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WO1994007438A1 - Mecanisme a manchon porteur incorpore dans l'element femoral - Google Patents

Mecanisme a manchon porteur incorpore dans l'element femoral Download PDF

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Publication number
WO1994007438A1
WO1994007438A1 PCT/US1993/009323 US9309323W WO9407438A1 WO 1994007438 A1 WO1994007438 A1 WO 1994007438A1 US 9309323 W US9309323 W US 9309323W WO 9407438 A1 WO9407438 A1 WO 9407438A1
Authority
WO
WIPO (PCT)
Prior art keywords
prosthesis
bearing
distal portion
proximal portion
elongated
Prior art date
Application number
PCT/US1993/009323
Other languages
English (en)
Inventor
Raymond G. Tronzo
Original Assignee
Tronzo Raymond G
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 Tronzo Raymond G filed Critical Tronzo Raymond G
Priority to AU52951/93A priority Critical patent/AU5295193A/en
Publication of WO1994007438A1 publication Critical patent/WO1994007438A1/fr

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    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit

Definitions

  • the present invention generally relates to a hip replacement prosthesis and more particularly to improving the function of the femoral component as part of a hip replacement system by creating a bearing mechanism for transferring torque stresses to and/or from bone of which the following is the specification.
  • hip replacement prosthesis comprise generally of a ball attached to a stem which is secured inside of the femoral canal.
  • the ball articulates with an acetabulum, or as a socket fixed inside of the acetabulum, either of which make up what is know as either a hemiarthroplasty for the former and total hip arthroplasty for the latter design.
  • Bone cement (“Cemented Prosthesis”)
  • Bone Ongrowth porous coated, or bone Ingrowth, relatively smooth sides and fitted into place by friction
  • cementless Prosthesis Bone Ongrowth, porous coated, or bone Ingrowth, relatively smooth sides and fitted into place by friction
  • the present invention overcomes torsional stresses by the use of a bearing mechanism built into the femoral component which may extend the life of the arthroplasty and diminish, or eliminate thigh pain.
  • the internal bearing mechanism can take one of three forms described as follows. Design I being the most preferred embodiment:
  • the overall femoral stem is of a form with a porous coating on its upper surfaces with two exceptions: 1) The upper end is fenestrated as a round window which is porous coated within its interior. The fenestration with its specially coated inner surface is meant to more firmly secure the upper end of the prosthesis as an adjunct to the porous coating of its outer surface; 2) The distal end is shaped as a cylinder over which a bearing of various sizes fits. The cylindrical end is polished to a mirror finish. The bearing has its inner surface like a mirror finish with its outer surface roughened or coated with a porous finish. The net result of this design combination is:
  • the basic prosthetic configuration is the same as in Design I with the exception of the location of the bearing mechanism. It is so located that the stem rotates within the longitudinal channel or opening.
  • the basic prosthetic configuration is the same as in Design I with the exception of the location of the bearing mechanism. It is located within the upper end of the implant, where an upper portion of the stem rotates within an upper opening in the proximal shank portion.
  • the present invention utilizes an optional fenestration at the upper end of the prosthesis for additional fixation, which is preferred (there may be one or more such openings) , however its presence is not essential to the function of the bearing mechanism.
  • the fenestration feature while uniquely different from previous art in that its inner walls are porous coated in some manner, is an option to the basic bearing design on the implant.
  • the bearing can be located at various positions within the prosthesis depending on the circumstances of use.
  • the distal end of the femoral stem is located within the rotational bearing of the device.
  • the bearing is secured within the femoral canal by a frictional fit which may be further enhanced by the eventual growth of bone about its textured outer surface for its secure position inside the femoral canal.
  • the shaft of the femoral component rotates about the secured bearing in concert with the stresses induced, rather than antagonistic to them and thereby alleviates the torsional stresses placed on the prosthesis.
  • While some prior art hip prosthetic devices have utilized a sleeve or collar in conjunction with the generally elongated femoral shaft component, they generally do so to permit the proper sizing of a prosthesis to the individual by screwing or swedging the chosen collar length to the end of the device, thus the sleeve becomes a sold part of the prosthesis. None of these prior devices have utilized a device such as a bearing to reduce or eliminate torsional stresses placed on the prosthesis in accordance with the various embodiments of the present invention.
  • one such device is believed to be sold under the trademark OMNIFLEX and is advertised to minimize the potential of postoperative thigh pain and stress abrasion.
  • the prosthesis is advertised to comprise a modular, cylindrical, polished cobalt chromium allow femoral distal tip available in 1mm. increments from 8mm. to 25mm.
  • the distal tip in this device is claimed to be well fitted inside the femoral canal and is further claimed to enhance both proximal and distal stem stability against torsional and toggling forces.
  • distal fitting sleeve having a highly polished exterior and whose length can be chosen for each patient to provide a more congruent fit and which may be sold under the term, APR II HIP SYSTEM.
  • the distal sleeve is claimed to permit the surgeon to have the ability to increase the effective prosthetic stem diameter without going to a larger implant having a comprised bone structure.
  • the sleeves merely function to increase surface area contact of the prosthesis and are solidly fixed to its distal end.
  • a distal sleeve is that sold by Howmedica of Rutherford, NJ under the trademark, HOWMEDICA'S PRECISION OSTEOLOCK. That device comprises a femoral component design which is advertised to have achieved a cementless fixation in the proximal femur by making contact with the proximal femoral canal in strategic locations. Horizontal integration grooves, strategically located in the four corners of the proximal stem, are claimed by the manufacturer to enhance stability and reduce stem/bone micro-motion. The distal sleeves are stated to enable the independent filling of the canal distally and are solidly fixed to the prosthesis.
  • a femoral stem prosthesis to be implanted in the proximal end of the femoral canal.
  • the femoral stem prosthesis of the present invention is a device having an elongated shaft comprising a shank proximal portion with one or more openings therethrough.
  • the outer surface of the shaft comprises an affixation surface adjacent to the shank proximal portion.
  • the distal portion of the shaft is located longitudinally from the shank of the proximal portion, and is of a diameter to permit it to fit within the femoral canal.
  • a bearing permits the prosthesis to have potential internal micro-motion in response to stresses exerted on the prosthesis when it is implanted.
  • the bearing is located about the distal portion of the elongated shaft and additionally comprises a securing shoulder to secure the bearing within the femoral canal while permitting the distal portion to rotate only about the inner bearing.
  • the bearing is fixed within the femoral canal about which the distal portion of the shaft may rotate.
  • Fig. 1 is a side view of one embodiment of a device constructed in accordance with this invention shown implanted in the femoral canal; (Femoral Stem Design I).
  • Fig. 2 is an enlarged side view, partially in section of the device of Fig. 1.
  • Fig. 3 is an enlarged cross-section of a device constructed in accordance with this invention taken along line 3-3 of Fig. 2;
  • Fig. 4 is an enlarged, three dimensional view of the embodiment of a device constructed in accordance with the present invention as depicted in Fig. 1;
  • Fig. 5 is a partial view of the upper portion of the second embodiment of a device constructed in accordance with the present invention (Femoral Stem Design II) ;
  • Fig. 5A is a side view, partially in section, of the cooperating element used in conjunction with the other cooperating element shown in Fig. 5 (Femoral Stem Design II) ; and
  • Fig. 6 is an enlarged, partially in section, side view of the third embodiment of a device constructed in accordance with the present invention (Femoral Stem Design III) .
  • Fig. 1 the proximal end of a femur 10 which has been resected for the implant of a femoral prosthesis.
  • the femur 10 comprises an outer shell of cortical bone 12, inner cancellous bone 14 and calcar 16.
  • a femoral prosthesis constructed in accordance with one embodiment of the present invention is shown at 20 as implanted at the prepared proximal end of the femur 10.
  • the femoral prosthesis 20 has an elongated shaft 22 having a proximal shank portion 24 with opening 26 therethrough and a distal portion 28 which may be rounded at its extreme end and is generally narrower in diameter than the proximal shank portion 24.
  • the distal portion 28 is inserted into the proximal portion of the femur 10 so that the distal portion 28 can move within the bearing 30 (Fig. 2) which is fixedly secured within the femoral canal by its outer affixation surface 32 as described in further detail below.
  • the motion of stem portion within the bearing 30 is a special type best described as "micro-motion".
  • the prosthesis 20 is designed so that the prosthetic portion 34 which is unitary with the elongated shaft 22 at the proximal shaft 22 at the proximal shank portion 24 will provide a neck 36 upon which is fitted a generally spherical head 38 to engage an acetabular prosthesis for articulation in a hip replacement (not shown) .
  • the femur 10 is prepared to receive the prosthesis 20 by cutting tools to establish a neck resection level at 40 and then creating a passage 42 to receive first the bearing 30 followed by the insertion of the elongated shaft 22.
  • the distal portion 28 of the device 20 is seated within the bearing 30 which is fixedly secured within the passage 42.
  • the bearing 30 may be manually pounded into place at the desired site.
  • the outer affixation surface 32 of the bearing is designed to aid in retaining the bearing in place and may include a roughened or textured surface which may be achieved by conventional methods including, but not limited to, applying a conventional porous coating by sintering or plasma spraying, and/or by mechanical tooling methods such as knurling or sandblasting.
  • the distal portion 28 of the elongated shaft 22 extends downward into the passage 42 and is of a generally cylindrical external peripheral surface, but not confined to a cylinder, and may be of an alternative configuration having a predetermined external diameter which is selected to be slightly less than the internal diameter of bearing 30.
  • the distal portion 28 is cylindrical and is located within bearing 30. The distal portion 28 is still permitted to freely rotate about its own longitudinal axis within the bearing 30 with minimized space between the two components.
  • the inner surface 30A of bearing 30 and the exterior surface 28A of distal portion 28 may be highly polished in accordance with conventional methods.
  • a bearing retaining shoulder 44 is located on the elongated shaft 22 near the distal portion 28. When the bearing 30 buttresses the bearing retaining shoulder 44, the bearing is prevented from migrating towards the proximal shank portion of the prosthesis.
  • the rotational capabilities of the distal portion 28 within bearing 30 will enable the prosthesis to dissipate the damaging effects associated with torque exerted during normal movement patterns, a "stress transfer" function.
  • the device 20 may also optionally include an opening 26 through the proximal shank portion 24.
  • the opening 26 permits the ingrowth of bone therethrough to aid in retaining the prosthesis in place at the proximal portion.
  • the opening may be of almost any shape, i.e., rectangular, polygonal, etc., and the present invention is not limited thereby. It is distinct in some way as to encourage or promote intimate layers of bone growth.
  • a conventional bolt may also pass through the opening to permit bone growth thereabout to further secure the device.
  • the exterior surface of the shank portion 24, the elongated shaft 22 (excluding the distal portion) and/or the interior surfaces of the opening 26, may include a roughened or textured affixation surface (not shown) , to enhance bone attachment to the prosthesis 20.
  • This affixation surface may be achieved by applying a porous coating such as by sintering or plasma spraying, and/or by mechanical tooling methods such as knurling or sandblasting.
  • the prosthesis 20 may be removed after some period of time which is facilitated by the fact that the distal portion 28 will be easily removed from the bearing 30 since the cooperating surfaces of these two components may be highly polished.
  • All of the components of the present invention may be comprised of biocompatible materials.
  • the proximal shank portion 24 for example, may be comprised of titanium steel while the distal portion 28 and bearing 30 may be comprised of cobalt chromium which does not abrade like titanium steel.
  • the entire prosthesis may also be made from one material such as cobalt chromium. It should be readily apparent to those skilled in the art that the present invention should not be limited to these particular types of materials, but may be comprised of any suitable materials presently known or developed in the future which are suitable for the manufacture of hip replacement components.
  • the present invention also includes a second embodiment 50 (as shown in Fig. 5, Femoral Design II).
  • the second embodiment 50 is similar to the first embodiment 20 of Figs. 1-4 and to that end, the same reference characters for similar parts will be used in describing the second embodiment 50.
  • the second embodiment of the femoral prosthesis 50 has an elongated shaft 22 having a proximal shank portion 24 with opening 26 therethrough.
  • the distal portion 28 of this prosthesis 50 is in reality, a portion of an elongated rod 52 which fits and may rotate within elongated passage 54 and which extends outwardly from the distal portion thereof.
  • the elongated rod replaces part 30 as the bearing mechanism.
  • Part 30 in Design I becomes a sold extension of rod 52.
  • the elongated rod 52 acts as a pivot member about which the elongated shaft 22 of the prosthesis may move in response to the torsional forces exerted on the prosthesis during use.
  • the second embodiment 50 (as shown in Figs. 5 and 5A) is also designed so that the prosthetic portion (not shown) which is unitary with the elongated shaft 22 at the proximal shank portion 24 will provide a neck 36 upon which is fitted a generally spherical head (not shown) to engage either the natural acetabulum, or an acetabular prosthesis for articulation in a hip replacement (not shown) .
  • the distal portion of the device 50 may be solidly secured to the bearing 30, (as shown in Fig. 5A) .
  • the bearing 30 is fixedly secured within the passage 42 (as shown in Fig. 1) .
  • the outer affixation surface 32 of the bearing is designed to aid in retaining the bearing in place and may include a roughened or textured surface which may be achieved by conventional methods.
  • the elongated rod 52 is of a generally cylindrical external peripheral surface having a predetermined external diameter which is selected to be slightly less than the internal diameter of elongated passage 54 of Fig. 5.
  • the exterior surface of elongated rod 52 and the internal surface of elongated passage 54 are brightly polished to permit their micro-motion within each other.
  • a retaining shoulder 44 is located on the elongated shaft 22 near the distal portion 22.
  • the bearing portion and elongated rod 52 are prevented from migrating towards the proximal shank portion of the prosthesis.
  • other forms of a bearing and rod retainer may be incorporated into the present invention, such as by conventional means such as a screw or protrusion (not shown) , extending generally perpendicular to the elongated shaft.
  • the third embodiment 55 of the present invention moves the rotational portion of the bearing mechanism up into the upper end of the prosthesis 24.
  • the prosthesis contains a cylindrical opening or channel 56 through which a cooperating bearing 58 passes.
  • Cooperating bearing 58 has a highly polished surface to match that of cylinder path 56.
  • Cooperating bearing 58 is a unitary part of stem 59 whose outer surface is roughened by the same means as described for alternate surface 32.
  • Cooperating bearing 58 has the potential of movement within the cylindrical channel 56 as described with respect to the other embodiments.
  • the bearing 30 is integral with stem 59 and the bearing 30 will be fixedly secured in the bone structure as previously set forth. It should be readily apparent to those skilled in the art that the actual longitudinal length of the bearing 30 may vary depending upon the circumstances of use, as may the degree of the outer surfacing thereof.
  • the rotational capabilities of the bearing 58 and elongated rod 52 will enable the prosthesis to dissipate the damaging effects often associated with torque exerted during normal movement patterns.
  • the exterior surface of the shank portion 24 and/or the interior surfaces of the opening 26, may include a roughened or textured affixation surface (not shown) to enhance bone attachment to the prosthesis. The same is true of part 30 and parts 59.
  • This affixation surface may be attained by any suitable method and includes, but is not limited to, the application of a porous coating such as by sintering or plasma spraying, and/or by mechanical tooling methods such as knurling or sandblasting.

Landscapes

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

Abstract

L'invention concerne une prothèse fémorale à tige (20) pouvant s'implanter dans l'extrémité proximale du canal fémoral. La prothèse (20) comprend un arbre allongé (22) pourvu d'une partie proximale (24) possédant une surface externe avec une surface de fixation adjacente à la partie proximale (24) de la tige. La partie distale (22) de l'arbre est située longitudinalement à partir de la partie proximale (24) de la tige, et a un diamètre qui lui permet de s'adapter à l'intérieur du canal fémoral. Un manchon porteur (30) permet le déplacement de la prothèse (20) en réponse aux forces exercées sur celle-ci (20) lorsqu'elle est implantée. Dans un mode de réalisation, le manchon porteur (30) est placé autour de la partie distale (28) de l'arbre allongé (22) et comprend en plus une épaule (44) de fixation pour fixer le manchon porteur (30) à l'intérieur du canal fémoral tout en laissant tourner la partie distale (28) autour du manchon porteur (30). Un élément de retenue retient le manchon porteur au niveau de la partie distale de l'arbre allongé. Dans un autre mode de réalisation (55), le manchon porteur comporte une tige (59) peut tourner à l'intérieur d'un canal interne (56) de l'arbre avec la manchon (30) fixé à la partie distale (28) de la tige (59), le manchon porteur (30) étant situé soit au niveau de sa section (prosthétique) médiane, soit au niveau de sa partie supérieure ou proximale (24).
PCT/US1993/009323 1992-10-01 1993-09-30 Mecanisme a manchon porteur incorpore dans l'element femoral WO1994007438A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU52951/93A AU5295193A (en) 1992-10-01 1993-09-30 Bearing mechanism built into the femoral component

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US95507992A 1992-10-01 1992-10-01
US07/955,079 1992-10-01

Publications (1)

Publication Number Publication Date
WO1994007438A1 true WO1994007438A1 (fr) 1994-04-14

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PCT/US1993/009323 WO1994007438A1 (fr) 1992-10-01 1993-09-30 Mecanisme a manchon porteur incorpore dans l'element femoral

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AU (1) AU5295193A (fr)
WO (1) WO1994007438A1 (fr)

Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0729732A3 (fr) * 1995-03-03 1996-09-25 Levante Ind Quirurgicas
EP0815809A3 (fr) * 1996-06-28 1998-08-12 Johnson & Johnson Professional, Inc. Prothèse à distribution variable de l'ajustement et des contraintes
FR2772595A1 (fr) * 1997-12-22 1999-06-25 Groupe Lepine Dispositif de centrage pour tige medullaire fixee par ciment
DE19730073C1 (de) * 1997-07-14 1999-07-15 Jansson Volkmar Priv Doz Dr Me Endoprothesensystem
EP0931524A3 (fr) * 1997-03-26 1999-11-17 Johnson & Johnson Professional, Inc. Prothèse d'essai modulaire de la hanche pour tiges longues
US6355069B1 (en) 1998-08-20 2002-03-12 Depuys Orthopaedics, Inc. Bone engaging prosthesis
US6464728B1 (en) * 1998-04-14 2002-10-15 Ian P. Murray Modular neck for femur replacement surgery
FR2834200A1 (fr) * 2001-12-31 2003-07-04 Arnaud Andre Soubeiran Prothese de reconstruction apte a etre associee a une portion d'os long restant apres une resection d'une des extremites de cet os
EP1391187A1 (fr) * 2002-08-20 2004-02-25 Depuy Products, Inc. Tige de prothèse avec des paliers
US6974483B2 (en) 1998-04-14 2005-12-13 Encore Medical Corporation Modular neck for femur replacement surgery
US7323013B2 (en) 1998-04-14 2008-01-29 Encore Medical Asset Corporation Differential porosity prosthetic hip system
GB2447018A (en) * 2006-12-01 2008-09-03 Sean Michael Scott Artificial hip joint
US8268007B2 (en) 2009-06-26 2012-09-18 The Cleveland Clinic Foundation Multi-piece prosthetic joint component
JP2018198958A (ja) * 2013-03-14 2018-12-20 デピュイ・シンセス・プロダクツ・インコーポレイテッド 埋め込み型股関節プロテーゼ用大腿骨コンポーネント

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB1442990A (en) * 1972-10-19 1976-07-21 English T A Prosthesis
WO1991003992A1 (fr) * 1989-09-15 1991-04-04 Walker Peter S Implants d'os sur le squelette
US5197989A (en) * 1987-09-03 1993-03-30 Hinckfuss Bruce W Two stage joint prosthesis

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB1442990A (en) * 1972-10-19 1976-07-21 English T A Prosthesis
US5197989A (en) * 1987-09-03 1993-03-30 Hinckfuss Bruce W Two stage joint prosthesis
WO1991003992A1 (fr) * 1989-09-15 1991-04-04 Walker Peter S Implants d'os sur le squelette

Cited By (17)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0729732A3 (fr) * 1995-03-03 1996-09-25 Levante Ind Quirurgicas
EP0815809A3 (fr) * 1996-06-28 1998-08-12 Johnson & Johnson Professional, Inc. Prothèse à distribution variable de l'ajustement et des contraintes
EP0931524A3 (fr) * 1997-03-26 1999-11-17 Johnson & Johnson Professional, Inc. Prothèse d'essai modulaire de la hanche pour tiges longues
US6193759B1 (en) 1997-03-26 2001-02-27 Depuy Orthopaedics, Inc. Modular long stem hip trial
DE19730073C1 (de) * 1997-07-14 1999-07-15 Jansson Volkmar Priv Doz Dr Me Endoprothesensystem
FR2772595A1 (fr) * 1997-12-22 1999-06-25 Groupe Lepine Dispositif de centrage pour tige medullaire fixee par ciment
US6974483B2 (en) 1998-04-14 2005-12-13 Encore Medical Corporation Modular neck for femur replacement surgery
US6464728B1 (en) * 1998-04-14 2002-10-15 Ian P. Murray Modular neck for femur replacement surgery
US7323013B2 (en) 1998-04-14 2008-01-29 Encore Medical Asset Corporation Differential porosity prosthetic hip system
US6613093B2 (en) 1998-08-20 2003-09-02 Johnson & Johnson Professional, Inc. Bone engaging prosthesis
US6355069B1 (en) 1998-08-20 2002-03-12 Depuys Orthopaedics, Inc. Bone engaging prosthesis
FR2834200A1 (fr) * 2001-12-31 2003-07-04 Arnaud Andre Soubeiran Prothese de reconstruction apte a etre associee a une portion d'os long restant apres une resection d'une des extremites de cet os
EP1391187A1 (fr) * 2002-08-20 2004-02-25 Depuy Products, Inc. Tige de prothèse avec des paliers
US6755866B2 (en) 2002-08-20 2004-06-29 Depuy Products, Inc. Prosthetic stem with bearings
GB2447018A (en) * 2006-12-01 2008-09-03 Sean Michael Scott Artificial hip joint
US8268007B2 (en) 2009-06-26 2012-09-18 The Cleveland Clinic Foundation Multi-piece prosthetic joint component
JP2018198958A (ja) * 2013-03-14 2018-12-20 デピュイ・シンセス・プロダクツ・インコーポレイテッド 埋め込み型股関節プロテーゼ用大腿骨コンポーネント

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