WO2021115960A1 - Prothèse totale de hanche ou d'épaule et kit d'instruments pour sa mise en place - Google Patents

Prothèse totale de hanche ou d'épaule et kit d'instruments pour sa mise en place Download PDF

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Publication number
WO2021115960A1
WO2021115960A1 PCT/EP2020/084669 EP2020084669W WO2021115960A1 WO 2021115960 A1 WO2021115960 A1 WO 2021115960A1 EP 2020084669 W EP2020084669 W EP 2020084669W WO 2021115960 A1 WO2021115960 A1 WO 2021115960A1
Authority
WO
WIPO (PCT)
Prior art keywords
prosthesis
acetabular
glenoid
femoral
introducer
Prior art date
Application number
PCT/EP2020/084669
Other languages
English (en)
Other versions
WO2021115960A4 (fr
Inventor
Javier CORTES CUBERO
Original Assignee
Desarrollos Biomecánicos Innovasan S.L.
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 Desarrollos Biomecánicos Innovasan S.L. filed Critical Desarrollos Biomecánicos Innovasan S.L.
Publication of WO2021115960A1 publication Critical patent/WO2021115960A1/fr
Publication of WO2021115960A4 publication Critical patent/WO2021115960A4/fr

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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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    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
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    • A61B17/1703—Guides or aligning means for drills, mills, pins or wires using imaging means, e.g. by X-rays
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    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1721—Guides or aligning means for drills, mills, pins or wires for applying pins along or parallel to the axis of the femoral neck
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    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4668—Measuring instruments used for implanting artificial joints for measuring angles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4677—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using a guide wire
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4681—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor by applying mechanical shocks, e.g. by hammering
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4687—Mechanical guides for implantation instruments

Definitions

  • Total shoulder replacement The joint is completely replaced, i.e. the scapular component (glenoid cavity) and the humeral component (humeral head).
  • the implanted device that replaces the scapular component and the humeral component is called a total shoulder prosthesis.
  • the instruments needed to place the partial PCT ES2019/070399 prosthesis include a Kirschner wire centring device that enables the placement of a Kirschner wire centred on the femoral or humeral head, a cannulated femoral or humeral head extractor and two inserters for the prosthesis components.
  • the most important of these are the inserters for the hemispherical component and the diaphyseal nail. They are shaped like an inverted “U” with a component holder and a handle provided with a groove aligned with the holder.
  • the total hip/shoulder prosthesis described in this report consists of the following components:
  • the acetabular prosthesis is comprised of an external component designed to be embedded in the hip bone (pelvic acetabulum) — by any method — and an internal component that comes into contact with the femoral prosthesis, specifically with the ball of the metaphyseal component.
  • the femoral prosthesis shall preferably be placed using the method set forth in the aforesaid PCT patent, using the same incisions. Other methods may be used although they are non-preferred procedures because they make placement more aggressive.
  • the invention also consists of a kit of instruments for the minimally invasive prosthesis placement.
  • removal of the femoral head may require an incision in the femoral neck (osteotomy) using a saw blade.
  • the saw blade must be guided during performance of this task.
  • This guidance may be provided by means of a guide for the osteotomy (cut) of the femoral neck that consists of a generally U-shaped handle (inverted in operating position) and a grip that occupies one vertical leg of the U and all or most of the horizontal section and a centring-nail support.
  • the centring nail is designed to be inserted into the femoral diaphyseal canal to immobilise that end of the guide while the grip is held from the outside.
  • the acetabulum can be milled by using a bur introducer — also generally U-shaped and inverted while in use — comprised of an introducer handle with a bur-holder attached at one end.
  • the free end of the bur-holder is formed by a ring in which the stem of the normally hemispherical bur rotates freely.
  • the bur stem is aligned using an aligner formed by a groove or orifice in the handle of the bur introducer that enables a rotary tool to be connected to the bur stem and perfectly aligned with the same.
  • the grip of the femoral neck osteotomy (cut) guide, the handle of the bur introducer and the acetabular prosthesis introducer may be equipped with series of marks with an X-ray transparency different from the rest of the instrument and arranged at different angles to help control the anteversion of each one at any given time.
  • Figure 3 Perspective view of an example of a femoral neck osteotomy guide.
  • Figure 4 Perspective view of the bur introducer.
  • Figure 6 Perspective view of the bur introducer prepared for milling.
  • Figure 8 Detail view of the alignment marks.
  • the acetabular prosthesis (10) of the invention is a body with a generally hemispherical internal opening, as is usual in the present state of the art, for insertion and movement of the spherical ball (19) of the metaphyseal component of the femoral prosthesis.
  • This acetabular prosthesis (10) is composed of an external component (11) — the outermost part, — embedded in the acetabulum of the pelvis and an internal component (12) (the "insert” or “liner”) which is the part that comes into contact with the ball of the metaphyseal component of the femoral prosthesis.
  • the outer component (11) and the inner component (12) could form a single element if the material possesses the required properties, although this would be a non-preferred embodiment.
  • the external component of the acetabular prosthesis (11) may be fixed to the pelvic bone (acetabulum) by threading, impaction, etc. or any other method and is not a relevant aspect of the invention.
  • Middle incision below the greater trochanter. It will be approximately aligned with the extension of the equivalent to the femoral neck of the latter. An opening aligned with this middle incision is made in the lateral cortical wall of the femur.
  • a Kirschner wire (39) must be inserted through the middle incision towards the centre of the femoral head using the aligner (36) on the grip (31) of the guide for the femoral neck osteotomy (cut) as a guide.
  • This aligner (36) is a groove or orifice on the grip (31) of the guide for the femoral neck (3) osteotomy (cut) that marks the direction (37) through which the sheath (57) for insertion of the Kirschner wire (39) must be inserted.
  • the femoral head can be removed through the upper incision once the osteotomy (cut) of the femoral neck has been performed. Any method, such as the femoral head extractor described in the aforesaid PCT, may be used for this step.
  • This is a cannulated femoral head extractor and is inserted through the middle incision, traversing the femur through the opening in its lateral cortical wall.
  • the cannulated extractor is embedded in the cancellous bone inside the femoral head to enable dislocation of the same and removal through the upper incision.
  • a bur introducer (5) is used once the femoral head has been removed.
  • the introducer may be composed of a generally U-shaped introducer handle (51) and bur support (52) assembly.
  • This bur introducer (5) may have parts in common with the femoral neck osteotomy (cut) guide (3).
  • the handle of the introducer (51) could be the grip (31), only replacing the support (32) by the bur support (52).
  • the bur support (52) is fitted with a bur-holding ring (53) with freedom of rotation for milling
  • the bur (54) may consist of central cannula for insertion of a Kirschner wire (39) on the stem of rotation in such a way that the bur (54) is held stable in the acetabulum but is able to rotate enable milling with the rotating tool (59).
  • the aligner (55) is first used with a sheath (57) to place the Kirschner wire (39), prior to the insertion of the rotating tool (59).
  • the rotating tool (59) also has a central cannula that enables insertion of the same once the Kirschner wire (39) is in place.
  • the rotating tool (59) is inserted and the acetabulum is milled. It may be necessary to repeat the operation with burs (54) of different sizes until the acetabulum is milled properly. Marks on the rotating tool (59) enable indicate how much has been milled at any one time by measuring how much said tool (59) has moved with respect to the aligner (55).
  • the next step is to place the acetabular prosthesis (10) comprised of the external component (11) and the internal component (12).
  • the internal component (12) is already placed inside the external component (11) when insertion takes place.
  • Insertion of the external component (11) together with the internal component (12) is performed through the upper incision using an acetabular prosthesis introducer (6), the general shape of which is similar to that of the bur introducer (5), being generally U-shaped and divided into an acetabular prosthesis introducer handle (61) and an acetabular prosthesis holder (62).
  • the acetabular prosthesis introducer handle (61) may be the same as the bur introducer handle (51) or as the femoral neck osteotomy guide (3) grip (31).
  • the acetabular prosthesis support (62) in contrast, has male fixations (63) on the side facing the femoral head for coupling to female fixations (13) located on the perimeter of the internal component (12) of the acetabular prosthesis (10).
  • the fixations (13, 63) can be released from the outside, for example from the acetabular prosthesis introducer (6) by means of a release rod (65).
  • acetabular prosthesis fixation device which is inserted through the middle incision, through the opening previously made in the lateral cortex of the femur to act on the acetabular prosthesis (10).
  • the acetabular prosthesis fixation device may be an impactor if the fixation is by impaction, any type of screwdriver or any other kind of device to rotate the acetabular prosthesis (10) if fixation is by threading on the acetabulum.
  • the external component (11) of the acetabular prosthesis (10) must be provided with external thread that enables it to screw into the bone.
  • the acetabular prosthesis fixator is inserted through an acetabular prosthesis aligner (64) on the acetabular prosthesis introducer handle (61) that defines the direction in which the acetabular prosthesis fixator is to be inserted to reach the appropriate point of the acetabular prosthesis (10) with absolute accuracy.
  • Placement of the femoral prosthesis (15) starts from the upper and middle incisions already made and the holes previously drilled in the femur for extraction of the femoral head. To do so, the metaphyseal component (16) can be inserted into the middle incision by the acetabular prosthesis aligner (64) to ensure that the ball (19) is inserted into the cavity intended for the purpose in the internal component (12) of the acetabular prosthesis (10).
  • the handle of the acetabular prosthesis introducer (61), the introducer handle (51) and the femoral neck osteotomy (cut) guide grip (31) may have a series of marks (35) that enable the surgeon to ascertain the angular orientation (anteversion) of the respective tool.
  • These marks consist of objects (holes, inserts%) with an X-ray transparency different from the rest of the instrument. Each one will be set at a different angle (“0°, 8° and 16°”; “0°, 10° and 20°”; “0°, 5°, 10° and 15°”, etc.).
  • the mark (35) that is not deformed will indicate the anteversion angle applied with respect to the femur or with respect to the pelvis, as the case may be.

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • General Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Surgery (AREA)
  • Cardiology (AREA)
  • Vascular Medicine (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Dentistry (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Neurology (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Prostheses (AREA)

Abstract

Prothèse totale de hanche ou d'épaule conçue pour un remplacement minimalement invasif de l'acétabulum pelvien et de la tête fémorale ou de la cavité glénoïde de l'omoplate et de la tête humérale, comprenant : - une prothèse acétabulaire/glénoïde (10) conçue pour être incorporée dans l'acétabulum pelvien/la cavité glénoïde. - une prothèse fémorale (15) formée par un composant métaphysaire droit (16) pourvu d'une bille (19) à une extrémité pour assurer la mise en place dans la prothèse acétabulaire/glénoïde (10) et pourvue d'un trou transversal (17) pour assurer le passage d'un clou diaphysaire (18) destiné à être inséré dans le canal fémoral/huméral. Elle comprend également un guide (3) pour une ostéotomie du col fémoral ou huméral afin d'extraire la tête fémorale ou humérale et les introducteurs (5, 6) présentant la forme d'un « U » inversé des différents composants de la prothèse à l'aide d'aligneurs (55, 64) pour atteindre et placer lesdits éléments sans qu'il soit nécessaire de voir la zone d'opération.
PCT/EP2020/084669 2019-12-10 2020-12-04 Prothèse totale de hanche ou d'épaule et kit d'instruments pour sa mise en place WO2021115960A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ESP201931091 2019-12-10
ES201931091A ES2832583B2 (es) 2019-12-10 2019-12-10 Prótesis total de cadera o de hombro e instrumental para su colocación

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WO2021115960A1 true WO2021115960A1 (fr) 2021-06-17
WO2021115960A4 WO2021115960A4 (fr) 2021-08-19

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Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5507824A (en) 1993-02-23 1996-04-16 Lennox; Dennis W. Adjustable prosthetic socket component, for articulating anatomical joints
US20020095214A1 (en) 2001-01-16 2002-07-18 Hyde Edward R. Transosseous core approach and instrumentation for joint replacement and repair
EP1240879A2 (fr) * 2001-03-13 2002-09-18 Nicholas G. Sotereanos Ensemble pour implant de hanche
DE10120331A1 (de) * 2001-04-26 2002-11-21 Ulrich Muender Schenkelhals-Totalendoprothese
US20030060889A1 (en) 2001-09-24 2003-03-27 Tarabishy Imad Ed. Joint prosthesis and method for placement
US6562042B2 (en) * 2000-02-02 2003-05-13 Owen A. Nelson Orthopedic implant used to repair intertrochanteric fractures and a method for inserting the same
EP1344505A2 (fr) * 2002-03-11 2003-09-17 Nicholas G. Sotereanos Implant modulaire de hanche
US20160256281A1 (en) 2009-07-10 2016-09-08 Peter Forsell Hip joint device and method

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8579985B2 (en) * 2006-12-07 2013-11-12 Ihip Surgical, Llc Method and apparatus for hip replacement
WO2008069800A1 (fr) * 2006-12-07 2008-06-12 Anatol Podolsky Procédé et appareil pour un remplacement de hanche total
US8932301B2 (en) * 2009-08-26 2015-01-13 Biomet C.V. Targeting jig for hip fracture nail system
US8840675B2 (en) * 2010-04-22 2014-09-23 Benjamin S. Song Durable resurfacing hip replacement device
US20140128986A1 (en) * 2012-11-06 2014-05-08 Ihip Surgical, Llc Monoblock head and neck unit for total hip replacement
ES2735007B2 (es) * 2018-06-11 2020-07-17 Desarrollos Biomecanicos Innovasan S L Prótesis de cadera o de hombro e instrumental de colocación.

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5507824A (en) 1993-02-23 1996-04-16 Lennox; Dennis W. Adjustable prosthetic socket component, for articulating anatomical joints
US6562042B2 (en) * 2000-02-02 2003-05-13 Owen A. Nelson Orthopedic implant used to repair intertrochanteric fractures and a method for inserting the same
US20020095214A1 (en) 2001-01-16 2002-07-18 Hyde Edward R. Transosseous core approach and instrumentation for joint replacement and repair
EP1240879A2 (fr) * 2001-03-13 2002-09-18 Nicholas G. Sotereanos Ensemble pour implant de hanche
DE10120331A1 (de) * 2001-04-26 2002-11-21 Ulrich Muender Schenkelhals-Totalendoprothese
US20030060889A1 (en) 2001-09-24 2003-03-27 Tarabishy Imad Ed. Joint prosthesis and method for placement
EP1344505A2 (fr) * 2002-03-11 2003-09-17 Nicholas G. Sotereanos Implant modulaire de hanche
US20160256281A1 (en) 2009-07-10 2016-09-08 Peter Forsell Hip joint device and method

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ES2832583A1 (es) 2021-06-10
ES2832583B2 (es) 2022-05-05
WO2021115960A4 (fr) 2021-08-19

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