WO2000044315A1 - A device for and method of replacing or repairing a joint - Google Patents
A device for and method of replacing or repairing a joint Download PDFInfo
- Publication number
- WO2000044315A1 WO2000044315A1 PCT/IB2000/000115 IB0000115W WO0044315A1 WO 2000044315 A1 WO2000044315 A1 WO 2000044315A1 IB 0000115 W IB0000115 W IB 0000115W WO 0044315 A1 WO0044315 A1 WO 0044315A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- prosthesis
- joint
- articular
- articular surface
- sleeve member
- Prior art date
Links
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/32—Joints for the hip
- A61F2/36—Femoral heads ; Femoral endoprostheses
- A61F2/3601—Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices
- A61F2/3603—Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices implanted without ablation of the whole natural femoral head
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- 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
- A61F2/30756—Cartilage endoprostheses
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- 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
- A61F2/3601—Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices
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- 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
- A61F2/46—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
- A61F2/4618—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 cartilage
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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
- A61F2/28—Bones
- A61F2002/2817—Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]
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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
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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
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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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- A61F2/00—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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- A61F2/00—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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- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30405—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
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- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
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- A61F2002/30579—Special structural features of bone or joint prostheses not otherwise provided for with mechanically expandable devices, e.g. fixation devices
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- 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
- A61F2310/00011—Metals or alloys
- A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni 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 present invention relates to a device for replacing or repairing a joint. More particularly but not exclusively the present invention relates to a prosthesis for a joint, adapted for insertion from behind an articular surface of the joint through said surface, and adapted to abut the opposing articular surface.
- Standard joint replacement technology and methodology has remained substantially unchanged for 30 years or more.
- Hip replacement operations for example, have involved the replacement of the head of the femur with alloy implants which allow ball and socket motion of the hip joint.
- the surgery involved is invasive, requires a great deal of physical work and thus requires a great deal of training which makes it a costly procedure to perform.
- Hip joint implants require the removal of a substantial amount of bone mass which is replaced by a rigid metallic implant. Implanting such devices produces complications which are well documented in medical literature. Furthermore, the removal of a substantial amount of bone mass to replace relatively minor articular damage is undesirable.
- WO 98/34567 describes a hip prosthesis and a method for fitting such a prosthesis through a femoral bone extending from the outside of the femur to the femoral head, which is removed.
- the prosthesis and method for fitting are suitable for total hip replacement surgery where both the ball and socket of the joint are replaced.
- US Patent Number 4.714,478 describes an endoprosthesis comprising a flexible, collapsible, hollow device which can be filled after it is positioned within the bone structure.
- a method of installing such an endoprosthesis to replace the ball of the femur is also described in which a portal is drilled through the lateral cortex of the femur at a location opposite the ball, the ball of the femur is removed, and the endoprosthesis is inserted through the portal.
- a prosthesis for a joint adapted for insertion from behind an articular surface of the joint through said surface, and adapted to abut the opposing articular surface, said prosthesis being substantially rigid and adjustable after insertion.
- An advantage of a prosthesis adapted for insertion from behind an articular surface of a joint is that damage to the membranes surrounding the joint is avoided.
- an advantage of a prosthesis useable in a tunnel or passage bored or otherwise formed from behind the articular surface of a joint is that portions of the prosthesis for maintaining articular space, cushioning the joint and/or covering one or both of the articular surfaces can be easily and controllably inserted into the articular space.
- the prosthesis may be left in the bone behind the articular surface, so as to strengthen the joint.
- the prosthesis can be removed after surgery and the tunnel or passage filled with appropriate material.
- the prosthesis comprises a hollow elongate member adapted to engage the surrounding bone in the tunnel and an inner member which can be engaged within the hollow elongate member such that its longitudinal position therein can be adjusted from the outer end of the tunnel.
- the inner member has a head which can be positioned within the articular space.
- the head may be permanently fixed to the end of the inner member, or may be detachable so as to remain in the articular space after the prosthesis is removed.
- the inner member may carry a conduit or mechanical connector allowing the head to be actuated form the outer end of the tunnel.
- Figure 1 shows a sleeve member of a prosthesis in an embodiment of the present invention, with two alternative surfaces being shown in Figures la and lb;
- Figures 2a to 2c show alternative inner members for insertion into the sleeve member of Figure 1 ;
- Figures 3a to 3c show, from each end and from the side, the respective inner members of Figures 2a to 2c, when inserted in the sleeve member;
- Figures 4a to 4c show views of the prosthesis with the respective inner members of Figures 2a to 2c, in situ in a bore cut through the head and neck of the femur, which are shown cut away to reveal the prosthesis;
- Figures 5a to 5c show corresponding views to Figures 4a to 4c, but with the sleeve member shown in cross-section to show the inner member within.
- the method is preferably performed on a patient under local anaesthesia and sedation.
- the patient is placed on an orthopaedic theatre table in a supine position with a support under the hip so as to tilt laterally the thigh of the hip on which the operation is to be performed.
- An image intensifier fluoroscope or other radiological imaging device is set up so that the neck N of the femur and the hip joint can be visualised.
- the patient is draped, including double draping of the foot and knee of the operated leg, as the assistant may need to rotate the leg during arthroscopy.
- a small incision of approximately 5 cm is made on the lateral aspect of the thigh at approximately 5 cm from the lower end of the greater trochanter and the bone is exposed.
- a guide wire is introduced into the neck N and head H of the femur, visualised by the image intensifier. Once the guide wire has been located correctly, a tunnel T, preferably of 18 to 20 mm diameter, is drilled through the neck N and head H of the femur, from the outer side of the femur into the articular space between the hip bone and the head H of the femur. Residual drilled bone is aspirated out through the tunnel
- the sinovial membranes are not damaged.
- an arthroscope is introduced through the tunnel T into the articular space of the hip joint, and the joint is inflated with fluid or gas, so that the surgeon can inspect the joint and decide what type of treatment and what type and size of prosthesis is required.
- the endoscope may be used to remove foreign bodies and reshape damaged articular surfaces, for example by removing osteophites with a rotor or an articulated rotating burr, and to implant cultivated cartilage or bone morphonic proteins (BMP), for example by means of reabsorbable staples.
- BMP bone morphonic proteins
- a screw microprosthesis may be inserted into the tunnel T.
- the prosthesis comprises a sleeve member, and an inner member which is located within the sleeve member and which carries a head selected according to the function to be performed.
- the sleeve member 2 as shown in Figure 1 , has a diameter compatible with the diameter of the tunnel T, for example 18 to 20 mm, and a length equal to or less than that of the tunnel T.
- the sleeve member 2 is manufactured of titanium or any other biologically compatible metal, alloy or synthetic material of sufficient strength.
- the outer surface of the sleeve member 2 carries a screw thread 4, preferably a lag screw thread.
- the sleeve member 2 is a hollow cylinder and carries an inner screw thread on its inner wall.
- the proximal end of the sleeve member 2 carries a nut 6 which is rigidly fixed to or integrally formed with the sleeve, allowing the sleeve member 2 to be easily rotated.
- the sleeve member 2 is screwed into the tunnel T, with the outer screw thread engaging the bone in the tunnel wall, so that its distal end lies flush with or slightly behind the articular surface S of the femur and its proximal end lies within the tunnel T.
- Two alternative surface textures are provided on the outer surface of the sleeve member 2. If the sleeve member 2 is intended to be removed from the tunnel T after the hip operation, the surface of the outer screw thread is smooth, as shown in the inset Figure la. Alternatively, if the sleeve member 2 is intended to be permanently fixed in the tunnel T. the surface of the outer screw thread is pitted, as shown in the inset Figure lb. The pits allow bone growth into the ridges of the outer screw thread, which permanently fixes the sleeve member 2 within the tunnel T.
- a generally cylindrical inner member 8 is inserted into the sleeve member 2.
- the inner member 8 is shorter than the sleeve member, for example by 10 mm.
- the distal section of the inner member 8 carries an outer screw thread 9 which conforms with the inner screw thread of the sleeve member, so that the longitudinal position of the inner member 8 within the sleeve member 2 can be adjusted by rotating the inner member 8.
- a slot 10 is provided in the proximal end of the inner member 8 to allow adjustment of the inner member 8 within the sleeve member 2, by means of a screwdriver.
- the inner member 8 carries a head 12 is located within the articular space.
- the head 12 comprises a metal sphere 13 covered by a ceramic cup 14 of the same diameter as the tunnel T.
- the inner member 8 is screwed into the sleeve member 2 so that the ceramic cup 14 abuts the hip socket surface and maintains an adjustable separation between the articular surfaces of the femur and the socket, while allowing rotation of the femur.
- the head 12 comprises an inflatable sac 16 connected to a fluid conduit 17 extending through the inner member 8.
- the sac 16 is deflated during insertion of the inner member 8, until the head 12 is located within the articular space.
- Fluid or semisolid is then introduced through the conduit 17 into the sac 16, which inflates in the articular space and provides a cushion between the articular surfaces.
- the conduit is then sealed, for example at the proximal end of the inner member 8, to maintain the desired degree of inflation.
- the head 12 comprises a unfurlable covering 18 which is furled as the inner member 8 is screwed into the sleeve member 2.
- the covering 18 is unfurled within the articular space so that it covers at least part of the articular surface S of the femur, so as to protect the surface from wear.
- a mechanical connector 20, for furling and unfurling the covering passes through a passage in the inner member 8 and is operable from the proximal end.
- the covering 18 may have a support which is substantially rigid when unfurled.
- the prosthesis may be completely removed following the operation, in which case the tunnel T is filled with a threaded dowel of Surgibone, the tip of which is covered with cultivated cartilage.
- the prosthesis may be left in place; the prosthesis strengthens the neck N and head H of the femur and the head 12 remains in the articular space.
- the proximal end of the prosthesis is buried under the cortical bone of the femur. If it is subsequently necessary to adjust the position of the inner member 8, for example to adjust the articular separation using the prosthesis of the first embodiment, the cortical bone is removed and the inner member 8 screwed in or out as required.
- the head 12 is detached from the inner member 8 in its inflated or unfurled state in the articular space.
- the fluid conduit in the second embodiment may be sealed close to the sac 16, while the mechanical connector 20 in the third embodiment may have a point of weakness close to the covering 18 so that it can be detached.
- the inner member 8 and the sleeve member 2 are removed and replaced with the threaded dowel.
- the tissue layers are closed and dressings applied.
- the tunnel T is filled with the threaded dowel in the same way as if the prosthesis had been removed.
- the position of the tunnel T provides an advantageous means of access to the articular space for arthroscopy, independently of whether a prosthesis is subsequently inserted.
- the sleeve member 2 could be inserted into the tunnel T to provide a passage for an endoscope, without the inner member 8 being inserted.
- the sleeve member 2 need not have an internal screw thread, but instead may have a smooth inner surface to allow the endoscope to be slid in and out easily; preferably the outer surface of the sleeve member 2 is smooth as shown in Figure la, to allow subsequent removal.
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)
- Rheumatology (AREA)
- Prostheses (AREA)
Abstract
Description
Claims
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP00901288A EP1212014A1 (en) | 1999-01-26 | 2000-01-26 | A device for and method of replacing or repairing a joint |
AU21245/00A AU2124500A (en) | 1999-01-26 | 2000-01-26 | A device for and method of replacing or repairing a joint |
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
GB9901566A GB2346327A (en) | 1999-01-26 | 1999-01-26 | Bipolar screw microprosthesis of the hip |
GB9901566.1 | 1999-01-26 | ||
GB9915217A GB2344290B (en) | 1999-01-26 | 1999-06-29 | Device for replacing or repairing a joint |
GB9915217.5 | 1999-06-29 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2000044315A1 true WO2000044315A1 (en) | 2000-08-03 |
Family
ID=26315031
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/IB2000/000115 WO2000044315A1 (en) | 1999-01-26 | 2000-01-26 | A device for and method of replacing or repairing a joint |
Country Status (3)
Country | Link |
---|---|
EP (1) | EP1212014A1 (en) |
AU (1) | AU2124500A (en) |
WO (1) | WO2000044315A1 (en) |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7481841B2 (en) | 2004-06-30 | 2009-01-27 | Depuy Products, Inc. | Adjustable orthopaedic prosthesis and associated method |
US7559951B2 (en) | 2004-09-30 | 2009-07-14 | Depuy Products, Inc. | Adjustable, remote-controllable orthopaedic prosthesis and associated method |
Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4379451A (en) * | 1980-11-04 | 1983-04-12 | Getscher Philip E | Intramedullary hip pin and cortical plate |
US4714478A (en) | 1986-01-17 | 1987-12-22 | Fischer William B | Prosthesis, method, and tool for installing same |
WO1998034567A1 (en) | 1997-02-10 | 1998-08-13 | Novarticulate B.V. | Hip prosthesis and method for fitting such hip prosthesis |
US5827289A (en) * | 1994-01-26 | 1998-10-27 | Reiley; Mark A. | Inflatable device for use in surgical protocols relating to treatment of fractured or diseased bones |
WO1999056674A1 (en) * | 1998-05-01 | 1999-11-11 | Weiss James M | Hip replacement methods and apparatus |
-
2000
- 2000-01-26 WO PCT/IB2000/000115 patent/WO2000044315A1/en not_active Application Discontinuation
- 2000-01-26 AU AU21245/00A patent/AU2124500A/en not_active Abandoned
- 2000-01-26 EP EP00901288A patent/EP1212014A1/en not_active Withdrawn
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4379451A (en) * | 1980-11-04 | 1983-04-12 | Getscher Philip E | Intramedullary hip pin and cortical plate |
US4714478A (en) | 1986-01-17 | 1987-12-22 | Fischer William B | Prosthesis, method, and tool for installing same |
US5827289A (en) * | 1994-01-26 | 1998-10-27 | Reiley; Mark A. | Inflatable device for use in surgical protocols relating to treatment of fractured or diseased bones |
WO1998034567A1 (en) | 1997-02-10 | 1998-08-13 | Novarticulate B.V. | Hip prosthesis and method for fitting such hip prosthesis |
WO1999056674A1 (en) * | 1998-05-01 | 1999-11-11 | Weiss James M | Hip replacement methods and apparatus |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7481841B2 (en) | 2004-06-30 | 2009-01-27 | Depuy Products, Inc. | Adjustable orthopaedic prosthesis and associated method |
US7559951B2 (en) | 2004-09-30 | 2009-07-14 | Depuy Products, Inc. | Adjustable, remote-controllable orthopaedic prosthesis and associated method |
Also Published As
Publication number | Publication date |
---|---|
EP1212014A1 (en) | 2002-06-12 |
AU2124500A (en) | 2000-08-18 |
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