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WO2006004401A2 - Element de fixation destine a un implant, notamment une prothese de la hanche - Google Patents

Element de fixation destine a un implant, notamment une prothese de la hanche Download PDF

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Publication number
WO2006004401A2
WO2006004401A2 PCT/NL2005/000466 NL2005000466W WO2006004401A2 WO 2006004401 A2 WO2006004401 A2 WO 2006004401A2 NL 2005000466 W NL2005000466 W NL 2005000466W WO 2006004401 A2 WO2006004401 A2 WO 2006004401A2
Authority
WO
WIPO (PCT)
Prior art keywords
pin
bone
fastening element
longitudinal axis
supporting element
Prior art date
Application number
PCT/NL2005/000466
Other languages
English (en)
Other versions
WO2006004401A3 (fr
Inventor
Erik Leonard Hoffman
Original Assignee
Erik Leonard Hoffman
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
Priority claimed from NL1027111A external-priority patent/NL1027111C2/nl
Application filed by Erik Leonard Hoffman filed Critical Erik Leonard Hoffman
Publication of WO2006004401A2 publication Critical patent/WO2006004401A2/fr
Publication of WO2006004401A3 publication Critical patent/WO2006004401A3/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3601—Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/14—Surgical saws
    • A61B17/15—Guides therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • A61F2002/3013—Rounded shapes, e.g. with rounded corners figure-"8"- or hourglass-shaped
    • A—HUMAN NECESSITIES
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
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    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/30553—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting a position by translation along an axis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30574—Special structural features of bone or joint prostheses not otherwise provided for with an integral complete or partial collar or flange
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30604—Special structural features of bone or joint prostheses not otherwise provided for modular
    • A61F2002/30616—Sets comprising a plurality of prosthetic parts of different sizes or orientations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30784—Plurality of holes
    • A61F2002/30785—Plurality of holes parallel
    • A—HUMAN NECESSITIES
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/3082—Grooves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/3611—Heads or epiphyseal parts of femur
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
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    • A—HUMAN NECESSITIES
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/4631—Special tools for implanting artificial joints the prosthesis being specially adapted for being cemented
    • A—HUMAN NECESSITIES
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    • 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
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Definitions

  • the invention relates to a fastening element for an implant.
  • the invention relates in particular to a fastening element for a hip prosthesis.
  • Such a fastening element is known from NL9202201.
  • This known fastening element comprises a pin part which can be fixed in or on a bone, having a neck portion, on which neck portion a prosthesis head can be fixed.
  • the pin part is at least largely of solid design.
  • a relatively large part of a bone is sawn off.
  • a part of the neck and head of the femur are sawn off, optionally as far as the lesser trochanter, whereafter a relatively deep hole is drilled starting from the sawn off surface approximately parallel to the longitudinal axis of the femur, which hole is formed so as to taper slightly, and is reamed.
  • the pin part is driven into this hole and fixed.
  • both cemented and non-cemented pin parts can be utilized.
  • This known fastening element has as a drawback that it requires removal of relatively much bone material. In practice this means that if after a number of years such a fastening element exhibits play, replacement of the fastening element is very difficult since so much bone material has been removed.
  • a further drawback of such a fastening element is that forces and moments applied thereto are unfavourably transmitted, so that bone tissue disappears as a result of the known stress shielding phenomenon.
  • the object of the invention is a fastening element of the type described in the preamble, wherein the drawbacks mentioned are avoided, while maintaining the advantages thereof.
  • a fastening element according to the invention is characterized by the features of claim 1.
  • a fastening element cemented according to the invention does not have the problems occurring with traditionally cemented prostheses.
  • the most important component for such prostheses becoming dislodged is to prevent, at least to limit to a minimum, the moments around a longitudinal axis of the prosthesis.
  • a fastening element can be of very compact design, so that it is minimally invasive and located in the metaphysis only.
  • a prosthesis according to the invention is bone-conserving and weak part- conserving.
  • a fixed as well as a loose interface may be provided.
  • the pin can be placed in a bone such that the supporting element comes to lie against a sawn off face of the bone, while the longitudinal axis of the pin includes an angle therewith.
  • the main surface of the supporting element is then to be understood to include a surface approximately parallel to the sawing plane along which the bone portion has been sawn off.
  • a fastening for a hip prosthesis can be obtained with a normal angle between the longitudinal axis of the femur and the longitudinal axis of the neck, the so-called CCD angle.
  • Embodiments for a fastening element for a hip prosthesis are possible which are in particular suitable for a coxa vara or coxa valga, respectively.
  • the pin has at least partly a cross section which is non-rotation symmetrical at right angles to the longitudinal axis of the pin.
  • the invention further relates to an assembly of a bone and a fastening element for an implant, characterized by the features of claim 7.
  • the fastening element is provided with a supporting element, preferably plate-shaped, and a pin extending therefrom.
  • a portion of the bone is sawn off such that an abutment surface has been obtained, at least partly defined by spongy bone.
  • the pin is placed wholly or partly in the spongy bone such that the supporting element abuts against this abutment surface while the pin is surrounded by spongy and/or cortical bone, a sufficiently thick cement casing surrounding the pin.
  • the supporting element is preferably supported on the cortical bone that surrounds the spongy bone. This chiefly cortical part of the neck is called the calcar femorale. Thus particularly stable situation is obtained.
  • the femur head is sawn off, preferably subcapitally, while saving the neck as much as possible, but, if necessary, intracapitally, while obtaining an abutment surface.
  • This abutment surface preferably extends approximately at right angles to a load axis of the femur. In the normal position of the leg, the abutment surface will then be approximately horizontally.
  • the longitudinal axis of the pin includes an angle with the supporting element such that the supporting element abuts flatly against the abutment surface and the longitudinal axis of the pin includes an angle with it. It is then preferred that said angle corresponds approximately to the CCD- angle of the respective femur.
  • the invention further relates to a tool for providing a fastening element according to the invention, characterized by the features of claim 12.
  • the hole is made in a manner as is customary with a cemented prosthesis, i.e. first of all, a space is created with a reamer which may or may not be conical. Then, the space obtained is enlarged by means of a rasp, which has the shape of the prosthesis body and is slightly oversized (with conventional prostheses 2 mm) so that a cement casing of sufficient thickness is obtained.
  • the invention further relates to a method for attaching an implant in a bone, characterized by the features of claim 13.
  • a fastening element for a prosthesis can be provided in a bone such that during normal use it transmits forces and moments in an advantageous manner, while only a part of the metaphysis of the femur is used when the fastening element is placed.
  • Such a method offers the advantage that, if desired, the fastening element can be replaced relatively easily with a different fastening element or a different prosthesis, whose attachment is more invasive.
  • Figs. Ia — 1C show, in three steps, the provision of a fastening element for a prosthesis according to the invention;
  • Fig. 2 shows, in top plan view, a femur according to Fig. IB;
  • Fig. 3 shows the metaphysis of a femur with a cemented fastening device according to the invention, in cross-sectional view along the line III-III in Fig. 2;
  • Figs. 4A — 4D show three cross sections of a pin of a fastening device according to the invention along the line IV-IV in Fig. 3;
  • Fig. 5 shows a sawing tool for use with the invention, in mounted condition;
  • Fig. 6 shows an alternative embodiment of a fastening element according to the invention, placed on an abutment surface; and Figs. 7A and B show, in two views, a fastening element according to the invention.
  • Fig. Ia shows, approximately in front view, metaphysis and diaphysis of a femur 1.
  • the femur is provided laterally with a greater trochanter 2 and, on the proximal side, with a head 6 carried by a neck 4.
  • the neck 4 has a longitudinal axis LN which includes an angle ⁇ with the longitudinal axis LF, or the intramedullary axis, of the femur 1.
  • the projection of this angle on the anteroposterior plane (AP -plane), angle ⁇ is usually designated as the CCD angle and is normally between approximately 125° and 140°.
  • the CCD angle is less than or equal to 125°, a coxa vara is involved, if the angle is greater than or equal to 140°, a coxa valga is involved.
  • the angle ⁇ will further be indicated as the CCD angle while, each time, the actual angles, for instance between the pin and supporting element, can be derived from this. Represented under the neck 4 is the lesser trochanter 8.
  • the head 6, at least a part thereof, is to be removed with a portion of the neck 4.
  • the neck 4 is sawn off along a sawing plane 12, thereby forming an abutment surface 14.
  • a tool to be used to that purpose will be described in more detail with reference to Fig. 5.
  • the load axis LB is a straight line drawn through the center of the hip head and the intercondylar space of the knee.
  • a top plan view is shown of the femur 1 with abutment surface 14 according to Fig. IB. It clearly appears from Fig. 2 that the abutment surface 14 comprises a support edge 16 of cortical bone, which surrounds a center surface of spongy bone 18.
  • Fig. 1C shows a fastening element 10 attached in a femur 1.
  • a coupling element 20 of the fastening element 10 is visible, attached to a plate-shaped supporting element 22 which abuts against the cortical support edge 16 and the spongy bone 18.
  • the abutment surface extends approximately at right angles to the load axis LB.
  • FIG. 3 in cross section along the line III-III in Fig. 2, the top part of the femur 1 is shown with fastening element 10 as shown in Fig. 1C.
  • a pin 28 extending from the supporting element 22, is placed in the spongy bone 18 so that a particularly good attachment of the fastening element 10 is obtained.
  • the pin 28 is attached in the bone by means of a bonding agent such as bone cement.
  • bonding agent is at least understood to include an agent that can be provided between the pin and the cortical and/or spongy bone and/or in the bone, in particular the spongy bone, and that exhibits a good bonding to this bone. Included therein is at least bone cement, as used for cemented prostheses.
  • a cross section of a fastening element 10 comprising a plate-shaped supporting element 22 which is substantially flat and extends on at least two opposite, and, preferably, three sides, or around an upper end of a pin 28.
  • the shape of the supporting element 22 in top plan view has been chosen such that it can fittingly abut against the support edge 16 without undesirably extending beyond it unduly.
  • the supporting element 22 can fittingly abut against the abutment surface 14 so that vertical forces, at least forces F approximately at right angles to the plane of the supporting element 22 can be properly transmitted to the cortical bone and to the spongy bone.
  • the pin 28 is of substantially solid design and has a longitudinal axis LP which includes an angle ⁇ i with the plane V of the supporting element 22 which angle, preferably, approximately corresponds to the CCD angle as shown in Fig. IA.
  • the pin 28 preferably has a cross-section other than rotation symmetrical, at right angles to the longitudinal axis LD, while attaching means 5 are provided for attachment to the bonding means.
  • bonding is understood to include at least chemical bonding, mechanical bonding, form locking and/or force locking.
  • the attaching means can for instance comprise bores 38 through the pin 28 and/or channel- shaped notches or recesses 39.
  • the pin When placing the fastening element 10, the pin is placed in the spongy bone 18 in axial direction along the longitudinal axis LP, in a pre-provided cavity, closed off distally by a cement stopper (not shown), and then filled with bone cement.
  • the angle of placement is chosen such that it includes the angle ⁇ with the longitudinal axis LF of the femur 1, so that the supporting element 22 will end up lying flat against the abutment surface 14.
  • the angle ⁇ i can be chosen in a suitable manner, depending on the CCD angle of the respective femur and the angle of the abutment surface 14 relative to the longitudinal axis LF of the femur.
  • the coupling element 20 is designed as a cone which tapers in the direction away from the supporting element 22.
  • the cone 20 has a longitudinal axis LC which likewise includes approximately the CCD angle with the longitudinal axis LP of the pin 28.
  • the longitudinal axis LC of the cone 20 is then located approximately parallel to the longitudinal axis LF of the femur 1.
  • the distance between the longitudinal axis LF of the femur 1 and the longitudinal axis LC of the cone 20, and the angle ⁇ i substantially determines the offset.
  • the coupling element 20 can be arranged to be displaceable with respect to the supporting element 22 but also, a number of different supporting elements 22, at any rate fastening elements 10 may be provided from which a suitable embodiment can be chosen in each case.
  • the offset can also be influenced by the angle between the supporting element and the axis LC.
  • the pin 28 extends adjacent the lateral cortex 24.
  • adjacent is understood to mean that the distance between the end 32 and the inside of the lateral cortex is less than the maximum thickness of the pin, preferably considerably less, for instance less than hah 0 of it. Some millimeters or less suffice, while the end 32 can also be in abutment, for additional support.
  • the longitudinal axis LC of the coupling element 20 lies virtually completely within the space T defined by the outer contour of the pin 28, virtually drawn further beyond the supporting element at least insofar as this longitudinal axis LC lies within the coupling element.
  • this space T (the cement casing) is indicated by C 1 and C2.
  • Figs. 4A-D show four cross-sections of the pin 28 along the line IV-IV in Fig. 3, by way of example.
  • Each of these cross-sections is other than rotation- symmetrical with respect to the longitudinal axis LP, so that the pin 28 can receive torsional forces in the plane of the drawing while being restrained from rotation about the longitudinal axis LP.
  • a suitable cross- section can be chosen, which choice will be immediately clear to one skilled in the art.
  • current cross-sections of implants can then be employed.
  • FIGs. 4A-4C show bores 38 which interconnect the grooves 39.
  • cement can extend through the bores 38. With it, a particularly good locking is obtained.
  • ribs can be provided instead of and/or in addition to the grooves 39.
  • the grooves and, in particular, the bores 38 will provide for a fixed interface between the cement and the pin 28. This means that shifts and rotations are prevented.
  • surface roughnesses can also be used causing high friction, for instance higher than a Ra of approximately 0.015, more in particular higher than 0.1, and/or a profile.
  • Figs. 7A and B show two views of a fastening element 10 according to the invention, Fig. 7A showing a side view and Fig. 7B showing a cross-section of the pin 28.
  • the angle Oc 1 between the supporting element 22 and the longitudinal axis LD of the pin 28 is between 90 - 150°.
  • the longitudinal axis LC of the cone 20 includes an angle 0C2 with the surface of the supporting element 22, which angle is between 30 - 90°.
  • the height H of the cone 20 above the supporting element 22 is between 10 and 66 mm, measured at right angles to the plane of the supporting element 22 at the location of the longitudinal axis LC.
  • the pin 28 extends at the side of the supporting element 22 remote from the cone 20 and has a free end 32 which includes an angle ⁇ with the axis LD, which angle ⁇ is, in particular, between 20 - 100°, preferably between 30 - 80°. In the exemplary embodiment shown, the angle ⁇ is approximately 50°.
  • the length L 1 of the pin 28 is preferably between 35 — 110 mm. This length L 1 is preferably chosen such that the fastening element 10 reaches adjacent the lateral cortex. It will be clear that to that end, a pin 28 can be provided in several sizes, depending on the intended user.
  • the pin 28 has a cross-section that is somewhat 8- shaped. On both sides, a groove 39 is provided, interconnected by the holes 38.
  • the pin has a maximum thickness Di between 7 — 25 mm and a width Bi between 15 — 40. It is preferred that the two sides of the pin 28 are rounded with a radius between 0 — 15.
  • the pin 28 can, each time, have the same cross-section over its entire length, but can also taper slightly so as to obtain an even better fit.
  • a pin 28 is designed to be particularly smooth, with a surface roughness of, for instance, less than or equal to approximately Ra 0.01, a loose interface can be obtained between the pin 28 and the cement.
  • a pin tapering at least partly, so that when any play occurs, the pin 28 will be forced deeper into the cement casing when load is applied.
  • a non- cylindrical cross-section secures against rotations.
  • Fig. 3 it is shown that the cement 3 as bonding agent extends along virtually the entire pin 28 and the bottom side of the supporting element 22, which can be effected by, for instance, filling the bore in the neck 4 at least partly with cement and to then driving the pin 28 therein.
  • the pin 28 can also be designed such that parts thereof remain clear of cement so that attachment to the bone by tissue growing in becomes possible.
  • Fig. 6 a further alternative embodiment is shown, in which under the supporting element 22, a thickening 23 is provided with is located to some extent within the contours of the supporting element 22.
  • the thickening 23 When placing the supporting element, the thickening 23 is driven slightly into the cement which is thereby densified to some extent and is driven into the bone while the part of the supporting element 22 extending outside the thickening abuts against the cortical edge 16. As a result, a still better locking and densifying of the cement is obtained.
  • a thickening 23 as shown here can also be utilized with other embodiments, shown or not shown. It is preferred that the longitudinal axis LP of the pin 28 extends through the heart of the head 6A placed on the coupling element 20. Occurring forces and moment are thereby further reduced.
  • a sawing tool 3 is shown, suitable for use in sawing off at least a part of the head 6 and the neck 4.
  • This sawing tool 3 comprises a pin 5 which can be driven into the trochanter fossa, along the intramedullary axis LF of the femur 1. To that end, first, an appropriate hole is drilled.
  • a bridge piece 7 is carried, coupled thereto by means of a pivotal coupling 9, so that the position of the bridge part 7 can be set with respect to the longitudinal axis LF and the load axis LB of the femur 1.
  • a sawing table 13 is carried by the bridge part 7 with the aid of an arm 11 such that the sawing table 13 is carried on one side or on both sides of the head 6.
  • the sawing table 13 can be made of, for instance, fork-shaped design. As is indicated in Fig. 5, the height of the plane 12, 12' of the sawing table 13 can be set so that the head 6 and neck 4 can be sawn off at the proper height, with the saw being guided by the sawing table 13.
  • the sawing table 13 is set such that the plane 12, 12' extends approximately at right angles to the load axis LB. After the head 6 and the neck 4 have been correctly sawn off at the proper height, the sawing tool 3 is removed by pulling the pin 5 out of the femur.
  • a relatively large prosthesis head or artificial hip head 6A is employed, preferably together with a metal hip socket.
  • the hip head 6A has a diameter Dk of more than 32, more preferably more than 34 mm and most preferably more than 36 mm.
  • a head 6A with a diameter of at least 38 mm is particularly advantageous.
  • a relatively large hip head offers the advantage that bone impingement can be prevented, even with the prosthesis in valgus and varus positions, and that still the relatively elevated resection surface can be used as described and shown hereinabove.
  • the provision of the fastening element 10 according to the invention is relatively little invasive with respect to the method known from the state of the art.
  • the fact is that after sawing off the neck 4, no large bores need to be provided, while, furthermore, only a relatively limited part of the neck 4 needs to be removed. This means that relatively much bone material (both cortical and spongy) remains undamaged.
  • the prostheses can be inserted through a small incision and is therefore not only bone -conserving but also weak-part conserving. All known incisions for placing a total hip replacement can be utilized.
  • fastening element 10 can be removed and can be replaced with a new fastening element.
  • a new fastening element may be designed as outlined according to the invention, with which for instance a pin 28 with a different diameter or greater length can be used, while if necessary, also a further-reaching intervention can be performed wherein for instance a fastening element as described in the preamble can be used. This means that a successive set of prostheses can be used so that suitable prostheses can be provided for a longer time.
  • a fastening element 10 and the fixing elements to be used therefor are manufactured from conventional materials for prostheses and implants with any desired surface roughness.
  • the pin 28 is fixedly connected to the supporting element 22 and manufactured integrally therewith.
  • the pin 28 may also be manufactured separately from the supporting element and be subsequently coupled therewith, for instance by welding or soldering or by means of, for instance, a thread connection so that different sorts of pins can be connected to a supporting element, for instance at different angles.

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  • 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 un élément de fixation destiné à un implant, notamment une prothèse de la hanche, pourvu d'un élément de support sensiblement en forme de plaque d'une broche partant de l'élément de support afin de fixer l'élément de fixation dans une position dans laquelle au moins une grande partie de la broche pénètre dans un os. La broche comprend un axe longitudinal qui présente un angle en commun avec une surface principale de l'élément de support de sorte que, pendant l'utilisation, l'élément de support vient buter contre la surface sciée de l'os et l'extrémité longitudinale de la broche s'étend en formant un angle par rapport à cette surface. L'élément de support comprend, sur le côté éloigné de la broche, un élément de couplage pour une autre partie d'une prothèse tandis qu'une partie extérieure de la broche est pourvue d'un moyen de fixation permettant de cimenter l'os ou d'un agent de liaison.
PCT/NL2005/000466 2004-07-02 2005-07-01 Element de fixation destine a un implant, notamment une prothese de la hanche WO2006004401A2 (fr)

Applications Claiming Priority (6)

Application Number Priority Date Filing Date Title
NL1026560 2004-07-02
NL1026560 2004-07-02
NL1027111A NL1027111C2 (nl) 2004-07-02 2004-09-24 Bevestigingselement voor een implantaat, in het bijzonder een heupprothese.
NL1027111 2004-09-24
US65415805P 2005-02-18 2005-02-18
US60/654,158 2005-02-18

Publications (2)

Publication Number Publication Date
WO2006004401A2 true WO2006004401A2 (fr) 2006-01-12
WO2006004401A3 WO2006004401A3 (fr) 2006-04-13

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20220079767A1 (en) * 2019-06-12 2022-03-17 United States Government As Represented By The Department Of Veterans Affairs Femoral Head Arthroplasty System

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0078888A1 (fr) * 1981-11-10 1983-05-18 GebràœDer Sulzer Aktiengesellschaft Endoprothèse d'articulation à tige plate et rectiligne
FR2578738A1 (fr) * 1985-03-14 1986-09-19 Alfieri Antoine Tige femorale autostable a appui maximum pour prothese de la hanche
NL9202201A (nl) * 1992-12-18 1994-07-18 Ordev Bv Gewrichtsprothese met a-symmetrische prothesekop.
EP1205163A1 (fr) * 2000-11-07 2002-05-15 Erik Leonard Hoffman Elément de fixation pour un implant, en particulier une prothèse de hanche
EP1388329A1 (fr) * 2002-08-05 2004-02-11 LIMA Lto SpA Prothèse fémorale pour l'articulation de la hanche

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0078888A1 (fr) * 1981-11-10 1983-05-18 GebràœDer Sulzer Aktiengesellschaft Endoprothèse d'articulation à tige plate et rectiligne
FR2578738A1 (fr) * 1985-03-14 1986-09-19 Alfieri Antoine Tige femorale autostable a appui maximum pour prothese de la hanche
NL9202201A (nl) * 1992-12-18 1994-07-18 Ordev Bv Gewrichtsprothese met a-symmetrische prothesekop.
EP1205163A1 (fr) * 2000-11-07 2002-05-15 Erik Leonard Hoffman Elément de fixation pour un implant, en particulier une prothèse de hanche
EP1388329A1 (fr) * 2002-08-05 2004-02-11 LIMA Lto SpA Prothèse fémorale pour l'articulation de la hanche

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20220079767A1 (en) * 2019-06-12 2022-03-17 United States Government As Represented By The Department Of Veterans Affairs Femoral Head Arthroplasty System
EP3982884A4 (fr) * 2019-06-12 2023-06-21 Government of the United States of America as represented by the Department of Veterans Affairs Système d'arthroplastie de la tête fémorale

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