WO1993002641A1 - Systeme d'articulation prothetique servant au remplacement d'un os - Google Patents
Systeme d'articulation prothetique servant au remplacement d'un os Download PDFInfo
- Publication number
- WO1993002641A1 WO1993002641A1 PCT/US1991/005358 US9105358W WO9302641A1 WO 1993002641 A1 WO1993002641 A1 WO 1993002641A1 US 9105358 W US9105358 W US 9105358W WO 9302641 A1 WO9302641 A1 WO 9302641A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- bone
- prosthesis
- stem
- sleeve
- tapered portion
- Prior art date
Links
Classifications
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- 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
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- 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
- A61F2/32—Joints for the hip
- A61F2/36—Femoral heads ; Femoral endoprostheses
- A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
- A61F2002/3625—Necks
- A61F2002/3627—Necks with lateral apertures, holes or openings
-
- 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
- A61F2/32—Joints for the hip
- A61F2/36—Femoral heads ; Femoral endoprostheses
- A61F2/3662—Femoral shafts
- A61F2002/3678—Geometrical features
- A61F2002/369—Stepped shaft, i.e. having discrete diameter changes
-
- 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
- A61F2220/0033—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
-
- 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
-
- 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
- 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
- A61F2230/0067—Three-dimensional shapes conical
-
- 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
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys
Definitions
- This invention relates to prosthetic joints and, in particular, to a prosthetic joint system for use when bone replacement is required.
- Various prosthetic joints are known which include means for replacing bone which the patient has lost as a result of disease, trauma, or bio-mechanical degeneration caused by, for example, a previous joint implant.
- Figure 1 shows a two piece prosthesis 1A of this type which includes a stem 16 and a bone replacement portion 18 which can be a bone graft or a shaped part composed of a plastic material, such as ultra high molecular weight polyethylene (UHMWPE) .
- UHMWPE ultra high molecular weight polyethylene
- Figure 2 shows another prior art construction of this type which comprises a one piece metal prosthesis 10 which includes a proximal portion 12 which serves as a replacement for bone.
- prostheses of this general type include those sold by Howmedica under the product designations "Universal 32mm Proximal Femur Total Hip Components with Polished Loops", "Muller Type 32mm Proximal Femur”, "Harris Calcar Replacement 32mm Total Hip System", - 9 -
- these prostheses can provide the surgeon with some degree of choice at the time of surgery.
- a family of stems and a corresponding family of replacement portions 18 are provided to the surgeon.
- parts of the replacement portion can be cut away at the time of surgery to accommodate different amounts of bone loss. See the Allo Pro system, supra.
- these prostheses still suffer from problems in achieving an optimum interface between the stem 16 and the patient's bone.
- porous coating of the stem to achieve long term fixation through bone ingrowth is inadvisable since it may reduce the endurance-strength of the stem.
- Femoral prostheses which include sleeves for engagement with bone are also known in the art. See, for example, noisy U.S. Patent No. 4,846,839 and Noiles U.S. Patent No. 4,790,852. Such prostheses have not included separate bone replacement elements of the type shown in Figure 1 but in some cases have included an integral bone replacement portion of the type shown in Figure 2.
- the invention provides a prosthesis for implantation in bone which comprises: -L.
- a stem which has (i) a joint motion surface, e.g. , a " ball, at one end, and (ii) an outside surface which extends away from the joint motion surface and includes at least one tapered portion;
- the means for attaching the bone replacement element to the stem comprises an internal locking taper which engages either a part of the same tapered portion of the stem which the sleeve engages or a separate tapered portion of the stem.
- the bone replacement element can be composed of various materials including bone, metal, plastic, and ceramic.
- the means for attaching preferably comprises a second sleeve which is affixed to the bone graft and has an internal taper for locking onto the stem.
- the stem when used with a bone graft, the stem preferably includes two tapered portions and a fluted portion between the tapered portions which engages and cuts into the graft.
- the sleeve(s) are preferably stepped and may be porous coated.
- the outside surface of the element may be porous coated to aid in the attachment of muscles, tendons, and other tissues.
- families of stems and sleeves, and for certain embodiments, bone replacement elements are provided to the surgeon in the operating room. In this way, the surgeon can select those components which together provide the best overall fit and function for the particular conditions presented by the patient.
- the accompanying drawings which are incorporated in and constitute part of the specification, illustrate the preferred embodiments of the invention, and together with the description, serve to explain the principles of the invention. It is to be understood, of course, that both the drawings and the description are explanatory only and are not restrictive of the invention.
- Figure 1 is a side view of a prior art femoral prosthesis which includes a stem and a bone replacement portion.
- Figure 2 is a side view of a prior art femoral prosthesis whose proximal portion has been configured to replace lost bone.
- Figure 3 is a side view, partially . in cross-section, of a femoral prosthesis constructed in accordance with the invention for use with a bone graf .
- Figure 4 is a side view, partially in cross-section, of a femoral prosthesis constructed in accordance with the invention having a stem with two tapered portions, one for engagement with a bone replacement element and the other for engagement with a sleeve which is implanted in the patient's femur.
- Figure 5 is a side view, partially in cross-section, of a femoral prosthesis constructed in accordance with the invention having a bone replacement element which is clamped to the prosthesis' stem and a sleeve which engages a tapered portion of the stem.
- Figure 6 is a side view, partially in cross-section, of a femoral prosthesis constructed in accordance with the invention having a stem with an elongated tapered portion for engagement with both a bone replacement element and with a sleeve which is implanted in the patient's femur.
- Figure 7 is an expanded view of the outside surface of the sleeves of Figures 3-6 illustrating the use of steps or terraces on the outside surface.
- Figure 8 is a cross-sectional view along lines 8-8 in Figure 5 illustrating representative means for attaching a bone replacement element to the prosthesis' stem. DESCRIPTION OF THE PREFERRED EMBODIMENTS
- FIG. 3 a femoral prosthesis 20 constructed in accordance with the invention which incorporates bone graft 22.
- Prosthesis 20 includes elongated stem 13 which has ball 24 at one end which serves as a joint motion surface.
- the outside surface of stem 13 includes a first tapered portion 26 and a second tapered portion 28. Between the tapered portions are flutes 30.
- Stem 13 also includes a second set of flutes 38.
- Prothesis 20 further includes first sleeve 32, second sleeve 34, and trochanter washer 40 which is attached to stem 13 by screw 42.
- First sleeve 32 is - /
- a series (family) of sleeves 32 of different sizes and/or configurations is provided to the surgeon so that he or she can choose the sleeve which provides the best union with whatever portion of the femur remains for implantation.
- a family of stems 13 is also provided to the surgeon so that again optimizing choices can be made at the time of implantation.
- sleeve 32 preferably has a stepped outside surface 48 of the type described in noisy, U.S. Patent No. 4,846,839, the relevant portions of which are incorporated herein by reference.
- porous coating is used, such coating is preferably applied to just the sleeve and not to the stem. In this way, an opportunity for bone ingrowth is provided without putting the overall, structural integrity of the prosthesis at risk.
- sleeve 32 can include a collar 44 for engagement with the exposed, proximal end of the femur.
- the sleeve can include a protruding portion 46 constructed in accordance with noisy, U.S. Patent No. 4,790,852. It is to be understood, of course, that the illustrated sleeves can be used with any of the prostheses of Figures 4-6. Whatever construction is used for the sleeve's outside surface, its inner surface includes a tapered portion 50 for locking engagement with first tapered portion 26 of stem 13.
- the prosthesis of Figure 3 includes second sleeve 34 for engagement with bone graft 22.
- sleeve 34 can include various of the features discussed above with regard to sleeve 32.
- it can include a collar 44, a protruding portion 46, a stepped outside surface 48, and, if desired, a porous coating or other coating to enhance adhesion when cement is used to affix the graft.
- its inner surface includes a tapered portion 52 for locking engagement with second tapered portion 28 of stem 13.
- flutes 30 and trochanter washer 40 also help affix bone graft 22 to stem 13.
- the sleeve serves as the primary source of mechanical fixation between the graft and the stem.
- the flutes provide further fixation by helping prevent rotation of the graft about the stem as torque is applied to the graft by the patient's tendons and muscles.
- Trochanter washer aids in the attachment of those tendons and muscles to the prosthesis and also helps stabilize and strengthen the greater trochanter portion of the graft.
- the combination of these three - fixation mechanisms provides excellent stabilization of bone grafts including long bone grafts.
- Figure 4 shows an alternate embodiment 60 wherein a bone replacement element 54 composed of metal is used in place of bone graft 22.
- a series of bone replacements is preferably provided to the surgeon so that a selection of the - P .
- stem 13 includes a first tapered portion 26 which mates with first sleeve 32.
- the stem also includes second tapered portion 28 which mates and locks with taper 56 formed on the inside surface of element 54.
- the outside surface of element 54 can include a porous coating 58 to aid in the integration and bonding of the prosthesis to the patient's tissues.
- element 54 can also include a muscle/tendon attachment plate 62 of the type shown in Figure 5 ' .
- Figure 6 shows a variation of the prosthesis of Figure 4 wherein the stem's first tapered portion 26 has been elongated so that it mates with the internal tapers of both sleeve 32 and bone replacement element 54.
- Such a construction can also be used with the bone graft embodiment of Figure 3 for applications in which flutes 30 are not required.
- Figure 5 shows a further variation of the invention employing a bone replacement element 64 composed of plastic. Instead of locking tapers, this embodiment uses opposing flanges 66 and locking screws 68 to attach element 64 to stem 13. Such an attachment system can also be used with the metal bone replacement elements of Figures 4 and 6. Also, for a ceramic bone replacement element, the attachment system of Figure 5 can be combined with a taper lock of the type shown in Figures 4 and 6 to produce a strong attachment.
- the prostheses of the invention can be implante using a variety of techniques known in the art. Trial components are typically used to select a set of components best suited to the patient's needs.
- the patient's femur is resected as necessary and a straight hole for " receiving stem 13 is reamed into the femur's medullary canal.
- a conical cavity is then formed in the end of the femur for receiving sleeve 32.
- a side cavity for that portion can be formed in the end of the femur using a cutting tool of the type disclosed in U.S. Patent No. 4,790,852, the relevant portions of which are incorporated herein by reference.
- the bone replacement element is affixed to stem 13 prior to its implantation.
- fixation can be achieved by placing the element in an appropriate fixture and then applying a sharp impact force to stem 13 to lock the complimentary tapers on the element and the stem together.
- the element is slid over the stem and then tightened into place using screws 68.
- a cavity for the stem and sleeve 34 can be formed in the graft using techniques similar to those used to prepare the patient's femur.
- Sleeve 34 is then implanted in the graft, with or without cement, and the stem and sleeve are united by applying a sharp impact force to the stem to lock together the complimentary tapers.
- the prosthesis is inserted into the prepared femur by passing the stem through sleeve 32 into the straight cavity formed in the medullary canal. As the stem moves into its final position, flutes 38 cut channels into the canal. As the last step in the implantation, the stem and sleeve 32 are locked together by applying a sharp impact force to ⁇ l i ⁇
- the tapered surface(s) formed on stem 13 can have a variety of inclinations. For example, taper angles of 6° total included angle for surfaces 26 and 50 have been found to work successfully. Similar taper angles can be'used for surfaces 28 and mating surfaces 52 and 56. Other taper angles which can be used are in the range of from about 3° to about 10°.
- preferred surfaces for the interlocking tapers are a smooth machined surface on the stem and a recrystallized surface on the sleeve's internal taper as occurs during sintering of a porous coating.
- the components of the prosthesis can be constructed from surgically implantable materials such as chemically pure titanium or a titanium alloy containing 61 aluminum and 4% vanadium for stem 13, bone replacement element 54, and sleeves 32 and 34 (see ASTM Specification No. F136) and ultra high molecular weight polyethylene for element 64.
- the coating can comprise small spheres or particles of the same material as that used to form the underlying component.
Landscapes
- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
Abstract
L'invention décrit un système d'articulation prothétique s'utilisant quand il est nécessaire de remplacer un os. Le système comprend: (a) une tige allongée (13) possédant une surface de mouvement de l'articulation (24) située à l'une de ses extrémités et une surface extérieure comportant au moins une partie conique (26); (b) un manchon (32) se fixant sur l'os du patient et possédant un élément intérieur conique (50) se verrouillant sur la partie conique (26); (c) un élément de remplacement de l'os (22, 54, 64), pouvant être une greffe osseuse (22); enfin (d) des moyens (26, 28, 30, 34, 40, 42, 52, 56, 66, 68) servant à fixer l'élément de remplacement de l'os (22, 54, 64) à la tige (13) à un emplacement situé entre la surface de mouvement de l'articulation (24) et le manchon (32). Dans le cas de greffes osseuses (22), le système peut comporter un deuxième manchon (34) servant à une implantation dans la greffe (22), ainsi qu'une deuxième partie conique (28) située sur la tige (13), de façon à se verrouiller avec le deuxième manchon (34). On utilise de préférence une série de tiges coopérantes (13), des manchons (32), ainsi que des éléments de remplacement d'os (54, 64) (ou des deuxièmes manchons (34) dans le cas de greffes osseuses (22)).
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
CA002114208A CA2114208C (fr) | 1991-07-29 | 1991-07-29 | Systeme d'articulation prosthetique pour protheses osseuses |
PCT/US1991/005358 WO1993002641A1 (fr) | 1991-07-29 | 1991-07-29 | Systeme d'articulation prothetique servant au remplacement d'un os |
US08/185,914 US5658349A (en) | 1991-07-29 | 1991-07-29 | Prosthetic joint system for bone replacement |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
CA002114208A CA2114208C (fr) | 1991-07-29 | 1991-07-29 | Systeme d'articulation prosthetique pour protheses osseuses |
PCT/US1991/005358 WO1993002641A1 (fr) | 1991-07-29 | 1991-07-29 | Systeme d'articulation prothetique servant au remplacement d'un os |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1993002641A1 true WO1993002641A1 (fr) | 1993-02-18 |
Family
ID=25676956
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US1991/005358 WO1993002641A1 (fr) | 1991-07-29 | 1991-07-29 | Systeme d'articulation prothetique servant au remplacement d'un os |
Country Status (1)
Country | Link |
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WO (1) | WO1993002641A1 (fr) |
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2000072784A1 (fr) * | 1999-06-01 | 2000-12-07 | Apex Surgical, Llc | Protheses articulaires pouvant etre implantees |
EP0910999A3 (fr) * | 1997-10-21 | 2001-01-03 | Johnson & Johnson Professional, Inc. | Système prothétique modulaire à fixation hybride |
EP1398006A2 (fr) * | 2002-09-09 | 2004-03-17 | Depuy Products, Inc. | Articulation prothétique avec double fixation |
US7338496B1 (en) | 2003-08-29 | 2008-03-04 | Biomet Manufacturing Corp. | Method and apparatus for positioning an implant |
US7572297B2 (en) | 2003-10-09 | 2009-08-11 | Omni Life Science, Inc. | Tapered joint prosthesis |
US20210169655A1 (en) * | 2018-10-25 | 2021-06-10 | Revision Technologies Llc | Interconnected implants and methods |
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Cited By (10)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0910999A3 (fr) * | 1997-10-21 | 2001-01-03 | Johnson & Johnson Professional, Inc. | Système prothétique modulaire à fixation hybride |
WO2000072784A1 (fr) * | 1999-06-01 | 2000-12-07 | Apex Surgical, Llc | Protheses articulaires pouvant etre implantees |
US6702854B1 (en) | 1999-06-01 | 2004-03-09 | Apex Surgical, Llc | Implantable joint prosthesis |
US7044975B2 (en) | 1999-06-01 | 2006-05-16 | Apex Surgical, Llc | Joint prostheses and components thereof |
EP1398006A2 (fr) * | 2002-09-09 | 2004-03-17 | Depuy Products, Inc. | Articulation prothétique avec double fixation |
EP1398006A3 (fr) * | 2002-09-09 | 2005-01-19 | Depuy Products, Inc. | Articulation prothétique avec double fixation |
US7338496B1 (en) | 2003-08-29 | 2008-03-04 | Biomet Manufacturing Corp. | Method and apparatus for positioning an implant |
US8137358B2 (en) | 2003-08-29 | 2012-03-20 | Biomet Manufacturing Corp. | Method and apparatus for positioning an implant |
US7572297B2 (en) | 2003-10-09 | 2009-08-11 | Omni Life Science, Inc. | Tapered joint prosthesis |
US20210169655A1 (en) * | 2018-10-25 | 2021-06-10 | Revision Technologies Llc | Interconnected implants and methods |
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