WO1997036559A1 - Prothesenteil - Google Patents

Prothesenteil Download PDF

Info

Publication number
WO1997036559A1
WO1997036559A1 PCT/EP1997/001647 EP9701647W WO9736559A1 WO 1997036559 A1 WO1997036559 A1 WO 1997036559A1 EP 9701647 W EP9701647 W EP 9701647W WO 9736559 A1 WO9736559 A1 WO 9736559A1
Authority
WO
WIPO (PCT)
Prior art keywords
section
prosthesis part
cage structure
anchoring
bone
Prior art date
Application number
PCT/EP1997/001647
Other languages
English (en)
French (fr)
Inventor
Franz Copf
Ulrich Holz
Original Assignee
Franz Copf
Ulrich Holz
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 Franz Copf, Ulrich Holz filed Critical Franz Copf
Priority to EP97916423A priority Critical patent/EP0891167A1/de
Priority to US09/155,837 priority patent/US6287342B1/en
Publication of WO1997036559A1 publication Critical patent/WO1997036559A1/de

Links

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
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/82—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin for bone cerclage
    • 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
    • A61F2/30739—Devices connected to the proximal part of an endoprosthetic femoral shaft for reinforcing or replacing the trochanters, e.g. the greater trochanter
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • 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
    • A61F2/367—Proximal or metaphyseal parts of shafts
    • 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
    • A61F2/32—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
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4607—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of hip femoral endoprostheses
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4644—Preparation of bone graft, bone plugs or bone dowels, e.g. grinding or milling bone material
    • 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
    • A61F2/28—Bones
    • A61F2002/2835—Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
    • 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
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • 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
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30138—Convex polygonal shapes
    • A61F2002/30153—Convex polygonal shapes rectangular
    • 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
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30224—Three-dimensional shapes cylindrical
    • 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
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30273—Three-dimensional shapes pyramidal
    • A61F2002/30276—Three-dimensional shapes pyramidal frustopyramidal
    • 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
    • A61F2002/30317—The prosthesis having different structural features at different locations within the same prosthesis
    • A61F2002/30324—The prosthesis having different structural features at different locations within the same prosthesis differing in thickness
    • 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
    • A61F2002/30316—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
    • A61F2002/30317—The prosthesis having different structural features at different locations within the same prosthesis
    • A61F2002/30327—The prosthesis having different structural features at different locations within the same prosthesis differing in diameter
    • 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
    • A61F2002/30316—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
    • 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
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30462—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements retained or tied with a rope, string, thread, wire or cable
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    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30561—Special structural features of bone or joint prostheses not otherwise provided for breakable or frangible
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    • A61F2002/30593—Special structural features of bone or joint prostheses not otherwise provided for hollow
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    • A61F2002/30602—Shaft made of a bundle of anchoring rods or bristles, e.g. fasciculate shaft
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    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30617—Visible markings for adjusting, locating or measuring
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    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30667—Features concerning an interaction with the environment or a particular use of the prosthesis
    • A61F2002/30672—Features concerning an interaction with the environment or a particular use of the prosthesis temporary
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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
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    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
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    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
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    • 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
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    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30795—Blind bores, e.g. of circular cross-section
    • A61F2002/308—Blind bores, e.g. of circular cross-section oblong
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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
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    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30879—Ribs
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    • 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
    • A61F2002/3631—Necks with an integral complete or partial peripheral collar or bearing shoulder at its base
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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
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    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
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    • A61F2/02—Prostheses implantable into the body
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    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3662—Femoral shafts
    • A61F2002/3678—Geometrical features
    • A61F2002/3694—Geometrical features with longitudinal bores
    • A—HUMAN NECESSITIES
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    • 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
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    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4619—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof for extraction
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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
    • A—HUMAN NECESSITIES
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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
    • A—HUMAN NECESSITIES
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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
    • A61F2220/0075—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements sutured, ligatured or stitched, retained or tied with a rope, string, thread, wire or cable
    • A—HUMAN NECESSITIES
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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
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • 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
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017—Angular shapes
    • A61F2230/0019—Angular shapes rectangular
    • 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
    • A61F2230/0069—Three-dimensional shapes cylindrical
    • 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
    • A61F2230/0086—Pyramidal, tetrahedral, or wedge-shaped
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0036—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in thickness
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    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0039—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in diameter
    • A—HUMAN NECESSITIES
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    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
    • A61F2250/0097—Visible markings, e.g. indicia
    • 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
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00952—Coating, pre-coating or prosthesis-covering structure made of bone cement, e.g. pre-applied PMMA cement mantle

Definitions

  • the invention relates to a prosthesis part for implantation into the end of a thigh bone adjacent to the hip joint. According to the preamble of claims 1 and 6, respectively.
  • the present invention is intended to further develop a prosthetic part in accordance with the preamble of claim 1 in such a way that the prosthetic part can be removed again from the thigh bone without removing parts of the corticalis.
  • passages are present or can be easily created by removing material webs located under recesses or by drilling the support plate through which a chisel or a slim milling cutter can be passed.
  • a slit can be created in the portion of the cancellous bone adjacent to the corticalis, as a result of which the cohesion between the cancellous bone that has grown into the cage structure and the corticalis is weakened.
  • Spongiosa bridges to the corticalis can then be broken open by mechanical loading of the prosthesis part (e.g. impact and / or twisting under high force).
  • the prosthesis part can then be removed from the bone.
  • the ingrown cancellous bone volume on the two main surfaces can be separated from the cortical bone.
  • the development of the invention according to claim 3 allows a cut to be made in the cancellous bone volume, which can extend practically over the entire contact area to the cortex. In this way, the prosthesis part can be removed in a simple manner.
  • the development of the invention according to claim 4 is advantageous with regard to a particularly rapid opening of the indentation, the indentations having only a small depth ensuring a secure and resilient connection of the edge of the plate section to the interior of the plate section is.
  • the material web can be removed by a milling cutter, the walls of the indentation serving as a guide for the milling cutter.
  • a drill for drilling out the starting points of the anchoring pillars of the cage structure can be easily and precisely aligned with the axis of an anchoring pillar.
  • FIG. 1 a side view of a prosthesis part for an artificial hip joint
  • Figure 2 is a plan view of the right side of the prosthesis part shown in Figure 1;
  • FIG. 3 a transverse section through an indentation which is provided in an area of a plate section of a modified prosthesis part near the edge;
  • FIG. 4 a longitudinal section through the indentation which is provided in an area of a plate section of the modified prosthesis part according to FIG. 3 near the edge;
  • FIG. 5 shows a view similar to FIG. 4, but in which an indentation with a small depth is shown;
  • FIG. 6 a top view of the plate section of a further modified prosthesis part, which is provided in the edge region of the plate section with a succession of impressions of different depths;
  • Figure 1 a similar view as Figure 1, in which a further modified prosthesis part is shown.
  • a prosthesis part which serves for implantation in the upper end of a femur 12 indicated by dashed lines, is designated overall by 10 in FIG.
  • the upper section of the femur 12 carrying the joint ball is resected and a recess 14 is produced in the femur which corresponds to the clear outer contour of the prosthesis part 10.
  • the prosthesis part 12 has a support plate 16 which has a horizontal plate section 18 and a plate section 20 which rises obliquely upward toward the greater trochanter.
  • a support pin 22, which rises obliquely upwards, is formed on the plate section 18, onto which a joint ball 24, indicated by dashed lines, can be placed.
  • a cage structure designated overall by 26, is cast onto the underside of the support plate 16.
  • This cage structure consists of four curved longitudinal anchoring pillars 28, 30, 32, 34, which essentially have the shape of a curved pyramid with a rectangular shape Specify transverse cross section.
  • Two curved additional anchoring posts 36, 38 extend from the upper end of the plate section 18, the shape of which is adapted to the greater trochanter of the femur and which are at a smaller distance from one another than the adjacent anchoring posts 32 and 34.
  • anchoring pillars 28-38 In the interior of the clear contour of the cage structure 26 specified by the anchoring pillars 28-38, further anchoring pillars are provided which run in oblique directions between the anchoring pillars 28-38. Three of these stiffening pillars 40, 42, 44 are shown.
  • the anchoring posts and the stiffening posts each have a cylindrical core 46 with axially spaced anchoring collars 48.
  • the cores 46 of the anchoring pillars typically have a diameter of 2.0-4.5 mm, the diameters of the anchoring collars are each approximately 0.8-1.5 mm larger than the diameter of the cores.
  • the axial extension of the anchoring collars is approximately 0.6-1.2 mm, their distance from each other approximately 3-6 mm.
  • the cores can have a diameter of approximately 1.5-3 mm, the diameter of the anchoring collars can be approximately 0.6-1.2 mm larger than the core diameter, and the axial dimension of the anchoring collars can be approximately 0 , 5 - 1 mm, their axial distance about 2 - 4 mm.
  • a shaft section 50 is cast onto the lower end of the cage structure 26. This has an olive-shaped end section 52.
  • a bore 54 extends through the interior of the shaft section 50.
  • the end of the thigh bone is resected as described above, the upper edge of the cortical being receiving a contour corresponding to the edge contour of the support plate 16.
  • the bone material removed from the bone end during the production of the recess 14 is ground in a bone mill and filled into the cage structure 26.
  • the outer surface of the shaft section 50 is coated with a cement.
  • the prosthesis part 10 is then inserted into the end of the femur 12, so that the support plate 16 now forms a new upper end for the bone.
  • the prosthesis part 10 is then provisionally fixed with wire.
  • the prosthesis part 10 is connected to the upper end of the femur in a partially load-bearing manner.
  • the ground cancellous bone grows together and fills the cage structure, growing up against the cortical bone and the residual cancellous bone remaining on it.
  • elongated openings 60, 62 are provided in the prosthesis part shown in FIGS. 1 and 2 in the vicinity of the longitudinal edges of the support plate 16. After the prosthesis part 10 has healed, a thin, slim chisel can be passed through it in order to clear one of the two main surfaces of the cage structure 26. After the cage structure 26 has been removed in this way, cancellous bridges, via which the cage structure remains connected to the corticalis, remain in the vicinity of the upper corners of the support plate 16 and on the narrow sides of the cage structure. These remaining bridges can be broken open by rotating the prosthesis part 10 about the axis of the recess 14 and / or by exerting hard blows on the support plate 10.
  • FIGS. 3 and 4 instead of openings Indentations 64 of the support plate 16 work, which, seen in FIG. 1, have the same geometry as the openings 60, 62 shown in FIGS. 1 and 2.
  • the indentations 64 however, have a thin bottom wall 66, which have the desired locking effect, but on the other hand mechanically the chisels used to free the cage structure 26 can be easily destroyed.
  • the side walls of the recesses 64 or the openings subsequently created therefrom or openings already present from the beginning are convex, as shown at 68. This also allows the chisel or milling cutter used to unclamp the cage structure 26 to be inclined in a direction perpendicular to the longitudinal direction of the retraction or opening.
  • such recesses can be used according to FIG. 5, in which the bottom wall 66 makes up a significant part of the thickness of the support plate 16, so that the recesses 64 do not adversely affect the mechanical strength of the edge region of the support plate 16.
  • This configuration of the indentations 64 makes it possible to distribute several such indentations along the edge of the support plate 16, as a result of which a larger part of the interface between the cage structure 26 and the cortical bone of the femur 12 is made accessible.
  • the bottom wall 66 is removed by a milling cutter of suitable width, this milling cutter being guided through the walls of the milling 64 parallel to the edge of the support plate 16.
  • one can according to 6 provide on the top of the support plate 16 an arrangement of recesses 64a and 64b which follows the edge continuously, the bottom walls 66a and 66b of which are thin and thick. You can then quickly open the bottom wall of the entire retraction arrangement by means of a milling cutter which is positively guided parallel to the edge of the support plate 16 through the walls of the retracts, but under conditions of use an arms formed by the bottom walls 66b have a very load-bearing connection between the edge of the support plate 16 and whose main section.
  • all the base points of anchoring pillars, which start from the support plate 16, are marked by a conical marking 70 on the upper side of the support plate 16. These markings also serve as centering holes for the tip of a drill, with which the material of the support plate lying above these anchoring posts can be drilled away. If this is done with all of the anchoring pillars, the support plate 16 is released from the cage structure (thin material webs which may remain during drilling due to the course of the drill can be broken), so that they can simply be chiseled out of the recess 14 or milled out.

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Abstract

Ein zementfrei implantierbares Prothesenteil (10) hat eine mit der Spongiosa des Knochens (12) verwachsende Käfigstruktur (26), eine mit dieser verbundene Tragplatte (16) und einen von der letzteren getragenen Tragzapfen (22) für ein Gelenkteil (24). Die Tragplatte (16) hat bei ihren seitlichen Rändern Durchbrechungen (60, 62), durch welche ein Meißel oder ein Fräser hindurchgeführt werden kann, um nach dem Einheilen des Prothesenteiles (10) im Bedarfsfalle die Käfigstruktur (26) zumindest weitgehend wieder von der Corticalis des Knochens (12) zu trennen.

Description

Prothesenteil
Die Erfindung betrifft ein Prothesenteil zum Implantieren in das dem Hüftgelenk benachbarte Ende eines Oberschenkel¬ knochens gemäß dem Oberbegriff des Anspruches 1 bzw. 6.
Ein derartiges Prothesenteil ist in der DE 37 07 518 AI beschrieben.
Nach dem Implantieren eines solchen Prothesenteiles wächst Spongiosa zwischen die Verankerungspfeiler der Käfigstruktur, wodurch der Verankerungsabschnitt des Prothesenteiles dynamisch und fest mit dem Ende des Oberschenkelknochens verbunden wird. Derartige zement- frei implantierbare Prothesenteile sind nach dem Ein- heilen in den Knochen so fest mit dem Knochen verbun¬ den, daß eine etwa wieder notwendig werdende Entfer¬ nung oft das Öffnen der dem Verankerungsabschnitt be¬ nachbarten Abschnitte der Corticalis des Knochens not¬ wendig macht.
Durch die vorliegende Erfindung soll ein Prothesenteil gemäß dem Oberbegriff des Anspruches 1 so weitergebil¬ det werden, daß ein Wiederentfernen des Prothesenteiles aus dem Oberschenkenknochen ohne Entfernen von Teilen der Corticalis möglich ist.
Diese Aufgabe ist erfindungsgemäß gelöst durch ein Pro¬ thesenteil mit den im Anspruch 1 bzw. 6 angegebenen Merkmalen.
BESTATIGUNGSKOPIE 7/36559 PC17EP97/01647
Bei dem erfindungsgemäßen Prothesenteil sind Durchgänge vorhanden oder durch Entfernen von unter Einziehun¬ gen liegenden Materialstegen oder durch Freibohren der Tragplatte leicht schaffbar, durch welche ein Meißel oder ein schlanker Fräser durchgeführt werden kann. Auf diese Weise kann in dem der Corticalis benachbarten Abschnitt der Spongiosa ein Schlitz erzeugt werden, wodurch der Zusammenhalt zwischen der in die Käfigstruktur eingewach¬ senen Spongiosa und der Corticalis geschwächt wird. Die durch den Meißel bzw. den Fräser nicht entfernbaren
Spongiosabrücken zur Corticalis können dann durch mecha¬ nische Belastung des Prothesenteiles (z.B. Schlag und/ oder Verdrehen unter hoher Krafteinwirkung) aufgebrochen werden. Danach kann das Prothesenteil aus dem Knochen herausgenommen werden.
Vorteilhafte Weiterbildungen der Erfindung sind in Unter¬ ansprüchen angegeben.
Bei einem Prothesenteil gemäß Anspruch 2 ist das einge¬ wachsene Spongiosavolumen auf den beiden Hauptflächen von der Corticalis des Knochens trennbar.
Die Weiterbildung der Erfindung gemäß Anspruch 3 erlaubt es, einen Schnitt im Spongiosavolumen zu erzeugen, der sich praktisch über die gesamte Kontaktfläche zur Cor¬ ticalis erstrecken kann. Auf diese Weise läßt sich das Prothesenteil auf einfache Weise entfernen.
Die Weiterbildung der Erfindung gemäß Anspruch 4 ist im Hinblick auf ein besonders rasches Öffnen der Ein¬ drückung von Vorteil, wobei durch die nur geringe Tiefe aufweisenden Eindrückungen eine sichere und belastungs- fähige Verbindung des Randes des Plattenabschnittes mit dem Inneren des Plattenabschnittes gewährleistet ist. In den nur geringe Tiefe aufweisenden Eindrückun¬ gen kann der Materialsteg durch einen Fräser entfernt werden, wobei die Wände der Eindrückung als Führung für den Fräser dienen können.
Die Weiterbildung der Erfindung gemäß Anspruch 5 er¬ laubt es, den Anstellwinkel des in einen Durchbruch oder eine geöffnete Eindrückung eingeführten Meißel oder Fräser zu variieren.
Bei einem Prothesenteil gemäß Anspruch 7 läßt sich ein Bohrer zum Freibohren der Ansatzpunkte der Verankerungs- pfeiler der Käfigstruktur einfach und genau auf die Achse eines Verankerungspfeilers ausrichten.
Nachstehend wird die Erfindung anhand von Ausführungs- beispielen unter Bezugnahme auf die Zeichnung näher erläutert. In dieser zeigen:
Figur 1: eine seitliche Ansicht eines Prothesenteiles für ein künstliches Hüftgelenk;
Figur 2 : eine Aufsicht auf die rechte Seite des in Figur 1 gezeigten Prothesenteiles;
Figur 3 : einen transversalen Schnitt durch eine Ein¬ drückung, die in einem randnahen Bereich eines Plattenabschnittes eines abgewandelten Prothe¬ senteiles vorgesehen ist;
Figur 4 : einen longitudinalen Schnitt durch die Ein¬ drückung, die in einem randnahen Bereich eines Plattenabschnittes des abgewandelten Prothe¬ senteiles nach Figur 3 vorgesehen ist; Figur 5: eine ähnliche Ansicht wie Figur 4, in welcher jedoch eine Eindrückung mit kleiner Tiefe wiedergegeben ist;
Figur 6 : eine Aufsicht auf den Plattenabschnitt eines weiter abgewandelten Prothesenteiles, welches im Randbereich des Plattenabschnittes mit einer Aufeinanderfolge von Eindrückungen unter¬ schiedlicher Tiefe versehen ist; und
Figur 1 : eine ähnliche Ansicht wie Figur 1, in welcher ein weiter abgewandeltes Prothesenteil gezeigt ist.
In Figur 1 ist insgesamt mit 10 ein Prothesenteil bezeich¬ net, welches zur Implantation in das gestrichelt angedeu¬ tete obere Ende eines Oberschenkelknochens 12 dient . Hierzu wird der die Gelenkkugel tragende obere Abschnitt des Oberschenkelknochens 12 reseziert und im Oberschenkelkno- chen eine Ausnehmung 14 erzeugt, die der lichten Außenkon¬ tur des Prothesenteiles 10 entspricht.
Das Prothesenteil 12 hat eine Tragplatte 16, die einen horizontalen Plattenabschnitt 18 und einen schräg nach oben zum Trochanter maior ansteigenden Plattenabschnitt 20 aufweist. An den Plattenabschnitt 18 ist ein schräg nach oben ansteigender Tragzapfen 22 angeformt, auf welchen eine gestrichelt angedeutete Gelenkkugel 24 aufsetzbar ist.
An die Unterseite der Tragplatte 16 ist eine insgesamt mit 26 bezeichnete Käfigstruktur angegossen. Diese Käfig¬ struktur besteht aus vier gekrümmten longitudinalen Verankerungspfeiler 28, 30, 32, 34, die im wesentlichen die Form einer gekrümmten Pyramide mit rechteckigem transversalem Querschnitt vorgeben. Vom oberen Ende des Plattenabschnittes 18 gehen zwei gekrümmte weitere Veran¬ kerungspfeiler 36, 38 aus, deren Gestalt dem Trochanter maior des Oberschenkelknochens (Femur) angepaßt ist und welche kleineren Abstand voneinander haben als die benach¬ barten Verankerungspfeiler 32 und 34.
Im Inneren der durch die Verankerungspfeiler 28-38 vorge¬ gebenen lichten Kontur der Käfigstruktur 26 sind weitere Verankerungspfeiler vorgesehen, die in schrägen Richtungen zwischen den Verankerungspfeilern 28-38 verlaufen. Hiervon sind drei solcher Versteifungspfeiler 40, 42, 44 gezeigt.
Die Verankerungspfeiler und die Versteifungspfeiler haben jeweils einen zylindrischen Kern 46 mit axial beab- standeten Verankerungsbunden 48.
Typischerweise haben die Kerne 46 der Verankerungspfeiler einen Durchmesser von 2,0 - 4,5 mm, die Durchmesser der Verankerungsbunde sind jeweils etwa 0,8 - 1,5 mm größer als der Durchmesser der Kerne. Die axiale Erstreckung der Verankerungsbunde beträgt etwa 0,6 - 1,2 mm, ihr Abstand voneinander etwa 3 - 6 mm.
Für die Versteifungspfeiler können die Kerne einen Durch¬ messer von etwa 1,5 - 3 mm haben, die Durchmesser der Verankerungsbunde etwa 0,6 - 1,2 mm größer sein als der Kerndurchmesser, und die axiale Abmessung der Veranke¬ rungsbunde kann etwa 0,5 - 1 mm betragen, ihr axialer Abstand etwa 2 - 4 mm.
An das untere Ende der Käfigstruktur 26 ist ein Schaft¬ abschnitt 50 angegossen. Dieser hat einen olivenförmigen Endabschnitt 52. Durch das Innere des Schaftabschnittes 50 erstreckt sich eine Bohrung 54. Zum Implantieren des oben beschriebenen Prothesenteiles wird das Ende des Oberschenkelknochens wie oben beschrie¬ ben reseziert, wobei der obere Rand der Corticalis eine der Randkontur der Tragplatte 16 entsprechende Kontur erhält. Das aus dem Knochenende bei der Herstellung der Ausnehmung 14 entfernte Knochenmaterial wird in einer Knochenmühle gemahlen und in die Käfigstruktur 26 eingefüllt. Die Außenfläche des Schaftabschnittes 50 wird mit einem Zement bestrichen. Das Prothesenteil 10 wird dann in das Ende des Oberschenkelknochens 12 eingesetzt, so daß die Tragplatte 16 nun einen neuen oberen Abschluß für den Knochen bildet. Das Prothesen¬ teil 10 wird dann mit Draht vorläufig fixiert.
Nach Aushärten des Zementes ist das Prothesenteil 10 teilbelastbar mit dem oberen Ende des Oberschenkelkno¬ chens verbunden. Im weiteren Heilungsprozeß wächst die gemahlene Spongiosa zusammen und füllt die Käfigstruk- tur aus, wobei sie zugleich gegen die Corticalis und auf dieser verbliebene Spongiosareste aufwächst.
Alternativ kann man den Schaftabschnitt 50 auch nicht mit Zement beschichten, was im Hinblick auf ein leichteres späteres Wiederentfernen des Prothesenteiles vorteilhaft ist.
Nach Abschluß des Heilungsprozesses hat man somit eine Klebeverbindung zwischen der Außenfläche des Schaft- abschnittes 50 und der Corticalis des Oberschenkelkno¬ chens, während man im Bereich der Käfigstruktur 26 ein durchgehendes Spongiosavolumen hat, welches um die Käfig¬ struktur 26 herumgewachsen ist.
Nach dem Einwachsen der Spongiosa in die Käfigstruktur 26 hat man eine sehr feste und belastungsfähige Verbin¬ dung zwischen dem Oberschenkelknochen und dem Prothesen¬ teil. Müßte das Prothesenteil einmal wieder aus irgend einem Grunde aus dem Oberschenkelknochen entfernt werden, würde dies wahrscheinlich notwendig machen, einen Teil der die Käfigstruktur 26 umgebenden Corticalis zu ent¬ fernen und durch das so geschaffene Fenster mit einem Meißel die Käfigstruktur 26 wieder freizustemmen. Dies würde die Wahlmöglichkeiten für ein Ersatz-Prothesenteil erheblich einschränken, insbesondere den Ersatz durch ein einzuzementierendes Prothesenteil ausschließen.
Um ein Freistemmen der Käfigstruktur 26 ohne Erzeugen eines Fensters in der Spongiosa zu ermöglichen, sind in dem in den Figuren 1 und 2 gezeigten Prothesenteil in der Nachbarschaft der Längsränder der Tragplatte 16 langgestreckte Durchbrechungen 60, 62 vorgesehen. Durch diese hindurch kann nach dem Einheilen des Pro¬ thesenteiles 10 ein dünner schlanker Meißel hindurch- geführt werden, um jeweils eine der beiden Hauptflä¬ chen der Käfigstruktur 26 freizustemmen. Nach einem solchen Freistemmen der Käfigstruktur 26 verbleiben Spongiosabrücken, über welche die Käfigstruktur mit der Corticalis verbunden bleibt, in der Nachbarschaft der oberen Ecken der Tragplatte 16 und bei den Schmal¬ seiten der Käfigstruktur. Diese verbleibenden Brücken können durch Drehen des Prothesenteiles 10 um die Ach¬ se der Ausnehmung 14 und/oder durch Ausüben harter Schläge auf die Tragplatte 10 aufgebrochen werden.
Wünscht man, daß die Tragplatte 16 normalerweise das obere Ende des Oberschenkelknochens 12 vollständig ver¬ schließt, soll aber trotzdem ein Zugang zu den beiden Hauptflächen der Käfigstruktur 26 möglich sein, kann man gemäß Figur 3 und 4 anstelle von Durchbrechungen mit Einziehungen 64 der Tragplatte 16 arbeiten, welche in Auf sieht gesehen die gleiche Geometrie haben wie die in den Figuren 1 und 2 gezeigten Durchbrechungen 60, 62. Die Einziehungen 64 haben jedoch eine dünne Bodenwand 66, die die gewünschte Sperrwirkung haben, andererseits aber mechanisch durch den zum Freistemmen der Käfig¬ struktur 26 dienenden Meißel leicht zerstört werden können.
Wie aus Figur 3 ersichtlich, sind die seitlichen Wände der Einziehungen 64 bzw. der hieraus später geschaffenen Durchbrechungen oder schon von Anfang an vorhandener Durchbrechungen konvex, wie bei 68 dargestellt. Dies erlaubt es, den zum Freistemmen der Käfigstruktur 26 verwendeten Meißel oder Fräser auch in zur Längsrichtung der Einziehung oder Durchbrechung senkrechter Richtung zu neigen.
In weiterer Abwandlung kann man gemäß Figur 5 solche Einziehungen verwenden, bei welchen die Bodenwand 66 einen nennenswerten Teil der Dicke der Tragplatte 16 ausmacht, so daß die Einziehungen 64 die mechanische Festigkeit des Randbereiches der Tragplatte 16 nicht nachteilig beeinflussen. Diese Ausbildung der Einzie- hungen 64 erlaubt es, mehrere solcher Einziehungen längs des Randes der Tragplatte 16 zu verteilen, wodurch man einen größerem Teil der Grenzfläche zwischen Käfig¬ struktur 26 und Corticalis des Oberschenkelknochens 12 zugänglich macht. Bei einer derartigen Ausbildung der Einziehungen 64 erfolgt das Entfernen der Boden¬ wand 66 durch einen Fräser geeigneter Breite, wobei dieser Fräser durch die Wände der Einziehung 64 para¬ llel zum Rand der Tragplatte 16 geführt ist.
In weiterer Abwandlung der Erfindung kann man gemäß Figur 6 auf der Oberseite der Tragplatte 16 eine dem Rand durchgehend folgende Anordnung von Einziehungen 64a und 64b vorsehen, deren Bodenwände 66a bzw. 66b dünn bzw. dick sind. Man kann dann die Bodenwand der gesamten Einziehungsanordnung rasch durch einen wie¬ derum parallel zum Rand der Tragplatte 16 durch die Wände der Einziehungen zwangsgeführten Fräser öffnen, hat aber unter Gebrauchsbedingungen eine durch die Bodenwände 66b gebildete Arme sehr belastungsfähige Verbindung zwischen dem Rand der Tragplatte 16 und deren Hauptabschnitt.
Bei dem Prothesenteil 10 nach Figur 7 sind alle Fußpunkte von Verankerungspfeilern, die von der Tragplatte 16 aus¬ gehen durch eine kegelige Markierung 70 auf der Oberseite der Tragplatte 16 markiert. Diese Markierungen dienen zu¬ gleich als Zentrierlöcher für die Spitze eines Bohrers, mit welchem das über diesen Verankerungspfeilern liegende Material der Tragplatte weggebohrt werden kann. Erfolgt dies bei allen der Verankerungspfeiler, kommt die Tragplatte 16 von der Käfigstruktur frei (beim Bohren durch Verlauf des Bohrers etwa stehenbleibende dünne Materialstege können gebrochen werden) , sodaß diese einfach aus der Ausnehmung 14 herausgemeißelt oder herausgefräst werden kann.

Claims

Patentansprüche
1. Prothesenteil mit einem in eine Knochenausnehmung (14) einführbaren Verankerungsabschnitt (26, 50) , welcher zumindest teilweise als Käfigstruktur (26) aus¬ gebildet ist, mit einem Plattenabschnitt (16) , der in seitlicher Richtung über den Verankerungsabschnitt (26, 50) übersteht, und mit einem Tragabschnitt (22) für ein Gelenkteil (24) , dadurch gekennzeichnet, daß der Platten¬ abschnitt (16) mit mindestens einem Durchbruch (60, 62) oder mindestens einer Einziehung (64) versehen ist, durch welche (n) ein Werkzeug, z.B. ein Meissel oder Fräser einführbar ist.
2. Prothesenteil nach Anspruch 1, wobei der Platten¬ abschnitt (16) in Aufsicht gesehen im wesentlichen rechteckige Randkontur hat, dadurch gekennzeichnet, daß beide Längsseiten des Randes des Plattenabschnittes (18) mit jeweils mindestens einem Durchbruch (60, 62) und/oder mindestens einer Einziehung (64) versehen ist.
3. Prothesenteil nach Anspruch 1 oder 2, dadurch gekenn- zeichnet, daß der Plattenabschnitt (16) in seinem
Randbereich eine umlaufende Anordnung von Einziehungen (64a, 64b) aufweist.
4. Prothesenteil nach Anspruch 3, dadurch gekennzeich- net, daß die Einziehungsanordnung (64a, 64b) eine
Aufeinanderfolge von Einziehungen (64a, 64b) unterschied¬ licher Tiefe aufweist.
5. Prothesenteil nach einem der Ansprüche 1-4, dadurch gekennzeichnet, daß die seitlichen Ränder der Durch- brüche (60, 62) und/oder der Einziehungen (64) konvex gekrümmt sind.
6. Prothesenteil mit einem in eine Knochenausnehmung (14) einführbaren Verankerungsabschnitt (26, 50), welcher zumindest teilweise als Käfigstruktur (26) aus¬ gebildet ist, mit einem Plattenabschnitt (16) , der in seitlicher Richtung über den Verankerungsabschnitt (26, 50) übersteht, und mit einem Tragabschnitt (22) für ein Gelenkteil (24) , dadurch gekennzeichnet, daß der Platten¬ abschnitt (16) auf seiner Oberseite mit Markierungen (70) versehen ist, die jeweils mit einem Tragplatten-Anbrin¬ gungspunkt eines Verankerungspfeilers (28 bis 34) der Käfigstruktur (26) fluchten.
7. Prothesenteil nach Anspruch 6, dadurch gekennzeich- zeichnet, daß die Markierungen durch Vertiefungen (70) gebildet sind, die Zentriermittel für eine Bohrer¬ spitze bilden.
PCT/EP1997/001647 1996-04-02 1997-04-02 Prothesenteil WO1997036559A1 (de)

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EP97916423A EP0891167A1 (de) 1996-04-02 1997-04-02 Prothesenteil
US09/155,837 US6287342B1 (en) 1996-04-02 1997-04-02 Prosthesis part

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DE19613078.6 1996-04-02
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