WO1990004953A1 - Procede et appareil de traitement de ciment osseux pour la fixation d'une prothese dans un os - Google Patents

Procede et appareil de traitement de ciment osseux pour la fixation d'une prothese dans un os Download PDF

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Publication number
WO1990004953A1
WO1990004953A1 PCT/SE1989/000648 SE8900648W WO9004953A1 WO 1990004953 A1 WO1990004953 A1 WO 1990004953A1 SE 8900648 W SE8900648 W SE 8900648W WO 9004953 A1 WO9004953 A1 WO 9004953A1
Authority
WO
WIPO (PCT)
Prior art keywords
bone
bone cement
cavity
prosthesis
cement
Prior art date
Application number
PCT/SE1989/000648
Other languages
English (en)
Inventor
Magnus Nilsson
Original Assignee
Magnus Nilsson
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Magnus Nilsson filed Critical Magnus Nilsson
Publication of WO1990004953A1 publication Critical patent/WO1990004953A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8802—Equipment for handling bone cement or other fluid fillers
    • A61B17/8805—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
    • A61B17/8808—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it with sealing collar for bone cavity
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30721—Accessories
    • A61F2/30723—Plugs or restrictors for sealing a cement-receiving space
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30433—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws

Definitions

  • the present invention relates to a method and an ap- paratus for working bone cement placed in a cavity of a bone, for instance in the medullary canal of the femur, for fixing a prosthesis in the cavity.
  • Bone cement is prepared by mixing two or more components with each other to form a soft curing mass. The soft mass is placed in the cavity for receiv ⁇ ing the prosthesis and, after curing, fixing it in the cavity.
  • the bone cement currently used is of the poly- methyl methacrylate type (PMMA) which is prepared by mix ⁇ ing a powder of polymers with a liquid of monomers. The resulting mixture is caused to cure by polymerisation.
  • PMMA poly- methyl methacrylate type
  • the penetration of the bone cement into the spongy bone depends on how carefully the cavity, for instance a medullary canal, has been cleaned with respect to devita- lised tissue.
  • the degree of penetration also depends on the viscosity of the cement and the pressure of applica ⁇ tion. The lower the viscosity of the cement is and the higher the pressure of application is, the more easily does the penetration take place. With decreasing viscosity and increasing pressure, the PMMA mass however emits a larger amount of highly volatile monomers which have been found to be cytotoxic, that is have an injurious effect on vital cells, and may therefore cause tissue injuries.
  • the monomers may then interfere locally with the flow of blood and also give rise to intravascular hemolysis and inflam ⁇ matory reactions leading to ischemia, necrosis and re- sorption of bone substance.
  • monomers have been found to produce not only localised injuries but also system injuries, for instance by affecting the heart and by causing fat embolism in the lungs.
  • Tissue injuries may also arise in other ways.
  • the major portion of the bone marrow is removed, which causes injuries to blood vessels and, hence, adversely affects the flow of blood with a consequent risk of ischemia and tissue death.
  • Polymerisation of the PMMA cement takes place with emission of heat, the local temperature in ⁇ crease being proportional to the amount of cement used. Excessive temperature may in itself cause tissue injuries and also, the emission of injurious monomers increases with increasing temperature.
  • the object of the present invention is to provide a method making it possible to bring about efficient and durable immobilisation of a prosthesis in a cavity by means of bone cement, while overcoming as far as possible the above-mentioned drawbacks by ensuring a thorough and uniformly distributed penetration of bone cement into the spongy bone with a minimum of injuries to bone tissue and blood vessels and a minimum of air bubbles in the bone ce ⁇ ment.
  • this object is achieved by a method for working bone cement placed in a cavity of a bone, for instance in the medullary canal of the femur, for fixing a prosthesis in the cavity, which method is characterised in that the bone cement placed in the cavity is vibrated mechanically.
  • Another object of the present invention is to provide a device for carrying out this method.
  • this object is achieved by means of a device for working bone cement placed in a cavity of a bone, for instance in the medullary canal of the femur, for fixing a prosthesis in the cavity, which device is characterised by vibrating means adapted to vi- brate the bone cement placed in the cavity.
  • the vibrating means suitably is adapted to execute a rotary movement.
  • the device has pressure loading means having a cross-sectional shape corresponding to that of the cavity, and adapted to be introduced in the cavity to be pressed against the bone cement placed there ⁇ in.
  • the device used in the test and schematically illu ⁇ strated in the drawing has a flexible shaft 1 which is connected at one end to a motor (not shown) having a speed of rotation of 16,000 rpm, and which is connected at the other end to a chuck 2 normally used in a dentist's drill ⁇ ing equipment.
  • a metal tube 3 is arranged around the chuck 2.
  • a steel pin 4 having a diameter of about 2.5 mm is in ⁇ serted in the chuck 2 and axially extends a certain dis- tance outside the metal tube 3.
  • the steel pin 4 has a ra ⁇ dial projection 5 at its free end.
  • a rubber seal 6 having a central portion and an annular skirt portion is fixed with its central portion to the free end of the metal tube 3 by locking screws 7.
  • the rubber seal 6 has a central through bore in which a metal sleeve 8, closed at its free end, is mounted.
  • the steel pin 4 extends into the metal sleeve 8 with its radial projection 5 engaging the inner side of the me ⁇ tal sleeve 8 and slightly inclining the metal sleeve.
  • the steel pin 4 is shown in a position of ro- tation where the radial projection 5 is directed to the right, thus inclining the metal sleeve 8 to the right.
  • the metal sleeve 8 exe ⁇ cutes a movement of rotation, substantially describing a cone.
  • the device is shown when introduced in a cavity 9 of a bone 10 which in the contemplated ex ⁇ periment is a necrobone from cattle.
  • a bone 10 which in the contemplated ex ⁇ periment is a necrobone from cattle.
  • con ⁇ sisting of the distal part of the femur cut horizontally just above the condyles a vertical hole having a depth of about 4 cm and a diameter of about 34 mm has been drilled.
  • the interspongy fat has been removed by heating in water.
  • a PMMA bone cement mass 11 was placed after the different components had been mixed.
  • the test device was thereafter introduced in the cavity 9 by descending the metal sleeve 8 into the mass of bone cement 11 and lightly applying to the mass of bone cement 11 the rubber seal skirt portion which as appears from the drawing has substantially the same diameter as
  • the axial pressure was about 0.2 kp/cm .
  • the steel pin 4 and, thus, the metal sleeve 8 were rotated for 30 s, thereby vibrating the mass of bone cement 11, where ⁇ upon the device was removed.
  • the bone 10 was exa ⁇ mined, and it clearly appeared that the penetration of the mass of bone cement into the spongy bone was deeper and considerably more uniformly distributed than was the case when the same experiment was conducted without vibrating the mass of bone cement.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

Dans le procédé décrit, qui sert à traiter du ciment osseux (11) placé dans une cavité (9) d'un os (10), par exemple dans le canal médullaire du fémur, pour la fixation d'une prothèse dans la cavité, le ciment osseux (11) placé dans la cavité (9) est vibré mécaniquement. Un dispositif de réalisation dudit procédé comprend un organe vibrateur (8) destiné à vibrer le ciment osseux (11) placé dans la cavité (9).
PCT/SE1989/000648 1988-11-11 1989-11-10 Procede et appareil de traitement de ciment osseux pour la fixation d'une prothese dans un os WO1990004953A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
SE8804078-7 1988-11-11
SE8804078A SE462417B (sv) 1988-11-11 1988-11-11 Saett och anordning foer bearbetning av bencement foer fixering av en protes i ett ben

Publications (1)

Publication Number Publication Date
WO1990004953A1 true WO1990004953A1 (fr) 1990-05-17

Family

ID=20373912

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/SE1989/000648 WO1990004953A1 (fr) 1988-11-11 1989-11-10 Procede et appareil de traitement de ciment osseux pour la fixation d'une prothese dans un os

Country Status (3)

Country Link
AU (1) AU4512889A (fr)
SE (1) SE462417B (fr)
WO (1) WO1990004953A1 (fr)

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0598964A1 (fr) * 1992-11-20 1994-06-01 SULZER Medizinaltechnik AG Corps pour dispenser du ciment osseux pour la fixation d'implants
GB2277448A (en) * 1993-04-19 1994-11-02 Paul Albert Thodiyil Ultrasound apparatus and method for securing or removing a prosthesis
EP0628295A1 (fr) * 1993-05-11 1994-12-14 ARTOS Medizinische Produkte GmbH Dispositif de remplissage pour ciment à os
EP1095667A2 (fr) * 1999-11-01 2001-05-02 Dunsch-Herzberg, Renate Dispositif pour injecter du cement chirurgical dans le canal medullaire
WO2002074195A2 (fr) * 2001-03-19 2002-09-26 Cambridge Polymer Group Inc. Systeme et procedes permettant de reduire la porosite interfaciale dans des ciments
WO2004112661A1 (fr) * 2003-06-20 2004-12-29 Myers Thomas H Procede et appareil de renforcement des proprietes biochimiques d'implants
WO2006024840A1 (fr) * 2004-09-01 2006-03-09 University Of Dundee Instrument chirurgical et procede permettant de perfectionner des implants orthopediques
US7252672B2 (en) 2003-09-11 2007-08-07 Skeletal Kinetics, Llc Use of vibration with orthopedic cements
US8118812B2 (en) 2004-03-09 2012-02-21 Skeletal Kinetics, Llc Use of vibration in composite fixation
US8382363B1 (en) * 2005-08-31 2013-02-26 Subrata Saha Automated bone cement mixer
US9707024B2 (en) 2004-03-09 2017-07-18 Skeletal Kinetics, Llc Use of vibration in composite fixation

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB2104390A (en) * 1981-08-25 1983-03-09 Univ Exeter Pressurisation of cement in bones
EP0093560A2 (fr) * 1982-05-03 1983-11-09 Pfizer Hospital Products Group, Inc. Dispositif d'étanchéité pour la pressurisation du ciment dans le canal intramédullaire
US4787751A (en) * 1986-06-20 1988-11-29 Marinus Bakels Bone cement mixing device

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB2104390A (en) * 1981-08-25 1983-03-09 Univ Exeter Pressurisation of cement in bones
EP0093560A2 (fr) * 1982-05-03 1983-11-09 Pfizer Hospital Products Group, Inc. Dispositif d'étanchéité pour la pressurisation du ciment dans le canal intramédullaire
US4787751A (en) * 1986-06-20 1988-11-29 Marinus Bakels Bone cement mixing device

Cited By (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0598964A1 (fr) * 1992-11-20 1994-06-01 SULZER Medizinaltechnik AG Corps pour dispenser du ciment osseux pour la fixation d'implants
GB2277448A (en) * 1993-04-19 1994-11-02 Paul Albert Thodiyil Ultrasound apparatus and method for securing or removing a prosthesis
EP0628295A1 (fr) * 1993-05-11 1994-12-14 ARTOS Medizinische Produkte GmbH Dispositif de remplissage pour ciment à os
DE4316655C2 (de) * 1993-05-11 2003-10-30 Biomet Merck Deutschland Gmbh Einfüllvorrichtung für Knochenzement
EP1095667A2 (fr) * 1999-11-01 2001-05-02 Dunsch-Herzberg, Renate Dispositif pour injecter du cement chirurgical dans le canal medullaire
EP1095667A3 (fr) * 1999-11-01 2001-05-30 Dunsch-Herzberg, Renate Dispositif pour injecter du cement chirurgical dans le canal medullaire
US6884264B2 (en) 2001-03-19 2005-04-26 Cambridge Polymer Group, Inc. System and methods for reducing interfacial porosity in cements
WO2002074195A2 (fr) * 2001-03-19 2002-09-26 Cambridge Polymer Group Inc. Systeme et procedes permettant de reduire la porosite interfaciale dans des ciments
WO2002074195A3 (fr) * 2001-03-19 2003-07-24 Cambridge Polymer Group Inc Systeme et procedes permettant de reduire la porosite interfaciale dans des ciments
WO2004112661A1 (fr) * 2003-06-20 2004-12-29 Myers Thomas H Procede et appareil de renforcement des proprietes biochimiques d'implants
US7252672B2 (en) 2003-09-11 2007-08-07 Skeletal Kinetics, Llc Use of vibration with orthopedic cements
US7261717B2 (en) 2003-09-11 2007-08-28 Skeletal Kinetics Llc Methods and devices for delivering orthopedic cements to a target bone site
US8167889B2 (en) 2003-09-11 2012-05-01 Skeletal Kinectics, LLC Use of vibration with orthopedic cements
US9833274B2 (en) 2003-09-11 2017-12-05 Skeletal Kinetics, Llc Use of vibration with orthopedic cements
US8118812B2 (en) 2004-03-09 2012-02-21 Skeletal Kinetics, Llc Use of vibration in composite fixation
US9707024B2 (en) 2004-03-09 2017-07-18 Skeletal Kinetics, Llc Use of vibration in composite fixation
WO2006024840A1 (fr) * 2004-09-01 2006-03-09 University Of Dundee Instrument chirurgical et procede permettant de perfectionner des implants orthopediques
US8382363B1 (en) * 2005-08-31 2013-02-26 Subrata Saha Automated bone cement mixer

Also Published As

Publication number Publication date
SE8804078L (sv) 1990-05-12
AU4512889A (en) 1990-05-28
SE8804078D0 (sv) 1988-11-11
SE462417B (sv) 1990-06-25

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