WO1991003992A1 - Implants d'os sur le squelette - Google Patents

Implants d'os sur le squelette Download PDF

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Publication number
WO1991003992A1
WO1991003992A1 PCT/GB1990/001411 GB9001411W WO9103992A1 WO 1991003992 A1 WO1991003992 A1 WO 1991003992A1 GB 9001411 W GB9001411 W GB 9001411W WO 9103992 A1 WO9103992 A1 WO 9103992A1
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WO
WIPO (PCT)
Prior art keywords
εtem
bone
canal
bone canal
fit
Prior art date
Application number
PCT/GB1990/001411
Other languages
English (en)
Inventor
Peter Stanley Walker
Original Assignee
Walker Peter S
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 Walker Peter S filed Critical Walker Peter S
Publication of WO1991003992A1 publication Critical patent/WO1991003992A1/fr

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    • 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
    • A61F2/30721—Accessories
    • A61F2/30724—Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving 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
    • A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
    • 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
    • A61F2/3094—Designing or manufacturing processes
    • A61F2/30942—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3662—Femoral shafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3662—Femoral shafts
    • A61F2/3676—Distal or diaphyseal parts of shafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006—Properties of materials and coating materials
    • A61F2002/30062—(bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30224—Three-dimensional shapes cylindrical
    • A61F2002/30235—Three-dimensional shapes cylindrical tubular, e.g. sleeves
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • 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
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
    • 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
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
    • A61F2002/30339—Double cones, i.e. connecting element having two conical connections, one at each of its opposite ends
    • 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
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
    • A61F2002/30349—Conically- or frustoconically-shaped protrusion and recess the male and female complementary cones being of different conicities, i.e. for reducing the contact area
    • 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
    • A61F2/30724—Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity
    • A61F2002/30726—Centering or guiding rods, e.g. for insertion of femoral shafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30721—Accessories
    • A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
    • A61F2002/30738—Sleeves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30907—Nets or sleeves applied to surface of prostheses or in cement
    • A61F2002/30919—Sleeves
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/3094—Designing or manufacturing processes
    • A61F2/30942—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
    • A61F2002/30943—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques using mathematical models
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
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    • A61F2002/30952—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques using CAD-CAM techniques or NC-techniques
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3662—Femoral shafts
    • A61F2002/3678—Geometrical features
    • A61F2002/3694—Geometrical features with longitudinal bores
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4631—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor the prosthesis being specially adapted for being cemented
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    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0004—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof bioabsorbable
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    • 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
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
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    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0069—Three-dimensional shapes cylindrical

Definitions

  • This invention relates to endoprosthetic bone implant devices for joint replacement, particularly for total hip replacement.
  • Surgical removal of the natural joint and replacement with an artificial joint is practised in the treatment of severely diseased joints, for example, arthritic joints.
  • the procedure which is carried out routinely in total hip replacement surgery involves resecting the femoral head and neck, shaping the femoral canal using reamers and rasps and introducing an endoprosthetic femoral component.
  • This component generally consists of a metallic stem which locates down the medullary canal of the femur, and includes a head and neck portion. The ste is fixed into the canal using a self-curing acrylic cement, or the stem is pressed into place, relying on a good mechanical fit.
  • Cemented stems have generally had a good clinical record with only a small percentage of outright failures at a 10 year follow-up in old and generally inactive patients. However, for longer periods, or when the patients are younger and/or more active, failures are more common. The modes of failure include bone re ⁇ orption at the cement-bone interface due to high stresses, and cement cracking due to fatigue and stress concentrations. Uncemented press-fit stems have been used most often in the younger active group. A number of problems have been encountered with these patients.
  • the present invention is directed to the alleviation of the problems discussed above and to the provision of endoprosthetic joint devices which have other advantageous eatures.
  • a second approach is to define specific design features of a skeletal implant which have been found to have important practical advantages.
  • an endoprosthetic joint device especially a femoral joint component, having a stem adapted to be located within a canal of a bone forming part of a joint, said stem including a proximal portion which is a close fit in the bone canal and a distal portion which is tapered and an intermediate portion, shaped to provide clearance between the stem and the bone canal .
  • a method of determining the shape and dimensions of a femoral implant which comprises the following steps:-
  • (d) representing the exterior contour of the stem of the implant by a cubic curve which joins the proximalmo ⁇ t section to the distal half cylindrical part of the stem, and which is a close fit proximally to the bone canal, while the distal half is a ⁇ liding fit distally.
  • the present invention derive ⁇ in part from the realisation that it is highly desirable to design the prosthe ⁇ is ⁇ o that in u ⁇ e the bone i ⁇ loaded in a ⁇ imilar way to the normal condition in the body.
  • the prosthesis should transmit the load to the bone from the upper part of the femur downwards in such a way that there i ⁇ a gradual load transmission from the upper part of the stem downwardly to the bone in the lower part.
  • Overall loading of the bone i ⁇ important becau ⁇ e bone which is unloaded will tend to re ⁇ orb.
  • ⁇ tres ⁇ es are set up which cause bone damage.
  • the aim i ⁇ to produce a profile of the upper part of the ⁇ tem which i ⁇ a good fit in the proximal bone canal and a di ⁇ tal portion which applie ⁇ a gradual and uniform load di ⁇ tribution to the femur in the region of the di ⁇ tal canal.
  • the intermediate portion of ⁇ tem i ⁇ ⁇ haped to provide clearance in the bone canal and the di ⁇ tal portion of the ⁇ tem is tapered over at least part of its length.
  • micro-motion can be contained by in ⁇ erting a pla ⁇ tic ⁇ leeve or cap into the di ⁇ tal canal which i ⁇ a tight fit in the di ⁇ tal-most part of the canal and in which the di ⁇ tal end of the ⁇ tem i ⁇ tightly held.
  • the invention includes a specific design of ⁇ leeve which not only limit ⁇ micro-motion but ⁇ pread ⁇ the load generated by micro- ⁇ winging motion of the prosthe ⁇ i ⁇ .
  • the di ⁇ tal-mo ⁇ t portion i ⁇ preferably cylindrical.
  • the preci ⁇ e ⁇ hape of the distal portion has wider latitude since the ⁇ tem will be spaced from the interior of the bone canal by a cement mantle.
  • correct load distribution i ⁇ ju ⁇ t as important and it is an important feature of the implant ⁇ of the pre ⁇ ent invention that they can be employed in both cemented and cementle ⁇ fitting ⁇ .
  • the bone is sized initially for a pres ⁇ -fit prosthesis and then downsized to provide a sufficient clearance overall to allow for a cement mantle but with the ⁇ ame relative dimen ⁇ ion ⁇ .
  • an endopro ⁇ thetic femoral joint implant which compri ⁇ e ⁇ a ⁇ tem adapted to be located and cemented in place in a femoral bone canal, ⁇ aid ⁇ tem including a proximal portion which i ⁇ ⁇ haped to conform with the bone canal but with a predetermined ⁇ mall clearance intended to be filled with cement and a di ⁇ tal portion which i ⁇ tapered progressively from the proximal portion so a ⁇ to provide in the cemented implant a gradually thicker cement mantle between the implant and the bone canal and a load distribution, when said implant is inserted from the proximal end, which is concentrated in the proximal end of said femoral bone.
  • the invention also include ⁇ improved method ⁇ of fitting bone implant ⁇ into bone canal ⁇ , in which a cannulated ⁇ tem i ⁇ u ⁇ ed to enable the stem to be guided into the canal on a guide rod or to enable a pres ⁇ -fit pla ⁇ tic ⁇ leeve to be located over the distal end of the ⁇ tem and thereby reduce micromovement between the stem and the bone.
  • the present invention is intended to be applied mainly to femoral joint component ⁇ , but the principle ⁇ and de ⁇ ign ⁇ de ⁇ cribed hereinafter are adaptable to other joint ⁇ .
  • Figure 1 i ⁇ a repre ⁇ entation of an average femur taken from mea ⁇ urement ⁇ of 26 ⁇ pecimen ⁇ .
  • Figure 1A i ⁇ a view taken in the direction of the arrow A in Figure 1.
  • Figure 2 i ⁇ a plan view taken in the direction of arrow B in Figure 1.
  • Figure 3 i ⁇ a top plan view of the ⁇ tem of a hip pro ⁇ thesi ⁇ ⁇ howing al ⁇ o the outline of the bone canal.
  • Figures 4A and 4B are lateral and posterior view ⁇ showing the fit of the stem in the proximal femur.
  • Figure ⁇ 5A, 5B and 5C illustrate the manner of forming a symmetrical version of the stem of the pro ⁇ the ⁇ i ⁇ .
  • Figure ⁇ 6A & 6B how re ⁇ pectively anterior-po ⁇ terior (A-P) views of cemented and pre ⁇ -fit pro ⁇ the ⁇ i ⁇ in accordance with the invention.
  • Figure ⁇ 7A & 7B how A-P and lateral views of a second embodiment of the invention.
  • Figure ⁇ 8A, 8B, 8C & 8D how variou ⁇ perspective views of the proximal part of the stem of a further embodiment having a pseudo collar.
  • Figure ⁇ 9A, 9B & 9C show a sequence of step ⁇ for the introduction and fixing of a cemented pro ⁇ the ⁇ i ⁇ .
  • Figure ⁇ 10A & 10B illustrate the steps of fitting a pres ⁇ -fit pro ⁇ the ⁇ i ⁇ with cannulated ⁇ tem in accordance with the invention.
  • Figure 11 i ⁇ a view of a pres ⁇ -fit pro ⁇ thesi ⁇ in a bone canal having a modified di ⁇ tal ⁇ leeve for ⁇ preading the di ⁇ tal load di ⁇ tribution.
  • Figure ⁇ 1, 1A and 2 are repre ⁇ entation ⁇ of an average femur taken from measurements of 26 adult specimens. It will be appreciated that more or less specimen ⁇ may be taken, e.g. 15 or 30, ⁇ o long a ⁇ the number is enough to provide a representative average.
  • the inner and outer contour ⁇ of the average femur were produced by mea ⁇ urement ⁇ taken of ⁇ lice ⁇ made from ⁇ pecimen ⁇ and plotted u ⁇ ing the computer-aided technique de ⁇ cribed by Walker et al in Clinical Orthopaedic ⁇ and Related Re ⁇ earch, No. 235, October 1988, page 25. The inner and outer contour ⁇ were digiti ⁇ ed into a computer and ⁇ plined to determine 40 uniformly spaced points.
  • the next step i ⁇ to define the ⁇ hape of the stem and in particular the proximal part which will give the optimal fit in proximal portion of the re ⁇ ected femur. It ha ⁇ been determined that optimal fit i ⁇ achieved by implant-cortical bone contact (i.e. an implant bone ⁇ pacing of 1mm or le ⁇ ), between the cortex and the implant.
  • implant-cortical bone contact i.e. an implant bone ⁇ pacing of 1mm or le ⁇
  • An anterior circle B i ⁇ drawn with the ⁇ ame diameter as lateral circle A.
  • a medial circle C i ⁇ drawn a ⁇ the be ⁇ t fit to the proximal end of the bone canal.
  • the outline of the proximal ⁇ ection of the device i ⁇ then determined by the mutual tangent ⁇ T ⁇ , T2 and T3.
  • Figure 4 shows the preferred ⁇ hape of the proximal portion of the ⁇ tem 41 of the device.
  • the cro ⁇ -hatched part 35 repre ⁇ ent ⁇ the cubic curve in the anterior and lateral view ⁇ and the relation ⁇ hip of the device to the bone canal.
  • the contour of the upper region 40 of the ⁇ tem 41 i ⁇ a clo ⁇ e fit proximally to the bone canal, which provides good load tran ⁇ fer.
  • Upper ⁇ ection 40 merges into an intermediate ⁇ ection 42 in which clearance i ⁇ provided from the bone in the area between the le ⁇ er trochanter and the mid-point of the length of the ⁇ tem, (the di ⁇ tal end of which i ⁇ not ⁇ hown in Figure 4), which i ⁇ indicated by the arrow 43.
  • Thi ⁇ arrangement has two advantage ⁇ . Fir ⁇ t, loads are tran ⁇ mitted between the ⁇ tem and the bone proximally at 40, which corre ⁇ pond ⁇ to the phy ⁇ iological ⁇ ituation. Secondly, it avoid ⁇ the danger of hanging up of the ⁇ tem in the region 42 a ⁇ the ⁇ tem i ⁇ being introduced ⁇ urgically. The next ⁇ tep in the de ⁇ ign of the device i ⁇ to add a neck portion (together, if de ⁇ ired, with a partial collar a ⁇ de ⁇ cribed below) and a modular femoral head.
  • Figure ⁇ 6A & B the left-hand figure ( Figure 6A) ⁇ how ⁇ the outline of the ⁇ tem 41, the canal 46 and the intervening cement mantle 47.
  • a tapered di ⁇ tal portion 44 i ⁇ preferred since thi ⁇ prevent ⁇ high ⁇ tre ⁇ concentration at the tip. With a taper, load is tran ⁇ ferred to the bone uniformly, rather than abruptly near the tip a ⁇ would occur if the ⁇ tem were of uniform thickne ⁇ s.
  • Figure 6B show ⁇ the pre ⁇ -fit embodiment, in which the extreme distal end part i ⁇ closer to a cylindrical ⁇ hape and the loading on the distal load i ⁇ ⁇ pread by u ⁇ e of a pla ⁇ tic ⁇ leeve S, having a clo ⁇ ed lower end, which i ⁇ a pre ⁇ -fit in the canal.
  • the proximal part taper ⁇ ⁇ omewhat to approximately the di ⁇ tal quarter of the stem.
  • Radial or tor ⁇ ional micro-motion e.g. of up to about 50 micron ⁇ and angular movements of up to about 0.1° can be readily tolerated.
  • spreading of the load which is transmitted to the bone i ⁇ neverthele ⁇ desirable.
  • T i ⁇ spreading of the load is achieved in the embodiment shown in Figure 11 by internal shaping of the pla ⁇ tic ⁇ ⁇ leeve.
  • the pla ⁇ tic ⁇ sleeve • 110 (which i ⁇ a tight-fit in the di ⁇ tal bone canal 111) ha ⁇ a non-uniform bore and in ⁇ ection ha ⁇ a convex internal shape 112.
  • the ⁇ ituation i ⁇ exaggerated in Figure 11, but the internal ⁇ hape i ⁇ such that the di ⁇ tal portion of the ⁇ tem 113 i ⁇ a tighter fit in the intermediate part of the bore in the ⁇ leeve 110 than at its ends.
  • the groove ⁇ or recesse ⁇ X extend longitudinally of the ⁇ tem and preferably have rounded upper end ⁇ .
  • the groove ⁇ X begin ju ⁇ t below the neck or collar and form two ⁇ helve ⁇ Y which are capable of taking axial force and resisting ⁇ inkage.
  • the grooves are machined down the stem in a direction parallel to the axi ⁇ of the ⁇ tem so as to terminate at a point in the region of the mid-point of the stem or just above it.
  • the ⁇ tem could be removed ( in case of a uture problem) by simply tapping it upward ⁇ out of it ⁇ cement bed (where present), becau ⁇ e of the ⁇ tem divergence in the upper ⁇ tem, which greatly facilitate ⁇ a revision procedure.
  • Grooves formed in this way also provide axial load ⁇ upport and reduced ⁇ tem ⁇ tiffne ⁇ .
  • Figure ⁇ 8A-D include ⁇ everal view ⁇ of a p ⁇ eudo (partial) collar which is another advantageous, preferred feature of the de ⁇ ign.
  • a protru ⁇ ion or ledge i ⁇ provided, e.g. medially, anteriorly and po ⁇ teriorly but not laterally.
  • the p ⁇ eudo collar i ⁇ formed integrally between the upper ⁇ ection cf the ⁇ tem and the neck of the device.
  • Figure ⁇ 9A, 9B & 9C illu ⁇ trate the methods of introducing cemented ⁇ tems and Figures 10A & 10B the method of inserting pres ⁇ -fit ⁇ tem ⁇ in accordance with the invention.
  • the ⁇ tem is cannulated to receive a guide rod 91.
  • the polymer will gradually resorb, allowing some ⁇ pace for downward movement of the ⁇ tem within the pla ⁇ tic ⁇ leeve.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Vascular Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Cardiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Transplantation (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Physics & Mathematics (AREA)
  • Geometry (AREA)
  • Manufacturing & Machinery (AREA)
  • Prostheses (AREA)

Abstract

Est présenté un système d'endoprothèse plus particulièrement conçu pour la chirurgie de remplacement de la hanche, destiné à une transmission progressive de la charge sur l'os à partir de l'extrémité terminale. Le système comprend une fibre ayant un contact serré avec l'implant d'os dans la région proximale (40), une partie distale (43) ayant une section s'amincissant et une section intermédiaire (42) ayant un espace intermédiaire entre l'os et l'implant. Lorsque le système est implanté par ajustage serré, il comprend un manchon (45) qui est ajusté de manière serrée dans le canal de l'os distal et qui permet à la fibre de se glisser à l'intérieur. Sont également présentées des méthodes d'implantation des systèmes à l'aide de techniques de cimentation et d'ajustage serré.
PCT/GB1990/001411 1989-09-15 1990-09-13 Implants d'os sur le squelette WO1991003992A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB898921008A GB8921008D0 (en) 1989-09-15 1989-09-15 Skeletal implants
GB8921008.2 1989-09-15

Publications (1)

Publication Number Publication Date
WO1991003992A1 true WO1991003992A1 (fr) 1991-04-04

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EP (1) EP0491787A1 (fr)
JP (1) JPH05500177A (fr)
AU (1) AU646814B2 (fr)
CA (1) CA2064779A1 (fr)
GB (2) GB8921008D0 (fr)
WO (1) WO1991003992A1 (fr)

Cited By (14)

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EP0523926A2 (fr) * 1991-07-15 1993-01-20 SMITH & NEPHEW RICHARDS, INC. Implants prothétiques avec revêtement bioabsorbable
EP0530323A4 (fr) * 1990-05-23 1994-04-13 Mikhail, Michael W.E.
WO1994007438A1 (fr) * 1992-10-01 1994-04-14 Tronzo Raymond G Mecanisme a manchon porteur incorpore dans l'element femoral
EP0595956A1 (fr) * 1990-08-10 1994-05-11 MIKHAIL, Michael W.E. Systeme visant a remplacer une prothese de la hanche
EP0622061A1 (fr) * 1993-04-29 1994-11-02 Howmedica Inc. Composant fémoral pour prothèse de hanche
ES2067422A1 (es) * 1993-09-02 1995-03-16 Traiber S A Protesis intracementada para cadera humana.
FR2725617A1 (fr) * 1994-10-12 1996-04-19 Prost Didier Tige femorale pour prothese de hanche
EP0808618A2 (fr) * 1996-05-24 1997-11-26 Howmedica Inc. Tige asymétrique pour la hanche
WO1999003429A3 (fr) * 1997-07-14 1999-04-08 Volkmar Jansson Systeme d'endoprothese a compression
WO1999048443A1 (fr) * 1998-03-20 1999-09-30 Johnson & Johnson Medical Limited Element de centrage
US6464728B1 (en) 1998-04-14 2002-10-15 Ian P. Murray Modular neck for femur replacement surgery
EP1522280A2 (fr) * 2003-09-12 2005-04-13 Toshinobu Katsuya Elément intermédiaire/distal pour articulation artificielle
US6974483B2 (en) 1998-04-14 2005-12-13 Encore Medical Corporation Modular neck for femur replacement surgery
US8268007B2 (en) 2009-06-26 2012-09-18 The Cleveland Clinic Foundation Multi-piece prosthetic joint component

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GB9026592D0 (en) * 1990-12-06 1991-01-23 Meswania Jayantilal M Surgical instrument
US5976188A (en) * 1997-10-21 1999-11-02 Johnson & Johnson Professional, Inc. Modular prosthesis system with hybrid fixation
US10610364B2 (en) 2008-12-04 2020-04-07 Subchondral Solutions, Inc. Method for ameliorating joint conditions and diseases and preventing bone hypertrophy
CN108495595B (zh) 2015-11-25 2022-02-01 软骨解决方案股份有限公司 用于修复解剖关节病症的方法、系统和设备
CN110193926A (zh) * 2019-05-08 2019-09-03 西安交通大学 一种聚醚醚酮仿生多层次人工关节的设计与制造方法

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EP0358399A1 (fr) * 1988-08-31 1990-03-14 DePuy Inc. Implant fémoral pour la hanche avec distribution de charge
EP0363151A2 (fr) * 1988-10-07 1990-04-11 Howmedica Inc. Dispositif prothétique

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GB8426866D0 (en) * 1984-10-24 1984-11-28 Finsbury Instr Ltd Bone implants
US4813963A (en) * 1987-08-24 1989-03-21 Zimmer, Inc. Femoral component for a hip prosthesis
GB2222776B (en) * 1988-09-15 1992-12-02 Mclardy Smith Peter David A prosthesis

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CH651465A5 (fr) * 1981-04-07 1985-09-30 New York Society Composant femoral pour une prothese d'articulation de la hanche.
CH664081A5 (de) * 1984-12-13 1988-02-15 Sulzer Ag Hueftgelenkprothese.
EP0209516A2 (fr) * 1985-07-16 1987-01-21 BÖHLER Gesellschaft m.b.H. Implant osseux pour endoprothèses et instrument pour le positionner
DE3730814A1 (de) * 1987-09-14 1989-03-23 Gernot Dr Med Felmet Zementfrei implantierbarer, selbstnachspannender hueftgelenkschaft
EP0315283A2 (fr) * 1987-11-03 1989-05-10 Orthopaedic Technology B.V. Méthode pour former une endoprothèse
EP0358399A1 (fr) * 1988-08-31 1990-03-14 DePuy Inc. Implant fémoral pour la hanche avec distribution de charge
EP0363151A2 (fr) * 1988-10-07 1990-04-11 Howmedica Inc. Dispositif prothétique

Cited By (22)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0530323A4 (fr) * 1990-05-23 1994-04-13 Mikhail, Michael W.E.
EP0595956A1 (fr) * 1990-08-10 1994-05-11 MIKHAIL, Michael W.E. Systeme visant a remplacer une prothese de la hanche
EP0595956A4 (en) * 1990-08-10 1994-08-24 Michael W E Mikhail System for performing hip prosthesis revision surgery
EP0523926A2 (fr) * 1991-07-15 1993-01-20 SMITH & NEPHEW RICHARDS, INC. Implants prothétiques avec revêtement bioabsorbable
EP0523926A3 (en) * 1991-07-15 1993-12-01 Smith & Nephew Richards Inc Prosthetic implants with bioabsorbable coating
US5458653A (en) * 1991-07-15 1995-10-17 Smith & Nephew Richards, Inc. Prosthetic implants with bioabsorbable coatings
WO1994007438A1 (fr) * 1992-10-01 1994-04-14 Tronzo Raymond G Mecanisme a manchon porteur incorpore dans l'element femoral
EP0622061A1 (fr) * 1993-04-29 1994-11-02 Howmedica Inc. Composant fémoral pour prothèse de hanche
ES2067422A1 (es) * 1993-09-02 1995-03-16 Traiber S A Protesis intracementada para cadera humana.
EP0711534A1 (fr) * 1994-10-12 1996-05-15 Didier Dr. Prost Tige fémorale pour prothèse de hanche
FR2725617A1 (fr) * 1994-10-12 1996-04-19 Prost Didier Tige femorale pour prothese de hanche
EP0808618A2 (fr) * 1996-05-24 1997-11-26 Howmedica Inc. Tige asymétrique pour la hanche
EP0808618A3 (fr) * 1996-05-24 1999-03-10 Howmedica Inc. Tige asymétrique pour la hanche
US6007581A (en) * 1996-05-24 1999-12-28 Stryker Technologies Corporation Asymmetric hip stem
US6102957A (en) * 1996-05-24 2000-08-15 Stryker Technlogies Corporation Asymmetric hip stem
WO1999003429A3 (fr) * 1997-07-14 1999-04-08 Volkmar Jansson Systeme d'endoprothese a compression
WO1999048443A1 (fr) * 1998-03-20 1999-09-30 Johnson & Johnson Medical Limited Element de centrage
US6464728B1 (en) 1998-04-14 2002-10-15 Ian P. Murray Modular neck for femur replacement surgery
US6974483B2 (en) 1998-04-14 2005-12-13 Encore Medical Corporation Modular neck for femur replacement surgery
EP1522280A2 (fr) * 2003-09-12 2005-04-13 Toshinobu Katsuya Elément intermédiaire/distal pour articulation artificielle
EP1522280A3 (fr) * 2003-09-12 2005-10-26 Ltd. Senko Medical Instrument Mfg. Co. Elément intermédiaire/distal pour articulation artificielle
US8268007B2 (en) 2009-06-26 2012-09-18 The Cleveland Clinic Foundation Multi-piece prosthetic joint component

Also Published As

Publication number Publication date
EP0491787A1 (fr) 1992-07-01
AU646814B2 (en) 1994-03-10
CA2064779A1 (fr) 1991-03-16
GB2236679A (en) 1991-04-17
GB2236679B (en) 1994-02-16
GB9020035D0 (en) 1990-10-24
GB8921008D0 (en) 1989-11-01
AU6408790A (en) 1991-04-18
JPH05500177A (ja) 1993-01-21

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