WO2001013824A1 - Traitement conservateur de la hanche - Google Patents

Traitement conservateur de la hanche Download PDF

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Publication number
WO2001013824A1
WO2001013824A1 PCT/GB2000/003221 GB0003221W WO0113824A1 WO 2001013824 A1 WO2001013824 A1 WO 2001013824A1 GB 0003221 W GB0003221 W GB 0003221W WO 0113824 A1 WO0113824 A1 WO 0113824A1
Authority
WO
WIPO (PCT)
Prior art keywords
prosthesis
stem
barrel
femur
hip
Prior art date
Application number
PCT/GB2000/003221
Other languages
English (en)
Inventor
Peter Stanley Walker
Original Assignee
University College London
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 University College London filed Critical University College London
Priority to AU67094/00A priority Critical patent/AU6709400A/en
Priority to EP00954735A priority patent/EP1207820A1/fr
Publication of WO2001013824A1 publication Critical patent/WO2001013824A1/fr

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Classifications

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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—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
    • 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
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
    • A—HUMAN NECESSITIES
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
    • A61B17/746—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to a plate opposite the femoral head
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    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
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Definitions

  • the femoral head and neck are resected and a metallic stem about 150 mm in length is cemented into the femoral canal using acrylic cement.
  • the upper part of the stem has a metallic femoral head attached. This head articulates into a hemispherical plastic socket, which is cemented into the acetabulum.
  • Another scheme is where the components are press-fit into the bones without the use of cement. In this case specially adapted surfaces are usually used for bone attachment.
  • present invention concerns primarily an alternative scheme for the femoral component.
  • Total hip replacement as described above was developed in the 1960's and has been used to treat millions of patients with a remarkably high success rate. In elderly patient groups, a survivorship of over 90% at ten years follow-up is not uncommon.
  • the femoral head has remodelled inside the femoral component, primarily by resorption over a substantial part of the interface;
  • femoral head has been misshapen and unable to support the femoral component at the required ofiset.
  • This invention uses some of the design features of previous designs, such as described above, but adds certain refinements.
  • the original concept is that the design is based on the principle of transmitting the forces through the trabeculae between the femoral head and different endosteal regions of the upper femur in as physiological a way as possible.
  • a conservative hip prosthesis which comprises a stem for introduction into the femur, a collar for abutment on a resected surface of the femoral neck and a neck portion for carrying a head, the stem being in the form of a generally cylindrical barrel portion having a distal projection for engagement in the lateral cortex, wherein an intermediate portion between the distal projection and the barrel portion is tapered towards the distal end.
  • the intermediate portion is shaped as a generally right circular or
  • the intermediate portion may have rounded sides when viewed in cross-section.
  • the generally cylindrical portion of the stem is preferably tapered towards the distal projection but to a lesser degree than the intermediate portion.
  • the stem In order to stimulate integration of the prosthesis into the femur, the stem (and particularly all or part of the barrel) are provided with surface irregularities such as depressions, slots, grooves, projections or holes, typically in the range of 0.5 to 2 mm in diameter or width. Such irregularities can be made e.g. by grit blasting. Alternatively or additionally, the surfaces may be provided with an hydroxyapatite coating.
  • a conservative hip prosthesis comprising a stem portion, a collar portion and a neck portion, wherein the stem portion is formed with longitudinal cutting means so that on introduction into the femur, the cutting means cut into the bone thus improving stability of the prosthesis in the femur.
  • the invention also includes a conservative hip which comprises a modular head on a neck, attached to a collar which is adapted to locate on the surface of the lower femoral neck which has been resected at 35-55 degrees to the horizontal, the head being attached to a barrel which projects towards the lateral cortex, the barrel being distally tapered, and having a distal spigot for projection into a hole in the lateral cortex; the surfaces of the barrel and collar being adapted to transmit force in a similar manner to that of the trabecular bone within the upper femur.
  • Figure 1A to IF are longitudinal sections through prior art conservative hip designs
  • Figures 2 A to 2D are photographs of the resected head of a human femur which have been resected for conservative hip installation, showing the small amount of bone which is cut away;
  • Figure 3 is a longitudinal section through a first embodiment of conservative hip prosthesis in accordance with the invention, installed in a resected femur;
  • Figure 3 a is a similar view on a smaller scale of the prosthesis highlighting the areas which are important for bone growth stimulation and integration;
  • Figure 4 is a longitudinal section similar to Figure 3, of a second embodiment in accordance with the invention.
  • Figure 4a is a section on a smaller scale of a modification of the embodiment shown in Figure 4.
  • the following description refers particularly to the embodiments of the invention shown in Figures 3, 3a, 4 and 4a.
  • the femoral head and the upper part of the neck of the femur are resected ( Figure 2).
  • Figure 2 The higher point of resection provides several important advantages. There is a greater amount of bone preservation than for a conventional total hip, where the resection level is about 10 mm further down into the femur than that shown in Figure 2.
  • the drawbacks are loss of bone support and a reduced head offset if the arthritic head is seriously deformed, and
  • the upper part of the prosthetic device includes a head (1) and neck (2), which is similar to that used in a conventional total hip
  • the parts of the device which interface with the bone comprises a collar (3) which interfaces against the resected bone surface, a barrel (4) which locates in a
  • spigot (5) which passes through a hole drilled through the lateral cortex of the femur.
  • Stabilisation for the distal end of the barrel is provided by spigot (5), which is a close fit in the hole in the cortical bone beneath the greater trochanter (6).
  • This Spigot can itself have small flutes with cutting edges for engaging in the cortical bone, thereby providing greater resistance to motion.
  • the Spigot will provide enhanced stability for the entire device, an important factor considering that implant-bone interface micromotion is detrimental and causes the formation of fibrous tissue, which is itself detrimental to fixation.
  • One important principle of the prosthesis of the invention is to transfer the forces
  • the forces on the femoral head are located on an area at the superior region of the femoral head and are transmitted to the medial cortex by a fan of trabeculae.
  • the function of these trabeculae is replaced by two regions. First, by the collar (3) located on the resected neck surface, and secondly by the Barrel locating against the medial neck region (including the anterior and posterior aspects of this region).
  • the Collar is shaped to fit the resected bone surface, being preferably generally elliptical with the major axis substantially vertical but with an anterior bias.
  • a set of trabeculae can be seen streaming towards the femoral neck. These trabeculae are believed to transmit forces generated by the abductor muscles and by other muscles such as the ilio-tibial band wrapping around the greater trochanter.
  • the device of this invention is designed so that the end of the barrel is generally conical as shown at (7), providing a large surface area to interface with this set of trabeculae. It has been shown in many other implants that bone is attracted to convex surfaces and hence it is expected that trabeculae will strongly attach to the end of the barrel. This has been demonstrated in animal studies.
  • the design of the embodiments shown in Figures 4 and 4a is similar to that shown in Figures 3 and 3 a, and equivalent parts are indicated by the same reference numerals. The differences are discussed below.
  • Implant - see Figures 3a and 4a. These features include the following options. Numerous animal and human studies have shown that such surface features include grit-blasting, small grooves or projections about 0.5-2mm in size, cutting flutes with a triangular section about 0.5- lmm in height, and coatings such as porous or sintered
  • the neck is resected at an angle of preferably 35-55 degrees to the horizontal. From finite element analysis and animal studies, this has been shown to be the preferential range for the formation of bone both medially and at the lower end of the barrel.
  • the required centerline of the barrel is located on the resected surface and a small hole about 8 mm in diameter is drilled, passing through the lateral cortex. A round hole about 25 mm in diameter is then drilled and reamed through the neck, towards the lateral cortex.
  • a combined drill with the entire shape of the device can be used in one step.
  • the stem which is slightly larger in maximum transverse dimension than the hole reamed in the femur, is then tapped into place.
  • the Barrel is preferably made slightly tapered by about 0.5-1.0 mm to maintain tightness along its entire length as it is introduced.
  • the cutting flutes will cut their own track in the trabecular bone.
  • the implant according to the invention does not require access to the lateral cortex. This reduces the surgical exposure and will reduce the recovery time for the patient.
  • the tapered portion (7) between the barrel and the spigot is shorter than in Figure 3.
  • the tapered intermediate portion may have various forms and may, for example, be straight or rounded (e.g. at 9) when viewed in cross-section.
  • Additional fixation means may be employed for improved stability of the stem or Barrel within the femur. This may be particularly helpful to provide greater initial stability before osseointegration develops.
  • additional or auxiliary fixation is inserted within the femoral neck in order to avoid the need for surgical access to the lateral cortex.
  • fixation of this kind in this case a bolt or screw (10), fixed obliquely into and engaging in a threaded hole in the barrel
  • Figure 4 One type of fixation of this kind (in this case a bolt or screw (10), fixed obliquely into and engaging in a threaded hole in the barrel) is shown in Figure 4.
  • the stem including the barrel (4), is preferably generally straight which inakes its insertion easier, especially location of the spigot into a through or blind hole in the lateral cortex. However, a small degree of curvature would be tolerable.
  • the prosthesis is preferably designed as a press-fit implant.
  • bone cement may be used as an aid to fixation.
  • the socket provided for insertion into the acetabulum is preferably formed from ultra-high molecular weight polyethylene, with a cobalt-chromium metal shell liner for lower wear and reduced thickness of the socket.

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

On décrit une prothèse de la hanche destinée à la chirurgie conservatrice qui peut être introduite entièrement depuis la tête fémorale ayant subi une résection. La prothèse comporte une tête fémorale (1), un collet (3) qui bute sur une surface de résection de la tête fémorale et une partie tronc (2) supportant la tige. La tige comprend un élément (4) qui est globalement circulaire ou elliptique en coupe et qui comporte une partie saillante distale (5) prévue pour se loger dans le cortex latéral, cette partie située entre la partie saillante distale et l'élément étant réduite et effilée.
PCT/GB2000/003221 1999-08-20 2000-08-18 Traitement conservateur de la hanche WO2001013824A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
AU67094/00A AU6709400A (en) 1999-08-20 2000-08-18 Conservative hip
EP00954735A EP1207820A1 (fr) 1999-08-20 2000-08-18 Traitement conservateur de la hanche

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GBGB9919810.3A GB9919810D0 (en) 1999-08-20 1999-08-20 Conservative hip replacement
GB9919810.3 1999-08-20

Publications (1)

Publication Number Publication Date
WO2001013824A1 true WO2001013824A1 (fr) 2001-03-01

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PCT/GB2000/003221 WO2001013824A1 (fr) 1999-08-20 2000-08-18 Traitement conservateur de la hanche

Country Status (4)

Country Link
EP (1) EP1207820A1 (fr)
AU (1) AU6709400A (fr)
GB (1) GB9919810D0 (fr)
WO (1) WO2001013824A1 (fr)

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2003047471A1 (fr) * 2001-11-30 2003-06-12 Depuy International Limited Piece femorale de prothese de hanche
EP1276440B1 (fr) * 2000-05-03 2004-03-10 Aesculap AG & Co. KG Prothese du col du femur
WO2006092613A2 (fr) * 2005-03-03 2006-09-08 Veterinary Innovations Limited Dispositif et procede de remplacement de hanche
US7914584B2 (en) 2004-10-21 2011-03-29 Biomet Manufacturing Corp. Prosthesis system with trunnion and removably coupled head
WO2021029838A1 (fr) * 2019-08-09 2021-02-18 Efa Veterinerlik Hizmetleri Tic. Ltd. Sti. Prothèse de hanche angulaire multi-axiale pour animaux

Families Citing this family (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10537658B2 (en) 2017-03-28 2020-01-21 DePuy Synthes Products, Inc. Orthopedic implant having a crystalline gallium-containing hydroxyapatite coating and methods for making the same
US10537661B2 (en) 2017-03-28 2020-01-21 DePuy Synthes Products, Inc. Orthopedic implant having a crystalline calcium phosphate coating and methods for making the same

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR1063680A (fr) * 1952-09-26 1954-05-05 Perfectionnements aux têtes prothétiques fémorales
GB2033755A (en) * 1978-10-12 1980-05-29 Rambert Andre A hip prosthesis
EP0099167A1 (fr) * 1982-05-14 1984-01-25 Carbomedics Inc. Implant fémoral proximal
FR2674122A1 (fr) * 1991-03-21 1992-09-25 Super Patrick Prothese articulaire notamment pour articulation de type enarthrose.
WO1997025939A1 (fr) * 1996-01-19 1997-07-24 Astra Aktiebolag Dispositif de fixation et prothese dotee de celui-ci

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR1063680A (fr) * 1952-09-26 1954-05-05 Perfectionnements aux têtes prothétiques fémorales
GB2033755A (en) * 1978-10-12 1980-05-29 Rambert Andre A hip prosthesis
EP0099167A1 (fr) * 1982-05-14 1984-01-25 Carbomedics Inc. Implant fémoral proximal
FR2674122A1 (fr) * 1991-03-21 1992-09-25 Super Patrick Prothese articulaire notamment pour articulation de type enarthrose.
WO1997025939A1 (fr) * 1996-01-19 1997-07-24 Astra Aktiebolag Dispositif de fixation et prothese dotee de celui-ci

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1276440B1 (fr) * 2000-05-03 2004-03-10 Aesculap AG & Co. KG Prothese du col du femur
WO2003047471A1 (fr) * 2001-11-30 2003-06-12 Depuy International Limited Piece femorale de prothese de hanche
US7914584B2 (en) 2004-10-21 2011-03-29 Biomet Manufacturing Corp. Prosthesis system with trunnion and removably coupled head
WO2006092613A2 (fr) * 2005-03-03 2006-09-08 Veterinary Innovations Limited Dispositif et procede de remplacement de hanche
WO2006092613A3 (fr) * 2005-03-03 2006-10-19 Veterinary Innovations Ltd Dispositif et procede de remplacement de hanche
WO2021029838A1 (fr) * 2019-08-09 2021-02-18 Efa Veterinerlik Hizmetleri Tic. Ltd. Sti. Prothèse de hanche angulaire multi-axiale pour animaux

Also Published As

Publication number Publication date
EP1207820A1 (fr) 2002-05-29
GB9919810D0 (en) 1999-10-27
AU6709400A (en) 2001-03-19

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