KR102168573B1 - Prosthetic devices to improve joint mechanics in arthroplasty - Google Patents

Abstract

Kits disclosed herein include a humerus stem having a central longitudinal axis and configured to attach to an ablated bone; A first rough surface element having a first thickness about a central longitudinal axis of the humerus stem; A second rough surface element having a second thickness with respect to the central longitudinal axis of the humerus stem; And at least one proximal segment configured to engage at least one of the first rough surface element and the second rough surface element, wherein the first thickness of the first rough surface element is different from the second thickness of the second rough surface element. In an embodiment, the first thickness of the first rough element is at least 20 mm with respect to the central axis of the humerus stem, and the second thickness of the second rough element is at least 20 mm with respect to the central axis of the humerus stem.

Description

A prosthetic device to improve joint mechanics in arthroplasty {PROSTHETIC DEVICES TO IMPROVE JOINT MECHANICS IN ARTHROPLASTY}

This application is for U.S. Patent Application No. 13/955,083 filed on July 31, 2013, U.S. Provisional Patent Application No. 61/678,353 filed on August 1, 2012, and U.S. Provisional Patent Application on March 14, 2013. Claims the benefit of application 61/784,690 and priority to these applications, and the entirety of these applications is incorporated herein by reference for the purposes of description within the present invention.

The muscle generates a linear force converted to torque proportional to the muscle's vertical distance between the joint center of rotation (CoR) and the muscle's line of action. This vertical distance is referred to as the muscle moment arm; Therefore, a moment arm of 50% or more means less than 50% of the force required by a particular muscle to induce a given torque/motion. The position of the moment arm relative to the center of rotation of the joint determines the kind of movement the muscle will produce. In the shoulder joint, these movements are spreading/collecting (in the scapula/in the coronal plane and/or in the transverse section), inward rotation/outward rotation (rotation of the long axis of the humerus), and flexion/extension (in the sagittal plane). The larger the moment arm of a muscle, the greater the ability of the muscle to generate the torque required for movement and to support external loads. The trade off for the larger moment arm is that the muscle then needs greater excursion (ie, more muscle shortening to generate a given amount of movement). It should be appreciated that the muscle's moment arm is only one component of the muscle's ability to generate torque, while other factors include the muscle's physiological cross-section, structure, neural activity, and its length-tightness relationship.
The technology behind the present invention is disclosed in US 2008/0177393 A1 (2008.07.24).

Disclosed herein is a prosthetic device for improving joint mechanics in arthroplasty.

In accordance with aspects described herein, the device and by modifying the attachment position in a manner that can increase the moment arm, improve muscle tension, and facilitate greater joint compression to give stability. Disclosed is a prosthetic device for increasing the tension of the deltoid muscle and the rotator cuff by facilitating the surrounding muscles of the surrounding area.

According to aspects described herein, a prosthetic device of the present invention comprises a humerus stem having a central longitudinal axis and configured to attach the prosthetic device to the ablated bone; A proximal segment configured to directly or indirectly engage the humeral stem; And a rough surface configured to couple the proximal segment, wherein the rough surface is at least 20 mm thick with respect to the central longitudinal axis of the humerus stem so that the rough surface is sufficiently positioned to implement the encirclement of the deltoid muscle to promote joint compression. It is composed enough to have. In an embodiment, the humerus stem is a modular humerus stem that allows interchangeability of all dimensions between component parts and provides excellent resistance to component separation during use. In embodiments, the prosthetic device further comprises one or more intermediate segments engageably positionable between the proximal segment and the humerus stem. In an embodiment, the prosthetic device of the present invention is used during shoulder arthroplasty.

In accordance with aspects described herein, a kit of the invention comprises a humerus stem having a central longitudinal axis and configured to attach to an ablated bone; A first rough surface element having a first thickness about a central longitudinal axis of the humerus stem; A second rough surface element having a second thickness with respect to the central longitudinal axis of the humerus stem; And at least one proximal segment configured to engage at least one of the first rough surface element and the second rough surface element, wherein the first thickness of the first rough surface element is different from the second thickness of the second rough surface element. In an embodiment, the first thickness of the first rough element is at least 20 mm with respect to the central axis of the humerus stem, and the second thickness of the second rough element is at least 20 mm with respect to the central axis of the humerus stem.

The presently disclosed embodiments will be further described with reference to the accompanying drawings. The drawings shown are not necessarily drawn to scale, and instead the principles of the presently disclosed embodiments are generally emphasized.

Figure 1 is a photograph showing the middle deltoid muscle surrounding the control surface (大粗面) of the humerus head in order to increase stability through compression of the humerus head.
Figure 2 is a computer model of a normal shoulder joint that is opened up to 48 degrees with respect to the fixed scapula, and in the scapula, the middle triangular muscle no longer encloses the control surface of the humerus head and thus does not give a stable compressive force to the joint fossa.
3 is a computer model of a 36 mm Grammont inverted shoulder joint that is open to 8 degrees with respect to the fixed scapula, and in the scapula, the middle deltoid muscle no longer encloses the control surface of the humerus head and thus does not provide a stable compressive force to the joint fossa. Show.
Fig. 4 is a computer model of a 32 mm Encore reverse ^® shoulder joint that is open up to 28 degrees with respect to the fixed scapula, and in the scapula, the middle triangular muscle no longer encloses the control surface of the humerus head and therefore does not give a stable compressive force to the joint fossa. Show.
5 is a computer model of a 38 mm Equinoxe ^® inverse shoulder joint that is opened up to 40 degrees with respect to the fixed scapula, and in the scapula, the middle deltoid muscle no longer encloses the control surface of the humerus head and therefore does not provide a stable compressive force to the joint fossa. Show.
Figure 6 is a side view of an embodiment of a prosthetic device of the present invention that can be used for anatomical or inverted total shoulder arthroplasty, the device comprising a humerus stem, a middle segment, a proximal segment, and a rough surface, in which the humerus stem is Includes an offset taper for connection to the distal retaining ring.
7A-7C illustrate various aspects of an embodiment of a proximal segment of a prosthetic device of the present invention.
8A to 8C are views showing various aspects of an embodiment of a rough surface of a prosthetic device of the present invention.
9A-9C show various embodiments (one diameter, three lengths) of an intermediate segment of the prosthetic device of the present invention.
10 is a view showing an embodiment of the humerus stem of the prosthetic device of the present invention having an offset tapered portion for connection to the distal fixing ring of the present invention.
11A and 11B are views showing an embodiment of a distal fixing ring of a prosthetic device of the present invention having an offset taper for connection to a humerus stem, FIG. 11A is a side view of a distal fixing ring and FIG. 11B is a distal fixing ring It is a bottom view of.
12A and 12B are views showing an assembly of a distal fixing ring having an offset tapered portion and a humerus stem having an offset tapered portion, and FIG. 12A is a side view of the assembly and FIG. 12B is a bottom view of the assembly.
13A to 13C are views showing three embodiments of the rough surface of the present invention, FIG. 13A illustrates the prosthetic device of FIG. 6 with the rough surface of the "standard" dimension, and FIG. 13B is the "first extended" dimension. 6 shows the prosthetic device of FIG. 6 with a rough surface of FIG. 6, and FIG. 13C shows the prosthetic device of FIG. 6 with a rough surface of a “second extension” dimension.
14A and 14B are side views of an embodiment of a prosthetic device of the present invention for use with an inverted shoulder, the device having a humerus stem, an intermediate segment, and a standard sized rough surface 14a and an extended dimensioned rough surface 14b. Includes proximal segment.
15A and 15B are side views of the prosthetic device of FIGS. 14A and 14B when assembled to the humerus bone, in which the distal fixation ring fits around the interosseous bone of the humerus bone; Each of the stems and rings is provided in various dimensions and offset to allow better fit within the humerus of each dimension.
16A and 16B are side views of an embodiment of a prosthetic device of the present invention for use with an anatomical anterior shoulder joint, the device comprising a humerus stem, a medial segment and a standard dimension (Figure 16A) and an extended dimension (Figure 16B). Includes a proximal segment with
17A and 17B are side views of the prosthetic device of FIGS. 16A and 16B when assembled to the humerus bone, in which the distal fixation ring is fitted around the interosseous bone of the humerus bone; Each of the stems and rings is provided in various dimensions and offset to allow better fit within the humerus of each dimension.
18A-18C show the device of FIGS. 13A-13C covered with a humerus bone, in which the anatomical rough position has been restored.
19A-19H illustrate two or more intermediate segment elements without intermediate segment elements (FIG. 19A ), with intermediate segment elements of different lengths (FIGS. 19B-19D) or for use in surgical resection or tumor applications. A view showing the prosthetic device of FIG. 6 having (FIGS. 19E to 19H ).
20 is a view showing an embodiment of the kit of the present invention.
Figure 21 is a view showing an embodiment of the kit of the present invention.

Although the above-identified drawings describe the presently disclosed embodiment, other embodiments may also be considered as pointed out in the detailed description. By way of illustration and without limitation, the present disclosure presents exemplary embodiments. Many other modifications and embodiments can be devised by those skilled in the art that fall within the scope and spirit of the principles of the embodiments disclosed herein. Those skilled in the art will recognize that the prosthetic device of the present invention is applied to joints including, but not limited to, shoulder joints, hip joints and knee joints.

Detailed embodiments of the invention are disclosed in this description; However, it is understood that the disclosed embodiments are merely examples of the present invention that can be implemented in various forms. Also, each example given in connection with the various embodiments of the present invention is intended to be illustrative and non-limiting. In addition, the drawings are not necessarily to scale, and some features may be exaggerated to show the detailed configuration of other special elements (and, of course, certain dimensions, materials, and similar details shown in the drawings are illustrative and non-limiting. Is intended). Therefore, the specific structural and functional details disclosed in this description are not to be construed as limitations, but as merely representative grounds for teaching those skilled in the art to variously use the present invention.

Reduced muscle function in arthroplasty is a complex problem. In the shoulder joint, the prosthetic design element may change the tension of the muscle above or below the normal resting length of the muscle and/or change the muscle tension to make the moment arm a more (or less) important contributing factor for a given type of movement. You can strategically increase (or) decrease the moment arm. In the shoulder joint, the two most common muscle-related challenges with inverse shoulder arthroplasty are instability and loss of external rotation (and excessive inward rotation), while the loss of external rotation is the arm lift (e.g., obvious horn blower). The horn blower's sign] impairs the patient's ability to hold the patient's arm in a neutral position, preventing various activities in daily life. This problem is of particular concern in tumor or orthodontic applications where bone is removed and soft tissue is rebuilt into a different matrix that may or cannot occur at other points in the space.

The deltoid muscle is the largest and most important muscle in the scapula. It is the main mover within the shoulder joint and causes anterior elevation in the shoulder blade. The deltoid muscle consists of three separate heads: the anterior deltoid muscle (anterior acromion and clavicle), the middle deltoid muscle (the lateral margin of the acromion), and the posterior deltoid muscle (scapular spinous process). And the deltoid muscle makes up about 20% of the mass of the shoulder muscle. At low levels of distraction, the enclosing of the middle deltoid muscle around the control surface of the humeral head (Fig. 1) generates a stable compressive force; However, this compressive force is smaller than the force generated by the rotator cuff.

Changing the center of rotation of the joint with arthroplasty (especially with an anatomical concave conduction and an inverse shoulder joint with lower and inward movement of the center of rotation) dramatically changes the relationship of each (shoulder) muscle to normal physiological function. do. In the shoulder joint, moving the center of rotation inward increases the length of the anterior, medial and posterior deltoid distraction moment arms and lengthens the anterior, medial and posterior deltoids, making these deltoids more contributing to distraction. This larger splitting moment arm improves the ability of the deltoid muscle to lift the arm in the scapular and coronal planes and compensates for the impaired function of the supraneus and the upper part of the scapula and the inferior rotator cuff normally involved in the indicated pathology. Moving the center of rotation inward also moves the humerus inward, which increases the relaxation of any remaining rotator cuffs and also results in impact of the humerus with the scapula neck (i.e., scapular incision) at low elevations.

Restoring the lateral position of the humerus roughness is important in tightening the remaining rotator cuff in a more natural physiological way and offers the possibility to better restore rotational strength. While overtensioning this muscle may provide the possibility of improved muscle tone/tension, it may make it more difficult to correct the subsequent tendon transfer (in the case of the subscapularis).

It has been proposed to unilateralize the joint rotation center for the Grammont design as a way to improve active internal and external rotation, strength and stability. Unilateralizing the center of rotation of the joint unilateralizes the humerus, tightens the remaining rotator cuffs, and minimizes bumping of the humerus elements along the lower scapula. Unilateralizing the center of rotation of the joint also increases the torque on the joint and the fixation surface and decreases the length of the deltoid distraction moment arm. As the center of rotation is unilateralized, the deltoid splitting moment arm is reduced, so the deltoid becomes less efficient as a spreader and requires more force to raise the arm in the scapular and coronal planes. Elevated loads and torques can negatively affect patient rehabilitation, muscle fatigue, fatigue fractures, and prosthetic fixation. It should be recognized that the humerus can be unilateralized without unilateralizing the center of rotation of the joint. Doing so has the advantage of restoring the anatomical rotator cuff length/tension, while maintaining the Grammont's split moment arm length and minimizing torque on the joint and bone interface. Roche et al. first demonstrated that the humerus can be unilateralized to minimize bumping of the humerus liner into the lower scapula while trying to position the rough surface in a more anatomical position. This is achieved by reducing the humeral neck angle from the Grammont humerus neck angle of 155°, by proportionally increasing the Grammont joint and hemisphere diameter and thickness, by reducing the humeral liner compression and/or by reducing the humeral liner/humeral stem. This can be achieved by increasing the inward offset. Lemieux et al. reported that in total shoulder arthroplasty, increasing the inward offset of the humerus stem increased the middle deltoid moment arm, and also increased the angle of the middle deltoid muscle around the control surface, which compresses the humerus head into the mandible. It was proved that it helps to stabilize the joint. As described in Table 1, by different prosthetic designs (Grammont inverse shoulder, Encore inverse shoulder versus Equinoxe inverse shoulder), in different directions (e.g., changing the humerus posterior flexion and/or changing the inclination of the implant). By and/or by implanting the device within the scapula having various scapular shapes or wear patterns (eg, medial joint and wear) the deltoid muscle encirclement may be varied. These results were calculated from a computer model that simulates the muscle line of action within the shoulder joint during various arm positions. FIG. 2 is a computer model showing an open arm, in which the middle deltoid muscle (with respect to the fixed scapula) stops surrounding the humeral head control surface in the normal shoulder joint at 48° open in the scapula surface. Figures 3 to 5 show a variable reverse shoulder joint prosthesis design (36 mm Grammont inverse scapula open up to 8° to the fixed scapula (Fig. 3), 32 mm Encore reverse ^® scapula open up to 28° to the fixed scapula (Fig. 3). ), and a computer model showing the same deltoid muscle enclosing phenomenon with a 38 mm Equinoxe scapula (FIG. 5) open up to 40° with respect to the fixed scapula. In Figs. 3 to 5, the middle deltoid muscle no longer encloses the control surface of the humerus head and thus does not give a stable compressive force to the joint follicle any more.

Surrounding the middle triangular muscle around the control surface (computer modeling study) Spread where the deltoid muscle does not cover the rough surface Normal shoulder joint 48° 36 Grammont 20° 8° 32 Encore reverse ^® 28° 38 Equinoxe ^® 40° 36 Grammont 0° 16° 36 Grammont 40° 7° 36 Grammont 15° slope 7° 32 Encore reverse ^® 15° inclination 21° 36 Grammont, 10 mm inner wear -1° 32 Encore reverse ^® 10 mm inner wear 12° 38 Equinoxe ^® 10 mm inner wear 18°

6 is a side view of an embodiment of a prosthetic device 100 of the present invention that may be used for anatomical or inverted total shoulder surgery and may be used for hip arthroplasty. The device 100 includes a humeral stem 110, a medial segment 120, a proximal segment 130 and a rough surface 140. In this embodiment, the humerus stem 110 includes an offset tapered portion 114 for connection to the distal fixation ring 116. The proximal segment 130 unilateralizes the position at which the soft tissue of the shoulder joint is inserted into the device 100 (especially-the rotator cuff is attached with a suture hole), and also makes it possible to impart a greater compression into the joint and inward. The position where the deltoid muscle is wound around the device 100 is unilateralized. In an embodiment, the device 100 does not include an intermediate segment 120. In an embodiment, device 100 includes two or more intermediate segments 120. In embodiments, device 100 may include multiple suture bores 150 for soft tissue fixation.

7A-7C show various perspectives of the proximal segment 130. In an embodiment, the proximal segment 130 is made of Ti-6A1-4V. In an embodiment, the proximal segment 130 is solvent heat treated and deteriorated. In an embodiment, the proximal segment 130 is +0 mm in length. In an embodiment, the proximal segment 130 is +12.5 mm in length. In an embodiment, the proximal segment 130 is for attachment of a reverse shoulder prosthesis to a humerus tray (see, e.g., FIGS. 14A and 14B) or to a replica plate of a major shoulder prosthesis (e.g., FIG. 16A. And a spherical bore 132 for (see Fig. 16B). In an embodiment, the proximal segment 130 includes a tapered portion 134 for attachment to various sized modular roughening elements of the present invention. In an embodiment, the proximal segment 130 locks the connection 122 of the intermediate segment 120 of the present invention or locks the connection 112 of the humerus stem 110 of the present invention. It includes a connecting portion 136 configured to be.

8A to 8C show various perspectives of the rough surface 140 of the present invention. In an embodiment, the rough surface 140 is made of Ti-6A1-4V. In an embodiment, the rough surface 140 is made of Co-Cr. In an embodiment, the outer surface 140s of the rough surface 140 is smooth to prevent wear or damage to the deltoid muscle while the (electrolytically polished) deltoid muscle slides on the outer surface 140s of the rough surface 140. The outer surface 140s of the rough surface includes a lower portion 140l that is a substantially flat surface and an upper portion 140u having a convex curvature configured to allow the deltoid muscle to wrap around the contrast surface of the humerus head. In an embodiment, the rough surface 140 includes a mating connection 144 for attachment to the proximal segment 130 of the present invention.

9A-9C show various embodiments (one diameter, three lengths) of the middle segment 120 of the device 100 of the present invention. In an embodiment, each intermediate segment 120 has the same diameter, for example 24 mm, and has a suture cage 126. In an embodiment, the intermediate segment 120 has a length of 25 mm (FIG. 9A). In an embodiment, the intermediate segment 120 has a length of 50 mm (FIG. 9B). In an embodiment, the intermediate segment 120 has a length of 75 mm (FIG. 9C). The intermediate segment 120 may comprise an axial bore through the intermediate segment. In an embodiment, the axial bore of the intermediate segment 120 has a first tapered portion 122 and a second tapered portion 124. Here, the first tapered portion 122 is positioned adjacent to the proximal end of the intermediate segment 120 and is standardly configured to lockably engage the tapered portion 136 of the proximal segment 130, and the second The tapered portion 124 is positioned adjacent the distal end of the intermediate segment 120 and is standardly configured to lockably engage the tapered portion 112 of the humerus stem 110. Each of the intermediate segments 120 may be constructed from a biocompatible high strength aluminum alloy, but may also be composed of other biocompatible materials such as cobalt chromium alloy, stainless steel and composite materials. In an embodiment, the middle segment 120 is made from Ti-6A1-4V. Spiral screws can optionally be used to improve the locking engagement of the segments. In an embodiment, the intermediate segment 120 is solvent treated and deteriorated. The intermediate segment 120 may be coated with a soft tissue fixation material such as plasma coating.

10 shows an embodiment of a humeral stem 110 of the device 100 of the present invention having an offset taper 114 for connection to the distal retaining ring 116 of the present invention. In an embodiment, the tapered portion 114 is offset about 1 mm from the central longitudinal axis LA of the humerus stem 110. The humerus stem 110 may be offset to facilitate a better fit between the external humerus bone and the inner bone marrow diameter. In an embodiment, the humerus stem 10 may be used in three different lengths and six different diameters, so that 11 types of stems 110: 6x80/120, 7x80/120, 8x80/120/200, 9x80/120, 11x120 , 13x120) is produced.

11A and 11B show the distal retaining ring 116 of the device 110 with an offset taper (offset from the central longitudinal axis of the ring 116) for connection to the humerus stem. In an embodiment, the central longitudinal axis of ring 116 is offset about 1 mm. The distal fixation ring 116 (as can be seen in FIGS. 15A, 15B, 17A, 17B and 19B-19I) has a subsurface 118 adjacent to the cancellous bone forming the surface of the excised bone. . The size of the distal fixation ring 116 is selected so that the longitudinal section of the ring 116 is close to the size of the ablated longitudinal section of the resected bone. In embodiments, the ring 116 may be coated with a soft tissue fixation material such as a plasma coating and may be coated with a bone growth promoting material such as hydroxyapatite. Here, the bone growth promoting material may promote the growth of the cancellous bone over the surface of the ring 116 and may help to more securely lock the device 100 into the residual ablated bone.

12A and 12B show the humerus stem of FIG. 10 and the distal fixation ring 116 of FIG. 11A, in order to separate the offset of the external humerus interosseous diameter from any offset within the internal marrow intramedullary tube diameter. Each of the retaining rings has an offset.

13A to 13C show three embodiments of the rough surface of the present invention. Figure 13a shows a first rough surface (140a) of the present invention having a first thickness of 20 mm measured from the central longitudinal axis (LA) of the humerus stem (110) to the outer surface (140s), which is It is considered a rough surface 140a of "standard" dimension (+0 mm). 13B shows a second rough surface 140b of the present invention having a second thickness of 25 mm measured from the central longitudinal axis LA of the humerus stem 110 to the outer surface 140s, which is It is considered a rough surface 140b of "first extended" dimension (+5 mm). 13C shows a third rough surface 140c of the present invention having a third thickness of 30 mm measured from the central longitudinal axis LA of the humerus stem 110 to the outer surface 140s, which is It is considered a rough surface 140c of "second extension" dimension (+10 mm). Other roughenings allow intraoperative deformation of the deltoid wrap. In an embodiment, each rough surface includes a mating connection 144 for attachment to the proximal segment 130 of the present invention. In an embodiment, the rough surface 140a is sufficient to have a thickness of 20 mm with respect to the central longitudinal axis LA of the humerus stem 110 so that the rough surface is sufficiently positioned to implement the surrounding of the deltoid muscle to promote joint compression. Designed to do. The lateral margin of the roughened portion is defined as a distance of 20 mm, but can be increased to selectively facilitate more deltoid encirclement and greater joint compression. For example, in order to selectively facilitate more deltoid encirclement and greater joint compression, the rough elements 140b and 140c are 25 mm (+5 mm) relative to the central longitudinal axis LA of the humerus stem 110. ) And 30 mm (+10 mm), respectively. The rough surfaces 140a, 140b and 140c include an outer surface 140s having an upper portion 140u having a convex curvature. In an embodiment, the upper portion 140u having the convex curvature of each of the rough surfaces 140a, 140b and 140c has substantially the same radius of curvature. In an embodiment, the upper portion 140u having the convex curvature of the rough surface 140a has a radius of curvature of 16.5 mm. In an embodiment, the upper portion 140u having the convex curvature of the rough surface 140b has a radius of curvature of 16.0 mm. In an embodiment, the upper portion 140u having the convex curvature of the rough surface 140c has a radius of curvature of 15.0 mm.

14A and 14B are side views of a prosthetic device used with elements of the reverse shoulder joint. In FIG. 14A the rough surface 140a of the "standard" dimension is shown, whereas in FIG. 14B the rough surface 140b of the "first extended" dimension is shown. In an embodiment, the rough surfaces 140a and 140b are modularly connected to the proximal segment 130. In order to selectively tighten/reattach the rotator cuff, the rough surface may include an embedded suture hole 148 at various locations. In an embodiment, the humerus stem 110 is a modular humerus stem. As shown in FIGS. 14A and 14B, the device 100 includes a humeral liner 160. The rough surface 140 of the present invention may be integral to the proximal segment 130 or may be modularly coupled with the proximal segment 130.

15A and 15B are side views of the prosthetic device of FIGS. 14A and 14B when assembled to the humerus bone. In this figure, the distal fixation ring 116 fits around the interosseous periosteum of the humerus bone 180: the stem 110 and the ring 116 are each provided in various dimensions and a better fit within the humerus of each dimension. Offset to allow fit.

16A and 16B are side views of an anatomical frontal shoulder joint element and a prosthetic device 100 used. In FIG. 16A a rough surface 140a of the "standard" dimension is shown, while a rough surface 140b of the "first extended" dimension is shown in FIG. 16B. In an embodiment, the rough surfaces 140a and 140b are modularly connected to the proximal segment 130. In order to selectively tighten/reattach the rotator cuff, the rough surface may include an embedded suture hole 148 at various locations. In an embodiment, the humerus stem 110 is a modular humerus stem. As shown in FIGS. 16A and 16B, the apparatus 100 includes a replicator plate (not shown) and a humeral head 170. The rough surface 140 of the present invention may be integral to the proximal segment 130 or may be modularly coupled with the proximal segment 130.

17A and 17B are side views of the prosthetic device of FIGS. 16A and 16B when assembled to the humerus bone. In this figure, the distal fixation ring 116 fits around the interosseous periosteum of the humerus bone 180: the stem 110 and the ring 116 are each provided in various dimensions and a better fit within the humerus of each dimension. Offset to allow fit.

18A-18C show the device of FIGS. 13A-13C with the humerus bone covered. In Fig. 18A, the anatomical rough surface position is restored. In Figs. 18B and 18C, the rough surface position is unilateralized to enable larger deltoid wrap around each rough surface and more joint compression by the deltoid muscle. The ability to selectively select rough surfaces of varying thickness allows surgeons to tighten joints in major or inverse shoulder arthroplasty by varying the amount of deltoid muscles that wrap around the control surface, which increases the compression of the joint and the proximal humerus into the joint. Allow. The improved deltoid closure also improves cosmetic concerns about inverse shoulder arthroplasty.

19A-19H illustrate two or more intermediate segment elements without intermediate segment elements (FIG. 19A ), with intermediate segment elements of different lengths (FIGS. 19B-19D) or for use in surgical resection or tumor applications. The prosthetic device of FIG. 6 with having (FIGS. 19E to 19H) is shown. The device 100 may include a number of intermediate segments to accommodate a changing humeral fracture (as occurs in tumor applications where the humerus bone is excised and the soft tissue needs to be reattached). For surgical neck resection, the device 100 may include a two-piece design comprising a proximal segment and a rough surface (FIG. 19A), where the proximal segment engages the humerus stem. For tumor applications in which the humerus bone is excised between the surgical neck and the deltoid rough surface, the device 100 may include at least a three-piece design comprising a proximal segment, a rough surface, and one or more intermediate segments (FIGS. 19B-19D ), Here, the final middle segment is joined to the humerus stem. For tumor applications in which the humerus bone is excised under the deltoid rough surface, the device 100 may include at least a four-piece design comprising a proximal segment, a rough surface, and two or more intermediate segments (FIGS. 19E-19H), where The final middle segment is joined with the humerus stem.

20 shows an embodiment of the kit 200 of the present invention. The kit 200 has a central longitudinal axis and includes a humerus stem 110 configured to attach to the resected bone; A first rough surface element (140a) having a first thickness with respect to the central longitudinal axis of the humerus stem (110); A second rough surface element (140b or 140c) having a second thickness relative to the central longitudinal axis of the humerus stem (110); And a proximal segment 130a configured to engage both the first rough surface element 140a and the second rough surface element 140b or 140c, wherein the first thickness of the first rough surface element 140a is the second rough surface element ( 140b or 140c) is different from the second thickness. The elements of the kit 200 are placed within the case 210, which typically allows the kit elements to be easily recognizable and used during a surgical procedure. In an embodiment, as detailed with respect to FIGS. 13A to 13C, the first thickness of the first rough element is at least 20 mm with respect to the central axis of the humerus stem, and the second thickness of the second rough element is the humerus. At least 20 mm relative to the central axis of the stem. In an embodiment, the kit 200 further includes a distal retaining ring 116, a second proximal segment 130b, and one or more intermediate segments 120 that may be disposed within the case 210 or individual case 220. .

21 shows an embodiment of the kit 300 of the present invention. Kit 300 has a central longitudinal axis, the humerus stem 110 configured to attach to the resected bone; An integral first rough surface element [140a] having a first thickness with respect to the central longitudinal axis of the humerus stem 110; A first proximal segment 130a having a proximal segment 130a and a roughening element 140a being a single member; And an integral second rough surface element [140b or 140c] having a second thickness with respect to the central longitudinal axis of the humerus stem 110; A second proximal segment 130b having a proximal segment 130b and a second roughening element 140b or 140c being a single member, wherein the first thickness of the first roughening element 140a is the second roughening element It is different from the second thickness of (140b or 140c). The elements of the kit 300 are placed within the case 310, which typically allows the kit elements to be easily recognizable and used during a surgical procedure. In an embodiment, as detailed with respect to FIGS. 13A to 13C, the first thickness of the first rough element is at least 20 mm with respect to the central axis of the humerus stem, and the second thickness of the second rough element is the humerus. At least 20 mm relative to the central axis of the stem. In an embodiment, the kit 300 further includes a distal retaining ring 116 and one or more intermediate segments 120 that may be disposed within the case 310 or individual case 320.

All patents, patent applications, and published references cited herein are incorporated by reference in their entirety. It will be appreciated that a number of the above-disclosed and other features and functions as well as their alternatives may preferably be combined in many other systems or applications. Various currently unexpected or unexpected alternatives, changes, modifications or improvements within this specification may be made later by those skilled in the art, and these are also intended to be covered by the following claims.

Claims (22)

A humerus stem having a central longitudinal axis and configured to attach to the resected bone;
As a plurality of proximal elements,
Each proximal element in the plurality of proximal elements has a different volume than the other individual proximal elements in the plurality of proximal elements,
Each proximal element in the plurality of proximal elements has a proximal end, a distal end, an inner portion and an outer portion,
The inner portion of the individual proximal elements in the plurality of proximal elements is connected to the articulating element of the humeral side of the shoulder prosthesis when the humerus side of the shoulder prosthesis is fully assembled, the articulating element having an articulating surface,
The volume of each proximal element is configured to wrap the patient's deltoid muscle to the desired extent by unilateralization around the lateral part of the proximal element, and the patient's deltoid muscle is shoulder joint to achieve the desired wrapping angle. Wrap around the prosthesis,
The outer surface of the outer portion of the individual proximal element is an abrasive surface configured to prevent wear or damage to the deltoid muscle when sliding on the outer surface of the outer portion of the proximal element,
The outer surface of the lateral portion of the individual prosthesis is that of the articulating element of the humerus side of the shoulder prosthesis, when the humerus side of the shoulder prosthesis is fully assembled, when the proximal element is connected to the articulating element of the humerus side of the shoulder prosthesis. It has a curvature that is discontinuous from the curvature of the joint surface,
The outer surface of the lateral portion of the individual proximal element further comprises a lower portion extending distally below the proximal end of the humerus stem,
A plurality of proximal elements, wherein each proximal element is configured to be lockably attached to the proximal end of the humerus stem element.
Kit comprising a. The kit of claim 1, wherein the proximal element comprises a suture bore for fixing soft tissue. The kit of claim 1, wherein the humerus stem comprises an offset tapered portion. The kit of claim 1, wherein the proximal element is modular. The method of claim 1, wherein the proximal element is configured to allow the surgeon to be configured to selectively adjust the muscle moment arm, muscle tone and muscle stability by unilateralizing the position at which the deltoid muscle is wound around the shoulder prosthesis. In kit. As a prosthetic device,
The prosthetic device is modular,
A humerus stem element having a proximal end, a central longitudinal axis and a distal end, the humerus stem element configured to attach a prosthetic device to an ablated bone; And
Integral proximal element with proximal end, distal end, medial and lateral parts
Including,
The medial portion of the proximal element is connected to the articulating element of the humerus side of the shoulder prosthesis when the humerus side of the shoulder joint prosthesis is fully assembled, and the articulating element has an articulating surface,
The volume of the proximal element is configured to wrap the patient's deltoid muscle to a desired extent by unilateralization around the lateral portion of the proximal element, and the patient's deltoid muscle is wrapped around the prosthetic device to achieve the desired wrapping angle,
The outer surface of the outer portion of the proximal element is an abrasive surface configured to prevent wear or damage to the deltoid muscle when sliding on the outer surface of the outer portion of the proximal element,
The outer surface of the outer part of the proximal element is the joint of the articulating element on the side of the humerus of the shoulder prosthesis, when the humerus side of the shoulder prosthesis is fully assembled, when the proximal element is connected to the articulating element on the side of the humerus of the shoulder prosthesis. It has a curvature that is discontinuous from the curvature of the surface,
The outer surface of the lateral portion of the proximal element further comprises a lower portion extending distally below the proximal end of the humerus stem,
Wherein the proximal element is lockably attached to the proximal end of the humeral stem element. 7. The prosthetic device of claim 6, wherein the proximal element includes a suture bore for fixing soft tissue. delete delete delete delete delete delete delete delete delete delete delete delete delete delete delete

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