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WO1989010730A1 - Prothese femorale de l'articulation de la hanche - Google Patents

Prothese femorale de l'articulation de la hanche Download PDF

Info

Publication number
WO1989010730A1
WO1989010730A1 PCT/US1989/002020 US8902020W WO8910730A1 WO 1989010730 A1 WO1989010730 A1 WO 1989010730A1 US 8902020 W US8902020 W US 8902020W WO 8910730 A1 WO8910730 A1 WO 8910730A1
Authority
WO
WIPO (PCT)
Prior art keywords
prosthesis
stem
trochanter
extending
neck
Prior art date
Application number
PCT/US1989/002020
Other languages
English (en)
Inventor
Desmond M. Dall
Johann F. A. Schmotzer
Original Assignee
Dall Desmond Meiring
Schmotzer Johann F A
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 Dall Desmond Meiring, Schmotzer Johann F A filed Critical Dall Desmond Meiring
Publication of WO1989010730A1 publication Critical patent/WO1989010730A1/fr

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/32Joints for the hip
    • A61F2/36Femoral heads ; Femoral endoprostheses
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30721Accessories
    • A61F2/30739Devices connected to the proximal part of an endoprosthetic femoral shaft for reinforcing or replacing the trochanters, e.g. the greater trochanter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/3094Designing or manufacturing processes
    • A61F2/30965Reinforcing the prosthesis by embedding particles or fibres during moulding or dipping
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/32Joints for the hip
    • A61F2/36Femoral heads ; Femoral endoprostheses
    • A61F2/3662Femoral shafts
    • A61F2/367Proximal or metaphyseal parts of shafts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/28Bones
    • A61F2002/2835Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/30004Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
    • A61F2002/30014Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis differing in elasticity, stiffness or compressibility
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108Shapes
    • A61F2002/3011Cross-sections or two-dimensional shapes
    • A61F2002/30112Rounded shapes, e.g. with rounded corners
    • A61F2002/30113Rounded shapes, e.g. with rounded corners circular
    • A61F2002/30118Rounded shapes, e.g. with rounded corners circular concentric circles
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30593Special structural features of bone or joint prostheses not otherwise provided for hollow
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30879Ribs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004Rounded shapes, e.g. with rounded corners
    • A61F2230/0006Rounded shapes, e.g. with rounded corners circular
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0029Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in bending or flexure capacity
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389The prosthesis being coated or covered with a particular material
    • A61F2310/00592Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
    • A61F2310/00796Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389The prosthesis being coated or covered with a particular material
    • A61F2310/00958Coating or prosthesis-covering structure made of bone or of bony tissue

Definitions

  • This invention relates to a femoral prosthesis for hip ar hroplasty which includes hemiarthroplasty or total Kip replacement.
  • the invention is directed to a device for implanting into the femur so as to achieve a 5 stable long-term fixation of the prosthesis by producing an improved physiological stress-strain environment at the bone implant interface and obtaining improved flexural matching between the prosthesis and the femur.
  • the invention also includes securing an artificial 10 articular surface or joint head to the femur.
  • the articular surface is carried on one end of the prosthesis stem.
  • the remaining portion of the prosthesis, namely the neck and shaft is fully or partially embedded and in contact with the bone of the femur.
  • hip prosthetic stems are either solid or hollow and have a variety of cross-sectional shapes, for instance, circular, oval, diamond, trapezoidal, square, rectangular, or I-beam. Fenestrations and variations in surface structure
  • the prosthesis is inserted into a prepared bone bed or cavity usually in the medullary canal of a long bone and fixed either by grouting with acrylic bone cement or by press-fitting them into the bony cavity. It is generally accepted that an exact initial fit is required in order to achieve good short term results. Further, for good long term results to be obtained the deformation of the stem should be similar to the deformation of the bone during loading, for instance, walking.
  • stems are either very stiff, especially the press-fit variety which attempts to fill the wholesbony/ canal with the stem to obtain a line-to-line contact:between prosthesis and strong outer cortical bone of the femur, or, if flexible, are too weak to withstand the cyclic loads.
  • the stiff stem results in stress shielding of the bone, affecting the physiological bone turnover and resulting in bone resorption.
  • the latter situation may lead to fatigue fracture of the stem.
  • Attempts to overcome this problem have focused on the use of materials with increased elasticity and strength. Thus far, the changes have not proven to provide improved long term results.
  • a more recently known stem uses a metallic tubular shaft, where the outer wall is of constant thickness and is the main load-bearing structure.
  • the stem is closed ended and the cavity in the shaft may be empty, or partially or totally filled with one or more other types of material.
  • This stem while it may provide variable loading stresses along the femoral canal, does not provide a mechanism for load transfer to produce an improved physiological stress-strain environment in the femur.
  • a partial split tube shell and a fin directed laterally at the stem neck there is a partial split tube shell and a fin directed laterally at the stem neck.
  • the fin has apertures for bone ingrowth; however, the narrow width does not permit for abductor forces to be transmitted to the fin, and thereby the stem, in compression. Instead these forces are at best effected on the fin in shear. This is undesirable since shear forces are not well tolerated by bone.
  • the abductor force loop exists through the head, neck and greater trochanter of the femur, pelvis and abductor muscles.
  • a femoral prosthesis comprises a stem with a proximal end and a distal end, an elongated shaft between the proximal and distal ends, and a neck towards the proximal end.
  • the stem includes means for extending into the trochanter for facilitating engagement of the abductor muscle with the stem thereby to transmit force from the abductor muscle directly to the stem.
  • the extending means facilitates attachment of the stem with the trochanter.
  • the shaft is at least partly hollow.
  • the extending means is located at the body adjacent the neck and includes a protruding element on the lateral side.
  • the protruding element includes a series of transverse ribs extending between an anterior side and a 5 posterior side of the body and are spaced apart along the elongated shaft. This depth across the transverse direction provides a compressive force on the bone at the interface with the transverse ribs, as opposed to a shear force at the interface. This effect produces a prosthetic procedure
  • ID- w ich- can: have effective short and long term results.
  • the extension* in: the lateral direction is relatively more or less or the same as the extension in the transverse direction thereby to maximize bone contact and minimize shear forces at the interface. Rather the force is a
  • the proximal extending means of protruding element or feature is provided to the shaft of the stem at the body of the stem for attachment to the greater trochanter.
  • the abductor muscle engages directly to the stem and permits for continuity of the abductor force loop.
  • the extending means is a protruding element which provides the potential for becoming an integral part of the trochanter to enable the abductor muscles to act directly on
  • the hollow shaft for the stem allows for fXea irally matching the deformation behavior of the stem to that- of the femur.
  • the shaft of the stem presents a wall of variable thickness in axial and radial directions thereby 30 to facilitate for flexural matching.
  • the stem may be solid, or partly tubular or hollow.
  • the cross-sectional geometry of the stem can vary according to the strength and deformation requirements.
  • the prosthesis implant, or its component parts is made of suitable bio-compatible material e.g. metals, ceramics, polymers or composites; singly or in any combination.
  • filler material can be provided for at least partly filling a hollow stem, which may be open at its distal end.
  • the outer surfaces of the stem can be smooth or porous and may be coated with other materials.
  • the surfaces can be regular or have irregular contours, interstices, apertures or can be fenestrated.
  • the prosthesis is selectively formed as an integral unit or as several component parts.
  • the prosthesis implant is inserted directly into the bone or with an interposing material, for instance, acrylic bone cement, namely polymethylmethacrylate.
  • tubular stem allows for variation of the inner and outer diameter of the implant to attain flexural matching.
  • Both the stiffness and the surface strain can be engineered to values tolerated by the bone.
  • bone growth can be stimulated and the normal physiological bone turnover maintained. Stress shielding and bone resorption is thereby prevented.
  • Figure la illustrates a diagrammatic force relationship of a natural femur and pelvis, showing the abductor force loop.
  • Figure lb illustrates the force relationship with a prior art prosthesis in the femur.
  • Figures 2 to 9 shows an invented prosthesis or implant for a left femur.
  • a prosthesis for the right femur would be a mirror image of the shown implant.
  • the figures are detailed below.
  • Figure 2 is a longitudinal, anterior-posterior sectional view through a femoral prosthesis in accordance with the invention along the line I-II of the section indicated in Figure 3.
  • Figure 3 is a lateral-medial view of the prosthesis of Figure 2.
  • Figure 4 is an isometric view of the prosthesis in a proximal to distal direction.
  • Figure 5 is a diagrammatic partial side view of an alternative means for extending into the trochanter.
  • Figure 6 is a diagrammatic partial side view of another alternative means of extending into the trochanter.
  • Figure 7 is a diagrammatic partial side view of a further alternative means for extending into the trochanter.
  • Figure 8 are diagrammatic partial side and end views of another alternative means of extending into the trochanter.
  • Figure 9 are diagrammatic partial side and end views of another alternative means of extending into the trochanter.
  • the joint force passing in the proximal region via the head 10, neck 11 and trochanter 12 regions of the femur is balanced by the abductor muscles 13 which arise from the pelvis 14. Simplistically this could be modelled as a closed loop, namely the abductor force loop 15, 16, 17 and 18 in these structures 10, 11, 12, 13 and 14 respectively.
  • the result is that the tubular, cortical shaft 19 of the femur 20 is loaded by the axial net force equal to the partial body weight 21 and the moment due to the offset 22 between the center of gravity 23 and the femoral shaft 19.
  • the fulcrum 24 is loaded on the one side by the partial body weight 21 acting on lever 25, and on the opposite side by ⁇ the abductor muscle 13 acting on lever 26.
  • the consequence of this abductor force loop is that the shaft 19 of the femur 20 is exposed to predominantly axial forces, bending moments and torque.
  • FIG. lb The insertion of a prosthesis 27 of the prior art is illustrated in Figure lb. This insertion involves removal of the femur head 10 and replacement with the artificial articular surface 28 with an elongated shaft 29 heing ⁇ . inserted in the femur cortical shaft 19 of the femur 2O.
  • the resultant joint force is transmitted via the neck 35 of the prosthesis 27 into the stem 29.
  • This force has to be transmitted into the femur 20.
  • This is different to the normal situation as illustrated in Figure la.
  • the resultant bending moment in the prosthesis 27 is insufficient to achieve physiological loading of the 5 proximal medial cortex 31. This is particularly the case with most known stems which have large cross-sectional dimensions proximally and therefore a high stiffness in bending.
  • a piston ⁇ like effect is produced during each load cycle as the shaft
  • 10. 29. is: pushed in a distal direction into the femoral canal 30 while the bone is pulled in a proximal direction towards the pelvis 14 by the action 17 of the abductor muscles 13. This is illustrated by the opposing force lines 32 and 33 and results in high shear forces at the implant-bone interface
  • the prosthesis includes a stem 200 which is composed of essentially four components; namely an articulating surface called the head 201, a central portion or body 236 including the neck 202, an 0 extending or protruding element or feature 203 extending proximally and laterally to achieve direct attachment of the greater trochanter to the stem 200, and a tubular hollow shaft 2.04 extending distally.
  • the components 201, 202, 203 and 204 may be made individually from different or similar 5 materials and permanently or exchangeably attached to each other or may be parts of an integral stem 200 without clear separations between them. This is shown in the Figures 2 to 8.
  • the function of the stem 200 is to transmit the 0 loads as indicated in the abductor loop as modified by prosthetic implant between the head 201, trochanter protruding element or attachment feature 203 and the shaft 204.
  • the protruding element consists of several ribs or lamellae 205 which are laterally connected by one or more bridges 206.
  • the ribs or lamellae 205 can be solid or have apertures or holes to allow for bone ingrowth by the greater trochanter.
  • the ribs 205 extend from the anterior to posterior sides over a su ficient in width extent to ensure that a physiologically acceptable compressive stress is applied to the ⁇ bone and the abductor muscles engage the protuberance thereby to input force from the abductor muscle directly to the stem.
  • a screw hole 207 is provided for securing the greater trochanter with a screw or bolt 211 or for attaching an external feature such as a hook or washer which engages the trochanter and facilitates reattachment of the trochanter.
  • the screw 211 is an auxiliary device to enhance trochanteric fixation and bony union between the greater trochanter 12 and the shaft 19 of the femur 20 when the trochanter 12 is osteotomised during surgical exposure.
  • protruding element 203 ass as trochanteric attachment are fibre sponges, meshes, interstices, fenestrations, have apertures or contain irregular protuberances which are firmly attached to the stem.
  • Figures 5 to 9 show a variety of options to achieve direct, mechanically sound integration of the attachment feature 203 into the trochanter 12.
  • FIG. 5 also shows a different option to achieve short term fixation of the trochanter 12 until the process of integration is successfully completed.
  • the attachment feature 203 is used together with or is completely in the form of a cage 213.
  • the cage 213 consists of a network of intersecting fibers, wires or cables 214 of any kind of material.
  • the cage 213 is either firmly attached to a base plate 215, which in turn rests against a face 216 of the stem 200 or is directly attached to the stem 200.
  • the cavity under the cage 213 may be filled with bone graft or other osteo-inductive materials.
  • the short term fixation system consists of one or more; pairs of wires or cables 217 and 218.
  • Wire 217 is attached to the prosthesis proximally of the trochanter attachment feature 203, and the other wire 218 is attached distally to the feature 203.
  • the proximal wire 217 is threaded through the tendinous insertion of the abductor muscles 13.
  • the two cables or wires 217 and 218 are then inserted into a sleeve 219 in such a way that the ends 220 of the cable point in opposite directions. After tensioning, the sleeve 219 is crimped and the wire or cable ends 220 are cut. If more than one pair 217 and 218 is used, the cables or wires 217 and 218 may be linked cross-wise.
  • the opposite ends 224 fit into apertures 225 in the protrusion 203.
  • Figure 6 shows the feature 203 made from a porous material 221. It has the structure of open cell foam 222; namely, the cells 222 are continuous with each other.
  • the ce l diameter may vary, and probably will be in the range of about
  • the outer surface may be regular or have grooves
  • curved or circumferential grooves 226, are cut into the feature 203.
  • the ribs 205 are cut in such a way that the distally facing surface 232 is perpendicular or undercut in relation to the elongated axis 233 of the 5 prothesis so as to represent a saw tooth type front face 234.
  • the circumferential grooves and ridges may be continuous or interrupted by axially directed bridges, grooves or ridges 206.
  • the ridges or teeth may have sharp edges 227 or may be rounded 228.
  • pins 229 of variable number and size extend laterally from the surface 230 of the feature 203. This e fectively presents a surface with multiple interstices, fenestrations or apertures 232.
  • Figure 9 shows a form of the feature where 5 circular or ellipsoidal, concentric rings 231 extend from the lateral surface 230.
  • the rim of these rings may be sharp for cutting or blunt ended.
  • a system for initial fixation on the external surface 230 may be used with any of the options of Figures 7 0 to 9 even though not shown in detail.
  • Figure 9 the components of the stem 200 are shown as separate parts 235.
  • Ribs 205 or bridges 206 can be wholely or partly curved.
  • the protruding element 203 can be filled or coated with bone graft or man-made materials such as ⁇ 5 hydroxyapatite, which have osteo-inductive potential to enhance the process of integration of the protruding element 203 into the trochanter 12 and to facilitate engagement of the abductor muscles 13 with the stem 200.
  • the axis of the stem 200 as viewed in the lateral-medial illustration of Figure 3 has an anterior tilt, firstly, to follow the geometry of the natural bone and secondly to position the protruding element or attachment feature 203 optimally for integration of the trochanter 12 and the engagement of the abductor muscles 13.
  • the shaft 204 is generally cylindrical in cross- section. In different embodiments the cross-section and its geometry can vary as the cross-sectional shape of the femoral canal 30 changes along its elongated axis.
  • the shaft 204 can be selectively hollowed where the bone dimensions allow a stronger stem 200 than required to sustain fatigue failure of material. This is likely the case at the junction between the shaft 204 and the neck 202.
  • the hollow shaft can selectively have a solid or foamed polymer filler 212 material such as polyethylene or polyurethane for reinforcement.
  • the filler may partly fill the bore 208 of the shaft 204, and the shaft 204 is open at the distal end.
  • the wall thickness 209 at the distal end is narrower than at the proximal medial end 210.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Vascular Medicine (AREA)
  • Transplantation (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Cardiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Manufacturing & Machinery (AREA)
  • Prostheses (AREA)

Abstract

Une prothèse fémorale pour arthroplastie de la hanche fournit un moyen destiné à s'étendre dans le trochanter afin de faciliter le contact de la prothèse avec les muscles abducteurs et la fixation de la prothèse avec le trochanter. Cela rétablit les forces en boucle des abducteurs et réduit au minimum les contraintes de cisaillement entre le fémur et la prothèse. La saillie se trouve à l'extrémité proximale fémorale adjacente au cou de la tige et comprend des nervures (205) et des ponts (206) à introduire dans la structure osseuse spongieuse du grand trochanter. Une tige creuse (204) de section transversale différente et ouverte à l'extrémité améliore l'adaptation flexionnelle entre le fémur et la prothèse.
PCT/US1989/002020 1988-05-11 1989-05-11 Prothese femorale de l'articulation de la hanche WO1989010730A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US19311888A 1988-05-11 1988-05-11
US193,118 1988-05-11

Publications (1)

Publication Number Publication Date
WO1989010730A1 true WO1989010730A1 (fr) 1989-11-16

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Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1993001770A1 (fr) * 1991-07-15 1993-02-04 Johnson & Johnson Orthopaedics, Inc. Constituant prothetique osteal cunieiforme cannele
WO1993021862A1 (fr) * 1992-04-24 1993-11-11 Klaus Draenert Composants de protheses femorales a ancrer avec du ciment osseux et leur procede de fabrication
FR2753081A1 (fr) * 1996-09-11 1998-03-13 Daniel Noyer Prothese femorale de hanche a embase antepulsee
US5824083A (en) * 1992-04-24 1998-10-20 Draenert; Klaus Cement-free femoral prosthesis component and method of producing it
FR2778090A1 (fr) * 1998-05-04 1999-11-05 Michel Porte Element de prothese de hanche a appui cortical externe pour fractures trochanteriennes et pince passe-cable pour la mise en place d'un tel element
US20120035734A1 (en) * 2009-03-24 2012-02-09 Stanmore Implants Worldwide Limited Intracorporeal Component for a Percutaneous Device
CN106491247A (zh) * 2016-12-27 2017-03-15 西安交通大学 一种用于人工假体的中空缓冲结构
US20180055541A1 (en) * 2009-08-27 2018-03-01 The Foundry, Llc Method and Apparatus For Force Redistribution in Articular Joints
US11241256B2 (en) 2015-10-15 2022-02-08 The Foundry, Llc Method and apparatus for altering biomechanics of the shoulder
US11517360B2 (en) 2009-08-27 2022-12-06 The Foundry, Llc Method and apparatus for treating canine cruciate ligament disease

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE2811603A1 (de) * 1978-03-17 1979-09-20 Maschf Augsburg Nuernberg Ag Endoprothese fuer gelenke des menschlichen bewegungsapparates
US4283799A (en) * 1979-09-10 1981-08-18 Massachusetts Institute Of Technology Pre-coated body implant
US4406023A (en) * 1982-04-19 1983-09-27 Harris William H Stemmed femoral component for the human hip
FR2528307A1 (fr) * 1982-06-14 1983-12-16 Tornier Sa Prothese de hanche perfectionnee

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE2811603A1 (de) * 1978-03-17 1979-09-20 Maschf Augsburg Nuernberg Ag Endoprothese fuer gelenke des menschlichen bewegungsapparates
US4283799A (en) * 1979-09-10 1981-08-18 Massachusetts Institute Of Technology Pre-coated body implant
US4406023A (en) * 1982-04-19 1983-09-27 Harris William H Stemmed femoral component for the human hip
FR2528307A1 (fr) * 1982-06-14 1983-12-16 Tornier Sa Prothese de hanche perfectionnee

Cited By (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1993001770A1 (fr) * 1991-07-15 1993-02-04 Johnson & Johnson Orthopaedics, Inc. Constituant prothetique osteal cunieiforme cannele
AU658659B2 (en) * 1991-07-15 1995-04-27 Johnson & Johnson Orthopaedics, Inc. Fluted-wedge osteal prosthetic component
WO1993021862A1 (fr) * 1992-04-24 1993-11-11 Klaus Draenert Composants de protheses femorales a ancrer avec du ciment osseux et leur procede de fabrication
US5554190A (en) * 1992-04-24 1996-09-10 Draenert; Klaus Prosthesis component and a method of producing it
US5824083A (en) * 1992-04-24 1998-10-20 Draenert; Klaus Cement-free femoral prosthesis component and method of producing it
FR2753081A1 (fr) * 1996-09-11 1998-03-13 Daniel Noyer Prothese femorale de hanche a embase antepulsee
WO1998010720A1 (fr) * 1996-09-11 1998-03-19 Daniel Noyer Prothese femorale de hanche a embase antepulsee
EP0955013A1 (fr) * 1998-05-04 1999-11-10 Michel Porte Element for stabilising trochanteric fractures and cable-passing pliers for positioning thereof
FR2778090A1 (fr) * 1998-05-04 1999-11-05 Michel Porte Element de prothese de hanche a appui cortical externe pour fractures trochanteriennes et pince passe-cable pour la mise en place d'un tel element
US20120035734A1 (en) * 2009-03-24 2012-02-09 Stanmore Implants Worldwide Limited Intracorporeal Component for a Percutaneous Device
US9855153B2 (en) 2009-03-24 2018-01-02 Stanmore Implants Worldwide Limited Method of installing a percutaneous device
US10751201B2 (en) 2009-03-24 2020-08-25 Stanmore Implants Worldwide Limited Percutaneous device
US20180055541A1 (en) * 2009-08-27 2018-03-01 The Foundry, Llc Method and Apparatus For Force Redistribution in Articular Joints
US11517360B2 (en) 2009-08-27 2022-12-06 The Foundry, Llc Method and apparatus for treating canine cruciate ligament disease
US11730519B2 (en) * 2009-08-27 2023-08-22 The Foundry, Llc Method and apparatus for force redistribution in articular joints
US11241256B2 (en) 2015-10-15 2022-02-08 The Foundry, Llc Method and apparatus for altering biomechanics of the shoulder
CN106491247A (zh) * 2016-12-27 2017-03-15 西安交通大学 一种用于人工假体的中空缓冲结构
CN106491247B (zh) * 2016-12-27 2017-12-26 西安交通大学 一种用于人工假体的中空缓冲结构

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