FR2803192A1 - Anneau impactable - Google Patents

Anneau impactable Download PDF

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Publication number
FR2803192A1
FR2803192A1 FR9916852A FR9916852A FR2803192A1 FR 2803192 A1 FR2803192 A1 FR 2803192A1 FR 9916852 A FR9916852 A FR 9916852A FR 9916852 A FR9916852 A FR 9916852A FR 2803192 A1 FR2803192 A1 FR 2803192A1
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FR
France
Prior art keywords
ring
implant
spikes
tapering
metal
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
FR9916852A
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English (en)
Other versions
FR2803192B1 (fr
Inventor
Jacques Fourastier
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Individual
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Individual
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Filing date
Publication date
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Priority to FR9916852A priority Critical patent/FR2803192B1/fr
Publication of FR2803192A1 publication Critical patent/FR2803192A1/fr
Application granted granted Critical
Publication of FR2803192B1 publication Critical patent/FR2803192B1/fr
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
    • A61F2/32—Joints for the hip
    • A61F2/34—Acetabular cups
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30721—Accessories
    • A61F2/30744—End caps, e.g. for closing an endoprosthetic cavity
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4609—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of acetabular cups
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/30004—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
    • A61F2002/30032—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis differing in absorbability or resorbability, i.e. in absorption or resorption time
    • A—HUMAN NECESSITIES
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    • A61F2002/3006—Properties of materials and coating materials
    • A61F2002/30062—(bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
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    • A61F2002/30317—The prosthesis having different structural features at different locations within the same prosthesis
    • A61F2002/30322—The prosthesis having different structural features at different locations within the same prosthesis differing in surface structures
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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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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30405—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/3082—Grooves
    • 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
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    • A61F2002/30838—Microstructures
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    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005—The prosthesis being constructed from a particular material
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00395—Coating or prosthesis-covering structure made of metals or of alloys
    • 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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00592—Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
    • A61F2310/00598—Coating or prosthesis-covering structure made of compounds based on metal oxides or hydroxides
    • A61F2310/00604—Coating made of aluminium oxide or hydroxides
    • 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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00592—Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
    • A61F2310/00796—Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite

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

L'invention conceme un élément pelvien de prothèse articulaire de hanche : anneau impactable non cimenté, caractérisé par une ceinture tronconique de stabilisation, doté de trois plots d'ancrage et recouvert d'une double couche de Plasma Al2 O3 + HAP.

Description

ANNEAUIMPACTABLE La présente invention concerne un implant<B>à</B> fixer dans la partie acétabulaire de l'articulation de la hanche. Cet implant se compose d'un anneau métallique supportant ou intégrant un insert destiné<B>à</B> recevoir la tête de l'implant fixé dans le fémur.
De tels implants font partie des systèmes prothétiques généralement utilisés pour l'arthroplastie totale de hanche et qui se composent<B>:</B> <B>-</B> d'une<B> </B> tige<B> </B> fémorale en métal dotée d'un col, <B>-</B> d'une<B> </B> tête<B> </B> fémorale en métal ou céramique s'adaptant au col précédent, <B>-</B> d'un cotyle ou anneau,<B>à</B> pose cimentée ou non cimentée, fixé dans la cavité acétabulaire et accueillant la tête fémorale. Les cotyles<B>à</B> pose cimentée, généralement usinés en Polyéthylène Haute Densité (PHD), ont démontré les limites de leur longévité suivant l'usure du PHD et les difficultés de reprise dues<B>à</B> des pertes osseuses importantes.
Les cotyles ou anneaux, généralement usinés en métal, ont été imaginés pour être implantés sur des patients jeunes et pour économiser le stock osseux en prévision d'une éventuelle réintervention. Les premières générations d'anneaux sans ciment métalliques, de forme hémisphérique ou tronconique, étaient vissés dans la cavité acétabulaire par un pas de vis extérieur. Ces anneaux vissés ont rapidement conduit<B>à</B> un taux d'échec inacceptable. Le large filet du pas de vis entraîne une surcompression des cellules osseuses pouvant conduire<B>à</B> des nécroses, au déscellement et<B>à</B> un mouvement protrusif de l'implant. Le vissage abandonné, les anneaux sont devenus impactables ou Press Fit, rigides ou élastiques<B>;</B> ce type d'anneau démontre des qualités de stabilité et de longévité comparables aux cotyles cimentés. Cependant, ces anneaux impactables, de forme généralement hémisphérique avec de nombreuses variantes<B>:</B> fentes, reliefs, trous et renforts de fixation<B>...</B> posent encore de nombreux problèmes<B>:</B> <B>-</B> de tenue primaire conduisant souvent le praticien<B>à</B> utiliser des vis de fixation complémentaires, <B>-</B> de douleur par sur-impaction, <B>-</B> de fixation<B>à</B> long terme.
Les surfaces des anneaux connaissent des traitements et reliefs très agressifs pour rechercher une fixation par repousse osseuse<B>:</B> microbilles, méchages métalliques, recouverts<B>CHAR</B> Ces revêtements et les vis entraînent aussi des effets négatifs dus aux micro- mouvements <B>:</B> rupture de vis, métalloses, et descellement avec parfois destructions osseuses importantes. En cas de déplacement de l'anneau, Vinsert en PHD peut enfin connaître une usure prématurée.
L'invention offre des caractéristiques visant<B>à</B> répondre aux défis de l'implant acétabulaire <B>:</B> <B>-</B> fixation primaire, <B>-</B> stabilité secondaire, <B>-</B> possibilité de réintervention sur un stock osseux préservé ou recomposé. <U>Fixation primaire</U> Les défauts de fixation et d'adaptation primaire des implants conduisent les praticiens<B>à</B> utiliser des vis transfixant l'anneau. Ces vis ne sont pas sans inconvénient. Elles sont vissées alors que l'anneau n'est pas nécessairement bien impacté. Les efforts dynamiques suivants provoquent parfois des fractures de ces vis travaillées contradictoirement par la rigidité de l'implant et les mouvement de l'os.
<B>Il</B> apparaît plus simple et logique de doter l'anneau de plots monoblocs courts (2). Après essais statiques et dynamiques sur des prototypes, l'invention est dotée de trois plots positionnés<B>à 55"</B> (2). Les trous de passage de vis sont supprimés, seul est conservé un trou polaire (4)<B>à</B> pas de vis, recevant un porte anneau et autorisant l'impaction dans l'axe. Ce trou est obturé par un bouchon après positionnement La stabilité primaire, puis secondaire, passe aussi par une meilleure adaptation de la forme de l'implant<B>à</B> l'anatomie du cotyle osseux.
Diverses études ont prouvé qu'il existait une élasticité du cotyle ou de la cavité acétabulaire, notamment de ses comes. D'autre part, l'étude anatomique comme les clichés radios, montrent une sphéricité de cette cavité sur sa partie extérieure et un véritable découvert au niveau de l'arcade supérieure.
La stabilité primaire lors de l'impaction sera donc supérieure si le rayon de courbure de l'anneau augmente<B>à</B> la ceinture équatoriale.
L'invention comporte une ceinture épaissie nettement tronconique<B>(1),</B> qui augmente l'adaptation anatomique, la capacité dynamique d'impaction de l'anneau et apporte une stabilité primaire et secondaire. Après essais biomécaniques, l'épaississement de la ceinture a été fixé<B>à 1</B> mm et la conicité<B>à</B> un angle au sommet de<B>10</B> <U>Fixation secondaire</U> Les états de surface des anneaux actuels sont généralement très irréguliers (treillis ou mèchages de titane, microbilles, dessins en creux) recouverts ou non CHAR La repousse osseuse dans ces états de surface est irrégulière, n'empêchant pas quelques descellement avec, dès lors, perte de matière osseuse.
L'implant, en plus des plots bloqués dans l'os, est doté d'un relief simple de surface stries, recouvert d'une couche d'alumine<B>A1203</B> inattaquable, biocompatible, et d'une couche finale d'HAP <B>(3).</B> Ces rainures s'étendent sur l'anneau et la ceinture tronconique. Ainsi l'invention bénéficiera des qualités reconnues d'ostéconduction de FHAP pour une accroche osseuse rapide et des qualités de neutralité biochimiques de l'alumine pour une fixation osseuse non agressive<B>à</B> long terme.
En s'adaptant mieux<B>à</B> l'anatomie extérieure de la cavité acétabulaire, l'implant par sa ceinture tronconique, permettra après repousse osseuse une meilleure stabilité de l'implant tant dans le plan vertical en limitant le risque de basculement, que dans l'axe de la cavité, en augmentant fortement la résistance<B>à</B> l'enfoncement ou<B>à</B> l'expulsion.
L'anneau est doté d'un insert en polyéthylène ou en métal céramisé, solidement fixé dans l'anneau, et débordant légèrement la partie métallique pour protéger la tête fémorale en cas de luxation<B>(5)</B> sans dépasser la moitié de l'épaisseur de l'anneau.

Claims (1)

  1. <B><U>REVENDICATIONS</U></B> <B>1-</B> Implant<B>à</B> fixer dans la partie acétabulaire de l'articulation de la hanche se composant d'un anneau métallique supportant ou intégrant un insert caractérisé en ce que l'anneau est de forme hémisphérique, doté sur son équateur d'une ceinture tronconique de stabilisation<B>(1)</B> d'un angle au sommet de<B>10 0</B> et d'une surépaisseur d'environ<B>1</B> mm. 2- Implant selon la revendication<B>1</B> caractérisé en ce que l'anneau rigide est doté de trois plots positionnés<B>à 55 '</B> d'angle (2) <B>3-</B> Implant selon l'une quelconque des revendications précédentes caractérisé en ce que l'implant est doté de stries ou rainures d'usinage et recouvert par torche plasma d'une double couche d'A1203 non dégradable et d'H.A. P. dégradable <B>(3).</B> 4- Implant selon l'une quelconque des revendications précédentes caractérisé en ce que l'anneau est doté d'un unique trou d'impaction<B>à</B> pas de vis (4), obturé par un bouchon après positionnement dans l'acetabulum. <B>5-</B> Implant selon la revendication<B>1</B> caractérisé en ce que l'insert orientable en PHD, déborde légèrement le bord de l'anneau<B>(5)</B> et qu'il comporte une version recouverte de métal céramisé.
FR9916852A 1999-12-31 1999-12-31 Anneau impactable Expired - Fee Related FR2803192B1 (fr)

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9017416B2 (en) 2009-12-21 2015-04-28 Derek J. McMinn Method of forming a polymer component

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4704127A (en) * 1986-01-23 1987-11-03 Osteonics Corp. Dual-geometry acetabular cup component and method of implant
FR2705884A1 (fr) * 1993-06-03 1994-12-09 Rech Fabrication Et Ensemble de tiges fémorales pour prothèse totale de la hanche.
WO1997017040A1 (fr) * 1995-11-08 1997-05-15 Emcc Engineering Manufacturing Consulting Corporation Ag Cavite cotyloide artificielle
WO1997042913A1 (fr) * 1996-05-14 1997-11-20 Bruno Balay Implant cotyloidien fixe sans ciment
FR2749162A1 (fr) * 1996-05-31 1997-12-05 Fauvy Alain Prothese cotyloidienne
FR2770769A1 (fr) * 1997-11-07 1999-05-14 Orthotechnique Composant acetabulaire

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4704127A (en) * 1986-01-23 1987-11-03 Osteonics Corp. Dual-geometry acetabular cup component and method of implant
FR2705884A1 (fr) * 1993-06-03 1994-12-09 Rech Fabrication Et Ensemble de tiges fémorales pour prothèse totale de la hanche.
WO1997017040A1 (fr) * 1995-11-08 1997-05-15 Emcc Engineering Manufacturing Consulting Corporation Ag Cavite cotyloide artificielle
WO1997042913A1 (fr) * 1996-05-14 1997-11-20 Bruno Balay Implant cotyloidien fixe sans ciment
FR2749162A1 (fr) * 1996-05-31 1997-12-05 Fauvy Alain Prothese cotyloidienne
FR2770769A1 (fr) * 1997-11-07 1999-05-14 Orthotechnique Composant acetabulaire

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9017416B2 (en) 2009-12-21 2015-04-28 Derek J. McMinn Method of forming a polymer component
US9283079B2 (en) 2009-12-21 2016-03-15 Derek James Wallace McMinn Cup with crosslinked polymer layer cable ties
US9649193B2 (en) 2009-12-21 2017-05-16 Derek James Wallace McMinn Cup with crosslinked polymer layer modular pegs
US9956081B2 (en) 2009-12-21 2018-05-01 Derek James Wallace McMinn Cup with cross-linked polymer layer
US10966837B2 (en) 2009-12-21 2021-04-06 Derek James Wallace McMinn Cup with conical permanent pegs

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