FR2780636A1 - Modular knee prosthesis comprises lower femoral mounting plate and upper tibial plate for total knee prosthesis - Google Patents

Modular knee prosthesis comprises lower femoral mounting plate and upper tibial plate for total knee prosthesis Download PDF

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Publication number
FR2780636A1
FR2780636A1 FR9808779A FR9808779A FR2780636A1 FR 2780636 A1 FR2780636 A1 FR 2780636A1 FR 9808779 A FR9808779 A FR 9808779A FR 9808779 A FR9808779 A FR 9808779A FR 2780636 A1 FR2780636 A1 FR 2780636A1
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FR
France
Prior art keywords
characterized
housing
accessory
prosthesis according
prosthesis
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
FR9808779A
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French (fr)
Other versions
FR2780636B1 (en
Inventor
Marc Augoyard
Gerard Bascoulergue
Maurice Basso
Rene Bertocchi
Philippe Charret
Philippe Courcelles
Jean Louis Debiesse
La Tour Laurent Dupre
Guy Eyraud
Jean Philippe Fayard
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Merck Biomaterial France
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Merck Biomaterial France
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Filing date
Publication date
Application filed by Merck Biomaterial France filed Critical Merck Biomaterial France
Priority to FR9808779A priority Critical patent/FR2780636B1/en
Publication of FR2780636A1 publication Critical patent/FR2780636A1/en
Application granted granted Critical
Publication of FR2780636B1 publication Critical patent/FR2780636B1/en
Anticipated expiration legal-status Critical
Application status is Expired - Lifetime legal-status Critical

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30721Accessories
    • A61F2/30734Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
    • AHUMAN NECESSITIES
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    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
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    • A61F2/3836Special connection between upper and lower leg, e.g. constrained
    • A61F2/384Special connection between upper and lower leg, e.g. constrained hinged, i.e. with transverse axle restricting the movement
    • A61F2/385Special connection between upper and lower leg, e.g. constrained hinged, i.e. with transverse axle restricting the movement also provided with condylar bearing surfaces
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    • A61F2/00Filters 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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    • A61F2/00Filters 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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    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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    • A61F2002/30331Connections 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
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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
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    • A61F2/00Filters 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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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30405Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
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    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878Special external or bone-contacting surfaces, 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
    • A61F2002/30886Special external or bone-contacting surfaces, 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 externally-threaded
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4631Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor the prosthesis being specially adapted for being cemented
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4637Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for connecting or disconnecting two parts of a prosthesis
    • A61F2002/4638Tools for performing screwing, e.g. nut or screwdrivers, or particular adaptations therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033Connections 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0041Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004Rounded shapes, e.g. with rounded corners
    • A61F2230/0013Horseshoe-shaped, e.g. crescent-shaped, C-shaped, U-shaped

Abstract

The prosthesis comprises a lower femoral mounting plate (1) comprising side walls (5,6) to provide lateral support for the knee. This is attached to the femur by way of a bolt (70). A plate (2) is mounted to the top of the tibia and is complimentary in shape to the upper plate. Support flanges guide the femoral plate to provide natural movement of the knee on the curved profile (21,22) of the plate.

Description

La présente invention concerne les prothèses articulaires et elle The invention relates to joint prostheses and

concerne, plus relates more

particulièrement, le domaine des prothèses de genou. Specifically, the field of knee prostheses.

Par prothèses du genou, il convient de retenir les systèmes articulaires artificiels visant à remplacer l'articulation naturelle constituée par la conformation épiphysaire basse du fémur, par la conformation épiphysaire complémentaire haute By prosthesis of the knee, it is appropriate to retain the artificial joint systems to replace the natural joint constituted by the low epiphyseal conformation of the femur, with the epiphyseal high complementary conformation

du tibia, voire par l'élément fémoro-patellaire. the tibia, or by the patellofemoral component.

La technique antérieure a formulé un grand nombre de propositions se The earlier technique made many proposals

rapportant au domaine technique ci-dessus. relating to the technical field above.

Il a ainsi été proposé des prothèses totales dites liées en ce sens qu'elles font intervenir deux pièces complémentaires qui sont réunies par un système articulaire matériel, tel qu'au moins un axe, constituant le système de pivotement artificiel matérialisant l'articulation du genou selon une direction perpendiculaire au plan It has thus been proposed total prostheses known related in that they involve two complementary parts which are joined by a material joint system, such as at least one axis, constituting the artificial pivot system embodying the knee joint in a direction perpendicular to the plane

sagittal ou antéro-postérieur. sagittal or anteroposterior.

Il a aussi été proposé des prothèses dites libres qui sont constituées, par opposition aux précédentes, à base de deux éléments respectivement adaptables sur les épiphyses basse du fémur et haute du tibia, pour coopérer par glissement relatif en étant maintenus en contact de surface par l'intermédiaire, notamment, des ligaments latéraux interne et externe naturels, sans faire intervenir la présence d'un It was also proposed prosthetics called free which consist, as opposed to earlier, based on two respectively adaptable elements on lower epiphysis of the femur and high tibia, to cooperate in relative sliding by being kept in surface contact by via, inter alia, internal lateral ligaments and natural external without involving the presence of a

lien d'articulation matériel entre ces deux éléments. hinge material link between these two elements.

En réalité, les prothèses dites liées ou libres sont conçues pour répondre à une exigence de restauration articulaire spécifique correspondant au problème articulaire In reality, the prostheses known as bound or free are designed to answer a specific joint restoration requirement corresponding to joint problem

devant être surmonté ou compensé. to be overcome or offset.

C'est la raison pour laquelle un très grand nombre de solutions techniques ont été proposées avec vocation pour chacune à résoudre un problème articulaire That is why a large number of technical solutions have been proposed for each vocation with solving a joint problem

spécifique. specific.

De telles prothèses doivent certainement être considérées comme ayant apporté Such prostheses must certainly be regarded as having brought

des solutions pratiques, convenables et acceptables. practical solutions, suitable and acceptable.

Cependant, le recul dont peuvent maintenant se prévaloir les praticiens permet de considérer que chaque intervention fait apparaître l'existence d'au moins un problème spécifique qui ne pouvait pas être aisément perçu et apprécié par les moyens d'investigation et de diagnostic habituels. However, the decline of which can now benefit practitioners to suggest that each intervention revealed the existence of at least one specific problem that could not be easily seen and appreciated by means of investigation and usual diagnosis. Il est ainsi fréquent qu'au cours d'une opération, la phase première d'intervention confronte le praticien à un choix It is so common that during an operation, the first intervention phase confronts the practitioner a choice

de prothèse qu'il n'avait pas initialement prévu. prosthesis he had not originally planned.

Une telle situation ne peut être réglée pratiquement qu'à partir du moment o le praticien dispose d'une grande possibilité de choisir la prothèse convenable au moment seulement o il est en mesure d'apprécier les complications auxquelles il se Such a situation can not be resolved practically from the moment where the practitioner has a great possibility to choose the suitable prosthesis at the time only where it is able to appreciate the complications which it

heurte face à une articulation naturelle qu'il convient de restaurer. strikes against a natural joint should be restored.

Si une telle possibilité technique peut être envisagée, elle est en réalité lourde de sujétions, de complications et de retards dans l'intervention en faisant naître un coût élevé correspondant à la nécessité de disposer d'un stock important de prothèses If such technical possibility may be envisaged, it is heavy reality of constraints, complications and delays in the procedure by raising a cost corresponding to the need for a large stock of prostheses

différentes devant, par ailleurs, être prévues généralement en plusieurs tailles. different front, also generally be provided in several sizes.

Il a ainsi été reconnu qu'il serait bon de pouvoir mettre à disposition d'un praticien une prothèse totale de genou qui offre la possibilité de pouvoir être adaptée dans ses caractéristiques structurelles de manière à lui conférer un caractère modulable offrant au praticien une possible et rapide adaptation au moment de l'intervention en fonction du caractère spécifique de restauration qu'il doit mener à It has been recognized that it would be good to be able to provide a practitioner total knee prosthesis that provides the ability to be adaptable in its structural characteristics so as to impart a modularity offering the practitioner a possible and rapid adaptation to the time of surgery depending on the specific nature of food that should lead to

bien sur l'articulation naturelle défaillante. well on the failing natural joint.

L'objet de l'invention est de répondre à cette demande en proposant une nouvelle prothèse totale de genou à caractère modulable qui se caractérise par la mise en oeuvre de moyens techniques structurels de base qui peuvent faire l'objet d'adaptation d'accessoires à même de répondre chacun, voire en combinaison, à des The object of the invention is to meet this demand by offering a new total prosthesis modularity knee characterized by the implementation of basic structural technical means that can be adaptive object accessories able to meet each or in combination with

exigences de restauration propres découvertes au moment de l'intervention. own discoveries catering requirements at the time of the intervention.

Une prothèse totale de genou selon l'invention est du type comprenant un élément prothétique fémoral formant une partie antérieure délimitant une trochlée par sa face avant et une partie distalo-postérieure composée de deux condyles séparés par un espace intercondylien et destinés à coopérer avec des glènes complémentaires présentées par un patin équipant un élément prothétique tibial, ledit élément prothétique fémoral présentant dans le plan sagittal la forme d'un U délimitant un logement d'emboîtement de la partie épiphysaire basse réséquée d'un fémur, un tel logement étant défini par deux faces planes en vis-à-vis présentées par la partie antérieure et par la partie postérieure, par une face plane transversale présentée par la partie distale des condyles et par deux pans coupés de raccordement entre les faces planes en vis-à-vis, une telle prothèse se trouvant caractérisée selon l'invention en ce que - les condyles présentent chacun A total knee prosthesis of the invention is of the type comprising a femoral prosthetic member forming a front part defining a trochlea by its front face and a rear distalo-section consisting of two condyles separated by an intercondylar space and intended to cooperate with the glenoid cavities Additional presented by a pad provided on a prosthetic tibial component, said femoral prosthetic element having in the sagittal plane the U-shaped defining a housing for fitting the lower epiphyseal part of a resected femur, such housing being defined by two planar faces vis-à-vis presented by the front portion and the rear portion, by a transverse planar face presented by the distal portion of the condyles and two canted connection between the planar faces vis-à-vis, a such a prosthesis being characterized according to the invention in that - the condyles each have une plage plane et deux surfaces inclinées contribuant à matérialiser la face transversale et les deux pans coupés du logement, chaque plage plane présente sensiblement en son centre un logement dans le fond duquel s'ouvrent un trou borgne taraudé bordé par un rebord annulaire définissant par sa surface extérieure une portée cylindrique de centrage, - chaque logement est apte à recevoir un accessoire fonctionnel maintenu a planar land and two inclined surfaces contributing to materialize the transverse face and two cut sides of the housing, each planar land has substantially at its center a housing in the bottom of which opens a tapped blind hole surrounded by an annular rim defining by its outer surface of a cylindrical centering bearing surface, - each housing is adapted to receive an accessory functional maintained

en place par un plot de fixation osseuse visé. up by a bone fixation pin referred.

En d'autres termes, l'objet de l'invention est de proposer une prothèse de genou de conception modulable de manière à pouvoir adapter une structure de base, commune dans tous les cas, en fonction des besoins qui sont détectés au moment de In other words, the object of the invention to provide a prosthetic knee modular design so as to adapt a basic structure common in all cases, depending on the needs that are detected at the time of

l'intervention même. the same intervention.

L'objet de l'invention est donc de réduire l'exigence de mise à disposition de prothèses de caractères spécifiques différents afin de parer à toute éventualité et d'offrir par un moyen unique et par la mise à disposition d'accessoires spécifiques, une adaptabilité qui permet de faire face, rapidement et à partir d'un faible nombre de pièces accessoires en stock, à la plus grande partie, sinon la totalité, des The object of the invention is to reduce the requirement for provision of prostheses of different specific characters to deal with any eventuality and provide a unique way and the availability of specific accessories, adaptability that allows to cope quickly and from a small number of parts accessories in stock at most, if not all, of

exigences d'intervention que le praticien peut découvrir au dernier moment. intervention demands that the practitioner may discover at the last moment.

Diverses autres caractéristiques ressortent de la description faite cidessous en Various other characteristics appear from the description given below in

référence aux dessins annexés qui montrent, à titre d'exemples non limitatifs, des reference to the accompanying drawings which, by way of non-limiting examples of

formes de réalisation de l'objet de l'invention. embodiments of the subject of the invention.

La fig. Fig. 1 est une coupe-élévation prise sensiblement selon un plan sagittal de la prothèse considérée dans un état d'implantation entre le fémur et le tibia d'un sujet. 1 is a cross-sectional elevation taken substantially along a sagittal plane of the prosthesis seen in a state of implantation between the femur and tibia of a subject.

La fig. Fig. 2 est une perspective illustrant un élément constitutif de la prothèse. 2 is a perspective view illustrating a component of the prosthesis.

La fig. Fig. 3 est une perspective mettant en évidence la constitution d'un 3 is a view showing the constitution of a

accessoire adaptable. adaptable accessory.

La fig. Fig. 4 est une perspective illustrant un autre accessoire. 4 is a perspective illustrating another accessory.

La fig. Fig. 5 est une vue éclatée en perspective faisant apparaître un autre élément 5 is an exploded perspective view showing another element

constitutif de la prothèse. constituent of the prosthesis.

La fig. Fig. 6 est une perspective montrant une autre forme d'accessoire. 6 is a perspective view showing another form of accessory.

La fig. Fig. 7 est une coupe longitudinale prise sensiblement selon la ligne VII-VII de la fig. 7 is a longitudinal section taken substantially along the line VII-VII of FIG. 6. La fig. 6. Fig. 8 est une perspective montrant une variante de réalisation de l'élément 8 is a perspective view showing an alternative embodiment of the element

de la prothèse complémentaire à l'accessoire selon les fig. the additional prosthesis to the accessory according to Fig. 6 et 7. 6 and 7.

La fig. Fig. 9 est une coupe-élévation montrant la coopération des éléments selon 9 is a cross-sectional elevation showing the cooperation of the elements according

les fig. FIGS. 6 et 8. 6 and 8.

La fig. Fig. 10 est une vue de face montrant une variante des éléments selon les 10 is a front view showing a variant of the elements as

fig. Fig. 6 et 8. 6 and 8.

La fig. Fig. 11 est une perspective montrant une troisième forme de réalisation d'accessoires. 11 is a view showing a third embodiment of accessories. La fig. Fig. 12 est une coupe-élévation mettant en évidence un détail constructif de 12 is a cross-sectional elevation showing a constructive detail

la forme de réalisation selon la fig. the embodiment according to FIG. 11. 11.

La fig. Fig. 13 est une coupe-élévation analogue à la fig. 13 is a cross-sectional elevation similar to FIG. 1 montrant la mise en 1 showing the installation

oeuvre d'un autre accessoire. work of another accessory.

Les fig. FIGS. 14 et 15 sont des perspectives illustrant deux formes de réalisation de 14 and 15 are perspective views illustrating two embodiments of

l'accessoire selon la fig. the accessory according to Fig. 13. 13.

Les fig. FIGS. 16 et 17 sont des perspectives montrant un autre développement de 16 and 17 are perspective showing another development

l'objet de l'invention. the object of the invention.

La fig. Fig. 18 est une perspective éclatée représentant une autre variante d'accessoire. 18 is an exploded perspective view showing another variant of an accessory. La fig. Fig. 19 est une vue en perspective éclatée représentant une autre forme de 19 is an exploded perspective view showing another form of

réalisation d'accessoire. realization of accessory.

La fig. Fig. 1 montre la prothèse selon l'invention constituée par un élément prothétique fémoral 1 et par un élément prothétique tibial 2, destinés à être adaptés respectivement, après résection osseuse, sur l'épiphyse basse fémorale 3 et sur 1 shows the prosthesis of the invention consists of a prosthetic femoral component 1 and a tibial prosthetic member 2, intended to be respectively adapted, after bone resection on the femoral epiphysis low 3 and

l'épiphyse tibiale haute 4. the tibial epiphysis high 4.

L'élément fémoral 1, qui peut être réalisé en tout matériau adapté connu de l'homme du métier, présente, selon un plan sagittal, une forme sensiblement en U comprenant une branche 5 dite avant ou antérieure, une branche 6 dite arrière ou postérieure, généralement de plus faible longueur que la branche 5, et une âme 7 de liaison. The femoral element 1, which can be made of any suitable material known to those skilled in the art, presents, according to a sagittal plane, a substantially U shape comprising a 5 said front leg or earlier, a branch 6 so-called rear or posterior , generally of shorter length than the leg 5, and a web 7 connecting. La surface interne délimitée par l'élément fémoral définit en quelque sorte un logement polygonal 8 destiné à emboîter l'épiphyse 3 soumise préalablemet à une The inner surface defined by the femoral component defines a kind of polygonal housing 8 designed to follow the epiphysis 3 préalablemet subjected to a

résection complémentaire. additional resection.

A cette fin, le logement 8 est défini par deux faces planes en vis-à-vis 9 et 10 appartenant respectivement à la branche 5 et à la branche 6, par une face plane 11 correspondant à l'âme 7 et par deux pans coupés 12 de raccordement entre la face To this end, the housing 8 is defined by two plane faces vis-à-vis 9 and 10 respectively belonging to the branch 5 and the arm 6, by a flat face 11 corresponding to the core 7 and two canted 12 for connection between the face

plane 11 et les faces 9 et 10. plane 11 and the faces 9 and 10.

L'élément fémoral est conformé pour présenter, par sa surface extérieure par rapport au logement d'emboîtement 8 une surface rotulienne 13 correspondant à la grande branche 5 et conformée pour délimiter de façon connue une trochlée apte à coopérer avec la protubérance naturelle ou avec un bouton artificiel présenté ou porté The femoral component is formed to have, at its outer surface with respect to the engagement recess 8 a patellar surface 13 corresponding to the large branch 5 and shaped to define in known manner a trochlea adapted to cooperate with the natural or with a protuberance presented or carried artificial button

par la rotule non représentée. by the not shown patella.

L'élément fémoral 1 forme, par sa surface extérieure correspondant à l'âme 7 et à la branche 6, deux condyles 14 et 15 qui définissent une partie distale et une The femoral member 1 forms, with its outer surface corresponding to the core 7 and the branch 6, two condyles 14 and 15 that define a distal portion and a

partie postérieure. posterior part.

En tant que tels, les condyles 14 et 15 doivent être considérés comme relevant As such, the condyles 14 and 15 should be considered as falling

de la technique connue largement possédée par l'homme du métier. of the prior art largely owned by the skilled person.

Les condyles 14 et 15 sont destinés à coopérer par leurs parties distale et postérieure avec l'élément protétique tibial 2 qui selon l'invention comprend un plateau 16 dont la face inférieure est pourvue d'au moins une queue 17 éventuellement renforcée par des goussets 18. La queue 17 est destinée à être implantée dans l'épiphyse tibiale 4 avec ou sans présence d'un ciment de liaison.Comme cela est connu, la fixation du plateau 16 peut aussi faire intervenir The condyles 14 and 15 are intended to cooperate by their distal and posterior portions with protétique tibial member 2 which according to the invention comprises a plate 16 whose underside is provided with at least one tail 17 optionally reinforced by gussets 18 . the tail 17 is intended to be implanted in the tibial epiphysis 4 with or without the presence of a liaison.Comme cement is known, fixing top 16 may also involve

la présence de vis 19. the presence of screws 19.

Le plateau tibial assure le support d'un patin 20 de préférence réalisé en une matière plastique appropriée telle qu'en polyéthylène. The tibial tray provides support of a pad 20 preferably made of a suitable plastic such that polyethylene. Le patin 20 est conformé pour offir sur son dessus, tel que cela ressort de la fig. The pad 20 is shaped to offir thereon, as is apparent from FIG. 5, deux glènes 21 et 22 destinées à coopérer avec les surfaces extérieures des condyles 14 et 15 et une épine 23 formée dans la partie sagittale à partir du bord antérieur 24 et entre les glènes 21 et 22. Une conformation d'élément prothétique tibial, telle qu'elle vient d'être décrite, doit être considérée comme relevant au sens général de la technique connue de l'homme du métier. 5, two glenoid cavities 21 and 22 for cooperating with the outer surfaces of the condyles 14 and 15 and a spine 23 formed in the sagittal section from the front edge 24 and between the glenoid cavities 21 and 22. A conformation of prosthetic tibial element, as just described, should be considered under the general direction of the technique known in the art. Conformément à l'invention et tel que cela ressort de la fig. In accordance with the invention and as is apparent from FIG. 2, l'élément prothétique fémoral 1 est réalisé de manière que chaque condyle 14 et 15 présente, 2, the prosthetic femoral element 1 is designed so that each condyle 14 and 15 has,

par sa face intérieure, une plage plane 30-31 contribuant à définir la face plane 11. by its inner face, a planar range 30-31 contributing to defining the planar face 11.

Chaque plage plane est bordée par deux surfaces inclinées 32 et 33 qui contribuent Each planar land is bounded by two inclined surfaces 32 and 33 which contribute

à définir les pans coupés 12. define the cut sides 12.

Chaque plage plane 30-31 présente, sensiblement en son centre, un logement 34-35 dans le fond duquel s'ouvre un trou borgne taraudé 36 bordé par un rebord annulaire 37 définissant par sa surface extérieure une portée cylindrique de centrage 38. Le trou borgne est destiné à permettre le montage d'un plot de fixation osseuse 39 destiné à pénétrer dans un trou complémentaire pratiqué dans l'épiphyse basse du fémur. Each planar range 30-31 has, substantially at its center, a housing 34-35 in the bottom of which opens a tapped blind hole 36 bordered by an annular rim 37 defining its outer surface a centering cylindrical bearing 38. The hole blind is intended to allow the mounting of a bone fixation pad 39 intended to penetrate in a complementary hole in the lower femoral epiphysis. Le plot 39, qui peut contribuer à la fixation avec ou sans interposition d'un ciment, comprend un corps de fixation 40 et un embout fileté 41 apte à coopérer par vissage avec le trou borge 36. Le corps 40 est raccordé à l'embout 41 par une portée The stud 39, which may contribute to the binding with or without the interposition of a cement, comprises an attachment body 40 and a threaded end 41 adapted to cooperate by screwing with the borge hole 36. The body 40 is connected to the tip 41 by a bearing

tronconique 42 dont la fonction apparaît dans ce qui suit. truncated 42 whose function appears in the following.

Chaque logement 34, 35 est destiné à permettre le montage, l'adaptation et la fixation d'un accessoire fonctionnel I dont le premier exemple de réalisation est montré par la fig. Each housing 34, 35 is intended to allow the mounting, adaptation and fixing a functional accessory I which the first embodiment is shown in FIG. 3. Selon cet exemple, l'accessoire est constitué sous la forme de deux cales de compensation 43 qui présentent chacune une forme conjuguée à celle du logement correspondant, de manière à pouvoir bénéficier d'une immobilisation en rotation sur l'axe du trou borgne 36. Dans ce but, chaque logement 34 ou 35 peut donc comporter deux bords parallèles rectilignes 44 aboutissant aux chants internes 3. In this example, the accessory is constructed as two shims 43 which each have a conjugate shape to that of the corresponding housing, so as to receive a rotational immobilisation of the blind hole of the axis 36. to this end, each housing 34 or 35 may thus comprise two parallel rectilinear edges 44 leading to the internal edges

des condyles 14 et 15 qui délimitent entre eux et par lesdits chants un espace inter- of the condyles 14 and 15 which define between them and said edges a space inter-

condylien E. Chaque cale 43 présente un trou traversant 45 bordé par une collerette 46 dont la surface périphérique interne délimite un siège tronconique 47 qui est du condylar E. Each wedge 43 has a through hole 45 surrounded by a collar 46 whose inner peripheral surface defines a frustoconical seat 47 which is the

type complémentaire à la portée 42 du plot 39. complementary type to the scope 42 of the stud 39.

Comme cela apparaît à la fig. As shown in FIG. 1, lorsque l'adaptation de l'élément prothétique fémoral 1 sur l'épiphyse 3 n'exige aucune autre intervention que celle d'une résection habituelle, l'élément 1 est alors adapté par mise en place des cales de compensation 43 dans les logements 34 et 35, de manière à combler complètement ces derniers en centrant les cales par l'engagement des trous traversants 45 sur les collerettes 38. Dans cette situation, le maintien des cales 43 intervient par mise en place des plots 39 qui sont vissés par leur embout 41 dans les trous borgnes 36, de manière à amener en coopération les portées 42 avec les sièges 47. Il est avantageux de conférer aux portées 42 et aux sièges 47 une conicité de l'ordre de 5', de manière à bénéficier d'un effet de coincement, du type "cone-morse". 1, when the adaptation of the prosthetic femoral component 1 of the epiphysis 3 requires no further intervention than a usual resection, the element 1 is then adapted by placing the shims 43 in the housing 34 and 35, so as to completely fill these centering wedges by engagement through holes 45 of the flanges 38. in this situation, the maintenance wedges 43 intervenes by placing the pads 39 that are screwed by their tip 41 in the blind holes 36, so as to bring in cooperation spans 42 with the seats 47. It is advantageous to give the ranges 42 and 47 seats a taper of about 5 ', so as to benefit from a jamming effect, such as "cone-morse". Chaque plot 39 est ainsi affecté d'une immoblisation et d'une solidité d'ancrage en raison de la coopération de la cale 43 avec le logement 34-35, de celle de la collerette 38 avec le trou 45, de la liaison par vissage entre l'embout 41 et le trou 36 et de la Each stud 39 is thus assigned a immoblisation and a solid anchor due to the cooperation of the wedge 43 with the housing 34-35 to that of the collar 38 with the hole 45, the screw connection between the tip 41 and the hole 36 and the

coopération des surfaces tronconiques 42 et 47. cooperation frustoconical surfaces 42 and 47.

Il peut arriver, au cours de l'intervention, que le praticien ressente le besoin de pouvoir disposer d'une adaptation de la prothèse de manière à lui conférer une caractéristique de postéro-stabilisation qui est une exigence bien connue des praticiens. Sometimes, during the intervention, the practitioner feels the need to have available an adaptation of the prosthesis so as to impart a posterior stabilization feature which is a well known requirement of practitioners. Si un tel besoin se fait sentir, le praticien peut alors avoir recours à l'adaptation d'un accessoire I du type de la fig. If such a need arises, the practitioner can then use the adaptation of an accessory I the type of Fig. 4. Un tel accessoire I possède en quelque sorte les cales d'épaisseur 43 qui sont liées entre elles par une platine 48, de manière à former une barrette à même d'être montée simultanément dans les logements 34 et en occupant par la platine 48 la partie correspondante de l'intervalle ou espace inter- condylien E. L'accessoire I selon la fig. 4. Such an accessory I has somehow shims 43 which are interconnected by a plate 48, so as to form a strip adapted to be mounted simultaneously in the housing 34 and occupying by the plate 48 the corresponding portion of the interval or space inter- condylar E. the accessory I according to fig. 4 comprend, à partir du bord postérieur de la platine 48 une éminence 49 orientée vers la partie postérieure et comportant une partie 50 allongée, sensiblement semi- torique formant au droit de son raccordement 4 comprises, from the rear edge of the plate 48 an 49 oriented towards the posterior of height and having a portion 50 elongated substantially semi-ring forming the right of its connection

avec la barrette une tête de butée antérieure 51. with the strip a front stop head 51.

L'adaptation d'un tel accessoire selon la fig. Adaptation of such an accessory according to FIG. 4 intervient comme dit précédemment pour ce qui concerne les cales 43 lesquelles peuvent être considérées 4 operates as previously stated with regard to the wedges 43 which can be considered

comme constituant les oreilles de la barrette portant l'éminence 49. as constituting the lugs of the bar carrying the eminence 49.

Dans cette forme d'adaptation de la prothèse, l'accessoire I comporte une In this form of adaptation of the prosthesis, the accessory comprises an I

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partie complémentaire Il constituée par le patin 20 qui est réalisé de manière que l'épine 23 définisse, en retrait du bord inférieur 24, une surface de glissement 52 apte à coopérer avec la partie semi-torique 50. La surface de glissement 52 se raccorde à l'épine 23 par une cavité sensiblement semi-sphérique 53 apte à recevoir la tête 51 pour laquelle elle constitue une butée d'appui et de postérostabilisation. It complementary part constituted by the pad 20 which is designed such that the spine 23 defines, recessed from the lower edge 24, a sliding surface 52 adapted to cooperate with the semi-ring portion 50. The sliding surface 52 is connected to the spine 23 by a substantially semi-spherical cavity 53 adapted to receive the head 51 for which it constitutes a support stop and postero. La fig. Fig. 5 fait apparaître que le patin 20 peut comporter une échancrure 54 réservée au passage du ligament croisé lorsque celui-ci subsiste ou est laissé en place lors de l'intervention. 5 shows that the shoe 20 can include an indentation 54 reserved for the passage of the cruciate ligament when the remains or is left in place during surgery. Il peut également se faire que lors de l'intervention, le praticien soit amené à adopter par nécessité l'implantation d'une prothèse totale de genou à caractère postéo-stabilisé et guidé. It can also be done during the intervention, the practitioner is required to adopt by necessity implantation of a total knee prosthesis posteo-stabilized and guided nature. Dans un tel cas, l'accessoire I pouvant être adapté dans les logements 34 et 35 est du type illustré par la fig. In such a case, the accessory I can be fitted into the housings 34 and 35 is of the type illustrated in FIG. 6. Un tel accessoire comporte un corps massif 60 bordé latéralement par les cales 43 qui répondent à la forme de construction selon la fig. 6. Such accessory comprises a solid body 60 bordered laterally by the wedges 43 corresponding to the form of construction according to FIG. 3. Le corps massif 60 forme, par sa face inférieure, la partie semi-torique 50 et la tête 51 et délimite, à partir de cette dernière un alvéole 61 se raccordant à un mentonnet 62 (fig. 7). 3. The solid body 60 forms, with its lower side, the semi-ring portion 50 and the head 51 and defines, from the latter a cavity 61 adjoins a flange 62 (Fig. 7). L'accessoire I est associé à un accessoire complémentaire I2 qui est formé par le patin 20 qui comporte à partir de l'épine 23 une saillie 63 se raccordant (fig. 8) au bord postérieur 64 par une rampe complémentaire à la partie 50. La fig. The accessory I is associated with a complementary accessory I2 that is formed by the pad 20 which comprises from the spine 23, a protrusion 63 connecting (Fig. 8) to the rear edge 64 by a complementary ramp in the part 50. fig. 9 met en évidence la coopération entre les 9 shows the cooperation between

accessoires I et 12 qui, outre le glissement relatif autorisé en flexion, réalisent une postéro- accessories I and 12 which, besides the relative sliding permitted flexion, perform a posterior

stabilisation ainsi qu'une butée d'extension par l'engagement de la saillie 63 dans l'alvéole stabilization and an extension stop by engagement of the protrusion 63 in the socket

61 derrière le mentonnet 62. 61 behind the flange 62.

Il est avantageux comme le montre la fig. It is advantageous as shown in Fig. 10 de réaliser aussi les accessoires I et I2 de manière à faire comporter à la partie 50 deux flancs 66 coopérant avec les faces 10 also perform the I and I2 accessories so as to include the portion 50 two flanks 66 cooperating with the faces

latérales de la saillie 63 pour réaliser un guidage dans le plan de flexion antéro-postérieur. side of the projection 63 to provide a guide in the antero-posterior bending plane.

Les fig. FIGS. 11 et 12 illustrent une variante de réalisation dans laquelle l'accessoire I selon la fig. 11 and 12 illustrate an alternative embodiment wherein the accessory I according to fig. 7 peut être choisi pour améliorer la fixation de la prothèse fémorale sur l'épiphyse fémorale. 7 may be selected to enhance fixation of the femoral prosthesis the femoral epiphysis. Selon cette variante, le corps 60 comporte, à partir de sa face correspondant à la délimitation du logement 8, un canon 67 s'ouvrant comme According to this variant, the body 60 has, from its face corresponding to the delimitation of the housing 8, a barrel 67 opening as

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cela est illustré par la fig. shown in FIG. 12 par un siège tronconique 68 aboutissant à un trou borgne taraudé 69. Le canon 67 est réservé à la mise en place d'une queue d'ancrage 70 12 by a frustoconical seat 68 terminating in a threaded blind hole 69. The barrel 67 is reserved for the establishment of an anchor shank 70

comportant un corps 71 raccordé à un embout fileté 72 par une portée tronconique 73. comprising a body 71 connected to a threaded end 72 by a frustoconical bearing surface 73.

La fixation de la queue 70 sur le canon 67 et le montage de l'accessoire I dans les logements 34 et 35 par les plots 39 permettent de disposer de trois points d'ancrage dont le central est constitué par une queue de grande longueur coopérant avec un passage ménagé The attachment of the tail 70 on the barrel 67 and the mounting of the accessory I in the housings 34 and 35 by the studs 39 allow to dispose of three anchorage points of which the central is constituted by a very long tail cooperating with a passage

dans le canal médullaire de l'épiphyse fémoral. into the medullary canal of the femoral epiphysis.

Une telle adaptabilité est offerte au praticien par simple choix de l'accessoire I selon Such adaptability is offered to the practitioner by simple choice of accessory I according

la fig. FIG. 7 présentant ou non le canon 67. 7 with or without the barrel 67.

Dans certains cas, le praticien peut être amené, pour disposer d'un massif osseux suffisamment sain, à pratiquer une résection locale plus importante de l'épiphyse basse In some cases, the practitioner may need to have a solid bone healthy enough to practice greater local resection of the lower epiphysis

fémorale. Femoral. Une telle résection peut d'ailleurs intervenir pour l'un et/ou les deux condyles. Such resection can also intervene to one and / or both condyles.

La fig. Fig. 12 montre que dans un tel cas l'accessoire I pouvant être adapté par l'intermédiaire de l'un ou l'autre des logements 34 ou 35 peut alors consister en une cale de comblement 75 qui présente un trou traversant constitué par un siège tronconique 76 aboutissant à un lamage 77 débouchant sur la face 78 de la cale orientée pour coopérer avec la plage plane 30 ou 31. De cette manière, la cale de comblement 75 peut être mise en place sur la cale de compensation 43 sur laquelle elle est centrée par coopération entre 12 shows that in such a case the accessory I can be adapted by means of one or the other of housings 34 or 35 may then consist of a wedge filler 75 which has a through hole constituted by a frustoconical seat 76 leading to a countersink 77 opening into the face 78 of the wedge directed to cooperate with the planar land 30 or 31. in this manner, the filling wedge 75 may be placed on the compensating wedge 43 on which it is centered by cooperation between

le lamage 77 et la collerette 46. the counterbore 77 and the collar 46.

L'immobilisation et la fixation interviennent par mise en place d'un plot 39 du type de celui représenté à la fig. The immobilization and fixation occur by placing a pad 39 of the type shown in FIG. 1, mais dont la conformation est adaptée pour que la portée 42 1 but whose conformation is adapted to the scope 42

soit à même de coopérer avec le siège 76. is able to interact with the seat 76.

La cale de comblement 75 peut être du simple type distal, c'est-à-dire à même de coopérer uniquement par appui sur la plage plane 30 ou 31 et les surfaces inclinées 32 ou 33. La fig. Filling the bilge 75 may be distal of simple type, that is to say adapted to cooperate only by pressing the planar land 30 or 31 and the inclined surfaces 32 or 33. Fig. 13 montre en pointillés que la cale de comblement 75 peut posséder une partie 79 visant à assurer un comblement postérieur en étant placée en appui contre la face interne du condyle constituant la branche postérieure 6 du U. Une représentation en perspective de la cale de comblement 78 est montrée 13 shows in dotted lines that the filling wedge 75 may have a portion 79 to ensure a subsequent filling being placed in abutment against the inner face of the condyle constituting the posterior branch 6 of the U. A perspective representation of the filler wedge 78 is shown

en fig. in fig. 14 et de la cale de comblement 78-79 en fig. 14 and the bilge filling 78-79 in Fig. 15. 15.

Les fig. FIGS. 16 et 17 montrent une variante d'adaptation selon laquelle le plateau 16 est pourvu de trous 80 permettant la fixation par des vis 81 d'une cale de comblement 82 adaptée sur la face inférieure du plateau pour coopérer éventuellement avec le croisillon 18 lorsque ce dernier existe. 16 and 17 show a variation of modification whereby the plate 16 is provided with holes 80 for attachment by screws 81 to a filling wedge 82 fitted on the underside of the tray for cooperating possibly with the spider 18 when the latter exist. La cale de comblement 82 peut être prévue pour correspondre à l'un ou aux deux côtés du plateau lorsque l'intervention fait intervenir une nécessité de résection correspondante du plateau tibial. The bilge filling 82 may be provided to correspond to one or both sides of the tray when the intervention involves a corresponding need for resection of the tibial plateau. La fig. Fig. 18 montre que le plateau 16 peut être dépourvu de tout rebord périphérique tel que prévu dans les exemples précédents pour contribuer au maintien du patin 20. Par contre, la face supérieure du plateau possède avantageusement un tourillon cylindrique 83 destiné à s'emboîter dans un puits complémentaire du patin qui peut ainsi être soumis à pivotement sur l'axe zz' du tourillon 83 lequel est généralement perpendiculaire au plan de la face supérieure du plateau 16. Cette disposition présente un intérêt notamment dans le cas de mise en oeuvre d'un guidage relatif entre les éléments prothétiques 1 et 2 comme illustré par les fig. 18 shows that the tray 16 can be devoid of any peripheral edge as provided in the previous examples to help maintain the shoe 20. against the upper face of the plate preferably has a cylindrical pin 83 for engagement in a well complementary to the pad which can thus be subjected to pivoting about the axis zz 'of the pin 83 which is generally perpendicular to the plane of the upper face of the plate 16. This arrangement has a particular interest in the case of implementation of a guide relative movement between the prosthetic elements 1 and 2 as illustrated in FIGS. 9 et 10. La fig. 9 and 10. Fig. 19 montre une variante d'accessoire I adaptable sur la prothèse notamment dans le cas o le chirurgien prend la décision de mettre en place une prothèse du type liée comme évoqué précédemment. 19 shows a suitable accessory I variant of the prosthesis in particular in the event that the surgeon decides to establish a prosthesis of the type connected as mentioned above. Dans cet exemple, l'accessoire I comprend deux pattes coudées 90 dont une branche de chacune forme la cale de In this example, accessory I comprises two bent lugs 90 which form a branch of each shim

compensation 43. Les branches 91 des pattes 90 délimitent dans leurs faces en vis-à- compensation 43. The branches 91 of the tabs 90 define in their faces vis-à

vis deux paliers 92 réservés au support et au centrage avec rotation de deux tourillons extrêmes 93 d'un axe 94 destiné à matérialiser l'axe artificiel de rotation entre les éléments I et 2. L'axe 94 est pourvu d'un prolongement médian orthogonal qui est destiné à pénétrer à rotation dans un puits 96 que présente la surface supérieure du patin 20 dans la partie médiane entre les glènes 21 et 22. La longueur utile du prolongement 95 et la profondeur du puits 96 sont déterminées pour que dans tous les états d'extension complète à flexion complète le prolongement 95 reste engagé dans le puits 96 et que simultanément les condyles 14 et 15 coopèrent avec screw two bearings 92 reserved for support and centering with rotation of two end pins 93 of axis 94 for materializing the artificial axis of rotation between the components I and 2. The axis 94 is provided with an orthogonal median extension which is intended to penetrate into rotation in a well 96 that has the upper surface of the pad 20 in the middle portion between the glenoid cavities 21 and 22. the useful length of the extension 95 and the depth of the well 96 are determined so that in all the states full extension to full flexion extension 95 remains engaged in the well 96 and simultaneously the condyles 14 and 15 cooperate with

les glènes 21 et 22. the glenoid cavities 21 and 22.

Il he

Claims (14)

REVENDICATIONS
1 - Prothèse de genou modulable du type comprenant un élément prothétique fémoral (1) formant une partie antérieure délimitant une trochlée par sa face avant et une partie distalo-postérieure composée de deux condyles (14 et 15) séparés par un espace intercondylien (E) et destinés à coopérer avec des glènes complémentaires (21-22) présentées par un patin (20) équipant un élément prothétique tibial (2), ledit élément prothétique fémoral présentant dans le plan sagittal la forme d'un U délimitant un logement (8) d'emboîtement de la partie épiphysaire basse réséquée d'un fémur, un tel logement étant défini par deux faces planes en vis-à-vis (9-10) présentées par la partie antérieure et par la partie postérieure, par une face plane transversale (11) présentée par la partie distale des condyles et par deux pans coupés (12) de raccordement entre les faces planes en vis-à-vis, caractérisée en ce que - elle comporte des condyles présentant chacu 1 - prosthesis modular knee of the type comprising a femoral prosthetic member (1) forming a front part defining a trochlea by its front face and a distalo-rear portion composed of two condyles (14 and 15) separated by an intercondylar space (E) and intended to cooperate with complementary glenoid cavities (21-22) presented by a pad (20) equipping a tibial prosthetic member (2), said prosthetic femoral component having in the sagittal plane the U-shape defining a housing (8) engagement of the low epiphyseal part of a resected femur, such housing being defined by two flat faces vis-à-vis (9-10) presented by the front portion and the rear portion, by a transverse planar face (11) by the distal portion of the condyles and two beveled corners (12) connecting between the planar faces vis-à-vis, characterized in that - it includes condyles having Chacu n une plage plane (30, 31) et deux surfaces inclinées (32, 33) contribuant à matérialiser la face transversale et les deux pans coupés du logement, - chaque plage plane (30, 31) présente sensiblement en son centre un logement (34) dans le fond duquel s'ouvrent un trou borgne taraudé (36) bordé par un rebord annulaire (37) définissant par sa surface extérieure une portée cylindrique de centrage (38), - chaque logement est apte à recevoir un accessoire fonctionnel (1) n a planar pad (30, 31) and two inclined surfaces (32, 33) contributing to materialize the transverse face and two cut sides of the housing, - each planar pad (30, 31) has substantially in its center a housing (34 ) in the bottom of which opens a tapped blind hole (36) bordered by an annular rim (37) defining by its outer surface a cylindrical bearing surface for centering (38), - each housing is adapted to receive a functional accessory (1)
maintenu en place par un plot (40) de fixation osseuse, visé. held in place by a stud (40) for bone fixation, referred.
2 - Prothèse de genou selon la revendication 1, caractérisée en ce que chaque logement est occupé par une cale de compensation (43) constituant un accessoire fonctionnel (1) présentant un trou cylindrique traversant (45), destiné à être placé en coincidence avec le trou taraudé borgne (36) dudit logement, le trou traversant étant bordé par une collerette (46) dont la surface périphérique interne délimite un siège tronconique (47) et en ce que le plot de fixation (39) comporte, entre un corps d'ancrage (40) et un embout fileté (41), une portée tronconique (42) complémentaire 2 - Knee prosthesis according to Claim 1, characterized in that each slot is occupied by a compensation wedge (43) constituting an operating attachment (1) having a cylindrical through hole (45) intended to be placed in coincidence with the blind threaded hole (36) of said housing, the through hole being bordered by a collar (46) whose inner peripheral surface defines a frustoconical seat (47) and in that the retention pin (39) is provided between a body of anchor (40) and a threaded end (41), a frustoconical bearing surface (42) complementary
au siège avec lequel elle coopère pour immobiliser la cale dans le logement. the seat with which it cooperates to immobilize the wedge in the housing.
3 - Prothèse selon la revendication 2, caractérisée en ce que le logement 3 - A prosthesis according to claim 2, characterized in that the housing
12 2780636 12 2780636
(34, 35) et la cale (43) présentent des formes conjuguées assumant une fonction (34, 35) and the wedge (43) have conjugate shapes assuming a function
d'immobilisation en rotation de la cale sur l'axe de la portée cylindrique. for preventing rotation of the wedge on the axis of the cylindrical seat.
4 - Prothèse selon la revendication 2 ou 3, caractérisée en ce que les cales sont liées 4 - A prosthesis according to claim 2 or 3, characterized in that the shims are linked
entre elles. between them.
5 - Prothèse selon l'une des revendications 2 à 4, caractérisée en ce que les cales 5 - A prosthesis according to one of claims 2 to 4, characterized in that the shims
(43) forment les oreilles d'une platine (48) constituant un accessoire fonctionnel (1) portant une éminence (49) de postéro-stabilisation destinée à être disposée dans l'espace intercondylien. (43) form the ears of a plate (48) constituting an operating attachment (1) having an eminence (49) posterior stabilization to be arranged in the intercondylar space. 6 - Prothèse selon la revendication 5, caractérisée en ce que l'éminence présente un corps de forme semi-torique (50) définissant une tête de butée (51) et en ce que l'accessoire (1) est complété par un accessoire complémentaire (Il) représenté par l'élément prothétique tibial dont le patin (20) forme, sensiblement dans un plan antéro-postérieur et entre les glènes, une épine (25) s'élevant en retrait du bord antérieur (24) du patin et se raccordant au bord postérieur par une cavité d'appui (53) et une surface de glissement 6 - A prosthesis according to claim 5, characterized in that the elevation has a semi-ring shaped body (50) defining an abutment head (51) and in that the accessory (1) is complemented by a complementary accessory (II) represented by the prosthetic tibial which the pad member (20) shaped substantially in an anterior-posterior plane and between the glenoid cavities, a thorn (25) rising back from the front edge (24) of the shoe and adjoining the rear edge by a bearing cavity (53) and a sliding surface
(52). (52).
7 - Prothèse selon la revendication 6, caractérisée en ce que l'accessoire (1) comprend un corps massif (60) pourvu des cales latérales (43) et présente un alvéole (61) entre la forme semi-torique et un mentonnet (62) pour l'emboîtement d'une saillie (63) 7 - A prosthesis according to claim 6, characterized in that the accessory (1) comprises a solid body (60) provided with means of lateral stops (43) and has a cavity (61) between the semi-ring shape and a flange (62 ) for fitting a projection (63)
s'élevant à partir du patin (20) qui constitue un accessoire complémentaire (12). rising from the shoe (20) which is a complementary accessory (12).
8 - Prothèse selon la revendications 7, caractérisée en ce que le corps (60) 8 - A prosthesis according to claim 7, characterized in that the body (60)
comporte, de part et d'autre de la forme semi-torique deux flancs de guidage (66) comprises, on both sides of the semi-toric form two guide flanks (66)
coopérant avec les faces latérales de la saillie. cooperating with the side faces of the projection.
9 - Prothèse selon l'une des revendications 5 à 8, caractérisée en ce que l'accessoire 9 - A prosthesis according to one of claims 5 to 8, characterized in that the accessory
(I) forme un corps massif dont la surface tournée vers le logement d'emboîtement (8) comporte un canon saillant (67) délimitant un trou borgne formant, à partir de son (I) form a solid body whose surface facing the plug housing (8) has a protruding barrel (67) defining a blind hole forming, from its
ouverture, un siège tronconique (68) aboutissant à un taraudage (69). opening, a frustoconical seat (68) leading to an internal thread (69).
- Prothèse selon la revendication 9, caractérisée en ce que le canon (67) est réservé à la mise en plan d'une queue (70) d'engagement médullaire possédant un embout formant une portée tronconique (73) prolongée par une partie terminale - The prosthesis of claim 9, characterized in that the barrel (67) is reserved for the drawing a tail (70) of bone marrow involvement with an endpiece forming a frustoconical bearing surface (73) extended by a terminal portion
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fjletée (72). fjletée (72).
11 - Prothèse selon l'une des revendications 1 à 3, caractérisée en ce que l'accessoire 11 - A prosthesis according to one of claims 1 to 3, characterized in that the accessory
(1) est constitué par une cale (75) de comblement de l'épiphyse fémoral prenant appui au (1) consists of a wedge (75) filling the epiphysis femoral bearing the
moins sur la plage plane (30,31) et les pans coupés. least over the planar land (30,31) and the canted.
12 - Prothèse selon la revendication 11, caractérisée en ce que la cale de comblement (75) présente sur sa face tournée vers le logement d'emboîtement (8) un siège tronconique (76) apte à coopérer avec la portée (42) d'un plot de fixation (40) et se raccordant à un lainage (77) de réception de la collerette (46) de la cale de compensation 12 - A prosthesis according to claim 11, characterized in that the augment (75) has on its side facing the plug housing (8) a frustoconical seat (76) adapted to cooperate with the bearing surface (42) of a fixing stud (40) and connecting to a wool (77) receiving the flange (46) of the compensating wedge
(43) occupant le logement. (43) occupying the housing.
13 - Prothèse selon la revendication 1 ou 6, caractérisée en ce qu'elle est composée d'un élément fémoral (1) et d'un élément tibial (2) comprenant un plateau (16) portant un patin (20) formant sur sa face supérieure les glènes (21, 22) et l'épine (23), ledit plateau 13 - The prosthesis of claim 1 or 6, characterized in that it is composed of a femoral element (1) and a tibial element (2) comprising a tray (16) carrying a shoe (20) forming on its upper face the glenoid cavities (21, 22) and spine (23), said tray
possédant sur sa face inférieure une queue (17) de fixation dans le massif tibial. having on its underside a tail surface (17) for fixing into the tibial solid.
14 - Prothèse selon la revendication 13, caractérisée en ce que la queue est 14 - A prosthesis according to claim 13, characterized in that the tail is
complétée par un croisillon de renforcement (18). supplemented by a reinforcement brace (18).
- Prothèse selon la revendication 13 ou 14, caractérisée en ce que le plateau comporte, adaptée sur sa face inférieure, au moins une cale (82) de comblement de - The prosthesis of claim 13 or 14, characterized in that the plate comprises, adapted on its lower face, at least one shim (82) of filler
l'épiphyse tibiale. tibial epiphysis.
16 - Prothèse selon la revendication 13, caractérisée en ce que le patin (20) est monté sur le plateau (16) de manière à pouvoir tourné sur un axe (yy') sensiblement 16 - A prosthesis according to claim 13, characterized in that the pad (20) is mounted on the tray (16) so as to be rotated about an axis (yy ') substantially
perpendiculaire au plan du plateau. perpendicular to the plate plane.
17 - Prothèse selon la revendication 1 à 3, caractérisée en ce que l'accessoire I est constitué par un axe (94) pourvu d'un prolongement orthogonal (95) destiné à pénétrer dans un puits (96) du patin (20), ledit axe étant porté à rotation par deux pattes coudées 17 - A prosthesis according to claim 1 to 3, characterized in that the accessory I is constituted by a pin (94) provided with an orthogonal extension (95) for entering a well (96) of the shoe (20), said shaft being rotatably supported by two bent lugs
(90) dont l'une des branches de chacune constitue la cale (43). (90) whose one arm of each is the wedge (43).
FR9808779A 1998-07-06 1998-07-06 Modular knee prosthesis Expired - Lifetime FR2780636B1 (en)

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CN102048594A (en) * 2009-10-30 2011-05-11 德普伊产品公司 Prosthesis for cemented fixation and method for making the prosthesis
US8128703B2 (en) 2007-09-28 2012-03-06 Depuy Products, Inc. Fixed-bearing knee prosthesis having interchangeable components
US8187335B2 (en) 2008-06-30 2012-05-29 Depuy Products, Inc. Posterior stabilized orthopaedic knee prosthesis having controlled condylar curvature
US8192498B2 (en) 2008-06-30 2012-06-05 Depuy Products, Inc. Posterior cructiate-retaining orthopaedic knee prosthesis having controlled condylar curvature
US8206451B2 (en) 2008-06-30 2012-06-26 Depuy Products, Inc. Posterior stabilized orthopaedic prosthesis
US8236061B2 (en) 2008-06-30 2012-08-07 Depuy Products, Inc. Orthopaedic knee prosthesis having controlled condylar curvature
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US9398956B2 (en) 2007-09-25 2016-07-26 Depuy (Ireland) Fixed-bearing knee prosthesis having interchangeable components
US9278003B2 (en) 2007-09-25 2016-03-08 Depuy (Ireland) Prosthesis for cementless fixation
US8128703B2 (en) 2007-09-28 2012-03-06 Depuy Products, Inc. Fixed-bearing knee prosthesis having interchangeable components
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US8784496B2 (en) 2008-06-30 2014-07-22 Depuy (Ireland) Orthopaedic knee prosthesis having controlled condylar curvature
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US8834575B2 (en) 2008-06-30 2014-09-16 Depuy (Ireland) Posterior stabilized orthopaedic knee prosthesis having controlled condylar curvature
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US8206451B2 (en) 2008-06-30 2012-06-26 Depuy Products, Inc. Posterior stabilized orthopaedic prosthesis
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