FR2755847A1 - Shoulder joint articulation prosthesis - Google Patents

Shoulder joint articulation prosthesis Download PDF

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Publication number
FR2755847A1
FR2755847A1 FR9612650A FR9612650A FR2755847A1 FR 2755847 A1 FR2755847 A1 FR 2755847A1 FR 9612650 A FR9612650 A FR 9612650A FR 9612650 A FR9612650 A FR 9612650A FR 2755847 A1 FR2755847 A1 FR 2755847A1
Authority
FR
France
Prior art keywords
humeral
assembly
glenoid
cooperating
cup
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.)
Granted
Application number
FR9612650A
Other languages
French (fr)
Other versions
FR2755847B1 (en
Inventor
Didier Capon
Patrick Chatelier
Buttet Michel De
Didier Oudet
Gilles Voydeville
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Medinov Amp
Original Assignee
Medinov Amp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Medinov Amp filed Critical Medinov Amp
Priority to FR9612650A priority Critical patent/FR2755847B1/en
Publication of FR2755847A1 publication Critical patent/FR2755847A1/en
Application granted granted Critical
Publication of FR2755847B1 publication Critical patent/FR2755847B1/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/40—Joints for shoulders
    • 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
    • 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
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    • A61F2/4059—Humeral shafts
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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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    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
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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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    • A61F2002/30354—Cylindrically-shaped protrusion and recess, e.g. cylinder of circular basis
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    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
    • A61F2002/30364—Rotation about the common longitudinal axis
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    • A61F2/30—Joints
    • A61F2/40—Joints for shoulders
    • A61F2/4014—Humeral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic humeral shafts
    • A61F2002/4051—Connections of heads directly to shafts
    • 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
    • A61F2/40—Joints for shoulders
    • A61F2/4059—Humeral shafts
    • A61F2002/407—Intermediate parts of shafts
    • A61F2002/4074—Connections of proximal or metaphyseal parts to distal or diaphyseal parts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • A61F2230/0008—Rounded shapes, e.g. with rounded corners elliptical or oval
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017—Angular shapes
    • A61F2230/0019—Angular shapes rectangular
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
    • A61F2250/0006—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting angular orientation
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • 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

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

The prosthesis has a humeral implant cooperating with a contact surface for a sliding glenoid implant (1) fixed to the socket of the shoulder joint. The contact and sliding surface of the implant is concave and disposed at an angle with respect to a horizontal plane, following a vertical axis. The glenoid implant can have a symmetrical elliptical shape. The angle (alpha) of the implant is given with respect to the smaller axis (XX) of the elliptical contact surface around its major axis. The glenoid implant can have a cup mounted in a support with fixings to the shoulder socket.

Description

ENSEMBLE PROTHETIOUE POUR L'ARTICULATION DE
L'EPAULE.PROTHETIOUE ASSEMBLY FOR THE ARTICULATION OF
SHOULDER.

L'invention concerne les implants orthopédiques, notamment les prothèses d'épaule. The invention relates to orthopedic implants, in particular shoulder prostheses.

Il est connu, pour reproduire la surface anatomique de l'articulation de l'épaule, d'utiliser différents types de prothèses. It is known, to reproduce the anatomical surface of the shoulder joint, to use different types of prostheses.

Généralement, ces prothèses comprennent un élément huméral fixé dans le canal médullaire de l'humérus, en étant apte à coopérer soit directement avec la glène, soit avec un élément glénoïdien fixé au niveau de la glène de l'omoplate. On peut citer par exemple, l'enseignement de la demande de brevet FR 8913366 dont le demandeur de la présente est également titulaire. Generally, these prostheses include a humeral element fixed in the medullary canal of the humerus, being able to cooperate either directly with the glenoid, or with a glenoid element fixed at the level of the glenoid of the scapula. We can cite for example, the teaching of patent application FR 8913366 which the applicant of this also holds.

Dans cette demande de brevet, il est indiqué que la tête humérale coopère en appui avec un organe glénoidien agencé pour être solidaire d'un support conformé pour être implanté au niveau de la glène de l'épaule. In this patent application, it is indicated that the humeral head cooperates in support with a glenoid organ arranged to be secured to a support shaped to be implanted at the glenoid of the shoulder.

L'organe glénoïdien peut présenter différentes formes de réalisation. Notamment, l'organe glénoïdien est réalisé sous forme d'une cupule concave coopérant avec la tête humérale de forme générale hémisphérique. Les surfaces d'appui et de glissement de l'organe glénoïdien sont parallèles, ce qui peut poser certains problèmes, notamment dans le cas d'une mauvaise orientation de la métaglène. Il en résulte un mauvais positionnement de l'ensemble prothétique et des risques d'instabilité. The glenoid organ can have different embodiments. In particular, the glenoid organ is produced in the form of a concave cup cooperating with the humeral head of generally hemispherical shape. The bearing and sliding surfaces of the glenoid organ are parallel, which can pose certain problems, in particular in the case of a poor orientation of the metaglene. This results in poor positioning of the prosthetic assembly and risks of instability.

L'invention s'est fixée pour but de remédier à ces inconvénients, de manière simple, sûre et efficace. The object of the invention is to remedy these drawbacks in a simple, safe and effective manner.

Le problème que se propose de résoudre l'invention est de pouvoir régler l'orientation dans un plan horizontal suivant un axe vertical de l'ensemble prothétique au niveau de l'implant glénoïdien, pour assurer une meilleure stabilité.  The problem which the invention proposes to solve is to be able to adjust the orientation in a horizontal plane along a vertical axis of the prosthetic assembly at the level of the glenoid implant, to ensure better stability.

Pour résoudre un tel problème la surface d'appui et de glissement de l'implant glénoidien est concave et est disposée angulairement par rapport au plan horizontal, suivant un axe vertical. To solve such a problem, the bearing and sliding surface of the glenoid implant is concave and is arranged angularly relative to the horizontal plane, along a vertical axis.

Un autre problème que se propose de résoudre l'invention, est de permettre la réversibilité de l'implant glénoïdien. Dans ce but, ce dernier a une forme générale elliptique et symétrique. Another problem which the invention proposes to solve is to allow the reversibility of the glenoid implant. For this purpose, the latter has a general elliptical and symmetrical shape.

Compte-tenu du problème posé à résoudre, l'angulation est donnée à partir du petit axe de la surface d'appui elliptique, autour de son grand axe. Given the problem to be solved, the angulation is given from the minor axis of the elliptical bearing surface, around its major axis.

Avantageusement, l'implant glénoïdien est constitué par une cupule montée dans un support présentant des agencements de fixation avec la glène de l'épaule. Advantageously, the glenoid implant is constituted by a cup mounted in a support having fixing arrangements with the glenoid of the shoulder.

Compte-tenu des possibilités d'orientation angulaire, il est apparu nécessaire de prévoir un assemblage spécifique entre la cupule et l'embase support, notamment pour résister aux contraintes de cisaillement. Dans ce but, la face de dessous de la cupule présente, en débordement et dans sa partie centrale, un pion de centrage et de fixation apte à être engagé dans l'alésage d'un plot, que présente l'organe support. Given the possibilities of angular orientation, it appeared necessary to provide a specific assembly between the cup and the support base, in particular to withstand the shear stresses. For this purpose, the underside of the cup has, in overflow and in its central part, a centering and fixing pin capable of being engaged in the bore of a stud, which has the support member.

Le pion de centrage de la cupule présente une lèvre de rétention coopérant avec un décrochement formé dans l'alésage du plot du support.The centering pin of the cup has a retention lip cooperating with a recess formed in the bore of the stud of the support.

Suivant une autre caractéristique, la cupule et le support présentent des agencements complémentaires de positionnement et de centrage. La face de dessous de la cupule présente une empreinte en creux, de forme générale très sensiblement rectangulaire avec des angles, arrondis, ladite empreinte coopérant avec une empreinte de forme complémentaire formée en débordement de la face de dessus du support. According to another characteristic, the cup and the support have complementary positioning and centering arrangements. The underside of the cup has a hollow imprint, of generally very substantially rectangular shape with rounded corners, said imprint cooperating with an imprint of complementary shape formed in overflow from the top face of the support.

La fixation de l'implant glénoïdien s'effectue au moyen de vis divergentes coopérant avec les trous filetés orientés angulairement et formés dans l'épaisseur du support recevant la cupule. The glenoid implant is fixed by means of divergent screws cooperating with the angularly oriented threaded holes formed in the thickness of the support receiving the cup.

Un autre problème que se propose de résoudre l'invention, est de pouvoir modifier l'angulation de la tête humérale, afin de régler notamment l'angle d'antéversion. Another problem which the invention proposes to solve is to be able to modify the angulation of the humeral head, in order in particular to adjust the angle of anteversion.

Pour résoudre un tel problème, la tête humérale présente des agencements d'accouplement coopérant avec des agencements complémentaires formés en bout d'une tige humérale pour autoriser à ladite tête un montage avec capacité d'orientation et d'indexation angulaire. To solve such a problem, the humeral head has coupling arrangements cooperating with complementary arrangements formed at the end of a humeral rod to allow said head to be mounted with capacity for orientation and angular indexing.

Avantageusement, les agencements de la tête humérale sont constitués par une portée tronconique excentrée formée en débordement d'une empreinte en étant apte à être engagée dans un logement de forme complémentaire formé en bout de la tige dans une empreinte en relief présentant des pans coupés coopérant, selon différentes orientations angulaires, en position de butée avec l'un des rebords de l'empreinte en creux. Advantageously, the arrangements of the humeral head are constituted by an eccentric frustoconical bearing formed in overflow of an imprint being able to be engaged in a housing of complementary shape formed at the end of the rod in an imprint in relief having cooperating cut sides , according to different angular orientations, in the abutment position with one of the edges of the hollow imprint.

Pour résoudre le problème posé de respecter la cinétamique de l'articulation de l'épaule, les rayons de la tête humérale et de la cupule ne sont pas congruants. To resolve the problem of respecting the kinetics of the shoulder joint, the rays of the humeral head and the cup are not congruent.

il en résulte que ces caractéristiques combinées permettent d'obtenir plusieurs réglages de l'ensemble de la tête et de la glène dans différents plans de l'espace. as a result, these combined characteristics make it possible to obtain several adjustments of the whole of the head and of the glenoid in different planes of space.

Toujours en ayant pour objectif de proposer différentes orientation, la tête humérale est disposée angulairement par rapport à la tige humérale, selon un angle cervico-diaphysaire soit d'environ 125 , soit d'environ 1400. Still having the objective of proposing different orientations, the humeral head is arranged angularly with respect to the humeral stem, at a cervico-diaphyseal angle either of approximately 125 or approximately 1400.

L'invention est exposée, ci-après plus en détail à l'aide des dessins annexés, dans lesquels:
La figure 1 est une vue montrant l'ensemble prothétique de l'articulation de l'épaule.The invention is set out below in more detail using the appended drawings, in which:
Figure 1 is a view showing the prosthetic assembly of the shoulder joint.

La figure 2 est une vue en coupe longitudinale considérée selon la ligne 2.2 de la figure 1. FIG. 2 is a view in longitudinal section considered along line 2.2 of FIG. 1.

La figure 3 est une vue en perspective considérée de dessous, et montrant avant assemblage, la cupule et le support de l'implant glénoïdien.  Figure 3 is a perspective view seen from below, and before assembly, the cup and the support of the glenoid implant.

La figure 4 est une vue semblable à la figure 3, considérée par le dessus. Figure 4 is a view similar to Figure 3, viewed from above.

La figure 5 est une vue longitudinale montrant l'accouplement de la cupule dans le support correspondant. Figure 5 is a longitudinal view showing the coupling of the cup in the corresponding support.

La figure 6 est une vue de face de la tige humérale montrant notamment les moyens d'indexation angulaire formés au niveau de l'extrémité supérieure de cette dernière. Figure 6 is a front view of the humeral rod showing in particular the angular indexing means formed at the upper end of the latter.

La figure 7 est une vue de côté correspondant à la figure 6. FIG. 7 is a side view corresponding to FIG. 6.

Les figures 8, 9 et 10 sont respectivement des vues de face, de côté, et selon les flèches FF, montrant l'indexation angulaire de la tête humérale par rapport à la tige selon une première position. Figures 8, 9 and 10 are respectively front, side, and according to arrows FF, showing the angular indexing of the humeral head relative to the rod in a first position.

Les figures 11- 12-13, 14- 15-16, 17-18 sont des vues semblables aux figures 8, 9 et 10, montrant une troisième position d'indexation angulaire. Figures 11-12-13, 14-15-16, 17-18 are views similar to Figures 8, 9 and 10, showing a third angular indexing position.

La figure 19 montre, par une vue de face, l'implant huméral disposé en regard de l'implant glénoïdien, dont la cupule présente une inclinaison dirigée vers la gauche. FIG. 19 shows, by a front view, the humeral implant placed opposite the glenoid implant, the cup of which has an inclination directed to the left.

La figure 20 est une vue correspondant à la figure 15, dans le cas où la cupule présente une inclinaison dirigée vers la droite. Figure 20 is a view corresponding to Figure 15, in the case where the cup has an inclination directed to the right.

La figure 21 est une vue de côté de l'implant huméral, montrant la disposition angulaire de la tête par rapport à la tige, selon un angle cervico-diaphysaire d'environ 125".  FIG. 21 is a side view of the humeral implant, showing the angular arrangement of the head relative to the rod, at a cervico-diaphyseal angle of approximately 125 ".

La figure 22 est une vue de côté de l'implant huméral, montrant la disposition angulaire de la tête par rapport à la tige, selon un angle cervico-diaphysaire d'environ 1400.  FIG. 22 is a side view of the humeral implant, showing the angular arrangement of the head relative to the rod, at a cervico-diaphyseal angle of approximately 1400.

De manière connue, l'ensemble prothétique comprend une tige humérale (T) destinée à être implantée dans la diaphyse de l'humérus. In known manner, the prosthetic assembly comprises a humeral rod (T) intended to be implanted in the diaphysis of the humerus.

La tige (T) reçoit une tête humérale (H) coopérant avec un implant glénoidien supplémentaire (C) destiné à être implanté de façon anatomique au niveau de la glène de l'épaule (figure 1). Ces dispositions ne sont pas décrites en détail car parfaitement connues pour un homme du métier. The rod (T) receives a humeral head (H) cooperating with an additional glenoid implant (C) intended to be implanted anatomically at the glenoid of the shoulder (Figure 1). These provisions are not described in detail since they are perfectly known to a person skilled in the art.

L'implant glénoïdien est réalisé sous forme d'une cupule (1) apte à être montée dans un support (2) présentant tout type d'agencement de fixation, avec la glène de l'épaule. The glenoid implant is produced in the form of a cup (1) capable of being mounted in a support (2) having any type of fixing arrangement, with the glenoid of the shoulder.

Selon une caractéristique à la base de l'invention, l'implant glénoïdien et plus particulièrement la cupule (1), présente une surface d'appui et de glissement (la) coopérant avec la tête humérale, qui est concave et disposée angulairement par rapport au plan horizontal, suivant un axe vertical. On renvoie notamment à la figure 1 qui montrent l'inclinaison (a) de la surface d'appui et de glissement (la) par rapport au plan horizontal. According to a characteristic on the basis of the invention, the glenoid implant and more particularly the cup (1), has a bearing and sliding surface (la) cooperating with the humeral head, which is concave and angularly arranged with respect to in the horizontal plane, along a vertical axis. Reference is made in particular to FIG. 1 which shows the inclination (a) of the bearing and sliding surface (la) relative to the horizontal plane.

La cupule (1) a une forme générale elliptique. L'angulation (a) est donnée à partir du petit axe (XX') de la prothèse autour du grand axe (Y-Y'). La forme de l'implant glénoïdien, notamment la cupule, est symétrique permettant ainsi sa réversabilité, pour obtenir une inclinaison du côté gauche (figure 19) ou du côté droit (figure 20). The cup (1) has a generally elliptical shape. The angulation (a) is given from the minor axis (XX ') of the prosthesis around the major axis (Y-Y'). The shape of the glenoid implant, in particular the cup, is symmetrical thus allowing its reversibility, to obtain an inclination on the left side (figure 19) or on the right side (figure 20).

Bien évidemment, le support (2) a une forme complémentaire de celle de la cupule (1). Comme le montrent les figures 3, 4 et 5 notamment, la cupule (1) présente, en débordement de sa face de dessous et dans sa partie centrale, un pion de centrage et de fixation (lb). Ce pion est destiné à être engagé dans l'alésage (2al) d'un plot central (2a) formé en débordement de la face de dessous du support (2). En outre, le pion de centrage (lb) présente une lèvre rétentive (tic) apte à coopérer avec un décrochement (2a2) que présente l'alésage (2al). Cette lèvre (tic) est biseautée pour permettre l'introduction du pion dans l'alésage (2al) et assurer le blocage dudit pion par rapport au décrochement (2a2) (figure 5). Obviously, the support (2) has a shape complementary to that of the cup (1). As shown in Figures 3, 4 and 5 in particular, the cup (1) has, projecting from its underside and in its central part, a centering and fixing pin (lb). This pin is intended to be engaged in the bore (2al) of a central stud (2a) formed in overflow from the underside of the support (2). In addition, the centering pin (lb) has a retentive lip (tic) capable of cooperating with a recess (2a2) that has the bore (2al). This lip (tic) is bevelled to allow the introduction of the pin into the bore (2al) and ensure the blocking of said pin with respect to the recess (2a2) (Figure 5).

Suivant une autre caractéristique, la face de dessous de la cupule (1) présente une empreinte en creux (nid) de forme générale rectangulaire. Les angles de l'empreinte (nid) sont arrondis en constituant, en combinaison avec les bords rectilignes de ladite empreinte, des zones d'indexation. According to another characteristic, the underside of the cup (1) has a hollow imprint (nest) of generally rectangular shape. The angles of the imprint (nest) are rounded by constituting, in combination with the straight edges of said imprint, indexing zones.

Le support (2) présente, en débordement de sa face de dessus, une empreinte en relief (2b) complémentaire de l'empreinte (nid).  The support (2) has, in overflow from its top face, a raised imprint (2b) complementary to the imprint (nest).

Il apparait donc que l'empreinte en creux (nid) coopère avec l'empreinte en relief (2b), afin d'assurer l'indexation angulaire de la cupule (1) par rapport au support (2), afin de résister aux contraintes de cisaillement. It therefore appears that the hollow imprint (nest) cooperates with the raised imprint (2b), in order to ensure the angular indexing of the cup (1) relative to the support (2), in order to resist the stresses shear.

De manière connue, le support (2) présente, en outre, deux trous filetés orientés angulairement (2c) et (2d), pour l'engagement de vis divergentes coopérant notamment avec le pilier de l'omoplate et le pilier coracoidien. La cupule glénoidienne est généralement exécutée en polyéthylène, sans pour cela exclure d'autres matériaux. In known manner, the support (2) has, in addition, two threaded holes angularly oriented (2c) and (2d), for the engagement of divergent screws cooperating in particular with the pillar of the scapula and the coracoid pillar. The glenoid cup is generally made of polyethylene, without excluding other materials.

Comme indiqué, la cupule (1) coopère avec la tête humérale (H) qui se présente sous forme d'un corps (3) de forme générale hémisphérique. As indicated, the cup (1) cooperates with the humeral head (H) which is in the form of a body (3) of generally hemispherical shape.

Suivant une autre caractéristique, qui se combine avantageusement avec la conception de l'implant glénoïdien tel que défini, la tête humérale (3) présente des agencements d'accouplement, coopérant avec des agencements complémentaires formés en bout de la tige humérale (T), pour autoriser un montage, avec capacité d'indexation et d'orientation angulaire. According to another characteristic, which advantageously combines with the design of the glenoid implant as defined, the humeral head (3) has coupling arrangements, cooperating with complementary arrangements formed at the end of the humeral stem (T), to authorize an assembly, with indexing capacity and angular orientation.

Comme le montrent les figures des dessins, la face de dessous de la tête humérale (3) présente une portée tronconique excentrée (4), formée en débordement d'une empreinte (5). La portée tronconique (4) est apte à être engagée dans un logement (6) de forme complémentaire formé en bout de la tige humérale (T), au niveau de sa face supérieure. As shown in the figures of the drawings, the underside of the humeral head (3) has an eccentric frustoconical bearing (4), formed in overflow of an imprint (5). The frustoconical bearing surface (4) is able to be engaged in a housing (6) of complementary shape formed at the end of the humeral rod (T), at its upper face.

Plus particulièrement, ce logement (6) est formée dans une empreinte en relief (7), présentant des pans coupés (7a) (7b) (7c) (7d) (7e) (figure 7), coopérant selon différentes orientations angulaires en position de butée, avec l'un des rebords (5a) de l'empreinte en creux (5).More particularly, this housing (6) is formed in a relief imprint (7), having cut sides (7a) (7b) (7c) (7d) (7e) (Figure 7), cooperating in different angular orientations in position abutment, with one of the edges (5a) of the hollow cavity (5).

Ces dispositions permettent avantageusement, de régler l'angle d'antéversion. On renvoie aux groupes de figures 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 qui montrent cinq indexations possibles de la tête humérales (3) par rapport à la tige humérale. These arrangements advantageously make it possible to adjust the angle of anteversion. We refer to the groups of figures 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 which show five possible indexations of the humeral head (3) relative to the humeral stem.

A noter que la tête humérale peut présenter des repères visuels coopérant avec des repères complémentaires que présente l'extrémité de la tige humérale, afin que le chirurgien puisse visualiser l'orientation angulaire choisie de la tête humérale. Note that the humeral head may have visual cues cooperating with complementary cues presented by the end of the humeral rod, so that the surgeon can visualize the chosen angular orientation of the humeral head.

Par ailleurs, afin de respecter la cinématique de l'articulation, les rayons de la tête humérale (3) et de l'implant cotyloïdien (1), ne sont pas congruents, afin de ne pas avoir une prothèse trop contrainte. Furthermore, in order to respect the kinematics of the joint, the rays of the humeral head (3) and of the acetabular implant (1), are not congruent, so as not to have a prosthesis that is too constrained.

Suivant une autre caractéristique, la face d'appui de la tige humérale présentant les agencements d'indexation (6) et (7), est disposée angulairement par rapport à l'axe (YY') de la tige humérale, soit selon un angle cervico-diaphysaire (ss) de sensiblement 125 (figure 17), soit selon un angle (ss) de sensiblement 140".  According to another characteristic, the bearing face of the humeral rod having the indexing arrangements (6) and (7), is arranged angularly with respect to the axis (YY ') of the humeral rod, or at an angle cervico-diaphysaire (ss) of substantially 125 (Figure 17), or at an angle (ss) of substantially 140 ".

Les avantages ressortent bien de la description, en particulier, on souligne et on rappelle les possibilités de réglages de l'ensemble tête humérale - implant glénoïdien dans différents plans.  The advantages emerge clearly from the description, in particular, the possibilities of adjustments of the whole humeral head - glenoid implant are emphasized and recalled in different planes.

Claims (10)

REVENDICATIONS -1- Ensemble prothétique pour l'articulation de l'épaule comprenant un implant huméral coopérant avec une surface d'appui et de glissement d'un implant glénoïdien (1) rendu solidaire de la glène de l'épaule, caractérisé en ce que la surface d'appui et de glissement (la) de l'implant glénoidien est concave et est disposé angulairement par rapport au plan horizontal, suivant un axe vertical. -1- Prosthetic assembly for the shoulder joint comprising a humeral implant cooperating with a bearing and sliding surface of a glenoid implant (1) made integral with the glenoid of the shoulder, characterized in that the bearing and sliding surface (la) of the glenoid implant is concave and is arranged angularly with respect to the horizontal plane, along a vertical axis. -2- Ensemble selon la revendication 1, caractérisé en ce que l'implant glénoidien (1) a une forme générale elliptique et symétrique. -2- An assembly according to claim 1, characterized in that the glenoid implant (1) has a generally elliptical and symmetrical shape. -3- Ensemble selon l'une quelconque des revendications 1 ou 2, caractérisé en ce que l'angulation (a) est donnée à partir du petit axe (XX') de la surface d'appui elliptique (la), autour du grand axe (YY'). -3- An assembly according to any one of claims 1 or 2, characterized in that the angulation (a) is given from the minor axis (XX ') of the elliptical bearing surface (la), around the large axis (YY '). -4- Ensemble selon la revendication 1, caractérisé en ce que l'implant glénoïdien (1) est constitué par une cupule montée dans un support (2) présentant des agencements de fixation avec la glène de l'épaule. -4- The assembly of claim 1, characterized in that the glenoid implant (1) consists of a cup mounted in a support (2) having fastening arrangements with the glenoid of the shoulder. -5- Ensemble selon la revendication 4, caractérisé en ce que la cupule (1) présente en débordement de sa face de dessous, un pion de centrage coopérant dans l'alésage d'un plot formé en débordement de la face de dessus du support (2), ledit pion présentant une lèvre de rétention apte à coopérer avec un décrochement que présente ledit alésage, la face de dessous de la cupule (1) et la face de dessus du support (2), présentant des empreintes complémentaires d'indexation angulaire. -5- An assembly according to claim 4, characterized in that the cup (1) has an overflow from its bottom face, a centering pin cooperating in the bore of a stud formed in overflow from the top face of the support (2), said pin having a retention lip capable of cooperating with a recess presented by said bore, the bottom face of the cup (1) and the top face of the support (2), having complementary indexing imprints angular. -6- Ensemble selon la revendication 1, caractérisé en ce que la tête humérale (3) présente des agencements d'accouplement coopérant avec des agencements complémentaires formés en bout d'une tige humérale (T) pour autoriser à ladite tête un montage avec capacité d'orientation et d'indexation angulaire. -6- The assembly of claim 1, characterized in that the humeral head (3) has coupling arrangements cooperating with complementary arrangements formed at the end of a humeral rod (T) to allow said head mounting with capacity orientation and angular indexing. -7- Ensemble selon la revendication 6, caractérisé en ce que les agencements de la tête humérale sont constitués par une portée tronconique excentrée (4) formée en débordement d'une empreinte en creux (5), en étant apte à être engagée dans un logement de forme complémentaire, formé en bout de la tige dans une empreinte en relief (7) présentant des pans coupés (7a-7b-7c-7d-7e) coopérant selon différentes orientations angulaires en position de butée avec l'un des rebords (5a) de l'empreinte en creux (5). -7- The assembly of claim 6, characterized in that the arrangements of the humeral head are constituted by an eccentric frustoconical bearing (4) formed in overflow of a recess (5), being able to be engaged in a housing of complementary shape, formed at the end of the rod in a raised impression (7) having cut sides (7a-7b-7c-7d-7e) cooperating in different angular orientations in the abutment position with one of the flanges ( 5a) of the hollow imprint (5). -8- Ensemble selon la revendication 7, caractérisé en ce que les rayons de la tête humérale et de la cupule ne sont pas congruants. -8- The assembly of claim 7, characterized in that the rays of the humeral head and the cup are not congruent. -9- Ensemble selon la revendication 1, caractérisé en ce que la tête humérale (3) est disposée angulairement par rapport à la tige humérale (T) selon un angle cervico-diaphysaire d'environ 125".  -9- The assembly of claim 1, characterized in that the humeral head (3) is arranged angularly relative to the humeral rod (T) at a cervico-diaphyseal angle of about 125 ". -10- Ensemble selon la revendication 1, caractérisé en ce que la tête humérale (3) est disposée angulairement par rapport à la tige humérale (T) selon un angle cervico-diaphysaire d'environ 140".  -10- The assembly of claim 1, characterized in that the humeral head (3) is arranged angularly relative to the humeral rod (T) at a cervico-diaphyseal angle of about 140 ".
FR9612650A 1996-10-11 1996-10-11 PROSTHETIC ASSEMBLY FOR THE SHOULDER JOINT Expired - Fee Related FR2755847B1 (en)

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EP0963742A1 (en) * 1998-06-09 1999-12-15 Depuy Orthopaedics, Inc. Modular glenoid assembly
US6228119B1 (en) 1998-06-09 2001-05-08 Depuy Orthopaedics, Inc. Modular glenoid assembly
US6514287B2 (en) 1998-06-09 2003-02-04 Depuy Orthopaedics, Inc. Modular glenoid assembly having bearing insert
WO2000018335A1 (en) * 1998-09-25 2000-04-06 Sulzer Orthopedics Inc. Implantable humeral prosthesis having offset head and stem connection
EP2258321A3 (en) * 1999-01-29 2012-05-02 Depuy Orthopaedics, Inc. Shoulder prosthesis with humeral fracture stem
EP1059071A1 (en) * 1999-06-09 2000-12-13 Tornier Sa Humeral prosthesis
FR2794641A1 (en) * 1999-06-09 2000-12-15 Tornier Sa HUMERAL PROSTHESIS
US6334874B1 (en) 1999-06-09 2002-01-01 Tornier Sa Humeral prosthesis
FR2826256A1 (en) * 2001-06-21 2002-12-27 Depuy France PROSTHESIS FOR TRAUMATIC SHOULDER
EP1269941A1 (en) * 2001-06-21 2003-01-02 Depuy France Shoulder prosthesis
CN1925814B (en) * 2004-02-05 2010-11-03 精密技术公司 Shoulder prosthesis with humeral fracture stem
EP1711132A4 (en) * 2004-02-05 2007-10-03 Exactech Inc Shoulder prosthesis with humeral fracture stem
JP2007536944A (en) * 2004-02-05 2007-12-20 イグザクテック，インコーポレイティド Shoulder prosthesis using a fracture stem of the humerus
EP1711132A1 (en) * 2004-02-05 2006-10-18 Exactech, Inc. Shoulder prosthesis with humeral fracture stem
JP4774485B2 (en) * 2004-02-05 2011-09-14 イグザクテック，インコーポレイティド Shoulder prosthesis using a fracture stem of the humerus
WO2005082291A1 (en) 2004-02-05 2005-09-09 Exactech, Inc. Shoulder prosthesis with humeral fracture stem
US9149362B2 (en) 2004-09-27 2015-10-06 DePuy Synthes Products, Inc. Instrument for preparing an implant support surface and associated method
US8556980B2 (en) 2004-09-27 2013-10-15 DePuy Synthes Products, LLC Glenoid augment and associated method
EP1776936A1 (en) * 2005-10-24 2007-04-25 Benoist Girard Sas Prosthetic glenoid component
US8241365B2 (en) 2008-12-23 2012-08-14 Depuy Products, Inc. Shoulder prosthesis with vault-filling structure having bone-sparing configuration
US8231683B2 (en) 2009-12-08 2012-07-31 Depuy Products, Inc. Shoulder prosthesis assembly having glenoid rim replacement structure
US8882845B2 (en) 2010-05-05 2014-11-11 DePuy Synthes Products, LLC Mobile bearing glenoid prosthesis
WO2011140191A1 (en) 2010-05-05 2011-11-10 Depuy Products, Inc Mobile bearing glenoid prosthesis
US9439769B2 (en) 2010-05-05 2016-09-13 DePuy Synthes Products, Inc. Mobile bearing glenoid prosthesis
US8465548B2 (en) 2010-11-24 2013-06-18 DePuy Synthes Products, LLC Modular glenoid prosthesis
US8480750B2 (en) 2010-11-24 2013-07-09 DePuy Synthes Products, LLC Modular glenoid prosthesis
US8961611B2 (en) 2010-11-24 2015-02-24 DePuy Synthes Products, LLC Modular glenoid prosthesis
US9301848B2 (en) 2010-11-24 2016-04-05 DePuy Synthes Products, Inc. Modular glenoid prosthesis
FR2992165A1 (en) * 2012-06-26 2013-12-27 Fx Solutions Humeral implant for shoulder prosthesis, has joint part including stud with height and cross-section lower than depth and cross-section of cavity of base part, to allow limited mobility of joint part relative to base part

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