WO2008146295A2 - Prothèses de remplacement de genoux et leur procédé d'utilisation - Google Patents

Prothèses de remplacement de genoux et leur procédé d'utilisation Download PDF

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Publication number
WO2008146295A2
WO2008146295A2 PCT/IL2008/000737 IL2008000737W WO2008146295A2 WO 2008146295 A2 WO2008146295 A2 WO 2008146295A2 IL 2008000737 W IL2008000737 W IL 2008000737W WO 2008146295 A2 WO2008146295 A2 WO 2008146295A2
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WO
WIPO (PCT)
Prior art keywords
tibial
femoral
component
tibial insert
femoral component
Prior art date
Application number
PCT/IL2008/000737
Other languages
English (en)
Other versions
WO2008146295A3 (fr
Inventor
Yona Kosashvili
Yaron Bar Ziv
Original Assignee
Backstein, David
Safir, Oleg
Gross, Allan E.
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 Backstein, David, Safir, Oleg, Gross, Allan E. filed Critical Backstein, David
Publication of WO2008146295A2 publication Critical patent/WO2008146295A2/fr
Publication of WO2008146295A3 publication Critical patent/WO2008146295A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees
    • 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
    • A61F2/38—Joints for elbows or knees
    • A61F2/3886—Joints for elbows or knees for stabilising knees against anterior or lateral dislocations

Definitions

  • the present invention relates to knee replacement prostheses for providing improved rotational alignment of the tibial and femoral components in primary and revision total knee arthroplasty surgery. More particularly, the present invention relates to devices and methods for the treatment of rotational malalignment of total knee arthroplasty components during revision total knee arthroplasty.
  • Knee replacement surgery also known as total knee arthroplasty
  • total knee replacement procedures damaged cartilage as well as tibia and femoral bone sections are removed from both the medial and lateral compartments of the operated knee joint and replaced with metal and/or plastic prostheses.
  • a partial knee replacement procedure only one compartment (either the medial or the lateral) of the knee joint is replaced.
  • the femoral and tibial components need to be in an optimal alignment in the coronal, sagital and axial planes for providing the treated patient a long term successful joint. Failure to achieve appropriate axial alignment will compromise the patello-femoral tracking. This is one of the common recognized causes of post surgical pain and patient discomfort. In the more severe cases patello- femoral mal tracking can lead to total knee revision arthroplasty surgeries.
  • the implants include a femoral component configured to be attached to the prepared femoral condyles, and a modular tibial component.
  • the medial and lateral condyles are parallel both distally and posteriorly.
  • the modular tibial component is typically comprised of a metal tray which is attached to the prepared proximal tibial surface in a cemented or cementless technique, and a layer of polyethylene (also referred to herein as tibial insert), which may be configured in various thicknesses, usually in the range of 8mm to 23mm.
  • the undersurface of the polyethylene layer corresponds to the upper surface of the metal tray for providing a fitted attachment therebetween, and the upper surface of the polyethylene layer is adapted to properly fit the articulating femoral component.
  • the upper and lower surfaces of the conventional polyethylene layers are parallel to each other.
  • the proximal tibia is cut horizontally, in order to result in a joint line perpendicular to the mechanical axis of the patient's lower extremity.
  • the appropriate tibial size is determined by positioning a tibial sizing plate that provides maximal coverage of the proximal tibia, while maintaining an. appropriate external rotation.
  • proximal tibia typically on the posterior medial part of the proximal tibia remains uncovered by the selected sized tibia plate.
  • This may lead to a less than optimal bony support to the tibial component, and may cause tibial implant subsidence, shorten the time period of orderly function of the treated knee and accelerate its failure.
  • This suboptimal bone support may be especially important in revision total knee arthroplasty, where following removal of previous tibial implant results in compromised host bone support. In those conditions it is important to make maximal use of remaining native bone for implant longevity.
  • the surgeon may encounter patellar maltracking due to rotational malalignment of the metal tray after the metal tray has already been fixed to the tibia in a cemented or cementless manner.
  • the distal part of the femur is also cut horizontally, in order for it to be perpendicular to the mechanical axis.
  • the anterior and posterior parts of the femur are typically cut using a cutting block that orients the rotational alignment of the femur to match the femoral epicondyles, using anatomic landmarks. Often, these landmarks are not precise.
  • Using the current femoral components often leads to an unbalanced flexion gap, producing tightness on one side of the joint and laxity on the other. This imbalance may lead to patellofemoral and/or midflexion instability, which is usually symptomatic in activities involving knee bending such as climbing stairs.
  • EP01327424 describes various surgically implantable knee prostheses in which the upper and lower surfaces of the tibial insert have different geometrical shapes and/or concave/convex contours, and wherein the tibial insert has varying thickness for providing an angle ( ⁇ ) , for improving knee joint alignment. Having such an angle, however, influences both the flexion and extension gaps while the culprit is normally only in the flexion gap, such that intraoperative soft tissue balancing is rendered unpredictable and suboptimal.
  • the inventors hereof developed new prostheses and methods for optimizing tibial component positioning in knee replacement procedures, such as total knee arthroplasty, for treating malrotated tibial metal tray intraoperatively, and for balancing knee joints with malrotated femoral cuts intraoperatively, which may reduce the need for revision total knee arthroplasty surgeries.
  • the invention aims to provide new prostheses for improving rotational alignment of the tibial and femoral components in primary total knee arthropalsty surgeries in general, and particularly in revision total knee arthroplasty.
  • the new prostheses of the present invention include an inventive tibial bearing insert having parallel top and bottom surfaces having more or less the same cross-sectional shape, wherein said bottom surface is adapted to fit onto the top surface of a tibial tray, and wherein said top surface is axially rotated externally or internally relative to said bottom surface of said tibial insert.
  • the top surface of the tibial insert preferably, but not necessarily, includes one or two concavities adapted to be engaged by condyle elements of a femoral component.
  • the top surface of the tibial insert comprises a stabilizing post adapted to fit into the depression between the femoral condyles, said stabilizing post is preferably aligned with the axis of symmetry of said top surface of said tibial insert.
  • the stabilizing post may be similar in size and shape to standard posts, as used in current models of polyethylene inserts for posterior or mediolateral stabilized knees.
  • the stabilizing post is typically located at the center of the polyethylene insert, and it is adapted to fit into the respective femoral component, which typically has a centrally located groove adapted to receive the stabilizing post.
  • the post functions as a posterior stabilizer by contacting a metallic bar appropriately prepared in the femur, while a force directed from the front of the tibia is applied in the posterior direction.
  • the posterior stabilizing post does not come into contact with the femoral component due varus-valgus (medial/lateral) forces.
  • axial rotation refers to an angular displacement provided between the axes of symmetries of opposing surfaces of a body.
  • rotational malalignment refers to insufficient rotation of femoral or tibial components in relation to the axial plane in various degrees of knee flexion. This malalignment typically causes suboptimal patellar tracking and postoperative knee pain especially when the knee is in flexion and under load such as climbing stairs.
  • malrotated refers to insufficient axial rotation of either of the knee prostheses components in the axial plane.
  • internal rotation and “external rotation” of the femur used herein refers to rotation of the femoral component while in 90° of knee flexion as seen from the front, in relation to the proximal tibia, that is, in the coronal plane, such that in case of internal rotation the rotation is in the direction of the medial condyle i.e., the inner part of the knee.
  • Malrotation of the tibial component refers to insufficient axial rotation of the tibial component relative to the course of the patella of the knee joint, as viewed from above of said joint.
  • extension gap relates to the gap between the distal femur and the proximal tibia when the knee is extended.
  • flexion gap relates to the gap between the posterior femur and the proximal tibia when the knee is in 90° of flexion.
  • each thickness of the tibial bearing insert there are several models of different axial top/bottom surfaces rotations, generally in the range of -30° to 60 ° (degrees), preferably in the range of -10° to 30°.
  • the tibial insert is selected from a set of tibial inserts having axial rotations of about -10°, -5°, 5°, 10°, 15°, 20°, 25° or 30°.
  • a stabilizing post is provided in the tibial bearing insert (for posterior or mediolateral stabilization)
  • said stabilizing post is provided on top of the top surface of the tibial insert of the invention with an external rotation generally of about 0° to 60°, preferably about 0° to 15° relative to the axis of symmetry of the top surface of the tibial insert.
  • the tibial insert is selected from a set of tibial inserts of the invention having such stabilizing posts with external rotations of about 0°, 5° and 10°, 15.
  • the knee replacement prostheses of the invention comprise an improved femoral component in which the inner portion (the portion covering the condyles) is matching the standard femoral cuts, while in its outer portion, the thickness of the posterior part of the lateral condyle element is either greater or smaller than the thickness of the posterior part of the medial element, by about 1 to 7 mm, preferably 2 to 5 mm.
  • the femoral component is selected from a set of femoral components of the invention in which the thickness of the posterior part of the lateral condyle element is either greater or smaller than the thickness of the posterior part of the medial element by about 2, 3 and 5mm.
  • the present invention is directed to knee replacement prostheses comprising a tibial component, a femoral component, and a tibial bearing insert made from a piece of material having a bottom surface adapted to appropriately attach to the top surface of standard tibial components as used in total knee arthroplasty procedures, and a top surface having dished area(s) adapted to be engaged with said femoral component, or with conventional femoral components as commonly used in total knee arthroplasty procedures, wherein said bottom and top surfaces are substantially parallel and having more or less the same cross- sectional shape, and wherein said top and bottom surfaces are axially rotated relative to each other.
  • the cross- sectional shape of the top and bottom surfaces of the tibial insert is substantially elliptic, or having a kidney-like shape .
  • the upper surface of the tibial insert comprises one or two concavities adapted to receive at least one of the condyle elements of the femoral component.
  • the one or more concavities are more or less elliptic in shape and their major axes are externally rotated.
  • the angle of rotation of the major axes of the one or two concavities may generally be in the range of -10° to 30°, preferably about 0°, relative to the axis of symmetry of the upper surface of the tibial insert.
  • the upper surface of the tibial insert further comprises a centrally positioned stabilizing post adapted to be received in a depression between the femoral condyles, wherein said stabilizing post is preferably aligned in parallel with the axis of symmetry of the upper surface of the tibial insert.
  • the femoral component preferably comprises an inner portion matching standard femoral cuts, and an outer portion comprising a lateral element adapted to fit over the lateral condyle, and a medial element adapted to fit over the medial condyle, wherein the thickness of the posterior part of said lateral element is either greater or smaller than the thickness of the posterior part of said medial element (e.g., by about 1 to 7 mm) .
  • the present invention is directed to a method for knee joint replacement, the method comprises :
  • a suitable femoral component from a set of femoral components having inner portions matching the femoral cuts, and outer portions in which the posterior part of the lateral element is either thicker or thinner than that of the posterior part of the medial element (e.g., by about 1 to I) 1 such that a symmetric flexion gap is obtained;
  • a suitable tibial insert of the invention having a suitable thickness to fit into the flexion gap and a suitable axial rotation conforming to potential malalignment between the femoral and tibial cuts;
  • patellar preparation either (e.g., by patelloplasty or by cementing a patellar component) .
  • Fig. 1 schematically illustrates mounting a tibial metal tray according to the invention, such that the proximal tibial cut is covered entirely without overhanging;
  • FIGs. 2A and 2B schematically illustrates an embodiment of an axially rotated tibial insert of the invention, wherein
  • Fig. 2A is a top view and Fig. 2B is a perspective view;
  • Fig. 3 schematically illustrates a knee joint in 90° knee bending having an asymmetric flexion gap
  • Fig. 4 schematically illustrates the treated knee joint shown in Fig. 3 with the femoral implant of the invention attached over the condyles for obtaining an implant symmetric in flexion gap without the need for re-cutting the femur;
  • Fig. 5 shows sectional views of the femur with the femoral implant taken along the lateral and medial condyes.
  • the embodiments exemplified in the Figs, are not intended to be in scale and are in diagram form to facilitate ease of understanding and description.
  • the preset invention provides new prostheses, for knee joint replacement procedures, including an innovative tibial insert having a lower surface which corresponds to the upper surface of the metal tray of the tibial component, and which upper surface is axially rotated externally or internally relative to its lower surface.
  • an innovative tibial insert having a lower surface which corresponds to the upper surface of the metal tray of the tibial component, and which upper surface is axially rotated externally or internally relative to its lower surface.
  • each thickness of the tibial insert there are several models of axial rotations provided, preferably in the range of -30° to 60°, most preferably about -10°, -5°, 5°, 10°, 15°, 20°, 25° and 30°.
  • the tibia inserts models of the invention preferably comprise a stabilizing post having an external rotation of about 0° to 10°, preferably about 0°, relative to the axis of symmetry of the tibial insert.
  • the present invention also provides a femoral component comprised of an inner portion matching the standard femoral cuts, while in its outer portion, the thickness of the posterior part of the lateral condyle element of the femoral component is either greater or smaller than the thickness of the posterior part of the medial element of the femoral component, by about 1 to 7 mm, preferably about 2, 3 or 5mm, thus allowing the surgeon to properly balance the flexion gap between the medial and lateral sides, without requiring augmentation or re-cut of the femur.
  • Fig. 1 illustrates the preparation of the tibia 11 for knee joint replacement according to the invention. As shown in Fig.
  • tibial cut is essentially covered by a standard supporting tray 10 (as commonly used in total knee arthroplasty procedures) having a kidney-like cross-sectional shape, such that the proximal tibial cut is maximally covered without overhanging.
  • Supporting tray 10 comprises a bottom bone engaging surface 10w adapted to cover the entire area of the tibial cut, and a top mating surface 1Ou adapted to receive the tibial bearing insert.
  • a rim portion 1Or of top surface 1Ou of tray 10 is preferably slightly elevated to form a kidney shape dent 1Od suitable for receiving the tibial insert .
  • Tray 10 is preferably a standard tibial tray (e.g., metal tray) as commonly used in total knee arthroplasty procedures.
  • the size of the top and bottom surfaces, 1Ou and 10w, of tray 10 may vary according to the size of the patient's tibia and the geometry of the tibial cut.
  • the surgeon should be provided with a set of supporting trays having different sizes to allow fitting a respective supporting tray 10 which covers the entire surface area of the tibial cut without overhanging.
  • Figs. 2A and 2B schematically illustrates a tibial insert 20 according to a preferred embodiment of the invention.
  • Tibial insert 20 is made from a body having a top surface 20b and a bottom surface 20a which both have more or less the same kidney-like shape. While bottom surface 20a of tibial insert 20 is more or less flat for allowing to snugly fitting it into dent 1Od of top surface 1Ou of supporting tray 10, the contour of its top surface 20b comprises concavities 22 and 23 adapted to articulate with the condylar elements of the femoral component.
  • top surface 20b and bottom surface 20a of tibial insert 20, AOC 3 and AOC b are axially externally/internally rotated relative to each other.
  • the upper surface 20b of tibial insert 20 may further comprise a stabilizing post 21 adapted to fit into the depression (33 in Fig. 4) between the medial and lateral condyles of the femur.
  • Tibial insert 20 can be made of a suitable form of polyethylene approved for use in total knee arthroplasty, preferably from cross linked or highly cross linked polyethylene, but other suitable materials may be equally used as well.
  • the thickness of tibial insert 20 may generally be in the range of 6 to 30 mm, preferably in the range of 10 to 25 mm and the sizes of its top and bottom surfaces may vary according to the geometry of the knee joint of the treated patient.
  • the angle of rotation 0 between the top and bottom surfaces of tibial insert 20 may generally be in the range of -30° to 60°, preferably about -10°, -5°, 5°, 10°, 15°, 20°, 25° or 30°.
  • Concavities 22 and 23 are preferably more or less elliptical in shape, and they are provided in each side of the axis of symmetry AOC b of top surface 20b, such that the axis connecting their centers (the major axis), 22x and 23x, are externally rotated relative to the axis of symmetry AOC b of top surface 20b.
  • the angle ⁇ between the axis of symmetry (AOC b ) of the top surface 20b and the central axes 22x and 23x of concavities 22 and 23, may generally be in the range of - 10° to 30°, preferably about 0°.
  • Fig. 3 exemplifies a prepared knee joint 35 in total knee arthroplasty in 90° knee bending, before implantation of the tibial and femoral components.
  • an asymmetric flexion gap 32 is obtained between the cuts in tibia 31 and femur 30, and depression 33 is maintained between lateral and medial condyles, 30a and 30b respectively, of femur 30.
  • Fig. 4 illustrates the prepared knee joint 35 in 90° knee bending as shown in Fig. 3, with a femoral implant 36 of the invention attached over the lateral and medial condyles (30a and 30b in Fig. 3) .
  • Fig. 3 exemplifies a prepared knee joint 35 in total knee arthroplasty in 90° knee bending, before implantation of the tibial and femoral components.
  • an asymmetric flexion gap 32 is obtained between the cuts in tibia 31 and femur 30, and depression 33 is maintained between lateral and medial condyles
  • Fig. 5 shows sectional views of femur 30, with femoral component 36, taken along the lateral condyle 30a (cut A-A in Fig. 4) and along the medial condyle 30b (cut B-B in Fig. 4) .
  • the thickness (Wa) of the posterior part 9a of lateral condyle element 36a is smaller than the thickness (Wb) of the posterior part 9b of medial condyle element 36b.
  • the anterior parts, 8a and 8b, of the lateral condyle element 36a and of the medial condyle element 36b have substantially the same geometrical dimensions.
  • Femoral implant 36 may be made from cobalt chrome, stainless steel alloys, titanium alloys, oxynium, or from other suitable metallic alloys approved for use in total knee arthroplasty, in a range of different sizes to allow proper fitting in femurs of different patients.
  • the inner portion (the portion attached of the cuts in the lateral and medial condyles) of femoral component 36 is configured according to the standard femoral cuts, while in its outer portion, the thickness of the posterior part 9a of the lateral condyle element 36a is either greater or smaller than the thickness of the posterior part 9b of the medial condyle element 36b, by about 1 to 7 mm, preferably by about 2, 3 or 5mm.
  • Other elements of femoral component 36 are substantially similar to such elements in conventional femoral implants. In this way the surgeon may properly balance the flexion gap 32 between the medial and lateral sides, without requiring augmentation or re-cut of the femur.
  • a method for improved alignment of the tibia and femur in primary or revision total knee arthroplasty is provided.
  • the tibial sizing guide will indicate what tibial tray will best cover the tibial bone without overhanging.
  • trial femoral and tibial inserts of the invention having the selected axial rotation and thickness can be assembled on the tibial tray.
  • the trial components of the tibia and femur can be used to evaluate patellar tracking and flexion and extension balancing. If the tracking is satisfactory and flexion and extension gap are balanced, same sized components as the trial ones will be chosen for implantation.
  • flexion gap is found unbalanced medially or laterally, an appropriate femoral trial will be inserted in order to compensate for this imbalance. If only patellar tracking is the issue then a more rotated, typically externally, insert will be selected. In addition, once the appropriate tibial metal tray is placed over the tibia cut, a trial of patellar tracking will be performed. If it is found unsatisfactory, a trial tibial insert having an increased rotation, typically external rotation, will be tried, until satisfactory tracking is accomplished.
  • the present invention further provides a method for improving tibial rotation and patellar tracking in patients having an inappropriate tibial metal tray implant, by means of the tibial insert of the invention.
  • trial tibial inserts of the invention with selected degrees of axial rotations and thicknesses will be assembled on the already implanted tibial tray.
  • the trial components of the tibial inserts will be evaluated for patellar tracking. If the tracking is satisfactory, same sized and angled components as the trial ones will be chosen for implantation. If patellar tracking is found unsatisfactory, a trial tibial insert with an increased/decreased external rotation, and/or thickness, will be tried, until satisfactory tracking is achieved.
  • revision of total knee arthroplasty for component rotational malalignment is performed by approaching the knee joint, preferably by using the previous incision, and removing the previously implanted tibial insert. Thereafter, a trial tibial insert implant of the invention having the appropriate thickness and the selected external/internal degree of axial rotation is inserted. If a satisfactory patellar tracking is achieved, than a corresponding tibial insert implant of the invention is implanted. If necessary, a tibial insert implant of the invention having an increased/decreased thickness, and/or degree of rotation is inserted in order to provide improved patellar tracking. Using this method can prevent an exchange of well fixed metal tibial/femoral components, consequent bone loss and use of stemmed components, and considerably simplify this kind of revision total knee arthroplasty.
  • femoral trial components with asymmetric posterior parts of the condyles elements are inserted according to the conditions observed during surgery. If further internal or external degree of rotation of the tibial insert is required, the appropriate trials are selected, until flexion gap balancing is achieved.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Physical Education & Sports Medicine (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

La présente invention vise à proposer des prothèses de remplacement de genoux comprenant un composant fémoral, un insert de support tibial fait d'un matériau muni d'une surface inférieure plate et apte à s'ajuster sur un composant tibial classique, et d'une surface supérieure pourvue d'une ou de plusieurs zones incurvées pouvant être engagées avec ledit composant fémoral, et, facultativement, un montant de stabilisation fixé à la surface supérieure de l'insert tibial et aligné avec son axe de symétrie. Les surfaces inférieure et supérieure sont sensiblement parallèles, présentent plus ou moins la même forme de section transversale et sont amenées à tourner axialement l'une par rapport à l'autre.
PCT/IL2008/000737 2007-05-31 2008-06-01 Prothèses de remplacement de genoux et leur procédé d'utilisation WO2008146295A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US94097407P 2007-05-31 2007-05-31
US60/940,974 2007-05-31

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WO2008146295A2 true WO2008146295A2 (fr) 2008-12-04
WO2008146295A3 WO2008146295A3 (fr) 2016-05-26

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Family Cites Families (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
USRE29757E (en) * 1971-04-21 1978-09-12 Replacements for bicondylar joints in human limbs
US7048741B2 (en) * 2002-05-10 2006-05-23 Swanson Todd V Method and apparatus for minimally invasive knee arthroplasty
CN1845713B (zh) * 2003-07-17 2010-06-02 精密技术公司 活动支承件膝盖假体

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Publication number Publication date
WO2008146295A3 (fr) 2016-05-26

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