WO2008000496A2

WO2008000496A2 - Orthopedic implant

Info

Publication number: WO2008000496A2
Application number: PCT/EP2007/005777
Authority: WO
Inventors: Christoph Haessig
Original assignee: Plus Orthopedics Ag
Priority date: 2006-06-29
Filing date: 2007-06-29
Publication date: 2008-01-03
Also published as: WO2008000496A3

Abstract

The invention relates to an orthopedic implant (10), particularly for a knee, a hip, a shoulder, or other joints, comprising at least two components (11, 12). The invention is characterized in that a removable connection (13) is provided between at least one first component (11) and at least one second component (12). Said removable connection (13) is adjusted such that the second component (12) can be revised in the implanted state.

Description

"Oithopädic implant"

Description

The invention relates to an oithopadic implant having the features of the preamble of claim 1

Em such implant is manufactured by the applicant and vertneben.

Partial prosthetic fractures have recently become more prominent. Responsible for this are non-demographic reasons, d. H. the people live longer. In addition, people are more active in their old age than in the past and get a joint already in their younger years. Among others, the following may be affected: Bone proximal / distal femur, proximal tibia, pioximal humerus.

In the event of an emergency, such fractures are usually treated by retrograde nailing or by angle-stable plates.

In case of revision, d. H. if the prosthetic fracture is proximal, for example, an already implanted femoral component, such femurs are usually treated with revision knee prostheses with pedicles and possibly additional plates.

In severe revision case, d. H. if the penprothetic case is above an already implanted revision knee with a stalk, d. h the fracture is located above the pedicle, such fractures are usually with tumor implants or so-called custom made implants, d. H. Custom made, supplied.

An example of such a revision knee prosthesis is the Applicant's implant sold under the name RT-PLUS ^{1 M} Modulai Solution.

Generally there are artificial knee joints, ie. Knee implants, one thigh part (femoral condyle) and one lower leg part (tibial plateau). These parts are grazing ai koipeiveitiaghchen made of metal alloy, mostly a cobalt-chiom alloy. A plastic plate is attached to the tibial plateau to minimize the friction between the top and bottom joint

The individual implant components are then either fixed in the bone with a quick-holding, self-supporting plastic, cemented or cemented into the bone and anchored cement-free. The bone then has to grow to the implant

Special prosthesis systems with a high degree of coupling gage, such as the implants named RT-PLUS ^{1 M} Modulai Solution, which carry out an axis-guided rotation-knee endoprosthesis system, are used to supply severe revision cases. Deiaitic implants are modularly constructed from various components On the other hand, these implants have a tibial PE insert, a tibial component and a tibial block. The femoral component or tibial component can each be fitted with different stems in modular combiners to adapt the implant to the patient _j eweiligen the shafts can be used as cement-free or cement derive shafts

As a rule, in the case of revision, bone preservation should be as much as possible so that a further spate revision can be carried out with the state aid inspection systems

In the case of the known revision knee prostheses with peduncles, the legs are either cemented or ce- mented with cementum, with a pnmaie and secondary stable should be provided between the implant and the bone

The problem is that this old of

can lead to the already well-known peni-prosthetic fractures outside the tip of the stem, which then is usually a costly affair with special revision systems (tumoipiotheses, probe leads) eifoidein The object of the invention is to provide an orthopedic implant, by which the risk of periprosthetic fractures can at least be reduced and / or in a further revision the implantation of a standard revision prosthesis instead of a more complicated tumor prosthesis or special design is favored.

Eifmdungsgemaß this object is achieved by an orthopedic implant with the Meik- times of claim 1, alternatively by an oithopaetic implant having the features of claim 8 and further alternatively by an orthopedic implant having the features of claim 18.

The invention is based on the idea of providing an orthopedic implant, in particular a knee, a hip, a shoulder or other joints, which comprises at least two components. In this case, a releasable connection between at least one first component and at least one second component is provided, which is adapted such that the second component in the implanted state, ie after insertion of the implant, is revidierbai and the other component remains in situ

The losbaie Veibmdung between the two components has the advantage that the implant, d. h the artificial joint, with a trauma implant, for example, a dream nail or shaft can graze combined. The second component, ie the trauma component, remains in the bone until it has healed. After disseminating the fracture, remove the second component wildly. This is made possible by the detachable connection being adapted such that the second component can be revised in the implanted state. The first component, for example a femoral component, remains in situ after osteointegration. In this way, the danger of piπiothetischer fractures is lowered above the shaft / stem tip.

The invention thus enables the combination of an implant, ie. an artificial joint with a trauma component.

Applicable is the attachment to the tibia, shoulder, hip, femur, humerus and other joints. In an advantageous embodiment of the invention, the first component with the second component is axially and / or rotationally veibmdbai. This wild created a stable arrangement of the first and second components, which allows a safe power transmission, at the same time a lifting of the binding for the purpose of revision is possible.

The first component may have at least one opening through which the second component is removable for revision. This means that the second component can move through the first component and be removed from the Koiper

The first and second components may be dynamic or static lockable, so that the location of the two components is either veianderbar or fixed relative to the bone.

The second component can have stabilizing agents, in particular for the angular stabilization of bone fragments, which enables a particularly good healing of the fracture.

Removal of the second component from the bone is facilitated by preferably having the second component having a surface adapted to prevent bone material from growing thereon.

In a preferred embodiment of the invention, the first component comprises a femoral component and the second component comprises a shaft, so that the orthopedic implant can be used as a knee implant, without the invention being restricted thereto

The releasable connection or the mechanical coupling may comprise a threaded arrangement with an internal thread of the first component and an external thread of the second component. In this case, the threaded arrangement an axial stop and / or a

Alternatively, the releasable connection or the mechanical coupling may include a frictional connection or a positive connection. A further possibility to disassemble the loose coupling or the mechanical coupling is then to provide a locking member which is screwed into the first component and axially fixes the second component. The loose assembly or mechanical coupling may comprise a pin or a pin shaft. the quei odei inclined to the longitudinal axis of the second component is angeoidnet and the éiste and second component in each case at least partially duichgieift The releasable connection or the mechanical coupling may comprise a Spieizkonus in the second component, in which a spreader derait is arranged that between the former and Alternatively, the losbaie Veibmdung or mechanical coupling may have a losbaie Rastveischluss In the Rastveischluss at least one in the first component voigesehene Zugangbohiung voigesehen be Duich the Zugangbohiung can Loseweikzeug e In the case of an infeed willow that responds to the circlip in the air condition and loosens it, alternatively, the loose cube or the mechanical coupling may comprise a bayonet circlip

In the following, the details are more closely understood on the basis of examples of exportation, with reference to the attached drawings

In this show

1 is a Voideiansicht an orthopedic implant for a knee according to a erfmdungsgemaßen Ausfuhiungsbeispiel,

FIG. 2 shows a side view of the implant according to FIG. 1,

FIG. 3 is a side view of the implant according to FIG. 1 with dissolved body;

FIG. 4 shows a side view of the implant according to FIG. 3, wherein the two-component component is partially pulled out,

FIG. 5 shows the implant according to FIG. 1 in the inserted state, and FIG. 5 shows the second one

Component is partially hot drawn, 6 shows the implant according to FIG. 5 with a completely hot-drawn second component, FIG.

7 shows two views of a femur with an implanted femoral condyle according to the exemplary embodiment of the present invention,

8 shows a section duich an implant with Schiaubverbmdung,

9 is a section duich an implant with emei kraftschlussigen connection,

10, 11 show schematic examples of film-tight connections of the two components of the implant,

12 shows a perspective view of the first component or of the primate implant according to an embodiment of the invention, FIG.

13 shows a section duich an implant with a counter nut,

FIG. 14 shows a section through the implant according to FIG. 13 in the region of a vertical rotation, FIG.

FIG. 15 shows a section through an implant with a pen needle, FIG.

FIG. 16 shows a section through an implant with a spreading ligament, FIG.

17 shows a section duich an implant with a Rastveischluss, and

18 shows a section duich an implant with a bayonet joint

FIGS. 1 to 4 show an orthopedic implant or implant system according to an exemplary embodiment with its most important components. This implant is used as a knee prosthesis. The invention is not an alleged one It is also limited to implants on the hips, shoulders or other joints

The implant comprises at least two components 11, 12, and in this embodiment example a femoral component 11 'as well as a shaft 12' or a thumb nail Dei shaft 12 'and the femoral component 11' are a loose connection 13 with each other For example, the receiving sleeve 16 and the femoral component 11 'can be formed in one piece or can be screwed together in place of the receiving sleeve 16 Other means for coupling the trauma nail or shank 12 'with the femur component 11' may be provided. Screw connections or other coupling elements enabling a loose connection between the shank 12 'and the femur component 11' are possible, whereby at the same time a revision of the shank 12 'in implantieiten condition The axial and the firm fixation of the shank 12 is carried out by a bolt 17, which has holes in the receiving sheath and in the shank 12 'duichgieift, as shown in FIGS. 1, 2. Anteie Old of the fixing of the shank 12 is possible. voiausgesetzt, these can be solved

In order to adjust the effective length of the shaft 12 ', ie the length of the shaft 12' inserted into the bone, there are provided at the proximal end of the shaft 12 'several boreholes, preferably two bores 21 which cooperate with the pin 17 m of the aforesaid manner Holes 21 can be seen in FIG. 4. In FIG. 4, the platen 21 is positioned so that the lower part of the shaft underneath the bore 21 does not protrude from the femoral component 11 but is in the receiving sleeve 16

Shaft 12 'has means 15 for stabilizing it, especially for bending of bone fragments. These means 15 comprise boreholes at the pioximal end of shaft 12', as in FIGS. 1 to 4, the above-mentioned holes are shown in FIG. So the means 15 zui Stabihsieiung, can suitable Fixieiungsoigane, in particular screws, felt that serve zui stabilization or angle stabilization of bone fragments

To allow easy revision of the stem 12 ', the surface of the stem 12' is such that bone material does not grow thereon. Thus, the function of the shaft 12 'is supported as Tiaumakomponente

The femoral component 11 'is designed as a femoral condyle and has an anatomical patellar groove 18 for patellar guidance. In the region of the patellar groove 18, an opening 14 is arranged, which is aligned with the longitudinal axis of the shank 12 '. The opening 14 in this case extends into the receiving sleeve 16, so that the shank 12' can be moved through the opening 14, as in FIGS , 5 are available.

The operation of the implant 10 will be explained below.

In the case of a piπothetic fracture, the implant shown in FIGS. 1 to 4 is used, the femoral component 11 'being anchored pπmar and secondarily stably. The shaft component 12 'is locked dynamically or statically with screws, so that the fracture is stabilized against rotation, so that it can grow together. The stabilization takes place proximally by means of screws and distally via the fixation on the femoral component 11 'and thereby indirectly with the condyles of the femoral component 11'.

After the fracture has been released, the locking screws and the shaft 12 'are removed. The femoral component 12 'is not replaced, but remains stable in situ.

Due to the releasable coupling of the shaft 12 'with the femoral component 11', in particular through the opening 14 m of the patellar groove 18 of the femoral component 11 ', the shaft 12' or the trauma nail can be removed through the femoral component 11 'after the fracture has healed , This can also be done with a small patella access

Thus, there is a chance that the injured bone will be able to fully replenish the forces. In case of a possible later fracture, it does not become too pioximal, d. H probably not above the tip of the stem. A further revision procedure with stand implants is therefore comparatively easy to feel

With the exemplary embodiment described above, therefore, the concept underlying the concept is realized, in which the first and second components 11, 12 of the orthopedic implant 10 are detachably connected to each other, wherein the releasable connection 13 is designed so that the second component 12 can be revised in the implanted state is. The revision of the second component 12 in the implanted state takes place concretely in that the locking of the second component 12 is released both distally and pioximally and the second component 12, i. H. the shaft 12 'pulled out wild through the provided in the femoral component 1 1' opening 14 in the direction of the arrow shown in Fig. 4. The distance of the shaft 12 'is also well recognizable in Figures 5 and 6.

The erfmdungsgemaß provided detachable connection 13, which allows a revision of the second component in the implanted state, creates the prerequisite for an oithopadic implant, so an artificial joint with a trauma product, such as a Traumanagcl can be combined. After the fracture has been resolved, the trauma product can be removed and the oithopadic implant remains in situ after osteomegmentation.

The exemplary embodiment of a knee implant according to the invention is also applicable to other orthopedic implants, for example for shoulders, hips or other joints. This means that even in these cases an oithopaetic implant is combined with a trauma product, whereby the tiaumaproduct is removable after a successful fracture. The mechanical coupling of the trauma product with the implant can be done in any way, provided that the removal of the trauma product after healing is possible.

This can be done for example by a voicesehene in the implant opening or recess through which the trauma product moves through and can be removed from the bone. The invention may be used by way of example without the following circumstances.

A patient with a Femuimarknagel, the wild because of the high age of the patient in situ, crashes. In the process, a fracture is created distally to the tip of the nail, which is to be treated with a retrograde nail. Intraoperatively, an arthiosis is diagnosed. Then the eifmdungsgemaße knee prosthesis is implanted with nail (trauma knee) Since in this case the nail in the patient Wud even after healing of the fracture wud, the nail or generally the Traumapiodukt also be firmly connected to the implant, in particular the knee prosthesis.

The patient stumbles with a knee prosthesis or a unicondylar implant. A metaphyseal fracture develops. The prosthesis must therefore be removed and wud replaced with a knee prosthesis with nail (trauma knee).

A patient with a hip joint and knee osteoarthritis falls. The distal end of the prosthesis tip is fractured. The Huftschaft _j edoch grown stably. A plate restoration would be inadequate, so that a knee prosthesis with mtiamedularem nail (trauma knee) used or implanted wild. It is also possible here that the nail is connected to the tip of the hoof shaft.

Another possible application of the invention is then to combine a spacer implant with a trauma product, in particular a nail. After the fracture has healed, the spacer implant including the nail is removed and, for example, a knee prosthesis implanted. The nail can be left and only the proximal screws removed.

FIG. 8 shows a partial section through an implant having a first component 11 and a second component 12 mechanically coupled thereto, the first component 11 providing a primary component which remains in situ after implantation. The second component 12 is a trauma component. For example, it is designed as an intramedullary nail or a trauma nail and can be revised after completion of the healing process. For this purpose, the mechanical coupling between the two components 1 1, 12 is designed as a detachable connection 13, the thread Anoidoidnung 22nd In the first component 11 is an internal thread and in the second component 12 a matching external thread voigesehen so that the two components 11, 12 can be screwed together. In order to achieve a defimeite screwing depth of the second component 12 m, the first component 11 and thus a predetermined effective length of the second component 12, an axial stop 23 is considered. The axial stop 23 has a radially projecting collar at one axial end of the second component 12, which in the screwed state rests against a shoulder 23a which is complementary to the stop 23 and which is seen in the first component 11. The threaded scanning arrangement 22 may have an anti-rotation device 24, for example in the form of a pin or a feather key, which form-lockingly connects the stop or the associated collar of the second component 12 with the first component 11.

Another possibility for the realization of the mechanical coupling between the first and second components 1 1, 12 is then to provide a kraftschlussige Veibindung 25, as m Fig. 9 shown. In this case, the axial end of the second component 12 is conically shaped, which is arranged in a complementary thereto arranged recess 25a of the first component 1 1 and in the implanted state empressed in this em

As an alternative to the non-positive connection form-fitting connections 26 may be provided, wherein the positive connection between the first and the second component 11, 12 can be realized in various ways, for example in the form of rectangular, triangular or rosette-like cross sections of the two components 11, 12 in the area the releasable connection 13 (Fig. 10, 1 1)

According to FIG. 13, the losbaie connection 13 or the mechanical coupling between the two components 1 1, 12 carried by a Konteimutter 27, which is screwed into the first component 1 1. The lock nut 27 fixieit the second component 12 in the axial direction. For this purpose, the second component at its axial end on a collar 27a, which is arranged between emci in the first component 1 1 provided shoulder 27b and the Kontermuttei 27 The lock nut 27 presses in the implanted state, the collar 27a against the Schultei 27b As shown in Figure 14, the Konteimuttei 27 may have a Veidrehsicheiung 27c, which a foimschlussige Veibmdung between the Konteimuttei 27 and the ei most component 11 hinist

According to FIG. 15, the loose connection 13 or the mechanical coupling can have a pin or a pin shaft 28, which at least partially through-transports both the first and second components 11, 12. In the embodiment of FIG. 15, the pin or pencil shaft 28 is related to FIG the longitudinal axis of the second component 12 inclined angeoidnet Dei pin or the Stiftschiaube 28 may also be angeoidnet transverse or perpendicular to the longitudinal axis

A wide possibility for the detachable element 13 then exists to provide a direction of movement between the first and second components 11, 12. The splicing cone comprises a splitting cone which is formed in the axial end of the second component 12 Spieizmittel 30, msbesondeic a Spieizschiaube used, the Spieizkonus 29 duich a movement m the longitudinal direction of the second component 12 iadial outward Daduich wud set a losbaie kiaft- schlussige connection between the first and second component (Fig 16) The Kiaftnchtung is duich the arrows are shown in FIG. 16

An alternative releasable connection 13 is shown in FIG. 17, which comprises a latching closure 31. The latching latch 31 has one or more latching lugs which are formed at the axial end of the second component 12. The latching lug 31 a engages in a locked recess in a complementary recess In this case component 11 is inserted, thus avoiding the two components 11, 12. In order to loose the locking cam 31, at least one, preferably two, access holes 32 are provided in the component 11, into which a loose tissue, for example a pin, is inserted Zugangbohiung 32 and the (not shown) Loseweikzeuges the locking lugs 31 a from dei complementary recess in dei most component 1 1 grazing george, so that the two components 11, 12 fell and disloyed ien The losbaie Veibindung can be ausgefuhit in Foim a Ba _j onettverschlusses 33, as shown in Figure 18

Both the bayonet loop 33 according to FIG. 18 and the latching cone 31 according to FIG. 17 and the splicing cone 29 as shown in FIG. 16 can have a rotation or vatting arrangement corresponding to the anticlocking according to FIG. 14 or FIG. 8 FIG. 18 shows a locking pin 34 or a threaded pin presented as Veidiehsicheiung

The oithopadic implant was claimed to be both a two or more component implant with a pial component adapted for osteometgiation and a trauma component that is levidatable after implantation. The orthopedic implant is also used as a priming implant (without trauma component), for example 12, the implant according to FIG. 12 is adapted so that it can be mechanically coupled to a tiaumacomponent, for example for retrogial nailing. For this purpose, the implant or the piocardial component according to FIG. 12 has a coupling means 35 which is suitable for a loose connection with The pnmark component or the pumai implant corresponds to the first component 11 of the embodiment according to FIGS. 1 to 4. The coupling means 35 is designed as a sleeve, so that the trauma component is inserted in the event of surgery and thus can lodge with the bone to be treated, so that the coupling agent makes it possible to access the bone to be treated. The coupling means 35 or the sleeve has the function of providing a detachable connection between the trauma implant and the pump implant 11 The dream implant sucks doing dei second component 12 and the shaft 12 'according to FIGS 1 to 4 for the losbaie

between the two components 11, 12, the sleeve or the coupling means 35 may be ausgefuhit as shown in Figures 8 to 18, that is, the coupling means 35, for example, an internal thread (Fig 8), a cone (Fig 9), etc ..

The pumping implant or the iced component 11 according to FIG. 12 has the advantage that it can be used without a tiaumimplant or implanted in the case of emei After the implantation of the implant there may be implanted a tiaumimplant implant mechanically connected to the already existing osteointegrated piimai implant 11. After completion of the healing process, the tiaum implant may rest on the loose connection 13 with the implant 11 be removed

In addition, the implant implant 11 according to FIG. 12 makes it possible to replace the Tiauma implant by surgery, for example if a long or shorter stem or nail is required as a trauma implant

The invention is not limited to dei-type implants. The invention is generally limited to other joint implants as primary implants, which are adapted for mechanical coupling with a tiaum implant and have a suitable coupling means 35

Bezugs7eichcnhste

10 implant

11, 11 'component, femine component

12, 12 'second component, shank

13 Veibmdung

14 opening

15 means of stabilization

16 exceptional

17 bolts

18 patellagi tube

19 implant component

20 tiaumacomponent

21 piles

22 threading

23 stop a shoulder

Anti-rotation non-positive Verbindunga recess form-fitting connection

Lock nut a collar b shoulder c anti-rotation lock

stud

expansion cone

spreading

Ras tver finish a catch

access holes

bayonet catch

safety pin

coupling agent

Claims

claims

An oithopiotic implant (10), preferably comprising a knee, a hip, a shoulder or other joints, comprising at least two components (11, 12), characterized in that a detachable connection (13) is provided between at least one component (11) and at least one second component (12) is adapted to match the second component (12) in the implanted state of being levidianibai, the first or at least one component (H) being adapted to remain in situ

Implant according to claim 1, characterized in that the first component (11) is axially and / or rigidly implantable with the second component (12)

Implant according to claim 1 or 2, characterized dadui ch in that the first component (H) has at least one opening (14) through which the second component (12) is zuri Revision entsembai

Implant according to any one of claims 1 to 3, characterized in that the first and / or the second component (11, 12) are dynamically or statically deflectable

Implant according to any one of claims 1 to 4, characterized in that the second component (12) has means (15) for stabilizing it, especially for angular stabilization on bone fibrils

Implant according to any one of claims 1 to 5, characterized in that the second component (12) has a surface that is adapted so that bone material does not grow on it.

7 implant according to one of claims 1 to 6, characterized in that the first component (11) comprises a femoral component and the second component (12) comprises a shaft

An orthopedic implant (10), in particular a knee, a hip, a shoulder or other joints, comprising at least two components (11, 12), wherein a first component (11) as an implant component (19) and a second component (12) is formed as a trauma component (20) and wherein the implant component (19) and the trauma component (20) are mechanically coupled.

9. Implant according to one of claims 1 to 8, characterized in that the releasable connection (13) or the mechanical coupling a Gewmdeanord- tion (22) with an internal thread of the first component (11) and an external thread of the second component (12 ).

10. Implant according to claim 9, characterized in that the threaded arrangement (22) has an axial stop (23) and / or an anti-rotation device (24).

11. Implant according to claim 9, characterized in that the releasable connection (13) or the mechanical coupling comprises a frictional or formschlussige Vcibindung (25, 26).

12. Implant according to claim 9, characterized Porsche Style n indicate that the losbaie

13 or the mechanical coupling comprises a Konteimuttei (27) which is screwed into the iste component (11) and the second component (12) axially fixieit

An implant according to claim 9, characterized in that the loose coupling 13 or the mechanical coupling comprises a pin or pin shaft (28) arranged transversely or inclined to the longitudinal axis of the second component (12) and the first and second components (11, 11). 12) in each case at least partially passes through

Implant according to claim 9, characterized in that the loose connection 13 or the mechanical coupling comprises an expansion cone (29) in the second component (12), in which a distraction means (30) is soothed between the first and the second second component (11, 12) is a losbaie kiaftschlussige Veibmdung heistellbai

Implant according to claim 9, characterized in that the losbaie connection 13 or the mechanical coupling has a losbaien latching closure (21)

Implant according to claim 15, characterized in that at least one access bore (32) provided in the first component (11) is closed to the latching cam follower (31)

Implant according Anspiuch 9, ch Dadui in that the losbaie connection 13 or the mechanical coupling of a Ba _j onettvei- circuit (33) comprises

18. An oithopiotic implant (10), in particular a knee, a hip, a shoulder or other joints, comprising at least one component (H) adapted as a implant for osteointegration, said component (11) having at least one further component (12) can be coupled mechanically, in particular mechanically coupled in the implanted state, wherein the further component (12) is designed as a Tiaumaimplantat that is vivisible after implantation.