LU87732A1 - HIP PROSTHESIS - Google Patents

Description

DESCRIPTIVE MEMORY FILED IN SUPPORT OF A PATENT INVENTION APPLICATION IN THE GRAND DUCHY OF LUXEMBOURG by: BCM Holding S.A. 41, boulevard Prince Henri L-1724 Luxembourg for: Hip prosthesis

The present invention relates to a total hip prosthesis comprising, in a conventional manner, on the one hand an acetabular implant capable of being screwed onto the bony support of the hip and a femoral rod implanted at the top of the femur and ending in a ball joint. - even introduced into the complementary and receptor housing provided on the acetabular implant.

Prostheses of this type therefore comprise two elements intended to ensure the rotoidal articulation of the femur on the hip and consequently consist of the fixed implant (cotyloid) defining a receptor capacity or housing, and on the other hand the femoral implant. ending with the ball joint intended to be put in place and retained in its housing.

Prostheses of this type have long been known which, to give complete satisfaction, must meet numerous objectives, which are far from being combined cumulatively in the various forms of embodiments currently known.

Firstly, the fixed acetabular implant must have a stable anchoring on its support, consequently avoiding any relative movement of the implant relative to its receiving bone seat.

And this stability means that not only is there no relative play between the implant and the bone seat, but also that the implant, once in place, does not undergo continuous parasitic displacement relative to its support.

This is the case in particular of certain known acetabular implants which are put in place by a screwing operation, the generally hemispherical implant having on its periphery helical threads therefore allowing a screwing effect in the bone mass; it happens that the phenomenon of rotation and self-tapping due to the presence of helical threads on the implant, causes, as a result of movements related to the subject's walking, a phenomenon of continuous tapping consequently causing the advancement of the acetabular implant in its support until it crosses the pelvic bone.

It is therefore necessary that the acetabular implant ensures by its morphology a balance and a distribution of the forces and back pressures exerted between the femur and the hip and such that the forces and pressures are balanced without inducing parasitic components likely to by repeating local and punctual constraints, the implant moves relative to its receiving cradle.

It also appeared desirable to provide for a possibility of removal of the prosthesis and in particular therefore of extraction of the acetabular fixed implant after a period of time of presence which may have given rise to harmful side effects necessitating the replacement of the implant. ; and if the implant is embedded and embedded in the bone mass, its extraction can present difficulties and cause damage to the support; it is therefore desirable that the configuration of the implant makes it possible to carry out its extraction by retroactive self-tapping, or retro-self-tapping, consequently avoiding an attack on the bone tissue during a possible extraction.

It is also necessary that the prosthesis can be placed in a perfectly adjusted manner on its support seat and that the practitioner can consequently constantly monitor and visually identify the instantaneous positioning of the implant being screwed relative to the receiving wall. .

Finally, it is still necessary to ensure cohabitation and symbiosis of the implant in its receiving niche, to avoid weakening of the bone fractions, in particular at the level between two fins or nets; and more particularly, the configuration of the implant should avoid any compaction and, all the more so, any crushing of the bone tissue in the lamellar form inserted between two threads.

The devices currently known only partially and imperfectly fulfill these objectives and above all they prove to be unsuitable for ensuring all of them cumulatively.

The femoral prosthesis according to the present invention makes it possible to achieve these various objects and allows the prosthesis to be put in place by a simple operative maneuver facing the different morphological types of the hip joint while avoiding the use of auxiliary material. complex.

In particular the fixed acetabular implant, while using a screwing system the principle of which is known per se, allows a stable anchoring respecting the anatomical data and avoiding excessive bone resection.

Another object of the invention is to provide an implant allowing, by a self-tapping effect, the removal of the prosthesis without deterioration of the carrier tissue during this operation.

The prosthesis according to the invention moreover ensures a distribution and a balance between the opposing forces exerted between the bone mass of the pelvis and the lower limb. To this end, the invention relates to a total hip prosthesis of the type comprising an acetabular implant consisting of a hemispherical shell comprising on its outer wall, in the part close to the equator, a helical and spiral thread, leaving free to the top of the hemisphere an upper cap, and the prosthesis is characterized in that the threading is provided with properties on the one hand of self-tapping and on the other hand of self-tapping, thus allowing an attack of the medium implantation for the insertion and passage of the nets on the one hand in the direction of implantation and also in the direction of withdrawal.

More particularly, the threads are interrupted at regular intervals by grooves arranged along a radial axis and defining segments of threads or fins distributed in a spiral helix on the wall of the hemispherical shell, at least in the area close to the equator.

Preferably and according to a more particular embodiment the edges of each groove, defined by the transverse and terminal edges of the thread segments superimposed in a helix, are parallel to the median axis of the groove, itself arranged radially, so that the two edges of two neighboring thread segments, delimiting between them a groove separating these two successive segments along the helix, are parallel to each other and not convergent, and thus each transverse and terminal edge of a thread segment constitutes a cutting edge capable of approaching the tapped material at an angle less than a right and such that the tapped material receives in the first place the attack from the outer tip of said transverse and terminal edge of the thread segment penetrating said tapped material.

According to yet another important characteristic of the invention, each groove has a constant width, between 2 and 5 millimeters, and its bottom follows the shape of a segment of sphere extending the upper spherical cap.

According to another characteristic, the segments of threads or fins together defining the self-tapping thread are distributed in a spiral helix with a pitch of between 3 and 4 millimeters and preferably around 3.5 millimeters.

According to yet another characteristic of the invention, the upper face on the one hand and the lower face on the other hand of each thread segment are convergent towards the outside, on either side of a median plane parallel to the equatorial plane of the hemispherical shell, and the angle formed by a radial section of the upper face, with respect to said plane parallel to the equator, is greater than the angle formed by a radial section of the underside of the segment of the thread relative to the same median plane parallel to the equator.

In addition and according to a more particular characteristic, the upper face of each segment of the thread is such that any radial cut of this upper face conforms at all points an angle between 8 and 12 ° relative to the median plane of the thread parallel to the equatorial plane of the hemispherical shell, and this angle is preferably close to 10 °.

And according to another more specific characteristic, the underside of each segment of the thread is such that a radial section of this face conforms at all points to an angle between 2 and 4 ° with a median plane of the thread parallel to the equatorial plane of the hemispherical shell, this angle preferably being close to 3 °.

According to another aspect of the invention, each end point of each thread segment corresponding to the angle formed between the outer curviform edge and the straight transverse edge of this segment, has an angular value less than 90 ° and between 80 and 85 °.

And more specifically, said end point of each cylinder segment, on one end of said segment and on the other, is provided at a sharp angle of thickness coming to die in a sharp point, thus constituting a punch for attacking the tapped material, this point preceding the attack by the wire constituted by the end and transverse edge of each segment of thread arranged along a straight line forming a non-zero angle with a radial direction, while the thread constituted by the curviform edge of the thread segment or fin is slightly blunt at a bevel.

According to yet another characteristic of the invention, the bottom of the thread, defined by the wall between the opposite faces of two superimposed threads, is contained in a spherical crown corresponding to the external wall of the hemispherical shell.

According to another development of the invention, said shell with a hemispherical outer face has an internal capacity, the part close to the equatorial plane defining a cylinder section with circular base extended towards the top by a concavity formed by a concentric hollow spherical cap with the hemispherical outer wall of the shell.

And said hemispherical shell has on the internal wall of its internal capacity a plurality of notches in the general shape of "T", each notch opening at its base, corresponding to the foot of the soul of "T", on the defined circular crown by the equatorial base of the hemispherical shell, and each notch opens at its apex on two symmetrical housings, each in the shape of Λ and with tight edges, the two housings being situated on the same parallel with respect to the equatorial plane, the assembly constituting a receiver system of a lug or stud engaged in said notch for a fixing of the "bayonet" type, the lug or stud thus being able to be immobilized by rotation in one or the other of said housings .

The hemispherical shell is capable of receiving in its internal capacity a core of generally hemispherical shape known per se and whose outer wall is provided complementary to the inner wall of said capacity, the outer wall of the core comprising for this purpose in its part close to the equatorial plane a zone in the shape of a cylinder section extended upwards by a spherical cap, and the core internally comprising a housing itself of hemispherical shape for the reception of the patella coming from the femoral implant.

And more specifically, the core comprises in its part in the form of a cylinder section a plurality of lugs or studs arranged radially, provided in number and positioning allowing them to come opposite the notches formed on the inner wall of the receiving capacity of said core, the studs or lugs being provided to be immobilized after engagement and linear displacement, followed by angular displacement, in one of the two housings of each of the notches.

According to yet another characteristic of the invention, the top of the hemispherical shell, conforming to the upper cap surmounting the part of the wall of the shell furnished with external threads, comprises at least one and preferably a plurality of lights allowing visual perception of the medium in which the shell is implanted by self-tapping, thereby authorizing the control of the positioning of the shell with respect to its receiving medium and the determination of the optimum end of tapping.

And the internal housing provided in said core, capable of receiving the terminal spherical ball joint of the femoral implant, is provided with an internal diameter corresponding to the diameter of said spherical ball joint, the receiving housing extending slightly beyond the equatorial plane to tighten the edges of the introductory opening of the patella and ensure self-retention of the latter.

And according to a more particular embodiment, the diameter of the lower opening of the receptacle for the ball joint and defining the passage of the latter is less than the diameter of the spherical ball joint, by a percentage of between 1/50 and 1 / 60.

In addition, the edges of this penetration opening of the ball joint in its receiving housing are provided slightly beveled to facilitate the engagement of penetration of said ball joint.

Another characteristic of the invention relates to the connection of the spherical ball joint relative to the rod implanted in the femur and this spherical ball joint is connected to the rod penetrating into the femur by a neck followed by a rod whose cross section from the base is in the form of a "D" horizontally elongated, this section defining a ratio between the anteroposterior and transverse axes respectively between 0.50 and 0.77 and preferably close to 0.62. Other characteristics and advantages of the invention will emerge from the description which follows and which is given in relation to a particular embodiment presented by way of nonlimiting example and with reference to the appended drawings.

Figure 1 shows a perspective view of the outer (convex) part of the hemispherical shell or support constituting the acetabular implant.

Figure 2 shows a side elevational view of the same support shell.

Figure 3 shows a detail view showing the configuration of the grooves separating two rows of fins or segments of threads superimposed on the outer wall of the previous shell.

Figure 4 shows a horizontal sectional view showing in the upper position the hemispherical shell constituting the acetabular implant and in the lower position the core intended to be engaged inside this shell to contain the patella.

Figure 5 shows a vertical sectional view of a detail revealing the configuration of the fins or segments of threads mounted on the periphery of the cup defining the acetabular implant.

Figure 6 shows a detail view to present the configuration of the departure of a fin or segment of net (or its end) at a groove.

Figure 7 shows a plan view from below of the naked shell and without the core.

Figure 8 shows the shell operating tool for its implantation on the one hand and for its extraction on the other hand.

Figure 9 shows a front elevational view (vis-à-vis the receiving subject) of the rod constituting the femoral implant.

Figure 10 shows a view of the same rod with the head.

Figure 11 shows a section of the rod at the base along the line KI - XI of Figure 9.

We see according to all of the Figures that the prosthesis consists, in a conventional manner, of an acetabular implant intended to be placed on the osseous pelvis of the hip and consisting of a support shell or cup shown in particular in perspective by its outer convex face in Figure 1 and shown in section in Figure 4. Inside this shell 1 is positioned an intermediate core 2 shown particularly in Figure 4 and which contains a concave spheroidal housing receiving the ball 3 extending at its top the rod 4 shown in particular in FIG. 9 and in FIG. 10.

We will successively describe the fixed implant or cotyloid implant and then the femoral stem. The acetabular implant according to Figures 1, 2, 3 and 4 meets various requirements.

A first object of this implant is to offer a wider field of indications for the use of a screwing system as an anchoring solution.

According to a second objective, the acetabular implant makes this solution satisfactory while respecting the anatomy data while limiting bone resection.

Finally, it allows a simple operative maneuver adapted to the different morphological types of the hip joint while avoiding the use of complex auxiliary equipment during installation. The fixed implant consists of a metal shell 1 in the shape of a substantially hemispherical cup, the convex external wall of which ensures anchoring in the bone support by means of a thread, on the one hand self-tapping during positioning but also self -retro-tapping during any subsequent withdrawal.

In order to ensure implantation and initial anchoring, the hemispherical shell constituting the fixed implant includes a threading system which will be described below.

According to Figures 1, 2 and 5, we see that the thread consists of a succession of threads arranged in a spiral helix from the top 5 to the end thread €.

And these successive threads are distributed according to superimposed thread segments 7, 7 ', 8, 8' which define between them grooves 9, 9 'arranged radially around the periphery of the hemispherical convex wall of the shell.

According to a first important characteristic of the invention and which is illustrated in Figure 3, the transverse and terminal edges of each thread segment 8 and 7 are arranged in parallel with each other and define between these two edges 10 and 10 'respectively groove 9 itself positioned along an axis 11 radial with respect to the hemispherical volume of the shell.

It can be seen according to FIG. 3 that the two transverse edges of the thread segments 7 and 8r, respectively 10 and 10 ′, are mutually parallel and parallel to the radial median axis 11 of the groove 9.

We also see that under these conditions each of the edges 10 and 10 'forms with the radius defined by the line 12, 12' joining the point 13, 13 'of the segment of the thread 7 or 8 at the polar top of the sphere, an angle OC different from the law.

Under these conditions it is understood that when the shell is engaged in rotation along the arrow F1 (Figure 3) the tip 13 initially attacks the bone material subjected to the tapping before the entire edge 10 thus allowing a regular attack and perfect penetration of the net in the carrier material.

Figure 6 also shows in more detail the configuration in space of the thread 7 at its self-tapping leading edge 10.

We see that if the thread has a certain thickness, at the leading edge 10 it ends in a cutting wire thereby allowing the effect of cutting and penetration into the mas.se of the support, while the angle 13 represents the initial point or punch of attack of the thread being penetrated by self-tapping î on its external curviform edge 14 the thread comprises, beyond the point 13, a bevel 15 which is in particular shown in section at the Figure 5 and which dulls the edge of this outer edge.

And according to another characteristic and another advantage of the invention, the edge 10 'situated opposite the edge 10, and ending the neighboring thread or segment of thread 8, is shaped symmetrically with respect to the edge 10, so that the rotation of the implant in an opposite direction to the previous one, that is to say according to arrow F2, opposite to arrow Fl, and corresponding to the rotation of the assembly during removal, causes the same attack phenomenon of the material by the tip 13 '.

This allows the support shell to operate a self-tapping action (by the edge 10 and the tip 13 during installation) but symmetrically a self-tapping action (by the tip 13 'and the edge wire 10 ') during the possible removal operation.

This prevents an attack on the bone material reconstituted or implanted in the radial grooves 9, 9 ', etc., during a subsequent removal of the implant.

According to another characteristic of the invention, the shape of the threads or segments of threads in section, and illustrated in FIG. 5, allows great primary stability of the implant after its placement thanks to a distribution and a transfer of the forces acting on each segment of the mesh inserted into living bone material.

Each thread segment 7, 7 ', 7 "corresponds in fact to a sectional configuration represented in FIG. 5 and defined by the angles Ος 1 and (X 2 respectively formed on the one hand between the line defined by the radial section of the upper face 15 ′ of the net relative to a horizontal median plane 16 and on the other hand between the line defined by the radial section of the lower face 17 of the net 7, 7 ′, 7 "relative to the same median plane 16.

And we see in particular for the thread 7 'that the angle OC 1 (formed between the straight line radially cutting the upper plane 15 ^ of the thread 7' and the median plane 16) is greater than, the angle OC 2 (formed between this same median plane 16 and the right corresponding to the radial section of the lower plane 17 of the thread 7 ').

Under these conditions the converging forces which are exerted in a direction normal to the upper face 15 / of the thread 7, 7 ', 7 "according to the arrow F3f are transferred by the thread segment 7, 7', 7" in a direction also normal with respect to the underside 17 of the net in accordance with arrows F4 and FS.

And we see that under these conditions the converging and centripetal forces which are exerted on the upper wall of the net are transferred from the lower wall of the net to the bone material in divergent and centrifugal directions.

In addition and according to Figure 5, the threads distributed over 5 to 6 turns of the propeller depending on the sizes, correspond to the preferential dimensional characteristics below.

The height of the net (reference H in Figure 5) is close to 3 mm. ? the thread pitch (reference P in the same figure) is around 3.5 mm. The angle OC 1 is of the order of 10 ° while the angle OC 2 is of the order of 3 °. The angle at the top 0 (3 (corresponding to the sum of the angles OC 1 and OC 2) is thus of the order of 13 °.

Finally, we note according to Figure 5 that the bottom of the net corresponding to the wall 18 is contained in a spherical crown which extends the upper spherical cap 19 and the bottom is coincident with the wall of the hemispherical shell thus containing not only the cap 19 but the walls of the grooves 9, 9 'and all the bottom of the net. To this end, the wall 18 constituting the bottom of the threads is machined to reconstitute at each bottom of the thread an outer wall of spherical profile extending the hemispherical walls of the shell and therefore of the same radius.

According to this characteristic, on the one hand, a weakening of the bone material is avoided as a result of the compression which would take place in this place if the bottom of the net was not properly released as described above; according to FIG. 5, we can see between the threads 7 'and? "a curvilinear dotted line 20 which illustrates a conventional thread bottom.

And we see that the presence of a net whose bottom would follow the line 20 would result in compressing the bone material in the bottom of the net, this material cannot occupy the space located in the lower corner 21, hence aggression living tissue which is a source of necrosis or sclerosis.

On the contrary, in the context of the present invention, the conformation of the thread bottoms extending the hemispherical outer wall of the shell releases this angle 21 and consequently allows the bone material to occupy this zone without being modified in its structure and without undergo aggressive compression during placement.

In addition, this avoids creating rupture zones in the reduction of the pressure gradient exerted on the implant from the polar zone to the equatorial zone; the pressures thus being exerted from the top to the bottom of the shell in a continuous and regularly decreasing manner without reconstituting a distribution of the pressures in staircase step.

The characteristics of the shell and of the segments of tapping threads which have been described thus allow an easy installation thanks to the bite of the thread with possibility of subsequent non-aggressive extraction. The acetabular implant thus described has high primary and secondary stability.

This on the one hand due to the large contact surface obtained between the prosthetic part and the bone (height of the thread and length of the thread).

And on the other hand, due to a particular configuration of the thread, the symmetry of which gives a false retentive appearance allowing the conversion of the field of concentric and centripetal forces into a gradient of centrifugal pressures transmitted by the lower edge of the thread segments.

The hemispherical shell has in its polar zone a piercing of spherical windows, in particular 3, 22, 23, 24 which allow, during the fitting, a visual perception of the bottom of the acetabulum and a constant verification by the practitioner of the positioning of the implant relative to its receiving bone niche, thus authorizing instantaneous identification in the penetration of the implant as soon as the "dockside" contact between the implant and its support is established.

Figure 4 shows a sectional view and partial perspective of the internal capacity of the shell 1 and the core 2 it contains.

While the shell is made of metal alloy, the core is machined from a mass of high density polyethylene.

The internal capacity of the acetabulum 1 has a hemispherical concavity in its upper part 25 while its base, close to the plane of the equator, adopts a cylindrical configuration 26.

This cylindrical zone internally receives 3 anchor grooves distributed equidistantly on the circumference of the wall 26, and each of these grooves 27, 27 ', is provided with a general configuration in the shape of a clover or "T". The central core 28 of this groove opens onto the lower edge of the hemispherical shell at its substantially equatorial plane through the inlet 29. This inlet will allow the engagement of a stud or lug 30 coming radially from the core 2; the groove 27 or 27 'extends from its outlet 29 in a direction orthogonal to the equatorial plane and it is extended by the two lateral wings of the "T" by conforming the two curviform housings 31 and 32 capable of receiving and immobilizing lug 30.

The arrangement of the two symmetrical housings 31 and 32 will allow the assembly to be operational for the implantation or withdrawal movement of the acetabular prosthesis.

In fact, each groove 27, 27 ′ is provided for receiving the engagement of the positioning tool shown in FIG. 8. At the base of the handle 33 the crown 34 also includes the lugs 35, which can thus be engaged in the three corresponding grooves (of which the two grooves 27, 27 'are shown) and come into the locking position either in a housing 31 or in a housing 32, according to the direction of rotation of the implant, that is to say -depending on whether the operation is done for implantation (establishment) or for withdrawal. The assembly thus described therefore allows, by cooperating with the conformation of the fins or segments of self-tapping and self-tapping threads, a bivalent function of the system capable of being maneuvered also with the same ease both for the positioning operations. and implantation only for retraction operations.

A bayonet immobilization assembly is produced (between the tool and the shell) capable of operating in one direction of rotation as in the other, therefore for screwing as for unscrewing.

For its part, the core 2 intended for the retention of the femoral patella is firmly anchored in the shell 1 by the positioning of the studs 30 in one of the housings 31 or 32; its convex external wall forming a dome 2a conforms to the concave internal part of the shell 1, thus giving it, thanks also to the cylindrical wall 2b fitted into the receiving cylindrical part 26, absolute support within the fixed implant 1.

The housing 2c internal to the core 2 intended to receive the femoral patella is characterized by a bearing surface of diameter "D" of 28 mm.

We see in Figure 4 that this internal housing of the core extends beyond the equatorial diameter "D" to define an inlet opening of diameter "Dl" slightly smaller than the equatorial diameter "D".

This opening is provided with an inlet diameter Dl of 27.5mm. thus ensuring a retention action exerted on a difference in diameter of 500 microns between the equatorial diameter D of the patella and its receptor housing 2a and the diameter "Dl" of the entry zone.

A slight chamfer 37 facilitates the penetration of the patella into its housing within the core 2. The use of a core of diameter as defined makes it possible, taking into account the different sizes, to leave a useful thickness of polyethylene necessary to prevent phenomena wear and deformation (creep) specific to synthetic resins. The femoral implant which will be described below is illustrated by Figures 9, 10 and 11.

The design of this implant retained in these guiding principles the taking into account of the following necessities: the sealed implant must ensure a maximum filling while decreasing the quantity of cement, by increasing the primary stability and by reducing the stress concentrations.

The synthesis of these selection criteria was made possible by the adoption of an original drawing, particularly at the section level.

The stem of the implant 4 consists of a piece of TA6V titanium alloy having in its front view the conventional curvatures of an implant whose base at 45 ° from the construction axis is surmounted by a flange resting at 1 cm. of the little trochanter.

The sections evolve according to the variations of the internal morphology of the femur. From experiments, the inventors were able to determine an optimal and critical relationship between the anteroposterior neck and the transverse neck at the level of the section plane of the rod at the level of the base. This ratio is equal to 0.62 with tolerance in more or less than 15 5 £.

The section of the base of the neck on the rod is in the form of a horizontally oblong "D". In addition to conforming to the anatomy, this avoids the external wedge effect and promotes proximal blockage. The tulip-shaped trochanteric part is connected to the ovoid diaphyseal part by simply smoothing the curves. The lower end of the implant is bevelled on its outer edge to facilitate insertion and reduce the probability of elective stresses on the tip on the outer cortex.

Finally, the cervix undergoes lateralization of 0.5 mm. by size going from 0 to 2.5 mm. The morphological adaptation of a prosthesis to the core of the femoral barrel according to the invention leads to: - the anatomical physiological anteversion, - the self-blocking by optimal filling of the cavity and not by the blocking on three selective points, - the elimination of the external wedge effect, - greater ease of introduction of the implant despite greater filling, - minimization of point stresses, - harmonious distribution of the loads diffused over the entire length of the implant.

Claims (20)

1 - Total hip prosthesis of the type comprising a cotyloid implant consisting of a hemispherical shell (1) comprising on its outer wall, in the part close to the equator, a helical and spiral thread, leaving clear at the top of the half sphere an upper cap (19), and the prosthesis is characterized in that the threading is provided with properties on the one hand of self-tapping and on the other hand of self-tapping, thus allowing an attack of the medium implantation for the insertion and passage of the nets on the one hand in the direction of implantation and also in the direction of withdrawal. 2 - Total hip prosthesis according to claim 1, and characterized in that the threads are interrupted at regular intervals by grooves (9, 9 ') arranged along a radial axis and defining segments of threads or fins (7, 7 ', 8, 8') distributed in a spiral helix on the wall of the hemispherical shell, at least in the area close to the equator. 3 - Total hip prosthesis according to claim 2, characterized in that the edges of each groove (9, 9 '), defined by the transverse and terminal edges (10, 10') of the thread segments (7, 7 ' , 8, 8 ') superimposed in a helix, are parallel to the median axis (11) of the groove, itself arranged radially, so that the two edges (10, 10') of two neighboring thread segments (7 and 8), delimiting between them a groove (9) separating these two successive segments along the helix, are parallel to each other and not convergent, and thus each transverse and terminal edge of a segment of thread constitutes a cutting edge of attack capable of approaching the tapped material at an angle less than a right and such that the tapped material receives in the first place the attack on the outer tip of said transverse and terminal edge of the thread segment penetrating said tapped material. 4 - Total hip prosthesis according to claim 2 or claim 3, characterized in that each groove (9, 9 ') has a constant width, between 2 and 5 millimeters, and its bottom follows the shape of a segment sphere extending the spherical cap (19). 5 - Total hip prosthesis according to one of claims 1 to 4, and characterized in that the segments of threads or fins (7, 7 ', 8, 8') together defining the self-tapping thread, are distributed on a spiral helix with a pitch of between 3 and 4 millimeters and preferably around 3.5 millimeters. 6 - Total hip prosthesis of the type comprising a cotyloid implant consisting of a hemispherical shell (1) comprising on its outer wall, in the part close to the equator, a helical and spiral thread, leaving clear at the top of the half sphere an upper cap (19), characterized in that the upper face (15) on the one hand and the lower face (17) on the other hand of each thread or segment of the thread (7, 7 ') converge towards the exterior, on either side of a median plane (16) parallel to the equatorial plane of the hemispherical shell, and the angle 0 <1 formed by a radial section of the upper face (15 '), with respect to said plane (16) parallel to the equator, is greater than the angle £ X 2 formed by a radial section of the underside (17) of the thread segment relative to the same parallel median plane of the equator. 7 - Total hip prosthesis according to claim 6, and characterized in that the upper face of each thread segment (7, 7 ') is such that any radial cut of this upper face (15') conforms in all respects to a angle between 8 and 12 ° relative to the median plane (16) of the thread parallel to the equatorial plane of the hemispherical shell, and this angle is preferably close to 10 °. 8 - Total hip prosthesis according to claim 6, and characterized in that the underside (17) of each segment of the thread (7, 7 ') is such that a radial section of this face conforms at all points to an angle between 2 and 4 ° with a median plane (16) of the thread parallel to the equatorial plane of the hemispherical shell, this angle preferably being close to 3 °. 9 - Total hip prosthesis according to one of claims 1 to 8, characterized in that each end point (13) of each thread segment corresponding to the angle formed between the outer curviform edge (14) and the straight edge transverse (10) of this segment (7, 7 ') has an angular value less than 90 ° and between 80 and 85 °. 10 - Total hip prosthesis according to claim 9, characterized in that said end point (13) of each cylinder segment (7, 7 ', 8, 8'), on one end of said segment and on the other, is provided at a sharp angle of thickness coming to die in a sharp point thus constituting an punch for attacking the tapped material, this point preceding the attack by the wire constituted by the end and transverse edge (10, 10 ') of each segment of thread arranged along a straight line forming a non-zero angle OC with a radial direction (12, 12 ′) while the thread formed by the peripheral curviform edge (14) of the segment of thread or fin (7, 7 ′, 8, 8 ') is slightly dull at a bevel (15). 11 - Total hip prosthesis of the type comprising a cotyloid implant consisting of a hemispherical shell (1) comprising on its outer wall, in the part close to the equator, a helical and spiral thread, leaving clear at the top of the half sphere an upper cap (19), and characterized in that the bottom (18) of net (7, 7 ', 8, 8') defined by the wall between the facing faces (15, 17 'or 15', 17 ) of two superimposed threads (7, 7 ', 7 "), is contained in a spherical crown corresponding to the external wall of the hemispherical shell. 12 - Total hip prosthesis according to one of claims 1 to 11, and characterized in that said shell (1) with hemispherical outer face has an internal capacity (25) whose part close to the equatorial plane defines a cylinder section (26) with a circular base extended towards the top by a concavity formed by a hollow spherical cap (25a) concentric with the hemispherical outer wall of the shell and the polar cap (19). 13 - Total hip prosthesis according to claim 12, characterized in that said hemispherical shell (1) comprises on the internal wall of its internal capacity (25) a plurality of notches (27, 27 ') in the general form of " T ", each notch opening at its base (at 29) corresponding to the foot of the core (28) of the" T ", on the circular crown (25b) defined by the equatorial base of the hemispherical shell, and each notch s' opens at its apex on two symmetrical housings (31, 32), each in the shape of and with narrow edges, the two housings being situated on the same parallel with respect to the equatorial plane, the assembly constituting a system for receiving a lug ( 30) or stud engaged in said notch for attachment of the "bayonet" type, the stud gu stud thus being able to be immobilized by rotation in one or the other of said housings. 14 - Total hip prosthesis according to one of claims 1 to 13, characterized in that the hemispherical shell is capable of receiving in its internal capacity (25) a core (2) of generally hemispherical shape known per se and whose outer wall is provided complementary to the inner wall of said capacity, the outer wall of the core comprising for this purpose in its part near the equatorial plane a zone (2b) in the form of a cylinder section extended upwards by a spherical cap (2d ), and the core internally comprising a housing (2c) itself of hemispherical shape for the reception of the patella coming from the femoral implant. 15 - Total hip prosthesis according to claim 14, and characterized in that the core (2) comprises in its part in the form of a cylinder section (2b) a plurality of lugs or studs (30) arranged radially, provided in number and positioning allowing them to come opposite the notches (27, 27 ') formed on the inner wall (26) of the capacity (25) receiving said core, the studs or lugs being provided to be immobilized after engagement and linear movement along of the core (28) of the receiving notch, followed by angular displacement, in one or the other of the two housings (31, 32) of each of the notches (27, 27 '). 16 - Total hip prosthesis according to one of claims 1 to 15, and characterized in that the top of the hemispherical shell (1) conforming the cap (19) upper surmounting the part of the shell wall furnished with threads external, comprises at least one and preferably a plurality of lights (22, 23, 24) allowing the visual perception of the environment in which the shell is implanted by self-tapping, thereby allowing control of the positioning of the shell relative to its receiving environment and the determination of the optimum end of tapping. at 17 - Total hip prosthesis according to one of claims 1 to 16, and characterized in that the interior housing (2c) provided in said core (2), capable of receiving the spherical end ball of the femoral implant, is provided with an inner diameter (D) corresponding to the diameter of said spherical ball joint, the receiving housing extending slightly beyond the equatorial plane to tighten the edges of the introductory opening of the ball joint and ensure self-retention of the latter. 18 - Total hip prosthesis according to claim 17, and characterized in that the diameter (Dl) of the lower opening of the housing (2a) receiving the patella and defining the passage of the latter is less than the diameter of the patella spherical, of a percentage between 1/50 and 1/60. 19 - Total hip prosthesis according to one of claims 17 or 18, and characterized in that the edges (37) of this opening for penetration of the patella in its receiving housing (2a) are provided slightly beveled to facilitate the engagement of penetration of said ball joint. 20 - Total hip prosthesis of the type comprising a cotyloid implant consisting of a hemispherical shell (1) comprising on its outer wall, in the part close to the equator, a helical and spiral thread, leaving clear at the top of the half sphere an upper cap (19), characterized in that it comprises a femoral implant known per se and provided with a spherical ball joint connected to the rod penetrating into the femur by a neck followed by a rod whose section at the base is in the form of a "D" horizontally elongated, this section defining a ratio between the anteroposterior and transverse axes respectively between 0.50 and 0.77 and preferably close to 0.62.