WO1996005784A1 - Endoprothese non guidee pour petites articulations - Google Patents

Endoprothese non guidee pour petites articulations Download PDF

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Publication number
WO1996005784A1
WO1996005784A1 PCT/DE1995/000611 DE9500611W WO9605784A1 WO 1996005784 A1 WO1996005784 A1 WO 1996005784A1 DE 9500611 W DE9500611 W DE 9500611W WO 9605784 A1 WO9605784 A1 WO 9605784A1
Authority
WO
WIPO (PCT)
Prior art keywords
joint
endoprosthesis
replaced
bone
guided
Prior art date
Application number
PCT/DE1995/000611
Other languages
German (de)
English (en)
Inventor
Hans-Jürgen Moje
Dieter Werner
Original Assignee
Moje Hans Juergen
Dieter Werner
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 Moje Hans Juergen, Dieter Werner filed Critical Moje Hans Juergen
Publication of WO1996005784A1 publication Critical patent/WO1996005784A1/fr

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Classifications

    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4225—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for feet, e.g. toes
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4225—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for feet, e.g. toes
    • A61F2002/4233—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for feet, e.g. toes for metatarso-phalangeal joints, i.e. MTP joints
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
    • A61F2002/4243—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for interphalangeal joints, i.e. IP joints
    • 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
    • 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
    • A61F2310/00179—Ceramics or ceramic-like structures

Definitions

  • the invention relates to a non-guided endoprosthesis for small joints, in particular for the joints of the toes and the joints of the fingers.
  • Endoprostheses for small joints have been known for years to replace damaged joints. These endoprostheses mostly consist of metals that are compatible with humans and are used surgically instead of the destroyed joint.
  • EP-A1-0 455 929 proposes a joint prosthesis, in particular for a finger joint, which comprises a bearing body having a bearing surface in the form of a thin-walled shell element made of high-strength metallic materials, on the rear side of which a shaft to be embedded in the bone is molded.
  • EP-A-0 420 794 suggests one
  • Finger joint prosthesis which consists of two prosthesis halves sliding on each other, each of which is anchored in the bone ends assigned to the joint part.
  • the prosthesis halves consist of a sintered structure of hydroxyl apatite.
  • this material is not suitable for highly stressed joints because it does not provide the required high strength properties.
  • EP-A-0 396 519 describes a special anchoring element for anchoring a prosthesis in the bone ends.
  • the joint prosthesis is anchored as firmly and deeply as possible in the adjacent bone.
  • a guide bush ensures sufficient centering.
  • This anchoring element is preferably made of titanium or is coated with titanium. There may be additional surface texture have to facilitate attachment in the bone and improve the hold.
  • a non-guided joint replacement is proposed in EP-A-0 314 593.
  • a metal joint surface which has the shape of a joint shell, is inserted between the bones between which the joint is to be replaced, and is held by a mandrel screwed in from the tip of the foot.
  • the mandrel is pulled in a second operation and in one third operation, when the new formation of the joint is complete, the joint surface is removed again.
  • This method long practiced in France, was intended to restore the natural joint.
  • the main disadvantage was the appearance that the joint surface was often displaced due to the lack of centering when the mandrel was pulled, and therefore the healing success was not achieved.
  • the patient was unable to walk for a longer period of time, but at least during the time in which the spine was needed.
  • the object of the invention is therefore to provide an endoprosthesis for small joints which is not guided and which replaces the destroyed joint with the aid of a single operation.
  • Another object of the invention is to heal the patient as quickly as possible and without inpatient treatment.
  • the joint surface which is to replace at least one missing joint part, is locked in the bone with a centering pin.
  • the articular surface which has a circular or rectangular shape with rounded edges, has a preferably conical center hole. Through this the centering pin is in the one behind
  • the joint surface and the centering pin are preferably made of a non-allergenic, high-strength ceramic material, such as, for example, a ceramic based on zirconium oxide from TOSOH CORPORATION, Japan, but they can also consist of plastics, metals or metal alloys which have the required properties possess non-allergenic properties. It is not necessary that the joint surface and the centering pin each consist of the same materials in a joint replacement.
  • the implantation of these endoprostheses consists of the following steps: In a first step, the through the
  • Bone part to be replaced resected in a second step the articular surface is adapted to the bone, in a third step the articular surface is centered with a centering pin which is pressed through the center hole of the articular surface into the underlying bone. The wound is then closed.
  • steps 1 to 3 are repeated on the opposite joint part and the wound is then closed.
  • the endoprosthesis preferably consists of a non-allergenic ceramic. This has much more favorable properties in terms of compatibility with humans than the metal parts used to date.
  • the invention allows inexpensive restoration of destroyed joints both with regard to the implant and with regard to the operation and the aftercare of the operated patient.
  • the invention is based on
  • 1A to IC show possible shapes of the articular surface in a view from above and as sectional views
  • Fig. 1d shows possible shapes of the centering pins
  • Fig. Le to lg show further embodiments of the
  • Fig. 2 shows a unilateral replacement of the finger end joint of the third finger
  • Fig. 3 shows a one-sided replacement of a joint of the first toe
  • Fig. 4 shows the replacement of a complete joint of the first
  • FIGS. le to lg show some forms of articular surfaces 1 for small joints as views from above and as sectional views along lines II to VI-VI.
  • Fig. La shows a circular joint surface 1 for the replacement of the joint of a toe with the center hole 3.
  • This center hole 3 preferably has a smaller diameter on the side lying on the bone 8 than on the joint side.
  • the circular surface here has a concave curvature 5 for the replacement of a proximal joint part.
  • the side abutting the bone 8 has a flattened portion 2.
  • FIG. 1b shows a joint surface 1 with a convex curvature 5 for the replacement of the distal joint part, which supplements the joint surface 1 according to FIG. 1 to form a complete joint for a toe joint.
  • Fig. Lc an articular surface 1 is shown for the replacement of a finger joint.
  • the joint surface 1 has a rectangular shape with rounded edges.
  • the joint surface of the endoprosthesis for the last finger joint is also equipped with a concave (5) and a convex curvature (6).
  • the concave curvature (5) is assigned to the proximal joint part and the convex curvature (6) to the distal joint part.
  • Fig. 1 g also represents an endoprosthesis for the last finger joint.
  • the entire last bone member can be replaced.
  • This form is particularly advantageous when the end member is so badly damaged that it can no longer offer the endoprosthesis an attachment.
  • Some forms of the centering pins 4 are shown in FIG.
  • the centering pin 4 preferably has a conical shape and it can have certain configurations known per se in order to enlarge the surface of the shaft.
  • the cross section of the centering pin 4 can be shaped differently.
  • a rounded head 9 can also be formed, which offers additional advantages for both insertion and centering.
  • the use of centering pins 4, which have a rounded head 9, is particularly advantageous when replacing finger joints.
  • FIG. 2 shows a schematic illustration of a one-sided replacement of a finger joint with the aid of the joint surface 1 shown in FIG. 1c. It can be clearly seen that the centering pin 4 penetrates the adjacent bone 8 only slightly. It can also be seen that the bone 8 has been resected only very slightly. This makes it possible for the first time to surgically restore the end joint of a finger. Since the articular surface 1 made of ceramic remains in the finger after the healing process, there are no further stresses. The newly formed bone tissue encloses the extremely compatible ceramic body and thus gives it the necessary support.
  • FIG. 3 shows a replacement of the proximal joint part of a joint of the first toe with the aid of the joint surface 1 shown in FIG. 1a.
  • the shallow depth of penetration of the centering pin 4 into the adjacent bones is also visible.
  • the concave curvature 5 runs against the healthy joint part. Experience shows that not only the functionality of the joint is restored, but also the natural joint side is stabilized again.
  • Fig. 4 shows the use of a complete joint in the first toe. Both an articular surface 1 according to FIG. 1 a and an articular surface 1 according to FIG. 1 b are used instead of the destroyed joint.
  • the figures 5a to 5c show endoprostheses according to the invention with wedge-shaped fits into the bones 8 of the end joints of the fingers.
  • 5a shows the replacement of the proximal joint part of the end member, 1 denoting the implant, 5 the concave curvature of the implant 1, 3 the center hole, 4 the centering pin and 7 the wedge-shaped recess.
  • Fig. 5b shows the replacement of the distal part of the end joint and
  • Fig. 5c shows the replacement of the complete joint.
  • the wedge is perpendicular to the direction of movement of the joint. This embodiment of the invention is particularly advantageous when replacing finger joints because the risk of twisting is relatively great in the case of the finger joints.
  • the flattening 2 of the joint surface 1 or the wedge-shaped opposite side of the joint surface is adapted to the bone 8 during operation and centered on the bone 8 located behind it with a centering pin 4.
  • this centering pin 4 is not used for fastening.
  • the required fixation of the implant takes place solely through the healing process, in which the newly formed bone tissue Encloses endoprosthesis. The operation is ended after the wound is closed.

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 concerne une endoprothèse non guidée pour petites articulations, notamment pour les articulations des orteils ou celles des doigts. L'endoprothèse permet de remplacer en une seule opération une partie ou l'ensemble de l'articulation endommagée, selon son degré de détérioration. Le patient peut ainsi être traité rapidement et de manière générale sans devoir resté hospitalisé. L'implantation de ces endoprothèses comprend les étapes suivantes: la partie osseuse à remplacer par la surface d'articulation (1) est tout d'abord recalibrée, puis la surface d'articulation est adaptée à l'os (8), et la surface d'articulation est centrée à l'aide d'une broche de centrage (4) qui est enfoncée dans l'os situé derrière, en traversant le trou médian (3) de la surface d'articulation. La plaie est ensuite refermée. La surface d'articulation et la broche de centrage (4) sont généralement réalisées dans un matériau céramique très résistant non allergène.
PCT/DE1995/000611 1994-08-19 1995-05-03 Endoprothese non guidee pour petites articulations WO1996005784A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DEP4429451.4 1994-08-19
DE4429451 1994-08-19

Publications (1)

Publication Number Publication Date
WO1996005784A1 true WO1996005784A1 (fr) 1996-02-29

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ID=6526091

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/DE1995/000611 WO1996005784A1 (fr) 1994-08-19 1995-05-03 Endoprothese non guidee pour petites articulations

Country Status (1)

Country Link
WO (1) WO1996005784A1 (fr)

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE19710948A1 (de) * 1997-03-15 1998-09-17 Moje Hans Juergen Nichtgeführte Endoprothese für Zehen
DE19925529A1 (de) * 1999-06-04 2000-12-07 Moje Hans Juergen Nichtgeführte Endoprothese für Fingergelenke
US8715325B2 (en) 2009-02-19 2014-05-06 Nextremity Solutions, Inc. Bone joining apparatus and method
US9072562B2 (en) 2009-02-19 2015-07-07 Nextremity Solutions, Inc. Bone joining device, kit and method
US9468465B2 (en) 2009-02-19 2016-10-18 Nextremity Solutions, Inc. Reversible bone coupling device and method
US11660133B2 (en) 2018-10-26 2023-05-30 Zimmer, Inc. Bone coupling device and method

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0314593A1 (fr) * 1987-10-27 1989-05-03 Louis Samuel Barouk Implant prothétique articulaire à fixation temporaire
EP0338715A1 (fr) * 1988-04-12 1989-10-25 Bahaa Botros Seedhom Prothèse d'articulation de doigt
EP0420794A1 (fr) * 1989-09-28 1991-04-03 SULZER Medizinaltechnik AG Prothèse pour articulation du doigt
EP0455929A1 (fr) * 1990-05-11 1991-11-13 THERA Patent GmbH & Co. KG Gesellschaft für industrielle Schutzrechte Partie d'une articulation de prothèse, notamment pour une articulation de doigt

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0314593A1 (fr) * 1987-10-27 1989-05-03 Louis Samuel Barouk Implant prothétique articulaire à fixation temporaire
EP0338715A1 (fr) * 1988-04-12 1989-10-25 Bahaa Botros Seedhom Prothèse d'articulation de doigt
EP0420794A1 (fr) * 1989-09-28 1991-04-03 SULZER Medizinaltechnik AG Prothèse pour articulation du doigt
EP0455929A1 (fr) * 1990-05-11 1991-11-13 THERA Patent GmbH & Co. KG Gesellschaft für industrielle Schutzrechte Partie d'une articulation de prothèse, notamment pour une articulation de doigt

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE19710948A1 (de) * 1997-03-15 1998-09-17 Moje Hans Juergen Nichtgeführte Endoprothese für Zehen
DE19925529A1 (de) * 1999-06-04 2000-12-07 Moje Hans Juergen Nichtgeführte Endoprothese für Fingergelenke
US8715325B2 (en) 2009-02-19 2014-05-06 Nextremity Solutions, Inc. Bone joining apparatus and method
US9072562B2 (en) 2009-02-19 2015-07-07 Nextremity Solutions, Inc. Bone joining device, kit and method
EP3037067A1 (fr) 2009-02-19 2016-06-29 Nextremity Solutions, LLC Appareil et procédé de jointure d'os
US9468465B2 (en) 2009-02-19 2016-10-18 Nextremity Solutions, Inc. Reversible bone coupling device and method
US9615873B2 (en) 2009-02-19 2017-04-11 Nextremity Solutions, Inc. Bone joining apparatus and method
US9687286B2 (en) 2009-02-19 2017-06-27 Nextremity Solutions, Inc. Bone joining apparatus and method
US10357299B2 (en) 2009-02-19 2019-07-23 Nextremity Solutions, Inc. Bone joining apparatus and method
US10639083B2 (en) 2009-02-19 2020-05-05 Nextremity Solutions, Inc. Reversible bone coupling device and method
US11660133B2 (en) 2018-10-26 2023-05-30 Zimmer, Inc. Bone coupling device and method

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