WO2000019945A1 - Implant designed to be fixed to a bone - Google Patents

Implant designed to be fixed to a bone Download PDF

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Publication number
WO2000019945A1
WO2000019945A1 PCT/FR1999/002388 FR9902388W WO0019945A1 WO 2000019945 A1 WO2000019945 A1 WO 2000019945A1 FR 9902388 W FR9902388 W FR 9902388W WO 0019945 A1 WO0019945 A1 WO 0019945A1
Authority
WO
WIPO (PCT)
Prior art keywords
stud
implant
bone
piece
implant according
Prior art date
Application number
PCT/FR1999/002388
Other languages
French (fr)
Inventor
Franck Bresler
Patrick Furno
Jacques Hummer
Hubert Lanternier
Michel Philippe
André ROCCA
Claude Schwartz
Javier Torres Fuxet
Laurent Barba
Gérard GACON
Jean-Jacques Lalain
Michel Laurencon
André RAY
Original Assignee
Parc Innovation
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 Parc Innovation filed Critical Parc Innovation
Priority to AU60928/99A priority Critical patent/AU6092899A/en
Publication of WO2000019945A1 publication Critical patent/WO2000019945A1/en

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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
    • A61F2/38—Joints for elbows or knees
    • A61F2/3859—Femoral components
    • 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30405—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
    • 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
    • A61F2002/30561—Special structural features of bone or joint prostheses not otherwise provided for breakable or frangible
    • 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
    • A61F2002/30593—Special structural features of bone or joint prostheses not otherwise provided for hollow
    • 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
    • A61F2002/30795—Blind bores, e.g. of circular cross-section
    • A61F2002/30797—Blind bores, e.g. of circular cross-section internally-threaded
    • 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
    • A61F2002/30891—Plurality of protrusions
    • A61F2002/30892—Plurality of protrusions parallel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4619—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof for extraction
    • 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
    • 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
    • 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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005—The prosthesis being constructed from a particular material
    • A61F2310/00353—Bone cement, e.g. polymethylmethacrylate or PMMA

Definitions

  • the present invention relates to an implant intended to be fixed to a bone, this fixing being able to be carried out by means of a synthetic cement for sealing or by growth of the bone cells through an osteoconductive coating which this implant comprises.
  • the invention is particularly applicable to a femoral piece of knee prosthesis.
  • the removal of the existing implant involves sliding a blade between the implant and the bone, either to separate this implant and the synthetic cement which ensures its fixation to the bone, or, when the implant includes an osteo coating. -conductor, to cut the newly formed bone at this coating.
  • the conformation of the implant and / or the bone site makes it possible to insert this blade in many directions and to make it play between the bone and the implant with a large clearance, as is the case of '' a knee prosthesis tibial base. It is then easy to separate the tibia and this base with minimal lesion of the bone, even if the base includes a medullary anchor rod and / or lateral stabilization pads. In particular, the blade can be engaged in the anteroposterior direction, between the stabilization pads.
  • US Patent 5,194,066 describes such a tibial base, comprising a cylindrical stud projecting from its lower face, this stud being made of a resistant material and forming a body with the base.
  • a femoral piece of knee prosthesis because it reproduces the natural femoral condyles, envelops the end of the femur, so that a separation blade can only be inserted laterally.
  • the presence of the lateral stabilization pads of this femoral part very significantly limits the possibilities of introduction and play of such a blade, and the area between the pads is inaccessible.
  • a femoral piece of knee prosthesis must therefore be more or less torn off, which causes significant bone loss around and between the studs.
  • Cutting the screws is however a relatively difficult operation, given the diameter of these screws, and the studs are relatively difficult to remove from the bone, because they have visible faces which are smooth and which are flush with the bone after this cut.
  • the present invention aims to remedy these significant drawbacks in practice.
  • the implant to which it relates is, in a manner known per se, formed by a prosthetic piece and by at least one stud for stabilization of this piece relative to the bone, each stud projecting from the face of this piece intended to come into contact with the bone.
  • each stud is separably connected to the part at the level of said face;
  • each stud internally delimits a gripping zone for an instrument allowing its removal, the connection of each stud with the part being such that said gripping zone is isolated from the cement or bone cells and is only accessible after separation the stud and this piece.
  • the gripping area allows, by means of said instrument, to easily grasp the stud for its removal. This removal can therefore take place without difficulty and without bone loss. Until each stud and said piece forming the rest of the implant are separated, this grip zone is perfectly isolated from synthetic cement or bone cells, so that any risk of clogging is eliminated.
  • each stud is made of a breakable material and has a portion of wall of reduced thickness, which is located, after mounting of this stud on said piece forming the rest of the implant, at the level the face of this part on which this stud is mounted; the thickness of this wall portion is such that the stud can be easily sectioned by means of a blade engaged between said piece and the bone for the purpose of separating this piece and this bone.
  • each pad comprises:
  • each pad is made of polymethyl methacrylate (PMMA).
  • PMMA polymethyl methacrylate
  • Figure 1 is a side view, partially in section, of the lower end of a femur, of a femoral piece of knee prosthesis and of one of the two lateral studs that this piece has for its stabilization relative to the femur;
  • Figure 2 is a front view, partially in section, of said part, after mounting of the studs thereon;
  • Figure 3 is a partial view of the bone, this piece and one of the studs, in section and on an enlarged scale, as well as a blade intended to be introduced between the part and the bone for the ablation of the latter, and
  • Figure 4 is a view similar to Figure 3, after removal of said part.
  • Figures 1 and 2 show a femoral part 1 of knee prosthesis.
  • This part 1 has, in a conventional manner, a shape which reproduces the femoral condyles and which, consequently, envelops the lower end of a femur 2, this end having been suitably resected to receive this part 1.
  • the part 1 comprises two lateral studs 3 projecting from its face 4 intended to come into contact with the bone 2. These studs 3 are provided to ensure the stabilization of this part 1 relative to the bone 2 while solidly attaches it to the bone.
  • This solid fixation can be carried out by means of a polymerizable synthetic cement ensuring the sealing of the part 1 to the bone 2, or by the growth of the bone cells through the pores of a porous osteoconductive coating which comprises in this case side 4.
  • each stud 3 comprises a threaded lower part 5, an internal axial chamber 6, arranged from the underside of the stud 3 and having a height greater than the height of the threaded part 5, and an axial bore tapped 7, fitted from the bottom of chamber 6.
  • the part 1 comprises, for its part, two tapped holes 8 intended to receive the threaded parts 5 of the studs 3.
  • each stud 3 and of the chamber 6 are such that each stud 3 has, above its threaded part 5, a wall portion 10 having a relatively small thickness.
  • This wall portion 10 has a thickness sufficiently reduced so that the stud 3 can be easily sectioned by a sharpened blade 20 intended to be engaged laterally between the piece 1 and the bone 2 for the separation of this piece 1 and this bone, this thickness being however sufficient for the stud 3 to retain a relative rigidity and to be able to fulfill its role of stabilization.
  • the depth of each hole 8 and the height of each part 5 are also such that the portion 10 is at the level of the face 4, after tightening of the stud 3 in this hole 8.
  • the studs 3 are mounted on the part 1 by completely screwing the parts 5 into the holes 8.
  • this screwing makes it possible to perfectly isolate the chamber 6 and the bore 7 of the sealing cement or growing bone cells.
  • the blade 20 is inserted between the part 1 and the bone 2, along the face 4, in order to operate the separation of part 1 and bone 2.
  • the portions 10 are located opposite this blade 20, which allows easy sectioning of the pads 3, without causing damage to the bone 2.
  • This section makes it possible to reach the zone of the part 1 located between the studs 3, at the level of which the separation of this part 1 and the bone 2 can also be carried out.
  • the removal of the part 1 can then be operated, which makes the bores 7 accessible to the practitioner, as shown in Figure 4, for the engagement of the threaded end of an instrument intended for the removal of the parts of the studs 3 remaining in the bone 2.
  • This instrument then allows easy removal of these parts of the studs, and without bone loss.
  • the invention is not limited to the embodiment described above by way of example, but on the contrary embraces all of the variant embodiments thereof.
  • the studs could be fixed to said piece forming the rest of the implant by any suitable means allowing a sufficiently strong connection so that these studs ensure the stabilization of this piece and so that the cavities delimited by the studs are sealed sealing cement or bone cells; in particular, the studs can be force-fitted into corresponding holes arranged in said part, or be fixed to the latter by gluing or snap-fastening; each stud may have a simple smooth-walled cavity to constitute its grip zone, in place of the chamber 6 and tapped bore 7, the aforementioned instrument having a complementary tip; furthermore, the invention was described with reference to stabilization pads but it is understood that it could also be applied to a medullary anchor rod.

Abstract

The invention concerns an implant comprising at least one pin (3) for stabilising it relative to the bone (2). The invention is characterised in that each pin (3) is linked detachably to the component (1) at said surface (4); and each pin (3) internally defines a grip zone (7) for an instrument for its removal, the linkage of each pin (3) with the component (1) being such that the grip zone (7) is isolated from the sealing material or bone cells and is only accessible after the pin (3) has been detached from said component (1). The invention is particularly applicable to a femoral component (1) or a knee prosthesis.

Description

IMPLANT DESTINE A ETRE FIXE A UN OS IMPLANT TO BE FIXED TO A BONE
La présente invention concerne un implant destiné à être fixé à un os, cette fixation pouvant être réalisée au moyen d'un ciment synthétique de scellement ou par croissance des cellules osseuses au travers d'un revêtement ostéo-conducteur que comprend cet implant.The present invention relates to an implant intended to be fixed to a bone, this fixing being able to be carried out by means of a synthetic cement for sealing or by growth of the bone cells through an osteoconductive coating which this implant comprises.
L'invention est notamment applicable à une pièce fémorale de prothèse de genou.The invention is particularly applicable to a femoral piece of knee prosthesis.
Il est parfois nécessaire de remplacer un implant chirurgical fixé à un os, en particulier dans des cas d'usure de cet implant, de dégradation de l'os ou de prise de jeu de l'implant par rapport à cet os.It is sometimes necessary to replace a surgical implant fixed to a bone, in particular in cases of wear of this implant, degradation of the bone or taking of play of the implant relative to this bone.
L'ablation de l'implant existant implique de glisser une lame entre l'implant et l'os, soit pour séparer cet implant et le ciment synthétique qui assure sa fixation à l'os, soit, lorsque l'implant comprend un revêtement ostéo-conducteur, pour sectionner l'os néoformé au niveau de ce revêtement.The removal of the existing implant involves sliding a blade between the implant and the bone, either to separate this implant and the synthetic cement which ensures its fixation to the bone, or, when the implant includes an osteo coating. -conductor, to cut the newly formed bone at this coating.
Dans certains cas, la conformation de l'implant et/ou du site osseux permet d'insérer cette lame selon de nombreuses directions et de la faire jouer entre l'os et l'implant avec un large débattement, comme cela est le cas d'une embase tibiale de prothèse de genou. Il est alors facile de séparer le tibia et cette embase avec une lésion minimale de l'os, même si l'embase comprend une tige médullaire d'ancrage et/ou des plots latéraux de stabilisation. En particulier, la lame peut être engagée dans la direction antéro-postérieure, entre les plots de stabilisation. Le brevet US 5 194 066 décrit une telle embase tibiale, comprenant un plot cylindrique faisant saillie de sa face inférieure, ce plot étant en un matériau résistant et formant corps avec l'embase.In certain cases, the conformation of the implant and / or the bone site makes it possible to insert this blade in many directions and to make it play between the bone and the implant with a large clearance, as is the case of '' a knee prosthesis tibial base. It is then easy to separate the tibia and this base with minimal lesion of the bone, even if the base includes a medullary anchor rod and / or lateral stabilization pads. In particular, the blade can be engaged in the anteroposterior direction, between the stabilization pads. US Patent 5,194,066 describes such a tibial base, comprising a cylindrical stud projecting from its lower face, this stud being made of a resistant material and forming a body with the base.
Dans d'autres cas, l'ablation de l'implant est rendue difficile par la configuration de l'implant et/ou du site osseux, et cette opération d'ablation implique des lésions ou des pertes osseuses importantes. Ainsi, une pièce fémorale de prothèse de genou, du fait qu'elle reproduit les condyles fémoraux naturels, enveloppe l'extrémité du fémur, de sorte qu'une lame de séparation ne peut être introduite que latéralement. La présence des plots latéraux de stabilisation de cette pièce fémorale limite très notablement les possibilités d'introduction et de jeu d'une telle lame, et la zone située entre les plots est inaccessible. Une pièce fémorale de prothèse de genou doit donc être plus ou moins arrachée, ce qui occasionne une perte osseuse importante autour des plots et entre ceux-ci.In other cases, the ablation of the implant is made difficult by the configuration of the implant and / or the bone site, and this ablation operation involves significant bone lesions or losses. Thus, a femoral piece of knee prosthesis, because it reproduces the natural femoral condyles, envelops the end of the femur, so that a separation blade can only be inserted laterally. The presence of the lateral stabilization pads of this femoral part very significantly limits the possibilities of introduction and play of such a blade, and the area between the pads is inaccessible. A femoral piece of knee prosthesis must therefore be more or less torn off, which causes significant bone loss around and between the studs.
Il a été conçu d'équiper une pièce fémorale de prothèse de genou de tiges filetées en matériau sécable, tel que du polyéthylène, sur lesquelles des plots en polyéthylène sont vissés. Lors de l'ablation de l'implant, les vis sont sectionnées à la base des plots, ce qui permet la séparation facilitée de la pièce fémorale et de l'os.It was designed to equip a femoral part of knee prosthesis with threaded rods in breakable material, such as polyethylene, on which polyethylene studs are screwed. When the implant is removed, the screws are cut at the base of the studs, which facilitates the separation of the femoral piece and the bone.
La coupe des vis est toutefois une opération relativement difficile à réaliser, compte tenu du diamètre de ces vis, et les plots sont relativement difficiles à retirer de l'os, du fait qu'ils présentent des faces visibles qui sont lisses et qui affleurent avec l'os après cette coupe.Cutting the screws is however a relatively difficult operation, given the diameter of these screws, and the studs are relatively difficult to remove from the bone, because they have visible faces which are smooth and which are flush with the bone after this cut.
La présente invention vise à remédier à ces inconvénients importants en pratique. L'implant qu'elle concerne est, de manière connue en soi, formé par une pièce prothétique et par au moins un plot pour la stabilisation de cette pièce par rapport à l'os, chaque plot faisant saillie de la face de cette pièce destinée à venir en contact avec l'os.The present invention aims to remedy these significant drawbacks in practice. The implant to which it relates is, in a manner known per se, formed by a prosthetic piece and by at least one stud for stabilization of this piece relative to the bone, each stud projecting from the face of this piece intended to come into contact with the bone.
Selon l'invention, - chaque plot est relié de manière séparable à la pièce au niveau de ladite face ; etAccording to the invention, - each stud is separably connected to the part at the level of said face; and
- chaque plot délimite intérieurement une zone de prise pour un instrument permettant son retrait, la liaison de chaque plot avec la pièce étant telle que ladite zone de prise est isolée du ciment de scellement ou des cellules osseuses et n'est accessible qu'après séparation du plot et de cette pièce.- each stud internally delimits a gripping zone for an instrument allowing its removal, the connection of each stud with the part being such that said gripping zone is isolated from the cement or bone cells and is only accessible after separation the stud and this piece.
La zone de prise permet, au moyen dudit instrument, de saisir facilement le plot en vue de son retrait. Ce retrait peut donc s'opérer sans difficultés et sans pertes osseuses. Jusqu'à la séparation de chaque plot et de ladite pièce formant le reste de l'implant, cette zone de prise est parfaitement isolée du ciment synthétique ou des cellules osseuses, de sorte que tout risque de colmatage est éliminé.The gripping area allows, by means of said instrument, to easily grasp the stud for its removal. This removal can therefore take place without difficulty and without bone loss. Until each stud and said piece forming the rest of the implant are separated, this grip zone is perfectly isolated from synthetic cement or bone cells, so that any risk of clogging is eliminated.
De préférence, chaque plot est en un matériau sécable et présente une portion de paroi d'épaisseur réduite, qui est située, après montage de ce plot sur ladite pièce formant le reste de l'implant, au niveau de la face de cette pièce sur laquelle ce plot est monté ; l'épaisseur de cette portion de paroi est telle que le plot peut être aisément sectionné au moyen d'une lame engagée entre ladite pièce et l'os en vue de la séparation de cette pièce et de cet os. Selon une forme de réalisation préférée de l'invention, chaque plot comprend :Preferably, each stud is made of a breakable material and has a portion of wall of reduced thickness, which is located, after mounting of this stud on said piece forming the rest of the implant, at the level the face of this part on which this stud is mounted; the thickness of this wall portion is such that the stud can be easily sectioned by means of a blade engaged between said piece and the bone for the purpose of separating this piece and this bone. According to a preferred embodiment of the invention, each pad comprises:
- une partie inférieure filetée, pour son montage par vissage dans un trou taraudé correspondant que comprend ladite pièce formant le reste de l'implant, - une chambre axiale interne, aménagée à partir de la face inférieure du plot et présentant une hauteur supérieure à la hauteur de ladite partie inférieure filetée, et- a threaded lower part, for its mounting by screwing in a corresponding tapped hole that includes said part forming the rest of the implant, - an internal axial chamber, arranged from the underside of the stud and having a height greater than the height of said threaded lower part, and
- un alésage axial taraudé aménagé à partir du fond de la chambre, les dimensions respectives du plot et de la chambre étant telles que cette chambre permet d'aménager ladite portion de paroi d'épaisseur réduite.- A threaded axial bore arranged from the bottom of the chamber, the respective dimensions of the stud and of the chamber being such that this chamber makes it possible to arrange said portion of wall of reduced thickness.
Avantageusement, chaque plot est réalisé en polymétacrylate de méthyle (PMMA). Ce matériau est le constituant principal des ciments de scellage utilisés en orthopédie, et les plots selon l'invention peuvent ainsi être parfaitement intégrés à leur ciment de scellage. Ce matériau offre par ailleurs des propriétés mécaniques supérieures à celles du polyéthylène, et évite de réaliser un contact os/polyéthylène, qui peut conduire à des ostéolyses.Advantageously, each pad is made of polymethyl methacrylate (PMMA). This material is the main constituent of sealing cements used in orthopedics, and the studs according to the invention can thus be perfectly integrated into their sealing cement. This material also offers mechanical properties superior to those of polyethylene, and avoids making bone / polyethylene contact, which can lead to osteolysis.
Pour sa bonne compréhension, l'invention est à nouveau décrite ci-après, en référence dessin schématique annexé représentant, à titre d'exemple non limitatif, une forme de réalisation préférée de l'implant osseux qu'elle concerne.For its proper understanding, the invention is again described below, with reference to the appended schematic drawing representing, by way of nonlimiting example, a preferred embodiment of the bone implant that it relates to.
La figure 1 est une vue de côté, partiellement en coupe, de l'extrémité inférieure d'un fémur, d'une pièce fémorale de prothèse de genou et de l'un des deux plots latéraux que comporte cette pièce pour sa stabilisation par rapport au fémur ;Figure 1 is a side view, partially in section, of the lower end of a femur, of a femoral piece of knee prosthesis and of one of the two lateral studs that this piece has for its stabilization relative to the femur;
La figure 2 est une vue de face, partiellement en coupe, de ladite pièce, après montage des plots sur elle ; la figure 3 est une vue partielle de l'os, de cette pièce et de l'un des plots, en coupe et à échelle agrandie, ainsi que d'une lame destinée à être introduite entre la pièce et l'os en vue de l'ablation de cette dernière, et la figure 4 est une vue similaire à la figure 3, après ablation de ladite pièce. Les figures 1 et 2 représentent une pièce fémorale 1 de prothèse de genou. Cette pièce 1 présente, de manière classique, une forme qui reproduit les condyles fémoraux et qui, par conséquent, enveloppe l'extrémité inférieure d'un fémur 2, cette extrémité ayant été réséquée convenablement pour recevoir cette pièce 1 . La pièce 1 comporte deux plots latéraux 3 faisant saillie de sa face 4 destinée à venir en contact avec l'os 2. Ces plots 3 sont prévus pour assurer la stabilisation de cette pièce 1 par rapport à l'os 2 le temps que s'opère la fixation solide de celle-ci à l'os. Cette fixation solide peut être réalisée au moyen d'un ciment synthétique polymérisable assurant le scellement de la pièce 1 à l'os 2, ou par la croissance des cellules osseuses au travers des pores d'un revêtement ostéo-conducteur poreux que comporte dans ce cas la face 4.Figure 2 is a front view, partially in section, of said part, after mounting of the studs thereon; Figure 3 is a partial view of the bone, this piece and one of the studs, in section and on an enlarged scale, as well as a blade intended to be introduced between the part and the bone for the ablation of the latter, and Figure 4 is a view similar to Figure 3, after removal of said part. Figures 1 and 2 show a femoral part 1 of knee prosthesis. This part 1 has, in a conventional manner, a shape which reproduces the femoral condyles and which, consequently, envelops the lower end of a femur 2, this end having been suitably resected to receive this part 1. The part 1 comprises two lateral studs 3 projecting from its face 4 intended to come into contact with the bone 2. These studs 3 are provided to ensure the stabilization of this part 1 relative to the bone 2 while solidly attaches it to the bone. This solid fixation can be carried out by means of a polymerizable synthetic cement ensuring the sealing of the part 1 to the bone 2, or by the growth of the bone cells through the pores of a porous osteoconductive coating which comprises in this case side 4.
Les plots 3 sont en un matériau sécable, notamment en polymétacrylate de méthyle. Comme le montrent les figures, chaque plot 3 comprend une partie inférieure filetée 5, une chambre axiale interne 6, aménagée à partir de la face inférieure du plot 3 et présentant une hauteur supérieure à la hauteur de la partie filetée 5, et un alésage axial taraudé 7, aménagé à partir du fond de la chambre 6.The pads 3 are made of a breakable material, in particular of polymethyl methacrylate. As the figures show, each stud 3 comprises a threaded lower part 5, an internal axial chamber 6, arranged from the underside of the stud 3 and having a height greater than the height of the threaded part 5, and an axial bore tapped 7, fitted from the bottom of chamber 6.
La pièce 1 comprend, quant à elle, deux trous taraudés 8 destinés à recevoir les parties filetées 5 des plots 3.The part 1 comprises, for its part, two tapped holes 8 intended to receive the threaded parts 5 of the studs 3.
Il apparaît que les dimensions respectives de chaque plot 3 et de la chambre 6 sont telles que chaque plot 3 présente, au-dessus de sa partie filetée 5, une portion de paroi 10 ayant une relativement faible épaisseur. Cette portion de paroi 10 a une épaisseur suffisamment réduite pour que le plot 3 puisse être aisément sectionné par une lame aiguisée 20 destinée à être engagée latéralement entre la pièce 1 et l'os 2 en vue de la séparation de cette pièce 1 et de cet os, cette épaisseur étant toutefois suffisante pour que le plot 3 conserve une relative rigidité et puisse assurer son rôle de stabilisation. La profondeur de chaque trou 8 et la hauteur de chaque partie 5 sont en outre telles que la portion 10 se trouve au niveau de la face 4, après serrage du plot 3 dans ce trou 8.It appears that the respective dimensions of each stud 3 and of the chamber 6 are such that each stud 3 has, above its threaded part 5, a wall portion 10 having a relatively small thickness. This wall portion 10 has a thickness sufficiently reduced so that the stud 3 can be easily sectioned by a sharpened blade 20 intended to be engaged laterally between the piece 1 and the bone 2 for the separation of this piece 1 and this bone, this thickness being however sufficient for the stud 3 to retain a relative rigidity and to be able to fulfill its role of stabilization. The depth of each hole 8 and the height of each part 5 are also such that the portion 10 is at the level of the face 4, after tightening of the stud 3 in this hole 8.
En pratique, les plots 3 sont montés sur la pièce 1 par complet vissage des parties 5 dans les trous 8. Outre le positionnement précité des portions 10 au niveau de la face 4, ce vissage permet d'isoler parfaitement la chambre 6 et l'alésage 7 du ciment de scellage ou des cellules osseuses en croissance.In practice, the studs 3 are mounted on the part 1 by completely screwing the parts 5 into the holes 8. In addition to the aforementioned positioning of the portions 10 at the level of the face 4, this screwing makes it possible to perfectly isolate the chamber 6 and the bore 7 of the sealing cement or growing bone cells.
Comme le montre la figure 3, lorsque l'on désire procéder à l'ablation de la pièce 1 , on insère la lame 20 entre la pièce 1 et l'os 2, le long de la face 4, aux fins d'opérer la séparation de la pièce 1 et de l'os 2.As shown in FIG. 3, when it is desired to ablate the part 1, the blade 20 is inserted between the part 1 and the bone 2, along the face 4, in order to operate the separation of part 1 and bone 2.
Les portions 10 sont situées en regard de cette lame 20, ce qui permet une section facile des plots 3, sans occasionner de lésions à l'os 2.The portions 10 are located opposite this blade 20, which allows easy sectioning of the pads 3, without causing damage to the bone 2.
Cette section permet d'atteindre la zone de la pièce 1 située entre les plots 3, au niveau de laquelle la séparation de cette pièce 1 et de l'os 2 peut également être réalisée.This section makes it possible to reach the zone of the part 1 located between the studs 3, at the level of which the separation of this part 1 and the bone 2 can also be carried out.
Le retrait de la pièce 1 peut alors être opéré, ce qui rend les alésages 7 accessibles au praticien, ainsi que le montre la figure 4, pour l'engagement de l'embout fileté d'un instrument destiné au retrait des parties des plots 3 restant dans l'os 2.The removal of the part 1 can then be operated, which makes the bores 7 accessible to the practitioner, as shown in Figure 4, for the engagement of the threaded end of an instrument intended for the removal of the parts of the studs 3 remaining in the bone 2.
Cet instrument permet alors un retrait facile de ces parties de plots, et sans pertes osseuses.This instrument then allows easy removal of these parts of the studs, and without bone loss.
Il va de soi que l'invention n'est pas limitée à la forme de réalisation décrite ci-dessus à titre d'exemple mais qu'elle en embrasse au contraire toutes les variantes de réalisation. Ainsi, les plots pourraient être fixés à ladite pièce formant le reste de l'implant par tous moyens appropriés permettant une liaison suffisamment résistante pour que ces plots assurent la stabilisation de cette pièce et pour que les cavités délimitées par les plots soient isolées de manière étanche du ciment de scellement ou des cellules osseuses ; notamment, les plots peuvent être emmanchés à force dans des trous correspondants aménagés dans ladite pièce, ou être fixés à cette dernière par collage ou encliquetage ; chaque plot peut présenter une simple cavité à paroi lisse pour constituer sa zone de prise, en lieu et place des chambre 6 et alésage taraudé 7, l'instrument précité présentant un embout complémentaire ; en outre, l'invention a été décrite en référence à des plots de stabilisation mais il est bien entendu qu'elle pourrait également être appliquée à une tige médullaire d'ancrage. It goes without saying that the invention is not limited to the embodiment described above by way of example, but on the contrary embraces all of the variant embodiments thereof. Thus, the studs could be fixed to said piece forming the rest of the implant by any suitable means allowing a sufficiently strong connection so that these studs ensure the stabilization of this piece and so that the cavities delimited by the studs are sealed sealing cement or bone cells; in particular, the studs can be force-fitted into corresponding holes arranged in said part, or be fixed to the latter by gluing or snap-fastening; each stud may have a simple smooth-walled cavity to constitute its grip zone, in place of the chamber 6 and tapped bore 7, the aforementioned instrument having a complementary tip; furthermore, the invention was described with reference to stabilization pads but it is understood that it could also be applied to a medullary anchor rod.

Claims

REVENDICATIONS
1 - Implant destiné à être fixé à un os (2) au moyen d'un ciment synthétique de scellement ou par croissance des cellules osseuses au travers au travers d'un revêtement ostéo-conducteur que comprend cet implant, cet implant étant formé par une pièce prothétique (1 ) et par au moins un plot (3) pour la stabilisation de cette pièce ( 1 ) par rapport à l'os (2), chaque plot faisant saillie de la face (4) de cette pièce ( 1 ) destinée à venir en contact avec l'os (2) ; implant caractérisé en ce que chaque plot (3) est relié de manière séparable à la pièce (1 ) au niveau de ladite face (4) ; et en ce que chaque plot (3) délimite intérieurement une zone de prise (7) pour un instrument permettant son retrait, la liaison de chaque plot (3) avec la pièce ( 1 ) étant telle que ladite zone de prise (7) est isolée du ciment de scellement ou des cellules osseuses et n'est accessible qu'après séparation du plot (3) et de cette pièce (1 ).1 - Implant intended to be fixed to a bone (2) by means of a synthetic cement for sealing or by growth of bone cells through through an osteoconductive coating which this implant comprises, this implant being formed by a prosthetic part (1) and by at least one stud (3) for the stabilization of this piece (1) relative to the bone (2), each stud projecting from the face (4) of this piece (1) intended coming into contact with the bone (2); implant characterized in that each stud (3) is detachably connected to the part (1) at the level of said face (4); and in that each stud (3) internally delimits a gripping zone (7) for an instrument allowing its removal, the connection of each stud (3) with the part (1) being such that said gripping zone (7) is isolated from the cement or bone cells and is only accessible after separation of the stud (3) and this part (1).
2 - Implant selon la revendication 1 , caractérisé en ce que chaque plot (3) est en un matériau sécable et présente une portion de paroi (10) d'épaisseur réduite, qui est située, après montage de ce plot (3) sur ladite pièce ( 1 ) formant le reste de l'implant, au niveau de la face (4) de cette pièce (1 ) sur laquelle ce plot (3) est monté ; l'épaisseur de cette portion de paroi (10) est telle que le plot (3) peut être aisément sectionné au moyen d'une lame (20) engagée entre ladite pièce ( 1 ) et l'os (2) en vue de la séparation de cette pièce (1 ) et de cet os (2).2 - Implant according to claim 1, characterized in that each stud (3) is made of a breakable material and has a wall portion (10) of reduced thickness, which is located, after mounting of this stud (3) on said part (1) forming the rest of the implant, at the face (4) of this part (1) on which this stud (3) is mounted; the thickness of this wall portion (10) is such that the stud (3) can be easily sectioned by means of a blade (20) engaged between said piece (1) and the bone (2) for the purpose of separation of this part (1) and this bone (2).
3 - Implant selon la revendication 2, caractérisé en ce que chaque plot (3) comprend :3 - Implant according to claim 2, characterized in that each stud (3) comprises:
- une partie inférieure filetée (5), pour son montage par vissage dans un trou taraudé (8) correspondant que comprend ladite pièce (1 ) formant le reste de l'implant,- a threaded lower part (5), for its mounting by screwing in a corresponding tapped hole (8) which comprises said part (1) forming the rest of the implant,
- une chambre axiale interne (6), aménagée à partir de la face inférieure du plot (3) et présentant une hauteur supérieure à la hauteur de ladite partie inférieure filetée (5), etan internal axial chamber (6), arranged from the underside of the stud (3) and having a height greater than the height of said threaded lower part (5), and
- un alésage axial taraudé (7) aménagé à partir du fond de la chambre (6), les dimensions respectives du plot (3) et de la chambre (6) étant telles que cette chambre (6) permet d'aménager ladite portion de paroi ( 10) d'épaisseur réduite. 4 - Implant selon la revendication 1 ou la revendication 2, caractérisé en ce que chaque plot est emmanché à force dans un trou correspondant aménagé dans ladite pièce formant le reste de l'implant.- a threaded axial bore (7) arranged from the bottom of the chamber (6), the respective dimensions of the stud (3) and of the chamber (6) being such that this chamber (6) makes it possible to arrange said portion of wall (10) of reduced thickness. 4 - Implant according to claim 1 or claim 2, characterized in that each stud is force-fitted into a corresponding hole arranged in said part forming the rest of the implant.
5 - Implant selon la revendication 1 ou la revendication 2, caractérisé en ce que chaque plot est fixé à ladite pièce formant le reste de l'implant par collage ou encliquetage.5 - Implant according to claim 1 or claim 2, characterized in that each stud is fixed to said piece forming the rest of the implant by gluing or snap-fastening.
6 - Implant selon l'une des revendications 1 , 2, 4 ou 5, caractérisé en ce que la zone de prise de chaque plot est constituée par une cavité à paroi lisse. 7 - Implant selon l'une des revendications 1 à 6, caractérisé en ce qu'il comprend une tige médullaire en lieu et place des plots (3).6 - Implant according to one of claims 1, 2, 4 or 5, characterized in that the grip zone of each stud is constituted by a smooth-walled cavity. 7 - Implant according to one of claims 1 to 6, characterized in that it comprises a medullary rod in place of the studs (3).
8 - Implant selon l'une des revendications 2 à 7, caractérisé en ce que chaque plot (3) ou tige médullaire est réalisé en polymetacrylate de méthyle. 8 - Implant according to one of claims 2 to 7, characterized in that each stud (3) or medullary rod is made of polymethyl methacrylate.
PCT/FR1999/002388 1998-10-07 1999-10-06 Implant designed to be fixed to a bone WO2000019945A1 (en)

Priority Applications (1)

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AU60928/99A AU6092899A (en) 1998-10-07 1999-10-06 Implant designed to be fixed to a bone

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FR9812710A FR2784288B1 (en) 1998-10-07 1998-10-07 IMPLANT TO BE FIXED TO A BONE
FR98/12710 1998-10-07

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Publication number Priority date Publication date Assignee Title
US7837737B2 (en) 2006-08-15 2010-11-23 Howmedica Osteonics Corp. Femoral prosthesis

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP5443335B2 (en) * 2007-04-19 2014-03-19 スミス アンド ネフュー インコーポレーテッド Artificial joint

Citations (3)

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Publication number Priority date Publication date Assignee Title
FR2638963A1 (en) * 1988-11-14 1990-05-18 Tornier Sa Artificial acetabula with studs for a total hip prosthesis
US5194066A (en) * 1988-01-11 1993-03-16 Boehringer Mannheim Corporation Modular joint prosthesis
EP0536457A1 (en) * 1991-10-11 1993-04-14 Societe Civile Essor Endoprosthesis for knee joint

Patent Citations (3)

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Publication number Priority date Publication date Assignee Title
US5194066A (en) * 1988-01-11 1993-03-16 Boehringer Mannheim Corporation Modular joint prosthesis
FR2638963A1 (en) * 1988-11-14 1990-05-18 Tornier Sa Artificial acetabula with studs for a total hip prosthesis
EP0536457A1 (en) * 1991-10-11 1993-04-14 Societe Civile Essor Endoprosthesis for knee joint

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7837737B2 (en) 2006-08-15 2010-11-23 Howmedica Osteonics Corp. Femoral prosthesis

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FR2784288B1 (en) 2001-01-05
FR2784288A1 (en) 2000-04-14

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