US20050143832A1 - High flexion articular insert - Google Patents

High flexion articular insert Download PDF

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Publication number
US20050143832A1
US20050143832A1 US10/964,151 US96415104A US2005143832A1 US 20050143832 A1 US20050143832 A1 US 20050143832A1 US 96415104 A US96415104 A US 96415104A US 2005143832 A1 US2005143832 A1 US 2005143832A1
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United States
Prior art keywords
intermediate structure
femoral component
knee prosthesis
knee
approximately
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Abandoned
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US10/964,151
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English (en)
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Christopher Carson
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Smith and Nephew Inc
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Individual
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Priority to US10/964,151 priority Critical patent/US20050143832A1/en
Assigned to SMITH & NEPHEW, INC. reassignment SMITH & NEPHEW, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: CARSON, CHRIS
Publication of US20050143832A1 publication Critical patent/US20050143832A1/en
Priority to US13/342,486 priority patent/US9642711B2/en
Abandoned legal-status Critical Current

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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/02—Prostheses implantable into the body
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Definitions

  • the invention relates generally to knee prostheses and, more specifically, to knee prostheses which include the use of posterior stabilized inserts and have an extended range of flexion.
  • Osteoarthritis of the knee is a disease in which the surfaces of the knee gradually “wear out.” Osteoarthritis, characterized by chronic degeneration of the cartilage of the joints, is the most common form of arthritis. This may be due to either old age, congenital deformity, or damage due to trauma. Osteoarthritis, characterized by chronic degeneration of the cartilage of the joints, is the most common form of arthritis.
  • Systemic arthritis such as rheumatoid arthritis, or gout affects the synovium (the membrane tissue in the joint that normally lubricates the joint), becomes pathologic and the surface of the joint is destroyed. In either case, when the surface of the joint is worn away, the activities of daily living can become very difficult. Standardized treatment such as weight loss, anti-inflammatory medication, braces, orthotics, steroid injections, physical therapy may be effective.
  • TRR total knee replacement
  • a surgeon typically affixes two prosthetic components to the patient's bone structure; a first to the patient's femur and a second to the patient's tibia. These components are typically known as the femoral component and the tibial component respectively.
  • the femoral component is placed on a patient's distal femur after appropriate resection of the femur.
  • the femoral component is usually metallic, having a highly polished outer condylar articulating surface, which is commonly J-shaped.
  • a common type of tibial component uses a tray or plateau that generally conforms to the patient's resected proximal tibia.
  • the tibial component also usually includes a stem that extends at an angle to the plateau in order to extend into a surgically formed opening in the patient's intramedullary canal.
  • the tibial component and tibial stem are both usually metallic.
  • a plastic or polymeric (often ultra high molecular weight polyethylene) insert or bearing fits between the tray of the tibial component and the femoral component.
  • This tibial insert provides a surface against which the femoral component condylar portion articulates, i.e., moves in gross motion corresponding generally to the motion of the femur relative to the tibia.
  • the insert also engages in motion relative to the tibial tray. Such motion can be translational and/or rotational sliding motion relative to the tibial plateau.
  • the tibial inserts can engage in other types of motion relative to the tibial plateau and/or femoral component.
  • TKR's are tricompartmental designs; they replace three separate articulating surfaces within the knee joint: the patello-femoral compartment and the lateral and medial inferior tibio-femoral compartments. Most TKR's are designed to articulate from a position of slight hyperextension to approximately 115 to 130° flexion. A tricompartmental design can meet the needs of most TKR patients even though the healthy human knee is capable of a range of motion (ROM) approaching 170°. However, there are some TKR patients who have a particular need to obtain high flexion in the knee joint. For many, a TKR that permits patients to achieve a ROM in excess of 130° is desirable to allow deep kneeling, squatting and sitting on the floor with the legs tucked underneath.
  • ROM range of motion
  • TKR patients Another problem encountered by TKR patients is unwanted movement of the femoral component on the tibial component. This occurs when the ligaments of the knee are “tight,” or not tensioned properly, during the TKR procedure. Ligaments located on the side of the knee where the deformity is present become tight due to contraction of the compartment. A tight posterior cruciate ligament may cause the knee to move in an unnatural motion.
  • a posterior stabilized insert may assist in preventing the femoral component from unnatural motion on the tibial component by providing posterior support after the posterior cruciate ligament is removed.
  • current inserts providing posterior support are designed to allow a ROM to only about 120°.
  • the invention provides various embodiments of improved knee prostheses for replacing at least a portion of a knee joint between the distal end of a femur and the proximal end of a tibia.
  • a knee prosthesis including a femoral component adapted to fit on a distal end of a femur, the femoral component including a lateral condylar structure and a medial condylar structure and an intermediate structure configured to cooperate with the femoral component.
  • the intermediate structure includes a proximal surface adapted to cooperate with an outer surface of the femoral component to allow flexion of the knee greater than 130°.
  • a knee prosthesis including a femoral component adapted to fit on a distal end of a femur, the femoral component including a lateral condylar structure and a medial condylar structure and an intermediate structure configured to cooperate with the femoral component, wherein the intermediate structure includes a proximal surface with an articular blend at the contact interface of the femoral component and the intermediate structure when the knee is flexed approximately 120° to 140°.
  • a knee prosthesis including a femoral component adapted to fit on a distal end of a femur, the femoral component including a lateral condylar structure and a medial condylar structure and an intermediate structure configured to cooperate with the femoral component.
  • the intermediate structure includes at least one surface for contacting the femoral component on a proximal surface of the intermediate structure between the intermediate structure and the femoral component the contact surface includes a curvature in the sagittal plane which transitions, in a posterior direction, from a concave surface into a convex surface at a contact point between the femoral component and the intermediate structure when the knee prosthesis is flexed at approximately 120° to 140°.
  • a knee prosthesis having a femoral component adapted to fit on a distal end of a femur, the femoral component including a lateral condylar structure and a medial condylar structure and an intermediate structure configured to cooperate with the femoral component.
  • the intermediate structure includes at least one surface for contacting the femoral component, a transition of a sagittal curvature of the contact surface from a concave surface into a convex surface, the transition occurring at a contact point between the femoral component and the intermediate structure when the knee prosthesis is flexed at approximately 120° to 140°, and a post adapted to provide posterior support to the femoral component, the post being adapted to minimize impingement on a patellar component when the knee is flexed approximately 130° or greater.
  • FIGS. 1A-1C show an exploded front view of a knee prosthesis according to an embodiment of the invention.
  • FIG. 2 is a back perspective view of a knee prosthesis according to an embodiment of the invention.
  • FIG. 3 is a side elevation view of an articular insert according to an embodiment of the invention.
  • FIG. 4 is a perspective view of an articular insert according to an embodiment of the invention.
  • FIG. 5 is a front elevation view of an articular insert according to an embodiment of the invention.
  • FIG. 6 is a bottom plan view of an articular insert according to an embodiment of the invention.
  • FIG. 7 is a side cross-sectional view of a partially assembled knee prosthesis according to an embodiment of the invention showing full extension of the knee.
  • FIG. 8 is a side cross-sectional view of a partially assembled knee prosthesis according to an embodiment of the invention showing flexion of the knee to 90°.
  • FIG. 9 is a side cross-sectional view of a partially assembled knee prosthesis according to an embodiment of the invention showing flexion of the knee to 160°.
  • FIG. 10 is a side cross-sectional view of a partially assembled knee prosthesis including a size 5 femoral component on a size 5-6 insert according to an embodiment of the invention showing the range of flexion from 120° to 140°.
  • FIG. 11 is a side cross-sectional view of the knee prosthesis of FIG. 10 showing flexion of the knee at 120°.
  • FIG. 12 is a side cross-sectional view of the knee prosthesis of FIG. 10 showing flexion of the knee at 130°.
  • FIG. 13 is a side cross-sectional view of the knee prosthesis of FIG. 10 showing flexion of the knee at 140°.
  • Various embodiments of the invention provide improved knee prostheses for replacing at least a portion of a knee joint between the distal end of a femur and the proximal end of a tibia.
  • Anterior and posterior mean toward the front or toward the back of the body, respectively.
  • Proximal means nearer to a point of reference, as opposed to distal which means farther from a point of reference.
  • distal femur is part of the knee joint, while the proximal femur is part of the hip joint.
  • Medial means nearer to the middle or center of the body. Lateral means farther from the middle or center of the body.
  • medial would mean the side of the knee that is closest to the other knee and lateral would mean the side of the knee that is farthest from the other knee.
  • Knee prostheses advantageously remove material from the posterior edge of the insert that may impinge on the femoral posterior cortex (or corresponding portions of a femoral component) in deep flexion. Additionally, the 160° flexion contact point is moved anteriorly on the insert and distally on the femoral component to reduce edge loading. The anterior shift in flexion contact also increases the dislocation safety factor in deep flexion. Finally, should the lateral posterior condyle of the femoral component externally rotate off of the tibial plateau, as may occur in the normal knee in deep flexion, it will more easily engage the articular surface as the knee returns to extension.
  • the invention also maintains conventional amounts of femoral resection and utilizes existing instrumentation so that a surgeon may decide intraoperatively whether to use a standard posterior stabilized insert or the high flexion posterior stabilized insert of the invention.
  • FIGS. 1A-1C A preferred embodiment of a knee prosthesis according to the invention is shown in FIGS. 1A-1C and identified by the numeral 100 .
  • the knee prosthesis 100 is designed to replace at least a portion of a left knee joint between the distal end of a femur and the proximal end of a tibia.
  • a mirror image of knee prosthesis 100 (not shown) will replace at least a portion of a right knee between the distal end of a femur and the proximal end of a tibia.
  • the knee prosthesis 100 includes a femoral component 200 for mounting to a distal end of a femur, a tibial component 300 for mounting to a proximal end of a tibia, and an intermediate component, such as articular insert 400 .
  • the femoral component 200 preferably includes a medial condylar portion 202 , a lateral condylar portion 204 and a patellar flange portion 206 joining the anterior portions 214 , 216 ends of the medial and lateral condylar portions 202 , 204 together.
  • the medial and lateral condylar portions 202 , 204 are substantially parallel to each other and are spaced apart from one another to form an intercondylar recess or notch 208 .
  • Each condylar portion 202 , 204 has an outer surface 210 , 212 for engaging a portion of the tibial component 300 in an articulating fashion as will become apparent.
  • the outer surfaces 210 , 212 of each condylar portion 202 , 204 preferably have a distal portion 218 , 220 for engaging a portion of the tibial component 300 when the knee joint is extended and partially flexed, and a posterior portion 222 , 224 (shown in FIG. 2 ) for engaging a portion of the tibial component 300 when the knee joint 102 is flexed substantially 90°.
  • the femoral component 200 may include typical attachment aids for helping to secure the femoral component 200 to a distal end of a femur.
  • attachment aids may include one or more pegs, fins, surface treatments, cement or other conventional or nonconventional structure or technologies.
  • the tibial component 300 includes a tray or base member 302 for being secured to a proximal end of a tibia, and a stabilizing post 316 , which is insertable into the tibial medullary canal and provides for the stabilization of the tibial component 300 on the tibia.
  • the tray member 302 has a proximal or upper surface 304 , a distal or lower surface 306 , a medial side 308 , a lateral side 310 , an anterior or front side 312 , and a posterior or rear side 314 (shown in FIG. 2 ).
  • the proximal surface 304 may be substantially flat and planar.
  • the tray member 302 preferably includes attachment aids for helping to secure the tray member 302 to a proximal end of a tibia. Such attachment aids may include one or more pegs, fins, screws, surface treatments, etc.
  • the femoral component 200 and tibial component 300 may be constructed in various manners and out of various materials.
  • the femoral component 200 and tibial component 300 may be machined, cast, forged or otherwise constructed as a one-piece integral unit out of a medical grade, physiologically acceptable metal such as a cobalt chromium alloy or the like, in various sizes to fit a range of typical patients, or may be custom-designed for a specific patient based on data provided by a surgeon after physical and radiography examination of the specific patient.
  • the articular insert 400 has a proximal or upper surface 402 , a distal or lower surface 404 , a medial side 406 (shown in FIG. 5 ), a lateral side 408 , an anterior or front side 410 , and a posterior or rear side 412 (shown in FIG. 2 ).
  • the medial and lateral sides 406 , 408 are separately identified, the insert 400 may be substantially symmetrical so that the medial and lateral sides 406 , 408 are substantially the same or are identical.
  • the proximal surface 402 of the insert 400 has a medial concave portion 414 for engaging the outer surface 210 of the medial condylar portion 202 of the femoral component 200 in an articulating relationship, and a lateral concave portion 416 for engaging the outer surface 212 of the lateral condylar portion 204 of the femoral component 200 in an articulating relationship.
  • Lateral concavity 414 is defined by curves C 1 , C 2 and C 3 . In the front or coronal plane, curve C 1 has a radius of curvature of approximately 1.05 inches. In the sagittal plane, curves C 2 and C 3 have varying radii of curvature of approximately 2.88 to 3.05 inches.
  • medial concavity 416 is similar to lateral concavity 414 and includes corresponding curves C 4 , C 5 and C 6 .
  • the insert includes a central post 420 .
  • the post 420 has a proximal surface 422 , anterior surface 424 , posterior surface 426 and side surfaces 428 , 430 .
  • the proximal surface 422 of the central post 420 preferably is parallel with distal surface 404 .
  • the anterior surface 424 of central post 420 in this embodiment is tapered at an angle of approximately 33° with respect to the distal surface 404 of the insert 400 to minimize impingement of the patella or a patellar implant (not shown) in deep flexion.
  • the base 425 is tapered 23° in a posterior direction from anterior surface 424 to minimize impingement of the intercondylar notch 208 of femoral component 200 in hyperextension.
  • the insert 400 may include a curved anterior surface 418 , as shown in FIG. 4 .
  • the curved anterior surface 418 has a curve C 7 with central radius of curvature varying between approximately 1.5 to 2.5 inches, lateral to medial, as a general matter. Again, radii of curvature can vary as desired.
  • the sagittal center line of the anterior curved surface 418 is oriented at approximately 30° to 45° above the distal surface 404 of the insert 400 .
  • the curved anterior surface 418 begins approximately 2 mm above the tray member 302 of the tibial component 300 to allow room for the patellar tendon (not shown).
  • the insert 400 preferably includes articular blends 432 , 436 on the lateral and medial sides of the insert 400 .
  • Articular blends 432 , 436 are similar and articular blend 432 is described in detail below.
  • the articular blend 432 begins at the contact interface of the femoral component 200 and the insert 400 (the femorotibial contact point 438 ) when the knee is flexed at approximately 120° to 140°.
  • One result of using an articular blend 432 is that the posterior side 412 of the insert 400 is lowered and flexion joint space is maintained.
  • the articular blends 432 , 436 (shown in FIG. 4 ) have a single sagittal radius of approximately 1.0 inch.
  • the articular blend 432 has a single sagittal radius of approximately 1.0 inch.
  • the radius may vary and may feature any radius or radii as circumstances dictate or suggest.
  • the articular blends 432 , 436 increase the amount of flexion allowed by the knee prosthesis 100 through the use of a transition or blend of the sagittal concave curvatures of the lateral and medial concavities, 414 , 416 into a convex surface.
  • the precise location of the articular blends 432 , 436 varies depending on the size of the femoral component 200 and the size of the articular insert 400 .
  • the articular blend will generally begin at a point defined as the point of contact between the femoral component and the insert (the femorotibial contact point 438 ) when the femoral component is at a flexion angle of approximately 120° to 140°.
  • FIG. 10 illustrates the range of flexion from 120° to 140° of a size 5 femoral component on a size 5-6 insert.
  • 120° also shown in FIG. 11
  • the posterior portion 224 of outer surface 212 of lateral condylar portion 204 has not yet engaged the articular blend 432 .
  • 130° also shown in FIG. 12
  • the posterior portion 224 of outer surface 212 of lateral condylar portion 204 directly engages the articular blend 432 at the femorotibial contact point, as shown in FIG. 12 .
  • 140° also shown in FIG.
  • the posterior portion 224 of outer surface 212 of lateral condylar portion 204 is past the beginning of the articular blend 432 at the femorotibial contact point 438 is on the convex surface of articular blend 432 .
  • the proximal surface 402 of the insert 400 transitions from concave to convex.
  • the insert may include a curved posterior surface 433 , which is multi-radius.
  • the curved posterior surface 433 has a curved surface C 8 with a varying radius of curvature, lateral to medial.
  • the result of the curved posterior surface 433 is the removal of material that may impinge on the posterior cortex of the femur in deep flexion.
  • the radius of curvature may vary as desired to provide sufficient room for maximal flexion.
  • the distal surface 404 of the insert 400 may be substantially flat or planar for contacting the proximal surface 304 of the tray member 302 of the tibial component 300 .
  • the distal surface 404 preferably includes a dovetail locking mechanism 434 that consists of an anterior portion 440 and a posterior portion 442 , however, any conventional method for disposing the insert relative to the tray member 302 , whether constrained or unconstrained, may be used.
  • a size 5-6 insert 400 has the following dimensions.
  • the overall width of the insert 400 is approximately 2.913 inches from medial side 406 to lateral side 408 .
  • the depth of the insert 400 is approximately 1.944 inches from anterior side 410 to posterior side 412 .
  • the thickness of the insert 400 at the medial and lateral sides 406 , 408 varies, ranging from approximately 0.381 to 1.011 inches.
  • the thickness of the insert 400 at the posterior side 412 ranges from approximately 0.548 to 1.178 inches.
  • the width of the anterior curved surface 418 ranges from approximately 1.869 to 2.421 inches. At the outermost edges of the anterior curved surface 418 , the thickness of the insert 400 ranges from approximately 0.408 to 1.001 inches.
  • the central post 420 is approximately 0.560 inches wide. Its height, from the distal surface 404 of the insert 400 , ranges from approximately 1.259 to 1.889 inches. These dimensions have a tolerance ranging from approximately +/ ⁇ 0.005 to 0.020 inches.
  • the insert 400 may be constructed in various manners and from various materials.
  • the insert 400 may be machined, molded or otherwise constructed as a one-piece, integral unit out of medical grade, physiologically acceptable plastic such as ultra high molecular weight polyethylene or the like, in various sizes to fit a range of typical patients, or may be custom-designed for a specific patient based on data provided by a surgeon after physical and radiographic examination of the specific patient.
  • the material can be treated, for example, by radiation, chemistry, or other technology to alter its wear properties and/or strength or hardness.
  • An articular insert 400 constructed of ultra high molecular weight polyethylene will freely slide on a polished upper surface of the tray member 302 of the tibial component 300 , thereby reducing material wear.
  • the posterior stabilized femoral component 226 includes a horizontal connection member, or cam, 228 between the posterior portions 222 , 224 of the condylar portions 202 , 204 .
  • the distal portions 218 , 220 of the condylar portions 222 , 224 rest on the medial and lateral concavities 414 , 416 of the insert 400 . Because the femoral component 226 and the insert 400 are not fastened to each other, the femoral component 226 is able to easily move on the insert 400 .
  • the particular knee prosthesis 100 of FIG. 7 is shown as it would appear when the knee is fully extended.
  • the distal portions 218 , 220 of the medial and lateral condylar portions 202 , 204 are in contact with the medial and lateral concavities 414 , 416 .
  • the posterior portions 222 , 224 of the medial and lateral condylar portions 202 , 204 are in contact with the medial and lateral concavities 414 , 416 .
  • the cam 228 is also in contact with the posterior surface 426 of the central post 420 of femoral component 400 .
  • the femoral component 200 begins to contact the articular blend 432 on the posterior side 412 of the insert 400 .
  • the knee can be flexed to approximately 160° before the femoral component 200 fully contacts the intersection edge of the articular blend 432 and the curved posterior surface 433 and additional flexion is difficult or impossible.
  • the increased flexion is achieved primarily by the articular blend 432 which results in a transition on the proximal surface 402 of the insert 400 of the sagittal concave curvature of the lateral and medial concavities 414 , 416 into a convex surface that maintains the coronal curvature of the medial and lateral condylar portions 202 , 204 .
  • the articular blend 432 moves the 160° femorotibial contact point 438 anteriorly on the insert 400 and distally on the femoral component 200 .
  • edge loading is reduced and material that may impinge on the femoral posterior cortex (not shown) in deep flexion has been removed.
  • the anterior shift in the femorotibial contact point 438 increases the dislocation safety factor in deep flexion, making dislocation less likely.
  • the posterior portion 224 of the lateral condylar portion 204 should rotate off the insert 400 , as may occur in the normal knee in deep flexion, it will more easily engage the lateral concavity 416 as the knee returns to extension.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
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US10/964,151 2003-10-17 2004-10-13 High flexion articular insert Abandoned US20050143832A1 (en)

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US20120101586A1 (en) 2012-04-26
CA2542619C (en) 2011-10-11
US9642711B2 (en) 2017-05-09
EP1684672B1 (en) 2020-03-25
TW200514549A (en) 2005-05-01
WO2005037147A1 (en) 2005-04-28
EP1684672A1 (en) 2006-08-02
AU2004281743A1 (en) 2005-04-28
AU2004281743B2 (en) 2011-06-09

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