DE2845231A1 - JOINT PROSTHESIS AND PROCEDURE FOR IMPLANTING THEREOF - Google Patents

Description

255

1. Indong Oh

Wayland, Mass. _f USA

2. Dr. William Hamilton Harris Belmont, Mass., U.S.A.

Joint prosthesis and procedures for their implantation

909818/0744

Joint prostheses and methods for their implantation

/regards
The invention relates to the surgical replacement of joints with artificial components and relates in particular to the total replacement of the joints on the hip, knee, elbow and shoulder, using the ingrowth of bone components for permanent attachment of the artificial joint components. The invention can be used in all of the joint operations mentioned, but in the following description the emphasis is predominantly placed on the use of the invention in hip joint operations, which is the most common of the operations mentioned. In a current total hip joint operation, the upper end of the femur with the spherical femoral head of the hip joint is replaced by a metal piece that has a small ball at one end and a shaft that protrudes into the medullary cavity of the femur. The socket of the hip joint, which is enlarged, is replaced by a socket made of a special plastic made of a very high molecular weight polyethylene. Both the metal piece and the polyethylene pan are fixed with a polymethyl methacrylate cement. This cement is processed in a viscous state with a pulpy consistency. The pulp is pushed into the bone and then these components are pushed into the pulp. As a result, the material in the body polymerizes within a very short time during the operation, and in the hardened state the two joint components are then firmly attached to the bones.

Hundreds of thousands of patients have already had hip joint operations of this kind. However, it has now turned out that the weak point in this procedure is the

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Is polymethyl methacrylate. Studies show that approximately 20% of the thigh-side components in the. X-rays show loosening after about 2 to 4 years. Other studies show that about 10% of the hip-side components loosen after .10 years. It can therefore be expected that between 20 and 30 % of the patients who are still alive 10 years after the total hip operation will experience mechanical defects of one kind or another.

The problem of inadequate attachment with the polymethyl methacrylate Cement also occurs in other joints. For example, all types of elbow joint prostheses which were used during the first half of 1970 became unusable as they became loose. The general error rate in total knee joint operations is 20 to 25% after 2 to 4 year duration. The use of the cement to attach the shoulder joint components to the shoulder blade is a problem that has not yet been resolved.

Considerable experimental work has been devoted to finding new methods of attachment to the exclusion of polymethyl methacrylate. One of the most promising developments uses the possibility of bone ingrowth into the porous surfaces of the prosthesis parts. If a surface is rigidly set against a bone and it has pores of the appropriate size, about 100 to 500 microns in diameter, then the bone itself will grow into those pores. In this way, a living biological form will create the mounting overall ""'. A problem with using this technique, however, is the need to initially rigidly define the component during a critical period of time when the bone is growing into the pores.

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This period is always between 3 and 6 weeks. If during this time the prosthesis part can move in relation to the bone, then the bone substance does not grow but fibrous tissue in the pores, and the attachment is not enough.

It is therefore the object of the invention to fix the joint components in total joint surgery to improve. According to the invention, this improved fastening is achieved in that fastening means can be provided that create an instant rigid definition of the components, at the same time these components Have porous surface areas, so that bone components grow into these surfaces can.

When the invention is applied to a total hip joint prosthesis, the socket component is in the form of a metallic one Pan designed with a porous outer surface. The pan part is dimensioned so that it is in a recess fits into it, which is created by milling out in the damaged bone. There will be bolts and nuts, one or several in number, to define the pan part used in the cutout. The screws go through Holes drilled in the pelvic bone through it. A plastic lining is then placed in the pan component used, which can be taken out if necessary and replaced when either their wear and tear is too great has become or better material is available. The component attached to the femur has the Shapes of a metallic cup with a porous inner surface and is designed to fit over the top of the thigh neck that has been milled off for this purpose can be turned over. One with the inner surface of the cup-shaped part Fixed shaft extends through a hole drilled through the upper part of the femur,

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that in extension of the thigh neck through the Bone passes through it, and a nut-like screw is inserted into a hole in the shaft and pulls the cup-shaped part against the end of the femoral neck via the shaft, whereby the element is immediately stable and the bone can grow into the pores. A sleeve is in the drilled hole in the Thigh bone inserted from the side facing away from the joint ball and connected to a plate, so that part of the contact pressure is transmitted in this way. Total operations are very similar of the elbow, shoulder and knee.

The invention is now based on exemplary embodiments explained in more detail in conjunction with the drawing. Show it:

1 shows a cross section through the hip joint of a person after a total hip joint operation and use a hip joint prosthesis according to the invention;

Figure 2 is a cross-section showing the first step in preparing the pelvic bone for implantation the artificial pan shows;

3 shows an exploded view of the pelvic bone

• and the implant component, from which the further steps for fastening the socket component are evident;

Fig. 4 is a perspective view of the socket component and the plastic lining shell, which is detachable is inserted into the component;

5 shows a cross section through the upper end of the femur, which is prepared for implantation according to the invention;

6 is an exploded view of the spherical component the artificial thigh joint and the other items for fixing them on the

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Femur neck bones;

7 and 8 are front and side views of an elbow joint prior to total joint operation;

9 is a partially sectioned front view of the lower end of the humerus after implantation the joint prosthesis;

10 shows a partially sectioned side view of the end of the ulna carrying the socket component the implantation operation;

11 shows a view of the humerus similar to FIG. 9 a modified fastening technique for the joint prosthesis;

12 is a view of a shoulder joint prior to a total operation and the replacement of the joint components;

13 is a partially sectioned front view showing the joint components on the shoulder blade and on the humerus after the operation;

14 shows a front view of a knee joint prior to a total knee joint operation ;

15 shows a partially sectioned front view of the knee joint according to FIG. 14 after the insertion of the joint prosthesis according to the invention;

FIG. 16 is a view similar to FIG. 15, but with a modified type of fastening compared to the fastening of the joint prosthesis parts.

The invention is first used in connection with a total hip joint operation described. Further embodiments of the invention are then described in connection with Total joint operations on the elbow, shoulder and knee are described.

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In Fig. 1 a human hip joint is shown, on which a total operation of the joint was carried out. The hip bone 10, which is part of the pelvis; is with the upper end of the thigh bone 12 means implanted joint components, designated as a whole by 14. The ones labeled 1.6 and 18 for themselves Components for the pelvic bones and thigh bones together form the artificial one. Joint. They will be in from each other essentially independent surgical steps associated with the pelvic bone and the femur.

According to the invention, the pelvic bone 10 is prepared by milling out a cavity 20 in that the damaged parts 22 of the bone are removed in the manner shown in FIG. With the milling out an accurate, hemispherical recess 24 is generated in which the pelvic bone component is then attached. After this Milling out one or more holes (in Fig. 3 the holes 26 and 28) through the pelvic bone from the lower End of the recess 24 to the inside 30 or to an outer surface 30A and / or 30B of the pelvic bone drilled through. In Figures 1 to 3, the holes 26 and 28 are drilled through to the inside of the pelvic bone Holes shown, but depending on the condition and shape of the pelvic bone, it may be advantageous to use the holes so that it extends from the recess 24 extend on outer surfaces 30A and 30B of the pelvic bone, as indicated by dashed lines at 26A and 28A in FIG.

A metallic joint socket 32, which is typically made of a cobalt-chromium alloy (Vitallium) or of stainless Steel or a similar suitable material is made, which is compatible for the body, possesses

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an outer porous surface 34 and thus fits snugly into the recess 24 into it. The recess is exact, worked out, so that the socket part with a press fit fits into it. The porous surface 34 of the. Joint shell- 32 can manufacture in different ways. For example, the outer surface of the joint socket can be roughened, see above appropriately sized pores are formed, generally greater than 1.00 microns in diameter. The surface however, it can also be sintered and thus get its porous structure. Another solution can be a fine-meshed Lattice be attached to the surface that forms the pores. It is essential that the surface is irregular is so that bone ingrowths mechanically cling to it can.

After the shell 32 has been pressed into the recess 24, are through the holes 40 and 42 in the shell and screws passed through the drilled holes 26 and 28 in the pelvic neck. The shell itself can be fitted with a Number of such holes may be provided, or it is possible that the holes in the bowl are elongated, so that the doctor has the ability to drill the holes in the pelvic bone in a direction that suits its condition and shape of the bone seems most suitable. Two screws are shown in the drawing, but this is not a limitation. Rather, the doctor can set as many screws as he considers necessary. One can also envisage that at least one screw leads through the metal shell into the pelvic bone. The nut on this screw can be attached to the bolt from the inside of the pool. This can be done with a short cut reach, through the middle, the Sartorius muscle under the Iliopsoas muscle is guided. A second screw can go through in an overlying or lateral direction the metal shell and the bone must be guided. The mother

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on this bolt can again on the side surface of the Iliuiri below the beginning of the gluteus medius- 'and the Gluteus mlnimus muscle to be attached. These '"screws and nuts ensure a temporary stiffness! Attachment during the insertion of the shell and during, new pieces of bone into the pores of the. Wax in surface 34.

The inner surface 44 of the metal shell 32 has various latching projections 46. .These. Projections 46 serve to to hold a replaceable polyethylene shell 48 in which the metallic femur component of the joint is mounted and can rotate, as will be described below. Fig. 1 shows that the inner surface the acetabulum is smooth 2oir receiving the ball, .der Femur component. The pan 48 has a number of slots 52 on its outer surface 50, which correspond to the number of projections 46, and together represent the slots 52 and the projections 46 a kind of bayonet locking with which the joint socket 48 is held in the shell 32. This training is shown in FIG. The outer surface 50 is also provided with recesses 54 for the heads 56 of the screws 36 and 38.

The joint socket 46 is made of a polyethylene of very high molecular weight, as it is for example by the company Ehure Chemie under the name RCH 1000 on the Market is coming. This material is known in the medical field. The pan 48 can because of the detachable Rastverbindurig can be exchanged without the metal shell therefore having to be exchanged. So if the plastic pan needs to be replaced due to wear and tear do this without the metal shell, in whose porous surface 34 the bone, in a serious operation has grown into it, must be removed. It is conceivable

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that better materials will be developed over time than the very, high molecular weight polyethylene. One from this. Material then produced joint socket can can either be used when the pelvic krioch component is inserted or when the plastic joint socket is replaced is required.

Figure 5 shows the manner in which the upper end of the femur is prepared for the implantation process will. A hole 66 is made through head 62 on femoral neck 64 to the opposite side of the femur drilled through. The hole 66 can have a bore widening from the side opposite the femoral neck, as shown at 70. The drilled hole 66: is adapted to a shaft 72 with which a cup-shaped spherical cap 74 is aligned and secured as a thigh component will. After the hole is drilled, the be ^ damaged joint head 60 milled off at the femoral neck, so that a head 62 of reduced size from healthy Bone remains. The reduced size of the femur is due in part to the size of the femoral neck 64 specified. Milling is necessary to reduce the volume of the head to the extent that the bone able to accommodate the component of the implant. 5 shows an idea of the milled off part 60 given.

The cup-shaped element 74 should be made of the same material as the shell 32 and should have a recess 76, which corresponds to the shape of the milled head 62 of the femur. The inner surface of the Recess 76 including the bottom 80 and the cylindrical side wall 81 is. of the same surface quality like the surface 34 of the shell 32, so that bone tissue grows from the head portion 62 of the bone can and thus the shell 74 is biologically attached.

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One. Sleeve 82 extends through a bore in plate 84 and nests in enlarged section 70. the Hole 66 in the bone. If the sleeve 82 is in the bone, then the plate 84 lies against the outer surface of the thighbone, and so that the plate does not rotate, a screw 86 can be used to put it through a hole are fixed in the 'plate 84 in the bone, as shown in FIG. The sleeve 82 has a keyway: 88 in the axial direction on its inner bore surface, · and a radially protruding extension 90 on the outer surface of the shaft 72 engages in the keyway 88, so that the Shaft cannot rotate with respect to the sleeve. The shaft 72 sits firmly in the bottom 80 of the cup recess 76, so that the two parts form a unit. However, they can also be two separate items that relate to ordinary Way are firmly connected to each other. The shaft is with Set using a tension screw 96 which, in cooperation with the plate 84 and the sleeve 82, serves as a tension element. When the screw 96 is tightened, its head .100 presses against the outer end 102 of the sleeve 82, and becomes the Screw. Then turned further, then the shaft 72 drawn in so that the hemispherical cup portion 74 is pulled tightly onto the bone and is fixed to it. In this way, the ingrowth of bone tissue into the porous inner surface is promoted without the fibrous tissue can arise.

The shaft 72 not only ensures the attachment of the cup part 74 during the ingrowth of bone tissue, but also strengthens the femoral neck so that fractures are less likely to occur, which is more likely than Consequence of joint head prostheses in total hip joint operations.

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The person skilled in the art recognizes from the above description that completely new hip joint shell and. Femur components, that have several advantages. The. Hip-joint shell coraponent is a combination: from. a 'metal bowl with a porous. Surface on the '. Outside ,, which with a press fit in a precisely milled, hemispherical Recess in the pelvic bone is used. "With one or more screws this metal shell -" temporarily immediately before inserting the polyethylene pan attached to the bone, the polyethylene cup can be replaced when it is worn out or when better Materials are available. The new hip leg component consists of a cup part with a porous inner surface into which, comparable to the outer surface of the / bowl, Bone tissue can grow into it. The shaft, the one, temporary Attachment of the shell is also a reinforcement of the femoral neck, and the pressure creates the best form of stable support, which promotes the ingrowth of bone tissue. ' The shaft itself can have a porous surface; S3 that this creates an additional area for bone tissue ingrowth, and thus an increased area Strength of the entire system results. Due to the method of attachment according to the invention, an instant Determination of the components with mechanical means, such as screws and nuts, as well as with the shaft and lag screws, achieved so that bone tissue can grow into the porous surfaces and die.Gelenkprothese is determined in a biological way.

In Figures 7 to 1.1 is a representation of a - Total elbow surgery shown. Figures 7 and 8 show the elbow joint before the attachment of the Front and side view of the prosthesis. The humerus 120 joins with its lower end 122

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known as the elbow joint, into a socket 124 at the top of ulna 126 and spoke 128. In Fig. 4, the lower surface of the humerus is separated by a dashed line 130, whereby the The height is indicated at which the humerus is milled off in preparation for receiving a metal shell 132 will. The metal shell 132 is provided with an irregular inner surface 134 similar to the surfaces as they are on the Components of the hip joint prosthesis were provided, and an instant and secure attachment of the shell is provided with Achieved using bolts and nuts 136 and 138, which are inserted through holes 140, 142 that are in the Condylar head of the humerus will be drilled into it after the lower end of the condylar head is in the plane of the line has been milled off. The screws 136, 138 have heads 144, which lie within the surface of the shell part 132 in suitable recesses. The screws extend through the holes 140, 142 and are secured at their other ends by means of nuts 146 which are headed Support on the outer surfaces of the humerus in the area to the side of the elbow joint head. As with the hip bone component in the case of total hip joint surgery according to FIGS. 1 to 6, the shell is also used in the present case fixed by two bolts with nuts creating an instant and very strong connection over the the shell firmly against the bone with a pressing force on the contact surface between the bone and the prosthesis part is pulled.

In Fig. 9, two screws for fastening are shown, which run transversely through the lower end of the humerus and cross each other, but these screws can also be guided in other directions, depending on the size and the condition of the humerus. So they can

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Holes for the screws can be drilled, for example, as indicated by dashed lines at 150 and 152 in FIG are, in which case the nuts are supported on the upper surfaces of the elbow joint head.

In Fig. 10 is used as a joint socket or socket Component shown being inserted into a recess 124. The recess is prepared in the ulna, like this is indicated with a dashed line 160 in the figure and then a shell 162 with an irregular or porous surface 164 is firmly inserted into the recess in FIG embedded in the same way as was done with the hip joint shell of the previously described joint. Holes 165 and 166 can be made from recess 124 in the ulna are drilled in and then take on bolts 168, which are in threaded holes 170 in the convexly curved Surface of the shell 162 are screwed. The outer ends of the bolts 168 are secured with nuts 172 pulled down. When the nuts 172 are then tightened, the shell 162 is secured via the bolts 168 been pulled into place. Bone tissue can then grow into the porous surface. A socket Made of very high molecular weight polyethylene is detachable into the concave surface of the shell 162 in the same Way used, as already described in Fig. 4 in connection with the hip joint-pelvic bone component became. The smooth inner surface of the polyethylene pan takes the joint part formed as a one-piece metal shell part 132, so that joint movement is possible.

Another way of attaching the cup-shaped component on the humerus is shown in FIG. 11. Here is at the. Metal shell 180 molded a shaft 182, the is inserted into a hole that is made lengthways in the humerus. The inner surface 186 of the shell is again irregular or porous, and so is the shaft

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may have a porous or irregular surface so that bone tissue can grow into it. A couple Transverse holes 188 are drilled through the humerus so that the holes also pass through the vertical hole 184 go through. Holes 190 in the shaft 182 then receive screws 192 which are inserted through the transverse holes 188 and secured by nuts 194 on the other side of the bone. The screws 192 can in their shaft area be wedge-shaped, as indicated at 196 in the drawing, so that they the shaft pull upwards when they are pulled through the holes 190 in the shaft, creating a sufficient contact pressure between the porous surface 186 of the shell and the opposite surface 200 of the humerus occurs.

In Figures 12 and 13, an embodiment of the Invention shown for a total shoulder joint prosthesis. In Fig. 12, the shoulder blade joint socket 210 is shown, which forms the ball joint surface of the shoulder blade on which the ball joint head 214 of the humerus 216 is present. 13 shows the joint socket and the humerus joint head after the total joint operation. As in the other embodiments, the recess located on the shoulder blade is milled out so that they have a shell 220 made of metal with an irregular shape or porous surface 222 facing the scapula bone. Through the bone one or more screw holes are drilled to accommodate screws. 224, whose heads are in the concave surface 226 of the shell 220 lie. The bolts 224 are held in place by nuts 228, thereby adhering to the mating surface a sufficient and substantial contact pressure between the irregular outer surface 222 of the shell and the bone is produced. In this way an intermediate

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Timeline reached. The bowl comes with a Pan 230 is lined with very high molecular weight polyethylene, which is set inside it in the same way can be, as it was described in connection with the acetabulum.

A hole has been drilled in the joint head 214 of the humerus, and the joint head itself has been milled off, as indicated at 234 and how it is carried out in a similar form with the joint head of the femur became. A cup-shaped hollow metal ball 236 with an irregular or porous concave inner surface 238 is provided with With the help of a shaft 240 on the cup part it is pulled tightly onto the head 214 of the humerus, for which purpose a sleeve 242 in an enlarged portion of the hole 233 is inserted and a screw 246 is screwed into the shaft. the smooth outer surface 248 of the externally spherical cup portion can reside in the smooth, concave inner surface of the socket Rotate 230. Both from the head of the humerus and the shoulder blade bone can enter the Wax into rough surfaces, as the joint components are fixed immediately and rigidly with the help of the screw-bolt connection are.

FIGS. 14 to 16 show the application of the invention in a total knee joint operation. Fig. 14 shows the lower one End 260 of femur 262 where. a dashed line 264 indicates how the joint is preparing for is prepared and milled to accommodate the joint prosthesis. The same applies to the upper end 266 of the tibia 268, which is also used to receive the prosthesis part is prepared. Further, holes 272 and 274 are made in the femur 262 and holes 276 and Drilled into the upper end of the tibia to accept fastening screws. In Fig. 15 is a metal shell

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280 shown with bolts 282 and 284 and associated nuts 286 and 288 is set at the lower end of the femoral head. The metal bowl 288 has a rough or porous inner surface 290 that is drawn tightly against the knee joint head 260 of the femur so that the shell is biologically fixed by the ingrowth of bone tissue. The nuts and bolts generate the required pressure at the interface between the shell and the bone and place the prosthesis part with it right from the start.

The shin component 292 consists of a metal shell or base 294 with an irregular surface 296, with which it rests against the milled surface of the tibia, as was the case with the other exemplary embodiments has been described. A pair of screws 298 and 300 are inserted through holes 276 and 278, the are drilled into the tibial head and through at the interface between the base component 294 and the bone tightening nuts 302 and 304 produce the required compression. A pan 306 made of polyethylene with The very high density is attached to the surface 308 of the base component 294 and can be in the same manner and Be held as shown in Fig. 4 in detail. Two concave surfaces 310 and 312 in the pan represent the bearing surfaces for the spherical joint sections 31.4 and 316 of the upper component 280.

Fig. 16 shows another way of fastening the metal shell and the base on the femur and the shin. This type of fastening corresponds to the second alternative the attachment in the total elbow operation according to Fig. 10.

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The fastening screws 320 and 322 extend to the side surfaces of the joint heads of the bones without them cross each other, as happens in the embodiment according to FIG. The bolts are in blind holes 324, which are provided in the substantially concave surface of the shell part, and with nuts 326 the pressure for the instant attachment of the shell part is produced. Similarly, will with bolts 330 and 332 and associated nuts 334 the compression of the tibia component 336 with its irregular Surface 338 caused. The latter component carries a socket part 340 that is interchangeable on the base component 336 is fixed. There is also the possibility that the bolts will extend from the space 342 as indicated by dashed lines 344 and 346 in FIG.

In all embodiments of the invention, the components are immediately fixed rigidly to the bone, so that Bone tissue can grow into the roughened surfaces, thus achieving a biological form of attachment will. The immediate fixing is achieved without tensile forces acting on the bone, which is what happens when in use of screws or similar fasteners that are screwed directly into the bone, is essential. The screw bolts used and their nuts or the like only exert compression forces on the bone. It should also be noted that the wear and tear subject surface of the artificial joint, which is formed as a plastic component, without destroying the Ingrown bone tissue, which is an excellent anchorage for the metal components, is replaced can be.

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The invention thus provides a joint prosthesis with a joint socket part created whose metal shell has a porous outer surface into which bone parts can grow. A polyethylene shell is removably inserted into the metal shell. The joint prosthesis also includes a metal joint head in the shape of a cup with a porous inner surface, in whose pores bone tissue can grow, so that the joint head is firmly and permanently connected to the bone. The metal parts are fastened with firmly connected to the bone so that an immediate rigid definition of the components is achieved and that Ingrowth of the bone tissue is favored.

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Claims (1)

PATENT CLAIMS 1. Implantation procedure for attaching a Part of the prosthesis on a bone, in which by removal the damaged bone parts of the bones of the surface of the prosthesis part to be connected to it is adapted, characterized in that that the implant receives an irregular surface that is firmly attached to the prepared bone and that the implant is mechanically attached to the implant by means of a device, between the latter and the bone a pressing element is fixed to the bone to create an immediate, rigid connection. 2. The method according to claim 1, characterized in that at least one hole is drilled through the bone extending from the prepared portion and that a fastener is set in the hole will to. to secure the implant mechanically and to press it against the prepared bone section, without tensile forces being exerted on the bone. 3. Procedure for performing a total joint operation, characterized in that the joint ball and joint socket sections of the joint .by removing the damaged sections of the bone are prepared and the bone surfaces are preformed to accommodate the implants that holes are drilled through the bone facing away from the surfaces for inclusion of compression-generating fasteners that a ball-and-socket metal component with extend an .unregular surface is provided into which bone tissue can grow, and that this metal component on suitably prepared bone parts with the help of at least one fastening device that generates tensile force 909816707Ä4 by means of which is determined by a hole in the Bone, which is a cup-shaped metal component with an irregular surface, extends into the bone tissue can grow in, placed on appropriately prepared bone areas and fixed with the aid of fastening means that generate tensile force and extend through a hole in the bone and that a plastic socket is inserted into the cup-shaped component, which is an articular surface forms for the metal ball component. 4. The method according to claim 3, characterized in that the joint socket is releasably fastened in the shell component is to be interchangeable. / 5.) Artificial hip joint, characterized by a metallic hip joint shell that can be inserted into a recess in the pelvic bone and is porous or irregular Outer surface has, in which bone tissue can grow, engaging screw bolts on the shell for fastening the shell on the pelvic bone, especially during the. Initial phase of bone tissue ingrowth into the porous surface, a socket fastened in the shell to hold the femoral head, a metallic femoral head, which is fitted into the socket and a cavity for receiving the upper end of the femur having, wherein the inner surface of the cavity is porous or irregular, so that bone tissue can ingrowth, and means including a stem attached to the cup-shaped femoral head within the cavity is attached and a provided in the thighbone hole penetrates for the attachment of the cup-shaped Femoral head at the upper end of the femur. 909818/0744 6. Hip shell coraponent for use in hip. total joint operations, characterized by a hip joint shell, which can be inserted into a recess in the pelvic bone and has an irregular outer surface has, in which to fix the shell in the bone ' recess bone tissue grows into it, and screw bolts that attack the shell and press it against it pulling the pelvic bones to them especially during the initial stages of bone ingrowth into the Surface to be determined. 7. pan component according to claim 6, characterized by a lining part that forms a base for receiving the joint ball component. 8. pan component according to claim 7, characterized in that that the lining element is replaceable. 9. pan component according to claim 7, characterized in that that the bolts have an irregular surface into which bone components can grow. 10. pan component according to claim 7, characterized in that it is penetrated by a hole through that the end of the fastening bolt protrudes and that the end of the bolt through the socket component liner protrudes below the insert element. 11. pan component according to claim 8, characterized in that that the pan element is made of metal and the pan lining is made of plastic material. . . 12. Base component for use in a total joint replacement operation, characterized by a pan-like Component that can be inserted into a recess in the bone and on the side facing the bone, 909818/0744 with which it comes into contact with the bone, an irregular one Has surface, and bolt means which act on the socket part and to attach it to the bone, in particular during the phase of the initial ingrowth of bone components into the surface, a pressing force against the bone produce. 13. Base component according to claim 12, characterized in that a lining can be fastened to the pan component, the has a cavity to accommodate the ball component of the joint. 14. A method for attaching an artificial joint socket to the pelvic bone, characterized in that a hemispherical Recess is milled out at the point of the natural joint socket that at least one hole through the recess Pelvic bone is drilled through that the artificial socket component has an outer surface into which bone components can grow, and that this joint socket component with the help mechanical fasteners, which are inserted through the hole in the hipbone, is attached so that they are with Pressure is drawn against the bone and that a liner is secured in the cavity of the socket component. 15. The method according to claim 14, characterized in that that as a fastening element a screw bolt with a nut dent and the nut from the inside of the body against the Pelvic bone is pulled. 16. Femoral head component for use in a Total hip joint surgery with an essentially hemispherical, cup-shaped spherical element made of metal, characterized in that that the cup-shaped spherical element has a cavity extending inward from its side opposite the hemispherical one Has surface which the upper end of the femur receives that the cavity for securing the cup-shaped spherical element by ingrowth of bone components ifi the Surface an irregularly shaped or porous surface coating having, and that in the cavity a device with a shaft is attached to the cup-shaped spherical element, which through a hole in the femoral head and neck for securing the cup-shaped spherical element in place at the top of the thighbone may protrude. 809918/0744 _ 5 - 17. femoral head component according to claim 5, characterized by a screw bolt shank. its end remote from the cup-shaped part Sleeve and a screw, which protrudes into the sleeve and can be screwed into the shaft, around the cup-shaped Pulling your head towards the top of the femoral neck. 18. joint ball component according to claim 17, characterized by a plate connected to the end facing away from the cup-shaped spherical element, which is connected to the outside of the femur is connectable. 19. Ball component for use in a hip joint » total surgery as a replacement for the femoral joint ball with a substantially hemispherical shape, thereby characterized in that the surface opposite the hemispherical surface is irregular and irregular intended for direct contact with the bone and designed in such a way that bone components grow into the surface can, and that bolt elements are connected to the ball component, which penetrate a hole made in the bone and pulling the ball component against the bone surface for temporary attachment. 20. Ball component according to claim 19, characterized in that that the bolt has a shank inserted in the hole, which at its remote from the ball component End is surrounded by a sleeve, and that a lag screw .einschraubbar in the shaft from the opposite side that pulls the component firmly against the bone. 21. Method of securing an artificial femoral ball joint component at the upper end of the femoral neck, characterized in that the damaged natural femoral head milled from healthy bone 909818/0744 and a hole through the femoral neck, from the top end Drilled down to the opposite side of the thigh bone. becomes that a cup-shaped spherical component the upper end of the femoral neck is put on and a shaft attached to it is inserted into the hole and that the shaft in the hole facing away from the femoral neck Side of the thighbone is tightened. 22. The method according to claim 21, characterized in that that the cup-shaped part has an irregular or porous surface on its inside, in which the Bones of the femoral neck can grow into it. 23. Artificial joint, characterized by a metal socket in a bone recess at the joint can be fastened and has a porous surface, in the openings of which bone parts can grow, screw bolts, which act on the socket element and with which the socket element during the initial phase of ingrowth the bone parts can be fastened in the porous surface, a lining which is exchangeably fastened to the socket element for receiving a spherical component of the joint, a metallic, spherical joint component that is inserted into the Cup lining fits and for attachment to the bone, which is normally the ball joint part, a Has porous surface into which bone parts can grow, and means including a shaft which is firmly connected to the ball component and is held in a hole in the bone to attach the Ball component on the bone to create a temporary rigid connection. 24. Artificial joint according to claim 23, characterized in that the socket is shaped so that it is on the Elle of the elbow joint is attachable, and that the 909818/0744 spherical component is designed so that it is on. lower end of the humerus' is attachable. 25. Artificial joint according to: Claim 23, characterized in that that the socket part is shaped so that it is shaped on the shoulder blade, and the spherical component is shaped so, that it can be attached to the upper end of the humerus. 26. Artificial joint according to claim 23, characterized in that the socket part is shaped so that he is at the top of the tibia, and the spherical component is shaped to be at the bottom of the femur is attachable. 27. Joint socket according to claim 12, characterized in that that the socket part is shaped so that it can be attached to the shoulder blade of the shoulder joint. 28. Joint socket according to claim 12, characterized in that that the socket part is shaped so that it can be attached to the tibia head in the knee joint. 29 Joint socket according to claim 12, characterized in that that the socket part is shaped so that it can be attached to the ulna of the elbow joint. 30. Joint component according to claim 19, characterized in that, that the hemispherical part is shaped for attachment to the lower end of the humerus is. 31. Joint component according to claim 19, characterized in that that the hemispherical part is shaped so that it is at the upper end of the humerus in the Shoulder joint is attachable. 909818/0744 32. Joint component according to claim 19, characterized in that the hemispherical part is shaped so
that it can be attached to the lower end of the thigh bone. 33. The method according to claim 14, characterized in that the fastening with at least two bolts and nuts
is carried out. 909818/0744