellipse formed by the large ring 17 (if the layer corresponds to this ring). The layer is then in the position shown in Figure 7 relative to the rings 15,17.
On peut en déduire, par lecture du calque, si l'implant 1 est en antéversion ou rétroversion. En effet, les repères affectés à chaque droite et répartis à la manière d'un cadran horaire s'étendent sur des arcs disposés de telle manière que des arcs placés dans le même angle de deux droites consécutives ne se superposent pas mais couvrent la totalité de l'angle entre ces deux droites. Ainsi par exemple les repères horaires 1 H30 A et 12H R sont décalés longitudinalement sur les droites, et occupent chacun une moitié de l'angle aigu formé par les droites 28 et 25. We can deduce, by reading the layer, if the implant 1 is anteversion or retroversion. Indeed, the marks assigned to each line and distributed in the manner of an hourly dial extend over arcs arranged in such a way that arcs placed in the same angle of two consecutive lines do not overlap but cover the whole of the angle between these two lines. Thus, for example, the hour markers 1 H30 A and 12H R are offset longitudinally on the straight lines, and each occupy one half of the acute angle formed by the straight lines 28 and 25.
Dans ces conditions, si, comme représenté à la figure 7, l'ergot terminal 17a du grand anneau 17 apparait dans le secteur angulaire occupé par l'arc repéré 12 H R, cela signifie que l'implant cotyloïdien est en rétroversion avec l'angle lu précédemment sur l'abaque, l'ergot 17a étant positionné dans l'exemple re présenté à environ 12 H30. Under these conditions, if, as shown in FIG. 7, the terminal lug 17a of the large ring 17 appears in the angular sector occupied by the arch marked 12 HR, this means that the acetabular implant is in retroversion with the angle previously read on the abacus, the lug 17a being positioned in the example re presented at around 12:30 p.m.
Par contre, si l'ergot 17a apparaissait dans le secteur angulaire couvert par le repère 1 H 30 A, cela signifierait que l'implant 1 est orienté en antéversion de l'angle lu précédemment sur l'abaque. On the other hand, if the lug 17a appeared in the angular sector covered by the reference 1 H 30 A, this would mean that the implant 1 is oriented in anteversion of the angle previously read on the abacus.
f) On détermine enfin aisément, à partir de ces constatations, la position horaire du bord antiluxation 24 à partir de la position horaire de l'extrémité coudée constituée par l'ergot 17a du grand anneau 17. En effet, du fait que les anneaux 15 et 17 sont normalement positionnés angulairement comme représenté à la figure 3 et décrit ci-dessus, le bord anti-luxation 24 s'étend approximativement à partir de l'extrémité coudée 17a dans le secteur angulaire couvert par le grand anneau 17. f) Finally, it is easy to determine, from these observations, the hourly position of the antiluxation edge 24 from the hourly position of the bent end formed by the lug 17a of the large ring 17. In fact, because the rings 15 and 17 are normally angularly positioned as shown in FIG. 3 and described above, the anti-dislocation edge 24 extends approximately from the bent end 17a in the angular sector covered by the large ring 17.
I1 convient de préciser que s'il n'existe pas de calque correspondant à l'angle exact lu sur l'abaque, on utilise le calque correspondant à l'angle le plus proche. It should be noted that if there is no layer corresponding to the exact angle read on the chart, the layer corresponding to the nearest angle is used.
L'angle le plus fréquemment choisi par les chirurgiens est de 15". Or, pour cette valeur, les deux ellipses vues sur l'image radiographique correspondant respectivement aux anneaux 15 et 17 sont tangentes (fig. The angle most frequently chosen by surgeons is 15 ". However, for this value, the two ellipses seen on the radiographic image corresponding respectively to the rings 15 and 17 are tangent (fig.
8), à condition que les deux anneaux 15, 17 soient convenablement positionnés. Dans ces conditions, on réalise l'implant 1 et on le positionne de la manière voulue, pour qu'effectivement les deux ellipses radiographiques soient tangentes pour un angle d'antéversion ou de rétroversion de 15". Pour que cette tangence soit obtenue avec un angle de 15 , les deux alésages 16 et 18 doivent être positionnés de telle façon que l'angle (OX,
OY) soit de 30 (fig. 4).8), provided that the two rings 15, 17 are properly positioned. Under these conditions, implant 1 is produced and it is positioned in the desired manner, so that the two radiographic ellipses are effectively tangent for an anteversion or retroversion angle of 15 ". So that this tangency is obtained with a angle of 15, the two bores 16 and 18 must be positioned so that the angle (OX,
OY) or 30 (fig. 4).
De ce fait, si sur l'image radiographique les ellipses sont tangentes, cela supprime la necessité de consulter l'abaque, cette tangence indiquant un angle de 15 . Il suffit ensuite de choisir le calque approprié et de procéder comme précédemment expliqué pour déterminer si l'angle de 15 correspond à une antéversion ou a une rétroversion. Therefore, if on the radiographic image the ellipses are tangent, this eliminates the need to consult the abacus, this tangency indicating an angle of 15. Then just choose the appropriate layer and proceed as previously explained to determine if the angle of 15 corresponds to an anteversion or a retroversion.
Enfin, les trous 26 de réception des deux ergots de l'ancillaire sont placés de façon que le chirurgien sache, lorsque l'ancillaire est effectivement engagé dans ces trous 26, où est exactement situé le bord anti-luxation 24. Finally, the holes 26 for receiving the two lugs of the ancillary are placed so that the surgeon knows, when the ancillary is actually engaged in these holes 26, where the anti-dislocation edge 24 is exactly located.
Les deux anneaux 15, 17 constituent des moyens particulièrement commodes de repérage radiographique de l'orientation de l'implant 1 après sa pose, et de plus permettent une étude radiologique de l'usure de l'implant 1. The two rings 15, 17 constitute particularly convenient means for radiographic identification of the orientation of the implant 1 after its installation, and moreover allow a radiological study of the wear of the implant 1.
L'invention n'est pas limitée au mode de réalisation décrit et peut comporter diverses variantes d'exécution. I1 est ainsi évident que le nombre de gorges 3... 9 et de plots 23 peut largement varier. Le bord antiluxation peut avoir une étendue angulaire différente et les anneaux 15, 17 être remplacés par d'autres moyens de repérage radiographique de l'orientation de l'implant. The invention is not limited to the embodiment described and may include various variant embodiments. It is thus obvious that the number of grooves 3 ... 9 and of studs 23 can vary widely. The antiluxation edge may have a different angular extent and the rings 15, 17 may be replaced by other means for radiographic tracking of the orientation of the implant.
Les plots 23 sont supprimés pour des cotyles de faibles diamètres, afin d'éviter de trop diminuer leur épaisseur. The studs 23 are eliminated for acetabulum of small diameters, in order to avoid reducing their thickness too much.
Claims (11)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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FR9408814A FR2722398A1 (en) | 1994-07-15 | 1994-07-15 | One=piece cotyloid implant for hip prosthesis |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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FR9408814A FR2722398A1 (en) | 1994-07-15 | 1994-07-15 | One=piece cotyloid implant for hip prosthesis |
Publications (2)
Publication Number | Publication Date |
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FR2722398A1 true FR2722398A1 (en) | 1996-01-19 |
FR2722398B1 FR2722398B1 (en) | 1997-02-28 |
Family
ID=9465444
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
FR9408814A Granted FR2722398A1 (en) | 1994-07-15 | 1994-07-15 | One=piece cotyloid implant for hip prosthesis |
Country Status (1)
Country | Link |
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FR (1) | FR2722398A1 (en) |
Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0997117A2 (en) * | 1998-09-24 | 2000-05-03 | GMT Gesellschaft für medizinische Technik mbH | Hip joint acetabular cup |
WO2002071987A1 (en) * | 2001-03-13 | 2002-09-19 | Iversen Bjoern Franc | Method and device for providing of information after insertion of a prosthesis in a hip-joint |
US6764512B2 (en) * | 2000-04-04 | 2004-07-20 | Link Spine Group, Inc. | Plastic implant with channel for radiographic contrast wire |
CN103181833A (en) * | 2011-12-30 | 2013-07-03 | 北京爱康宜诚医疗器材股份有限公司 | Polyethylene acetabulum capable of being bonded firmly |
Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CH561056A5 (en) * | 1971-09-24 | 1975-04-30 | Nat Res Dev | |
DE7500535U (en) * | 1975-01-10 | 1975-07-10 | Howmedica International Inc | Joint socket |
US4224698A (en) * | 1979-04-05 | 1980-09-30 | Hopson Clark N | Acetabular cup for total hip replacements |
EP0084089A1 (en) * | 1982-01-12 | 1983-07-27 | GebràDer Sulzer Aktiengesellschaft | Acetabular cup to be anchored in the pelvis |
GB2134360A (en) * | 1983-01-28 | 1984-08-08 | Thackray C F Ltd | Improvements relating to hip surgery |
EP0549483A1 (en) * | 1991-12-27 | 1993-06-30 | Merck Biomaterial France | Acetabular cup for hip prosthesis |
-
1994
- 1994-07-15 FR FR9408814A patent/FR2722398A1/en active Granted
Patent Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CH561056A5 (en) * | 1971-09-24 | 1975-04-30 | Nat Res Dev | |
DE7500535U (en) * | 1975-01-10 | 1975-07-10 | Howmedica International Inc | Joint socket |
US4224698A (en) * | 1979-04-05 | 1980-09-30 | Hopson Clark N | Acetabular cup for total hip replacements |
EP0084089A1 (en) * | 1982-01-12 | 1983-07-27 | GebràDer Sulzer Aktiengesellschaft | Acetabular cup to be anchored in the pelvis |
GB2134360A (en) * | 1983-01-28 | 1984-08-08 | Thackray C F Ltd | Improvements relating to hip surgery |
EP0549483A1 (en) * | 1991-12-27 | 1993-06-30 | Merck Biomaterial France | Acetabular cup for hip prosthesis |
Cited By (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0997117A2 (en) * | 1998-09-24 | 2000-05-03 | GMT Gesellschaft für medizinische Technik mbH | Hip joint acetabular cup |
EP0997117A3 (en) * | 1998-09-24 | 2001-01-17 | GMT Gesellschaft für medizinische Technik mbH | Hip joint acetabular cup |
US6764512B2 (en) * | 2000-04-04 | 2004-07-20 | Link Spine Group, Inc. | Plastic implant with channel for radiographic contrast wire |
WO2002071987A1 (en) * | 2001-03-13 | 2002-09-19 | Iversen Bjoern Franc | Method and device for providing of information after insertion of a prosthesis in a hip-joint |
CN103181833A (en) * | 2011-12-30 | 2013-07-03 | 北京爱康宜诚医疗器材股份有限公司 | Polyethylene acetabulum capable of being bonded firmly |
Also Published As
Publication number | Publication date |
---|---|
FR2722398B1 (en) | 1997-02-28 |
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