JP2013528110A - インプラント部品及びその製造方法 - Google Patents
インプラント部品及びその製造方法 Download PDFInfo
- Publication number
- JP2013528110A JP2013528110A JP2013514341A JP2013514341A JP2013528110A JP 2013528110 A JP2013528110 A JP 2013528110A JP 2013514341 A JP2013514341 A JP 2013514341A JP 2013514341 A JP2013514341 A JP 2013514341A JP 2013528110 A JP2013528110 A JP 2013528110A
- Authority
- JP
- Japan
- Prior art keywords
- cup
- cup member
- acetabular
- bone
- attachment
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
- A61B17/8066—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones for pelvic reconstruction
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Abstract
本発明は、整形外科用インプラントのためのシステム、装置、及び方法を提供する。インプラントは、補剛部品、フランジ付カップ、取付部材、又は任意の他の適切な整形外科用アタッチメントと結合するように構成されている、例えば寛骨臼シェルや補剛部品のようなベース部材を含んでいる。移植可能なシェルの内部に装着されるカップ部材は、患者の骨又は軟組織にインプラントを係止する取付部材を有している。カップ部材が、シェルの内部に装着されており、カップ部材をシェルに結合するためにシェルの対応する内面と結合するように構成されている外面を有している。取付部材はカップ部材と一体化されているか、又は特定のインプラント又は患者の解剖学的構造を収容するように柔軟性を有しているように調整可能とされる。
Description
[関連出願の相互参照]
本出願は、米国仮特許出願第61/352705号明細書、米国仮特許出願第61/352722号明細書、米国仮特許出願第61/422903号明細書、及び、米国仮特許出願第61/466817号明細書に基づく優先権を主張するものである。これら特許出願の全体が、参照により本明細書に組み込まれている。
本出願は、米国仮特許出願第61/352705号明細書、米国仮特許出願第61/352722号明細書、米国仮特許出願第61/422903号明細書、及び、米国仮特許出願第61/466817号明細書に基づく優先権を主張するものである。これら特許出願の全体が、参照により本明細書に組み込まれている。
関節は、様々な理由に起因して退行的な変化を受ける場合がある。関節の退行が進展するか又は元に戻すことができない場合には、生まれつきの関節を人工関節具に交換する必要がある。股関節、肩関節、及び膝関節を含む人工的なインプラントは、整形外科手術において広く利用されている。特に、人工股関節は一般的である。ヒトの股関節は、ボール状の大腿骨頭が骨盤のソケット状の寛骨臼内に配置された状態において、球窩関節として機械的に機能する。様々な変性疾患及び傷害では、一般に金属、セラミック、又はプラスチック材料のような合成材料を利用することによって股関節のすべて又は一部分を交換することが必要とされる。
より具体的には、生まれつきの股関節が対向的な変化を受ける場合があり、この場合には、股関節を人工股関節に交換することが必要とされる。股関節を大腿骨頭と寛骨臼との間における2つの支持面に交換する場合がある。一般に、第1の支持面は、金属、セラミック材料、又は所望の材料から形成されている、人工関節具のシェルすなわち寛骨臼カップである。ライナ(従来において、例えば超高分子量ポリエチレン、セラミック材料、時に金属から形成されている)が、シェル内に堅固に装着されており、これにより、人工大腿骨頭を受容すると共に関節結合の関係において人工大腿骨頭と協働する内部支持面を形成するので、大腿骨と寛骨臼との相対的な運動を追跡及び調整することができる。
カップ(又はカップ及びライナから成る組立体)は、一般にカップの開口部にネジを通すことによって、又は、セメントでカップを固着することによって固定されている。人工関節具を受容する部分の骨の質、量、及び/又は構造が不十分なこと(poor bone stock)に起因して、ライナのみが患者内に固着される場合もある。また、多孔性の表面を有しているカップが、リーマー仕上げされた寛骨臼の表面に圧入される場合もある。
人工関節具を(場合によっては、より大きい)交換するための関節に置換するために、第2の又はその後の手術が必要な場合がある。このような手術は、骨のさらなる退行又は変性疾患の進行、及び、さらなる骨を除去し、除去された罹患骨をより大きい又は改良された人工関節具に置換すること必要とすることに起因して必要となる場合があり、人工関節置換(revision prosthesis)と呼称される場合がある。例えば、骨が寛骨臼骨縁の周囲において失われる場合があり、この場合には、寛骨臼骨縁が圧入カップを確実に配設するために覆わなくなる。従って、このような手術は修正手術とも呼称される。
寛骨臼の修正手術では、一般に、人工寛骨臼は、例えば補剛部品、フランジ、フック、プレート、又は一旦位置決めすると交換するための人工関節具を付加的に支持及び/又は安定化させる任意の他の接続部品、取付ポイント若しくは取付部材のような、付加的な取付要素を含んでいる。これら付加的な取付部材又は接続部材が、患部領域(例えば股関節)における骨の退行、骨量の減少、又は骨の欠損に起因して必要とされる場合がある。
このような様々な取付部材(フランジ、ブレード、プレート、及び/又はフックを含みが、これらに限定される訳ではない)が、外科医が最適な固定を実現することを補助するために、人工関節具システムに関連して設けられている場合がある。人工関節具の非限定的な例としては、(骨盤の腸骨領域に固着及び固定するための)腸骨フランジ、(坐骨に固着及び固定するための)坐骨ブレード、及び、(閉鎖孔に係合することによって固着及び下固定(inferior fixation)するための)閉鎖筋フックが挙げられる。このような取付アタッチメントをモジュール式にしようとする試みがあるが、今日に至るまで真のモジュール性を得ることができていない。その代りに、取付アタッチメントは、外科医が決定したオプションの範囲内において取付部材を配置させるための幾つかの独立した位置を提供することができる。
さらに、最初の手術の際に及び修正手術の際に、寛骨臼が欠損するか、又は外科医は新しいシェルを挿入する前に骨移植片を充填させる必要がある、空洞が寛骨臼に生じる場合がある。このことは、時間及び費用を要するものであり、患者をさらなる健康上の危険に曝す可能性がある。幾つかの手法は、寛骨臼シェルと関連して、寛骨臼シェルの外面に結合されるか又は接続される補剛部品を利用する。
従来技術に基づく補剛部品を利用することによって、外科医は補剛部品を骨に接続した後に、寛骨臼カップを移植することができる。しかしながら、大部分の寛骨臼カップが、適切な固定を得るために骨ネジに依存しており、補剛部品がネジの障害となる場合がある。要するに、外科医は、ネジを最良の位置に配置させるための自由を必要としているが、補剛部品を利用するためにネジの配置について妥協している。従来技術に基づくシステムでは、コンポーネントの向きを試行するために多くの時間を要した後に、カップのための良好な骨の固定を見つける試みをしていた。外科医は、必要とされる補剛部品の大きさを見積もる一方、除去すべき骨の量を裁量で決定する必要があった。骨が欠損している場合には、外科医は必要以上に骨を除去することにためらいがあった。
また、例えば改良された骨ネジ、改良されたコーティング、及び様々な補剛部品の脱着方法のような、本明細書で説明される様々な付加的な特徴及び改良された特徴が、様々なタイプの関節インプラントと共に利用及び適用することを意図するにすぎない。
本発明は、モジュール式整形外科用インプラントを提供するためのシステム、装置、及び方法に関する。インプラントは、例えば寛骨臼シェルや補剛部品のようなベース部分を含んでおり、ベース部分は、補剛部品、フランジ付カップ、取付部材、任意の他の適切な整形外科用アタッチメント、又はこれらの組み合わせと結合するように構成されている。取付部材は、例えばフランジ、ブレード、フック、及びプレートを含んでいる。幾つかの実施例では、整形外科用アタッチメントは、ベース部材又は他のアタッチメントを中心として調整可能に位置決めすることができるので、装置の組立及び移植についてモジュール性を付与することができる。インプラントの構成部品同士の間で様々な固定機構及び/又はロック機構を利用することができる。特定の実施例では、整形外科用アタッチメントがベース部材又は他の構成部品に取り外し可能に結合されている。特定の実施例では、整形外科用アタッチメントがベース部材又は他の構成部品に一体に形成されているが、ベース部材又は他の構成部品を中心として調整可能に位置決めされている。幾つかの実施例では、膨張可能な補剛部材、ベース部材、又は他の骨充填装置が設けられている。幾つかの実施例では、表面形体が摩擦を発生させ、インプラントと患者の骨との界面において周囲の骨の内部成長を可能とするように形成されている。
本発明におけるシステム、装置、及び方法は、フランジ付カップを含んでいるインプラントを提供する。特定の実施例では、寛骨臼インプラントシステムは、寛骨臼シェルと、寛骨臼シェル内部に位置決め可能に装着されているカップ部材と、カップ部材に結合されている少なくとも1つの取付部材とを備えており、少なくとも1つの取付部材が、患者の骨に取り付けることによって患者の骨に係止することができる第1の部分を有している。取付部材が、カップ部材を中心として調整可能に位置決めすることができるフランジを備えており、患者の骨に係止するための接続部分を具備する第1の端部を有している。幾つかの実施例では、カップ部材が、寛骨臼シェル内部において接続部位にロックするためのテーパ状の遠位端部を含んでいる。寛骨臼シェル内部の接続部位が、ライナを受容するように構成されている。幾つかの実施例では、寛骨臼インプラントシステムは、カップ部材内部に配置されているライナを備えている。カップ部材が、ライナがカップ部材内部において完全にサポートされるように、完全なカップとして構成されている。少なくとも1つの取付部材が、フランジ、フック、又はプレートとされる。代替的には、少なくとも1つの取付部材が、カップ部材に一体に形成されている。
特定の実施例では、外科用インプラントを形成するための方法は、患者の寛骨臼内部にインプラントを挿入するステップと、挿入されたインプラント内部に少なくとも1つの取付部材を有しているカップ部材を準備するステップと、少なくとも1つの取付部材が患者の骨と位置合わせされるように、カップ部材をインプラントと位置合わせするステップと、少なくとも1つの取付部材を患者の骨に接続するステップとを備えている。また、当該方法が、少なくとも1つの取付部材をカップ部材を中心として調整可能に位置決めするステップと、インプラント内部においてカップ部材のテーパ状の遠位端部を接続部位にロックするステップとを備えており、少なくとも1つの取付部材が、患者の骨に係止するための接続部分を具備する第1の端部を有している。幾つかの実施例では、当該方法は、ライナを接続部位内部に配置するステップを備えており、カップ部材が、ライナがカップ部材内部において完全にサポートされるように、バンド又は完全なカップとして形成されている。少なくとも1つの取付部材が、フランジ、フック、又はプレートである。代替的には、少なくとも1つの取付部材が、カップ部材に一体に形成されている。
上述の目的及び他の目的並びに利点は、添付図面に関連して、以下の発明の詳細な説明を考慮することによって明らかとなるだろう。明細書全体を通じて、類似する部品には類似する参照符号が付されている。
本明細書で説明するシステム、装置、及び方法を総合的に理解するために、特定の図示した実施例について説明する。本明細書で説明する実施例及び機能は、特に寛骨臼システムと接続させた状態で利用するために説明されているが、以下に概略的に説明するすべての構成部品、接続機構、調整システム、固定方法、製造方法、コーティング、及びその他の特徴が、任意の適切な態様で互いに組み合わせられ、他の外科手術で利用するための医療装置及びインプラントに適用及び利用可能とされる。他の外科手術としては、脊椎関節形成術、頭蓋−顎顔手術、膝関節形成術、肩関節形成術、並びに足、足首、手、及び他の四肢の手術が挙げられるが、これらに限定される訳ではない。
本明細書で説明する様々なインプラント及び他の装置が、様々な実施例において任意の適切な補剛材料と関連して利用される場合がある。補剛材料の非限定的な例としては、骨セメント、適切な高分子材料、吸収性ポリウレタン、及びPolyNovo Biomaterials Limitedによって提供される任意の材料、並びにこれら材料の任意の適切な組み合わせが挙げられる。適用可能な材料のさらなる非限定的な例としては、特許文献1、特許文献2、特許文献3、特許文献4、特許文献5、特許文献6、及び特許文献7が挙げられる。
図1〜図4は、幾つかの実施例では寛骨臼カップ140とカップ部材120の内部に配置されているライナ160との間において、寛骨臼カップ140(“寛骨臼シェル”、“シェル”、“ケージ”、又は“カップ”とも呼称される)に挿入されるように構成されているカップ部材120を表わす。カップ部材120は、カップ部材120にそれぞれ取り外し可能に又は一体に設けられている様々な取付部材(“接続部材”とも呼称される)を、例えばフランジ、ブレード、フック、又はプレートを備えている。例えば図1に表わすように、カップ部材120はブレード102とフック104とフランジ106とを含んでいる。例えばブレード102、フック104、及びフランジ106のような取付部材は、カップ部材120を中心として(例えばカップ部材120の外周を中心として、又はカップ部材120の任意の他の適切な位置を中心として)調節可能に位置決めされている。例えば、取り外し可能な取付部材は、カップ部材に取り付けられた後に、そのような取付状態において、カップ部材に沿って第1の位置から第2の位置に位置変更される場合がある。代替的には、取り外し可能な取付部材が、取り外された後に再び位置決めされる。他の例として、一体的な取付部材(例えば取り外し不可能な取付部材)が、取り外し不可能であるにも関わらず、カップ部材を中心として調整可能に位置決めされる場合がある。幾つかの実施例では、一体的な取付部材が、第1の位置に堅固に固定されている場合があり、この場合には、カップ部材を中心として調整可能に位置決めされ得ない。
カップ部材120に取り付けられていない取付部材の一部分が、患者の骨に接続又は係止するために利用される場合がある。例えば図1に表わすように、フランジ106は、カップ部材120に取り付けられている部分108と、患者の骨に取り付けることによって患者の骨に係止することができる接続部分110とを含んでいる。接続部分110は、フランジ106を患者の骨に係止するための複数のネジ穴111を含んでいる。しかしながら、任意の適切な接続機構であれば利用可能なことに留意すべきである。例えば、フック104は湾曲した端部105を含んでいるので、患者の骨に係留することができる。ネジ穴111としては、従来技術に基づく穴、ロック穴や長穴が挙げられる。従来技術に基づく穴は、ネジが切られている穴、ネジが切られていない穴、又は部分的にネジが切られている穴であれば良く、固定ネジであっても多軸ネジであっても良い。幾つかの実施例では、ネジ穴111は、様々な角度でロック可能とされる様々な偏平穴を含んでいる。他の適切な接続機構としては、骨セメント、形状記憶高分子固定部材、膨張ネジ、取付部材を患者の骨又は軟組織に接続するための任意の適切な機構、これらの任意の組み合わせが挙げられる。
図1〜図4は、高分子材料製、セラミック製、又は金属製のライナ160を受容するように構成されているカップ部材120であって、カップ部材120から径方向に延在している取付部材を有しているカップ部材120の幾つかの実施例を表わす。カップ部材120は、寛骨臼シェル140内に配設されている場合がある。カップ部材120が寛骨臼シェル140内に挿入され、寛骨臼シェル140内に略完全に配設された場合には、例えばブレード102、フック104やフランジ106のような取付部材が、寛骨臼シェル140のリム142の周囲に配置されている。図1に表わすように、幾つかの実施例では、カップ部材の外側部分116には、テーパ状錘体112が寛骨臼シェル140内において相補的なテーパ状錘体と摩擦係合することによって相補的なテーパ状錘体をロックするための、テーパ状錘体112が形成されている。寛骨臼シェル140のテーパ状錘体114は、カップ部材120の特定のタイプのテーパ状錘体112を受容するように構成されている。幾つかの実施例では、多数のカップ部材が利用可能とされ、カップ部材それぞれがテーパ状錐体112に類似した外形を有しているので、カップ部材を相互交換可能に寛骨臼シェル140内に配置することができる。また、寛骨臼シェル140の相補的なテーパ状錐体114が、カップ部材120のテーパ状錐体116に類似したテーパ状錐体を有している、セラミック製ライナ162を受容するために利用されるので、手術中において様々な選択肢を提供することができる。カップ部材120のテーパ状錐体112が寛骨臼シェル140のテーパ状錐体114に適合しない場合であっても、セラミック製ライナ162を利用することによって、カップ部材120を寛骨臼シェル140と共に利用することができる。例えば、セラミック製ライナ162の内面が、カップ部材120のテーパ状錐体112に係合するように形成されているが、セラミック製ライナ162の外面が、寛骨臼シェル140のテーパ状錐体114に係合するための異なる形状を有している場合がある。取付部材は、高剛性若しくは可撓性を有していれば良い1つ以上のフランジ、ブレード、フック、又はプレートとして提供されるが、本明細書で説明する任意の他の適切な形体であれば良い。
特定の実施例では、図3に表わすように、ポリウレタン製又はセラミック製ライナ160は、カップ部材120の内側を裏打ちするために、カップ部材120(“フランジ付カップ”とも呼称される)内に配設されている。カップ部材120は、ライナ160を受容する内面の上側に位置している、一体化されたフランジを備えている場合がある。代替的には、金属製関節の上に金属が設けられていることが望ましい場合には、一体に形成されたフランジを具備する金属製ライナが利用される場合がある。しかしながら、本明細書で説明するモジュール式フランジ(option)も利用可能なことに留意すべきである。カップ部材は、従来技術に基づくポリウレタン製ライナと共に利用するように適合されている内部スカロップを含んでいる場合があり、この場合には、例えば米国仮特許出願第61/352705号明細書に開示されるシステムと共に利用可能とされる。
上述のカップ部材120が利用される場合には、ライナ160は、ライナとカップと間に間隙を形成することによってテーパ状の形態を利用してロックするために、カップを内蔵していない寛骨臼シェル内に配設されたライナより僅かに小さいことが必要とされる。代替的又は付加的には、より小さい大腿骨頭が利用される場合がある。
幾つかの実施例では、ライナがカップ部材内に配置されると共にカップ部材によって完全にサポートされることによって、ライナが懸架されないことが望ましい。幾つかの例では、懸架されたライナはクリープ又は変形する。図3に表わすように、カップ部材120は、調整可能な取付部材を具備するバントではなく、完全なカップとして形成されているので、利用時にライナを完全にサポートすることができる。しかしながら、他の実施例では、カップ部材が必ずしも完全なカップである必要はなく、カップ状の形態である必要もない。例えば図5に表わすように、カップ部材180は、取付部材182を有しているバンド状のカップとして設けられている。ライナ164は、ライナ164の一部分168がバンド状のカップの下方に懸架されるように、バンド状のカップ部材180の内部に配設されている。
幾つかの実施例では、カップ部材によって提供される優位点は、取付部材又は接続部材が寛骨臼シェルではなく別のカップ部材に配設されることである。これにより、モジュール性及び調節性の範囲を一層大きくすることできるので、カップ部材とは関係なく寛骨臼シェルを位置決めすることができる。カップ部材によって提供される他の優位点は、修正手術の際に発見することができる。外科医は、修正手術の際に寛骨臼シェルを取り除く必要が無く、寛骨臼シェルの内部からライナを取り除き、1つ以上の取付部材を具備するカップ部材を寛骨臼シェルに挿入した後に、新しいライナをカップ部材に挿入することができる。
上述の説明は、本発明の原理を説明することを目的とするにすぎず、システム、装置、及び方法は、説明することを目的とする非限定的な上述の実施例以外の実施例によって実施可能とされる。本明細書で説明するシステム、装置、及び方法は、寛骨臼システムで利用することを示す一方、他の手術処置で利用するために医療装置に適用される場合がある。他の外科手術としては、脊椎関節形成、頭蓋−顎顔手術、膝関節形成、肩関節形成、並びに足、足首、手、及び他の四肢の手術が挙げられるが、これらに限定される訳ではない。
当業者であれば、本明細書を検討した後に本発明を変更及び改良することができるだろう。開示された特徴は、本明細書で説明した1つ以上の他の特徴と共に、任意の組み合わせ及び小組み合わせ(多数の従属する組み合わせ及び小組み合わせを含む)において実施可能とされる。任意の構成部品を含む、上記において説明及び図解した様々な特徴は、他のシステムに組み合わせられるか又は組み込まれる場合がある。さらに、特定の特徴が省略されるか、又は実施されない場合がある。
当業者であれば、本明細書で説明した情報の範囲から逸脱することなく、変化、代替、及び変更の例を確認することができる。本明細書で引用されたすべての参照が、参照により全体に組み込まれており、本出願の一部を形成している。
102 ブレード
104 フック
105 湾曲した端部
106 フランジ
108 部分
110 接続部分
111 ネジ穴
112 (カップ部材120の)テーパ状錘体
114 (寛骨臼カップ140)テーパ状錘体
116 (カップ部材120の)外側部分
120 カップ部材
140 寛骨臼カップ(寛骨臼シェル)
142 (寛骨臼シェル140の)リム
162 ライナ
164 ライナ
168 (ライナ164の)一部分
180 カップ部材
182 取付部材(バンド状のカップ)
104 フック
105 湾曲した端部
106 フランジ
108 部分
110 接続部分
111 ネジ穴
112 (カップ部材120の)テーパ状錘体
114 (寛骨臼カップ140)テーパ状錘体
116 (カップ部材120の)外側部分
120 カップ部材
140 寛骨臼カップ(寛骨臼シェル)
142 (寛骨臼シェル140の)リム
162 ライナ
164 ライナ
168 (ライナ164の)一部分
180 カップ部材
182 取付部材(バンド状のカップ)
Claims (20)
- 寛骨臼シェルと、
前記寛骨臼シェル内部に位置決め可能に装着されているカップ部材と、
前記カップ部材に結合されている少なくとも1つの取付部材と、
を備えている寛骨臼インプラントシステムにおいて、
前記少なくとも1つの取付部材が、患者の骨に取り付けることによって前記患者の骨に係止することができる第1の部分を有していることを特徴とする寛骨臼インプラントシステム。 - 前記取付部材が、前記カップ部材を中心として調整可能に位置決めすることができるフランジを備えており、前記患者の骨に係止するための接続部分を具備する第1の端部を有していることを特徴とする請求項1に記載の寛骨臼インプラントシステム。
- 前記カップ部材が、前記寛骨臼シェル内部において接続部位にロックするためのテーパ状の遠位端部を含んでいることを特徴とする請求項1又は2に記載の寛骨臼インプラントシステム。
- 前記寛骨臼シェル内部の前記接続部位が、ライナを受容するように構成されていることを特徴とする請求項3に記載の寛骨臼インプラントシステム。
- 前記カップ部材内部に配置されているライナを備えていることを特徴とする請求項1〜4のいずれか一項に記載の寛骨臼インプラントシステム。
- 前記カップ部材が、前記ライナが前記カップ部材内部において完全にサポートされるように、完全なカップとして構成されていることを特徴とする請求項5に記載の寛骨臼インプラントシステム。
- 前記カップ部材が、バンドとして構成されていることを特徴とする請求項5に記載の寛骨臼インプラントシステム。
- 前記少なくとも1つの取付部材が、フランジ、フック、又はプレートであることを特徴とする請求項1〜7のいずれか一項に記載の寛骨臼インプラントシステム。
- 前記少なくとも1つの取付部材が、前記カップ部材に取り外し可能に接続されていることを特徴とする請求項1〜8のいずれか一項に記載の寛骨臼インプラントシステム。
- 前記少なくとも1つの取付部材が、前記カップ部材に一体に形成されていることを特徴とする請求項1〜8のいずれか一項に記載の寛骨臼インプラントシステム。
- 外科用インプラントを形成するための方法において、
患者の寛骨臼内部にインプラントを挿入するステップと、
挿入されたインプラント内部に少なくとも1つの取付部材を有しているカップ部材を準備するステップと、
前記少なくとも1つの取付部材が患者の骨と位置合わせされるように、前記カップ部材を前記インプラントと位置合わせするステップと、
前記少なくとも1つの取付部材を前記患者の骨に接続するステップと、
を備えていることを特徴とする方法。 - 前記方法が、前記少なくとも1つの取付部材を前記カップ部材を中心として調整可能に位置決めするステップを備えており、
前記少なくとも1つの取付部材が、前記患者の骨に係止するための接続部分を具備する第1の端部を有していることを特徴とする請求項11に記載の方法。 - 前記インプラント内部において前記カップ部材のテーパ状の遠位端部を接続部位にロックするステップを備えていることを特徴とする請求項11又は12に記載の方法。
- ライナを前記接続部位内部に配置するステップを備えていることを特徴とする請求項13に記載の方法。
- ライナを前記カップ部材内部に配置するステップを備えていることを特徴とする請求項11〜14のいずれか一項に記載の方法。
- 前記カップ部材が、前記ライナが前記カップ部材内部において完全にサポートされるように、完全なカップとして形成されていることを特徴とする請求項15に記載の方法。
- 前記カップ部材が、バンドとして形成されていることを特徴とする請求項15に記載の方法。
- 前記少なくとも1つの取付部材が、フランジ、フック、又はプレートであることを特徴とする請求項11〜17のいずれか一項に記載の方法。
- 前記少なくとも1つの取付部材を前記カップ部材に取り外し可能に接続するステップを備えていることを特徴とする請求項11〜18のいずれか一項に記載の方法。
- 前記少なくとも1つの取付部材が、前記カップ部材に一体に形成されていることを特徴とする請求項11〜18のいずれか一項に記載の方法。
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