WO2000023010A1 - Revision femoral component for knee joint prosthesis - Google Patents

Revision femoral component for knee joint prosthesis Download PDF

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Publication number
WO2000023010A1
WO2000023010A1 PCT/FR1999/002503 FR9902503W WO0023010A1 WO 2000023010 A1 WO2000023010 A1 WO 2000023010A1 FR 9902503 W FR9902503 W FR 9902503W WO 0023010 A1 WO0023010 A1 WO 0023010A1
Authority
WO
WIPO (PCT)
Prior art keywords
wedge
distal
wedges
condyle
posterior
Prior art date
Application number
PCT/FR1999/002503
Other languages
French (fr)
Inventor
Jean-Marc Toussaint
Michaël BREYSSE
Original Assignee
Depuy France
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 Depuy France filed Critical Depuy France
Priority to EP99947582A priority Critical patent/EP1121073A1/en
Priority to CA002347138A priority patent/CA2347138A1/en
Priority to JP2000576788A priority patent/JP2002527192A/en
Priority to AU60976/99A priority patent/AU6097699A/en
Publication of WO2000023010A1 publication Critical patent/WO2000023010A1/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
    • A61F2002/30535—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
    • A61F2002/30556—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting thickness
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30667—Features concerning an interaction with the environment or a particular use of the prosthesis
    • A61F2002/3069—Revision endoprostheses
    • 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
    • A61F2/30721—Accessories
    • A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
    • A61F2002/30736—Augments or augmentation pieces, e.g. wedges or blocks for bridging a bone defect
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
    • A61F2250/0009—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting thickness

Definitions

  • the present invention relates to a femoral implant for knee prosthesis in the context of the recovery of failed prostheses.
  • the femoral implant is of the type comprising a trochlea, a pair of condyles connected to the trochlea, as well as distal and posterior shims for adjusting the thickness of the condyles, a pair of these shims being provided to be fixed. at least one of the condyles.
  • the surgeon encounters difficulties in defining, using preoperative radiographs, the type of prosthesis that he can consider placing. Also it must have recourse to sets of wedges intended for the distal and posterior parts of the two condyles which compose the femoral element of the knee prosthesis. In addition, the surgeon must be able to perform his intervention in easy, reliable operating conditions and allowing him to reduce the necessary operating time.
  • Patent EP-0 378 928 teaches the use of distal and posterior wedges in a femoral implant of knee prosthesis, either independent of one another, or in one piece, the maintenance of these wedges on the condyles being ensured by clipping.
  • this bone catching wedge is made up of two distinct elements, it does not have the drawbacks of a one-piece wedge, but requires separate fixing means for each wedge, which results in higher production costs and handling. more important preoperative.
  • the shims described by the aforementioned patent cannot be tested beforehand by the surgeon to allow him to choose the thickness most suited to the patient, and this because of their method of fixing by clipping which results in a fitting. definitive on the condyle.
  • the invention aims to provide a femoral implant for knee prosthesis, fitted with bone adjustment shims arranged to avoid the above drawbacks.
  • one of the distal and posterior wedges is extended by an extension adapted to be able to be placed between the surface of the condyle and the second wedge, and a single means of fixing the two wedges is provided.
  • This unique fixing means can be easily removed to replace one or both of the shims with one or two shims of different thickness.
  • the extension is a tab extending the posterior wedge.
  • the tab is provided with an end adapted to at least partially surround a projection of the surface of the condyle that can be covered by the distal wedge, and in which is drilled a hole receiving a fixing element common to the two shims, a passage opening for this element also being formed in the distal shim.
  • Such an arrangement of wedges is particularly simple and convenient to implement by the surgeon, these two wedges being used alone or in combination; the unique means of fixing the two wedges to the condyle reduces the cost price of the implant as well as the necessary manipulations.
  • femoral implant can be used either with one or two wedges for one of the condyles or both condyles, or without wedge as required.
  • Figure 1 is an exploded perspective view, substantially to scale, of an embodiment of the femoral implant for knee prosthesis according to the invention.
  • FIG. 2 is a bottom view of the distal wedge visible in FIG. 1.
  • Figure 3 is a side elevational view, on an enlarged scale of the femoral implant of Figure 1 equipped with its distal and posterior thickness adjustment shims.
  • the femoral implant 1 illustrated in the drawings is intended for a knee replacement prosthesis, and comprises a trochlea 2 forming the anterior part of the implant, as well as a pair of condyles 3 having convex articular surfaces 4 adapted to cooperate with a tray of a tibial implant not shown.
  • the implant 1 is completed by a central tubular base 4 disposed on a central portion 5 of connection between the condyles 3 on the side opposite to their articular surfaces 4.
  • the base 4 is adapted to receive an intramedullary femoral stem not shown.
  • the femoral implant 1 is completed by at least one pair of compensating and bone adjustment wedges adapted to be able to be fixed on the internal surface of a condyle 3, namely a distal wedge 6 and a posterior wedge 7.
  • Each surface the interior of the condyles 3 is designed to be able to receive either only one of these two wedges 6, 7, or both in combination according to the needs observed by the surgeon for adjusting the thickness of the condyles 3.
  • the wedge 6 is constituted by a plate whose contour is adapted to the conformation of the associated condyle 3: thus the body of the wedge 6 consists of a first part of rectangular contour 6a extended in the direction of the trochlea 2 by a trapezoidal part 6b.
  • a hole 8 with a conical wall 9 which can be placed coaxially with a hole 11 of a boss 12 projecting from an imprint 13 arranged in the distal and posterior inner surface of each condyle 3.
  • the wedge 6 is completed, on its bearing face on the condyle 3, by studs 16, 17 and 20 arranged on either side of the bore 8 to facilitate the correct positioning of the distal wedge 6.
  • the two chamfered studs 16 are formed at the angles of the rectangular part 6a of the wedge 6, the central stud 20 is formed between the studs 16 and the hole 8, and the stud 17 is positioned to rest on the annular boss 12 when the wedge 6 is put in place, resting on the edges of the imprint 13 which it projects.
  • the posterior wedge 7 is formed by a plate 19 of suitable thickness, of substantially rectangular outline with two rounded vertices 21 provided to come to be positioned facing the free end of the corresponding condyle 3.
  • the posterior plate 19 is extended by an extension consisting of a tab 22 profiled to adapt to the conformation of the inner surface of the condyle 3.
  • the latter thus has, in the impression 13, a flat posterior surface 23, a flat distal surface 24 and a flat surface 25 of connection between surfaces
  • the tab 22 comprises a first flat part 22a fixed to the surface of the wafer 1 9 so as to be able to be housed in the imprint 1 3 bearing on the surface 23, a second flat part 22b adapted to be placed opposite of the chamfer surface 25, and a third end portion 22c coming to be placed in the cavity 13 on the distal surface 24.
  • the end portion 22c present in the example described a semi-circular wall 30 adapted to be able to surround the boss 12 , cylindrical in the example shown.
  • the tab 22 with its end portion 22c thus ensures correct positioning of the posterior wedge 7 on the condyle 3, only this tab 22 being housed inside the cavity 13 while the plate 19 projects from the plane defined by the edges of the imprint 13.
  • Two or more pairs of shims 6, 7 of variable thickness can thus be provided. Each wedge 6, 7 can be used in isolation, the two wedges can also be used in combination as illustrated in FIG. 3.
  • the thickness of the end portion 22c of the tab 22 is approximately equal to the height of the boss 12 above the bottom of the cavity 13, so that when the rear wedge 6 is put in place, the surface of the end portion 22c is flush with that of the boss 12. Therefore, when the surgeon wants to use only a posterior wedge 7 of appropriate thickness, he ensures the fixation of this wedge 6 by means of a flat head screw not shown, dimensioned to be applied to the surface of the boss
  • I femoral implant 1 can also be used without one of the wedges 6, 7 as required, the layout of the impressions
  • the depth of the imprint 1 3 constituting the housing of the wedges 6, 7 corresponds to the thickness necessary to create a reserve of cement and thus obtain a satisfactory connection of the implant 1 to I femoral bone
  • the set of shims 6, 7 required is very small in number for each condyle 3 thus two sets of shims having two different thicknesses, of 4mm and 8mm respectively for the distal shim 6 and the posterior shim 7, may be sufficient
  • the invention is not limited to the embodiment described and may include various variant embodiments.
  • the terminal piece 22c instead of having a substantially semi-circular bearing 30 as shown, could be annular and completely surround the boss. 12, the radial connections 12a of which at the edge of the imprint 1 3 would then be eliminated. It is also possible to make an extension from the distal wedge 6, fulfilling the role of the connecting tab 22, to connect this wedge to the posterior wedge 7, in which case the common means of fixing the two wedges would be arranged in the posterior end of the condyle 3

Abstract

The invention concerns a femoral component (1) comprising a trochlea (2), a pair of condyles, and distal (6) and posterior (7) blocks adjusting the thickness of the condyles, a couple of said blocks being designed to be fixed to at least one of the condyles; one (7) of the blocks is extended by an extension (22) adapted to be urged in position between the condyle (3) surface and the second block, and a single element (14) is arranged for fixing the two blocks; the extension is advantageously a lug (22) including an end part (22c) urged to enclose a boss (12) provided in the condyle (3) distal part, the two blocks (6, 7) being fixed by a screw with a countersunk screw passing through the distal block (6) and the boss (12). The bone adjusting blocks (6, 7) may be used either singly or in combination and can be easily set by the surgeon owing to their single fixing means.

Description

Implant fémoral de reprise pour prothèse de genou Femoral implant for knee prosthesis
La présente invention a pour objet un implant fémoral pour prothèse de genou dans le cadre de la reprise de prothèses défaillantes.The present invention relates to a femoral implant for knee prosthesis in the context of the recovery of failed prostheses.
Plus précisément, l'implant fémoral est du type comprenant une trochlée, une paire de condyles reliés à la trochlée, ainsi que des cales distale et postérieure d'ajustement de l'épaisseur des condyles, une paire de ces cales étant prévue pour être fixée à au moins l'un des condyles.More specifically, the femoral implant is of the type comprising a trochlea, a pair of condyles connected to the trochlea, as well as distal and posterior shims for adjusting the thickness of the condyles, a pair of these shims being provided to be fixed. at least one of the condyles.
On sait que l'adjonction de cales à la partie fémorale d'une prothèse de reprise de genou permet de réaliser un rattrapage de l'os fémoral faisant suite, soit à l'ablation de la prothèse précédente, soit à une mauvaise qualité osseuse, soit encore à une combinaison de ces deux causes.We know that the addition of wedges to the femoral part of a knee replacement prosthesis makes it possible to catch up on the femoral bone following either the ablation of the previous prosthesis or poor bone quality, or a combination of these two causes.
Dans le cas d'une prothèse de reprise, le chirurgien rencontre des difficultés pour définir, à l'aide de radiographies préopératoires, le type de prothèse qu'il peut envisager de poser. Aussi doit il avoir recours à des jeux de cales destinés aux parties distales et postérieures des deux condyles qui composent l'élément fémoral de la prothèse de genou. En outre le chirurgien doit pouvoir effectuer son intervention dans des conditions opératoires aisées, fiables et lui permettant de réduire le temps opératoire nécessaire.In the case of a revision prosthesis, the surgeon encounters difficulties in defining, using preoperative radiographs, the type of prosthesis that he can consider placing. Also it must have recourse to sets of wedges intended for the distal and posterior parts of the two condyles which compose the femoral element of the knee prosthesis. In addition, the surgeon must be able to perform his intervention in easy, reliable operating conditions and allowing him to reduce the necessary operating time.
Le brevet EP-0 378 928 enseigne la mise en œuvre de cales distale et postérieure dans un implant fémoral de prothèse de genou, soit indépendantes l'une de l'autre, soit monobloc, le maintien de ces cales sur les condyles étant assuré par clipsage.Patent EP-0 378 928 teaches the use of distal and posterior wedges in a femoral implant of knee prosthesis, either independent of one another, or in one piece, the maintenance of these wedges on the condyles being ensured by clipping.
Cette solution nécessite un important jeu de cales d'épaisseurs variables, entraînant un coût de fabrication élevé. En outre le chirurgien est dans l'impossibilité d'effectuer des tests préalables des cales, car leur clipsage s'oppose à tout retrait ultérieur après un test. Ainsi cette réalisation, bien que remplissant la fonction prévue de rattrapage et d'ajustement, présente l'inconvénient de ne pas correspondre de manière tout à fait satisfaisante aux besoins du chirurgien.This solution requires a large set of shims of variable thicknesses, resulting in a high manufacturing cost. In addition, the surgeon is unable to perform prior tests of the wedges, since their clipping prevents any subsequent removal after a test. Thus this embodiment, although fulfilling the intended function of catching up and adjustment, has the disadvantage of not corresponding completely satisfactorily to the needs of the surgeon.
En substance, pour des implants fémoraux de reprise de prothèse de genou, ce besoin du chirurgien réside en des moyens permettant une adaptation souple de la cale distale et/ou de la cale postérieure. Cette nécessité implique des moyens les plus simples possibles et en même temps les moins onéreux, aisés à poser, aussi bien à titre provisoire pour tester sur le patient la dimension de cale la plus adaptée, qu'à titre définitif. Cela n'est pas le cas pour les cales de la prothèse de reprise du brevet EP 0 378 928 : si la cale est monobloc elle est nécessairement standard et ne peut donc pas être choisie en fonction d une épaisseur distale ou d'une épaisseur postérieure différente des épaisseurs des parties distale et postérieure d'une cale moπobloc. Si par contre cette cale de rattrapage osseux est constituée de deux éléments distincts, elle ne présente pas les inconvénients d'une cale monobloc, mais nécessite des moyens de fixation distincts pour chaque cale, ce qui entraîne des coûts de réalisation plus élevés et une manipulation préopératoire plus importante. Dans les deux cas, les cales décrites par le brevet précité ne peuvent être testées au préalable par le chirurgien pour lui permettre de choisir l'épaisseur la plus adaptée au patient, et ce en raison de leur mode de fixation par clipsage qui entraîne une pose définitive sur le condyle.In essence, for femoral implants for resumption of knee prosthesis, this need of the surgeon resides in means allowing a flexible adaptation of the distal wedge and / or of the posterior wedge. This necessity involves the simplest possible means and at the same time the least expensive, easy to install, both temporarily to test the most suitable hold size on the patient, as well as definitively. This is not the case for the shims of the prosthesis of patent EP 0 378 928: if the shim is in one piece it is necessarily standard and therefore cannot be chosen according to a distal thickness or of a posterior thickness different from the thicknesses of the distal and posterior parts of a moπobloc wedge. If, on the other hand, this bone catching wedge is made up of two distinct elements, it does not have the drawbacks of a one-piece wedge, but requires separate fixing means for each wedge, which results in higher production costs and handling. more important preoperative. In both cases, the shims described by the aforementioned patent cannot be tested beforehand by the surgeon to allow him to choose the thickness most suited to the patient, and this because of their method of fixing by clipping which results in a fitting. definitive on the condyle.
L'invention a pour but de proposer un implant fémoral de reprise pour prothèse de genou, équipé de cales d'ajustage osseux agencées pour éviter les inconvénients ci-dessus.The invention aims to provide a femoral implant for knee prosthesis, fitted with bone adjustment shims arranged to avoid the above drawbacks.
Conformément à l'invention, l'une des cales distale et postérieure est prolongée par une extension adaptée pour pouvoir venir se placer entre la surface du condyle et la seconde cale, et un moyen unique de fixation des deux cales est prévu.According to the invention, one of the distal and posterior wedges is extended by an extension adapted to be able to be placed between the surface of the condyle and the second wedge, and a single means of fixing the two wedges is provided.
Ce moyen unique de fixation peut être aisément démonté pour remplacer l'une des cales ou les deux, par une ou deux cales d'épaisseur différente.This unique fixing means can be easily removed to replace one or both of the shims with one or two shims of different thickness.
Suivant un mode de réalisation avantageux, l'extension est une patte prolongeant la cale postérieure.According to an advantageous embodiment, the extension is a tab extending the posterior wedge.
Suivant une autre caractéristique de l'invention, la patte est munie d'une extrémité adaptée pour entourer au moins partiellement un bossage de la surface du condyle pouvant être recouvert par la cale distale, et dans lequel est percé un trou de réception d'un élément de fixation commun aux deux cales, une ouverture de passage de cet élément étant également ménagée dans la cale distale.According to another feature of the invention, the tab is provided with an end adapted to at least partially surround a projection of the surface of the condyle that can be covered by the distal wedge, and in which is drilled a hole receiving a fixing element common to the two shims, a passage opening for this element also being formed in the distal shim.
Un tel agencement de cales est particulièrement simple et commode à mettre en œuvre par le chirurgien, ces deux cales étant utilisées seules ou en association ; le moyen unique de fixation des deux cales au condyle diminue le prix de revient de l'implant ainsi que les manipulations nécessaires.Such an arrangement of wedges is particularly simple and convenient to implement by the surgeon, these two wedges being used alone or in combination; the unique means of fixing the two wedges to the condyle reduces the cost price of the implant as well as the necessary manipulations.
Bien entendu l'implant fémoral peut être utilisé soit avec une ou deux cales pour l'un des condyles ou les deux condyles, ou sans cale en fonction des besoins. D'autres particularités et avantages de l'invention apparaîtront au cours de la description qui va suivre, faite en référence au dessin annexé qui en illustre une forme de réalisation à titre d'exemple non limitatif.Of course the femoral implant can be used either with one or two wedges for one of the condyles or both condyles, or without wedge as required. Other features and advantages of the invention will become apparent during the description which follows, given with reference to the appended drawing which illustrates an embodiment thereof by way of nonlimiting example.
La figure 1 est une vue en perspective éclatée, sensiblement à l'échelle, d'une forme de réalisation de l'implant fémoral de reprise pour prothèse de genou conforme à l'invention.Figure 1 is an exploded perspective view, substantially to scale, of an embodiment of the femoral implant for knee prosthesis according to the invention.
La figure 2 est une vue de dessous de la cale distale visible à la figure 1.FIG. 2 is a bottom view of the distal wedge visible in FIG. 1.
La figure 3 est une vue en élévation latérale, à échelle agrandie de l'implant fémoral de la figure 1 équipé de ses cales distale et postérieure d'ajustement d'épaisseur.Figure 3 is a side elevational view, on an enlarged scale of the femoral implant of Figure 1 equipped with its distal and posterior thickness adjustment shims.
L'implant fémoral 1 illustré aux dessins est destiné à une prothèse de reprise de genou, et comprend un trochlée 2 formant la partie antérieure de l'implant, ainsi qu'une paire de condyles 3 présentant des surfaces articulaires convexes 4 adaptées pour coopérer avec un plateau d'un implant tibial non représenté. L'implant 1 est complété par une embase tubulaire centrale 4 disposée sur une partie centrale 5 de liaison entre les condyles 3 du côté opposé à leurs surfaces articulaires 4. L'embase 4 est adaptée pour recevoir une tige fémorale intramédullaire non représentée. L'implant fémoral 1 est complété par au moins une paire de cales de rattrapage et d'ajustement osseux adaptées pour pouvoir être fixées sur la surface interne d'un condyle 3, à savoir une cale distale 6 et une cale postérieure 7. Chaque surface intérieure des condyles 3 est aménagée pour pouvoir recevoir soit l'une seulement de ces deux cales 6, 7, soit les deux en combinaison en fonction des besoins constatés par le chirurgien pour l'ajustement de l'épaisseur des condyles 3.The femoral implant 1 illustrated in the drawings is intended for a knee replacement prosthesis, and comprises a trochlea 2 forming the anterior part of the implant, as well as a pair of condyles 3 having convex articular surfaces 4 adapted to cooperate with a tray of a tibial implant not shown. The implant 1 is completed by a central tubular base 4 disposed on a central portion 5 of connection between the condyles 3 on the side opposite to their articular surfaces 4. The base 4 is adapted to receive an intramedullary femoral stem not shown. The femoral implant 1 is completed by at least one pair of compensating and bone adjustment wedges adapted to be able to be fixed on the internal surface of a condyle 3, namely a distal wedge 6 and a posterior wedge 7. Each surface the interior of the condyles 3 is designed to be able to receive either only one of these two wedges 6, 7, or both in combination according to the needs observed by the surgeon for adjusting the thickness of the condyles 3.
La cale 6 est constituée par une plaquette dont le contour est adapté à la conformation du condyle associé 3 : ainsi le corps de la cale 6 est constitué d'une première partie de contour rectangulaire 6a prolongée en direction de la trochlée 2 par une partie trapézoïdale 6b. Dans la cale 6 est percé un trou 8 à paroi conique 9 pouvant se placer coaxialement à un trou 11 d'un bossage 12 saillant d'une empreinte 13 agencée dans la surface intérieure distale et postérieure de chaque condyle 3. Une vis à tête plate ou fraisée selon que la cale 6 est utilisée seule ou associée avec la cale postérieure 7, peut être vissée dans le trou taraudé 1 1 , lequel se prolonge dans la condyle 3 par un trou borgne, afin de solidariser la cale distale 6 avec l'implant fémoral 1. La cale 6 est complétée, sur sa face d'appui sur le condyle 3, par des plots 16, 17 et 20 agencés de part et d'autre de l'alésage 8 pour faciliter le positionnement correct de la cale distale 6. Ainsi les deux plots chanfreinés 16 sont ménagés aux angles de la partie rectangulaire 6a de la cale 6, le plot central 20 est formé entre les plots 16 et le trou 8, et le plot 17 est positionné pour se placer en appui sur le bossage annulaire 12 lorsque la cale 6 est mise en place, en appui sur les bords de l'empreinte 13 dont elle fait saillie.The wedge 6 is constituted by a plate whose contour is adapted to the conformation of the associated condyle 3: thus the body of the wedge 6 consists of a first part of rectangular contour 6a extended in the direction of the trochlea 2 by a trapezoidal part 6b. In the wedge 6 is drilled a hole 8 with a conical wall 9 which can be placed coaxially with a hole 11 of a boss 12 projecting from an imprint 13 arranged in the distal and posterior inner surface of each condyle 3. A flat head screw or milled depending on whether the wedge 6 is used alone or associated with the rear wedge 7, can be screwed into the tapped hole 1 1, which is extended in the condyle 3 by a blind hole, in order to secure the distal wedge 6 with the femoral implant 1. The wedge 6 is completed, on its bearing face on the condyle 3, by studs 16, 17 and 20 arranged on either side of the bore 8 to facilitate the correct positioning of the distal wedge 6. Thus the two chamfered studs 16 are formed at the angles of the rectangular part 6a of the wedge 6, the central stud 20 is formed between the studs 16 and the hole 8, and the stud 17 is positioned to rest on the annular boss 12 when the wedge 6 is put in place, resting on the edges of the imprint 13 which it projects.
La cale postérieure 7 est formée par une plaquette 19 d'épaisseur appropriée, de contour sensiblement rectangulaire avec deux sommets arrondis 21 prévus pour venir se positionner en regard de l'extrémité libre du condyle correspondant 3. La plaquette postérieure 19 est prolongée par une extension constituée d'une patte 22 profilée pour s'adapter à la conformation de la surface intérieure du condyle 3. Ce dernier présente ainsi, dans l'empreinte 13, une surface postérieure plane 23, une surface distale plane 24 et une surface plane 25 de raccordement entre les surfacesThe posterior wedge 7 is formed by a plate 19 of suitable thickness, of substantially rectangular outline with two rounded vertices 21 provided to come to be positioned facing the free end of the corresponding condyle 3. The posterior plate 19 is extended by an extension consisting of a tab 22 profiled to adapt to the conformation of the inner surface of the condyle 3. The latter thus has, in the impression 13, a flat posterior surface 23, a flat distal surface 24 and a flat surface 25 of connection between surfaces
23 et 24. Ces trois surfaces 23, 24, 25 correspondent à des coupes osseuses pratiquées par le chirurgien.23 and 24. These three surfaces 23, 24, 25 correspond to bone cuts made by the surgeon.
Corrélativement la patte 22 comprend une première partie plane 22a fixée à la surface de la plaquette 1 9 de façon à pouvoir venir se loger dans l'empreinte 1 3 en appui sur la surface 23, une seconde partie plane 22b adaptée pour se placer en regard de la surface de chanfrein 25, et une troisième partie terminale 22ç venant se placer dans l'empreinte 13 sur la surface distale 24. La partie terminale 22ç présente dans l'exemple décrit une paroi semi-circulaire 30 adaptée pour pouvoir entourer le bossage 12, cylindrique dans l'exemple représenté.Correlatively, the tab 22 comprises a first flat part 22a fixed to the surface of the wafer 1 9 so as to be able to be housed in the imprint 1 3 bearing on the surface 23, a second flat part 22b adapted to be placed opposite of the chamfer surface 25, and a third end portion 22c coming to be placed in the cavity 13 on the distal surface 24. The end portion 22c present in the example described a semi-circular wall 30 adapted to be able to surround the boss 12 , cylindrical in the example shown.
La patte 22 avec sa partie terminale 22ç assure ainsi un positionnement correct de la cale postérieure 7 sur le condyle 3, seule cette patte 22 étant logée à l'intérieur de l'empreinte 13 tandis que la plaquette 19 fait saillie du plan défini par les bords de l'empreinte 13. Deux ou plusieurs paires de cales 6, 7 d'épaisseur variable peuvent ainsi être prévues. Chaque cale 6, 7 peut être utilisée isolément, les deux cales pouvant également être mises en œuvre en combinaison comme illustré à la figure 3.The tab 22 with its end portion 22c thus ensures correct positioning of the posterior wedge 7 on the condyle 3, only this tab 22 being housed inside the cavity 13 while the plate 19 projects from the plane defined by the edges of the imprint 13. Two or more pairs of shims 6, 7 of variable thickness can thus be provided. Each wedge 6, 7 can be used in isolation, the two wedges can also be used in combination as illustrated in FIG. 3.
L'épaisseur de la partie terminale 22ç de la patte 22 est à peu près égale à la hauteur du bossage 12 au-dessus du fond de l'empreinte 13, de sorte que lorsque la cale postérieure 6 est mise en place, la surface de la partie terminale 22ç affleure celle du bossage 12. De ce fait, lorsque le chirurgien veut utiliser uniquement une cale postérieure 7 d'épaisseur appropriée, il assure la fixation de cette cale 6 au moyen d'une vis à tête plate non représentée, dimensionnée pour s'appliquer sur la surface du bossageThe thickness of the end portion 22c of the tab 22 is approximately equal to the height of the boss 12 above the bottom of the cavity 13, so that when the rear wedge 6 is put in place, the surface of the end portion 22c is flush with that of the boss 12. Therefore, when the surgeon wants to use only a posterior wedge 7 of appropriate thickness, he ensures the fixation of this wedge 6 by means of a flat head screw not shown, dimensioned to be applied to the surface of the boss
12 et sur la partie terminale 22ç Par contre si le chirurgien veut utiliser uniquement la cale distale12 and on the terminal part 22c By cons if the surgeon wants to use only the distal wedge
6 ou cette cale en association avec la cale postérieure 7, il assure la fixation de la cale 6 ou des deux cales 6, 7 par une vis 14 à tête fraisée 15, dont la surface conique vient prendre appui sur la paroi conique 9 de la cale 6 Corrélativement, la partie terminale 22ç se trouve placée entre la surface distale 24 et le plot central 20 de la cale 6, qui s'appuie ainsi sur ladite partie6 or this wedge in association with the rear wedge 7, it secures the wedge 6 or the two wedges 6, 7 by a screw 14 with a countersunk head 15, the conical surface of which comes to bear on the conical wall 9 of the wedge 6 Correlatively, the end part 22c is placed between the distal surface 24 and the central stud 20 of the wedge 6, which thus rests on said part
22ç et maintient la cale postérieure 7 en place22ç and holds the rear wedge 7 in place
Bien entendu I implant fémoral 1 peut être également utilisé sans l'une des cales 6, 7 en fonction des besoins, l'aménagement des empreintesOf course I femoral implant 1 can also be used without one of the wedges 6, 7 as required, the layout of the impressions
1 3 dans les condyles 3 ne constituant pas alors une gêne Du fait que l'implant fémoral 1 est généralement fixé à l'aide d'un ciment orthopédique, la profondeur de l'empreinte 1 3 constituant le logement des cales 6, 7 correspond à l'épaisseur nécessaire pour réaliser une réserve de ciment et obtenir ainsi une liaison satisfaisante de l'implant 1 à I os fémoral1 3 in the condyles 3 then not constituting a discomfort Because the femoral implant 1 is generally fixed using an orthopedic cement, the depth of the imprint 1 3 constituting the housing of the wedges 6, 7 corresponds to the thickness necessary to create a reserve of cement and thus obtain a satisfactory connection of the implant 1 to I femoral bone
Le jeu de cales 6, 7 nécessaire est en nombre très réduit pour chaque condyle 3 ainsi deux jeux de cales présentant deux épaisseurs différentes, de 4mm et 8mm respectivement pour la cale distale 6 et la cale postérieure 7, peuvent suffirThe set of shims 6, 7 required is very small in number for each condyle 3 thus two sets of shims having two different thicknesses, of 4mm and 8mm respectively for the distal shim 6 and the posterior shim 7, may be sufficient
L'invention n'est pas limitée au mode de réalisation décrit et peut comporter diverses variantes d'exécution Ainsi la parue terminale 22ç au lieu de présenter une portée 30 sensiblement semi-circula're comme représenté, pourrait être annulaire et entourer complètement le bossage 12, dont les raccordements radiaux 12a au bord de l'empreinte 1 3 seraient alors supprimés II est également possible de réaliser une extension à partir de la cale distale 6, remplissant le rôle de la patte de liaison 22, pour raccorder cette cale à la cale postérieure 7, auquel cas le moyen commun de fixation des deux cales serait aménagé dans l'extrémité postérieure du condyle 3 The invention is not limited to the embodiment described and may include various variant embodiments. Thus the terminal piece 22c, instead of having a substantially semi-circular bearing 30 as shown, could be annular and completely surround the boss. 12, the radial connections 12a of which at the edge of the imprint 1 3 would then be eliminated. It is also possible to make an extension from the distal wedge 6, fulfilling the role of the connecting tab 22, to connect this wedge to the posterior wedge 7, in which case the common means of fixing the two wedges would be arranged in the posterior end of the condyle 3

Claims

REVENDICATIONS
1 . Implant fémoral (1 ) de reprise pour prothèse de genou, comprenant une trochlée (2), une paire de condyles (3) reliés à la trochlée, ainsi que des cales distale (6) et postérieure (7) d'ajustement de l'épaisseur des condyles, une paire de ces cales étant prévue pour être fixée à au moins l'un des condyles caractérisé en ce que l'une (7) des cales est prolongée par une extension (22) adaptée pour pouvoir venir se placer entre la surface du condyle (3) et la seconde cale, et en ce qu'un moyen unique (14) de fixation des deux cales est prévu. 1. Femoral implant (1) for a knee prosthesis, comprising a trochlea (2), a pair of condyles (3) connected to the trochlea, as well as distal (6) and posterior (7) wedges for adjusting the thickness of the condyles, a pair of these shims being provided to be fixed to at least one of the condyles characterized in that one (7) of the shims is extended by an extension (22) adapted to be able to be placed between the surface of the condyle (3) and the second wedge, and in that a single means (14) for fixing the two wedges is provided.
2. Implant selon la revendication 1 , caractérisé en ce que ladite extension est une patte (22) prolongeant la cale postérieure (7).2. Implant according to claim 1, characterized in that said extension is a tab (22) extending the posterior wedge (7).
3. Implant selon la revendication 2, caractérisé en ce que la patte (2) est munie d'une partie terminale (22c) adaptée pour entourer au moins partiellement un bossage (12) de la surface du condyle (3) pouvant être recouvert par la cale distale (6) qui recouvre également ladite partie terminale, et dans lequel est percé un trou (1 1 ) de réception d'un élément (14) de fixation commun aux deux cales, une ouverture (8) de passage de cet élément étant également ménagée dans la cale distale (6).3. Implant according to claim 2, characterized in that the tab (2) is provided with an end portion (22c) adapted to at least partially surround a boss (12) of the surface of the condyle (3) which can be covered by the distal wedge (6) which also covers said end portion, and in which is drilled a hole (1 1) for receiving a fixing element (14) common to the two wedges, an opening (8) for passage of this element also being provided in the distal wedge (6).
4. Implant selon les revendications 2 et 3, caractérisé en ce qu'une empreinte (13) de positionnement des cales (6. 7) est agencée dans chaque condyle (3).4. Implant according to claims 2 and 3, characterized in that an impression (13) for positioning the shims (6. 7) is arranged in each condyle (3).
5. Implant selon la revendication 4, caractérisé en ce que la cale distale (6) est pourvue d'un plot (17) de positionnement de la cale dans l'empreinte (13) et un plot (20) d'appui sur la patte (22) de la cale postérieure (7), les deux cales (6, 7) faisant saillie des pians définis par les bords de l'empreinte.5. Implant according to claim 4, characterized in that the distal wedge (6) is provided with a stud (17) for positioning the wedge in the impression (13) and a stud (20) bearing on the tab (22) of the posterior wedge (7), the two wedges (6, 7) projecting from the planes defined by the edges of the imprint.
6. Implant selon l'une des revendications 3 à 5, caractérisé en ce que l'éiément de fixation commun aux deux cales (6, 7) est une vis (14), à tête fraisée ( 15). 6. Implant according to one of claims 3 to 5, characterized in that the fixing element common to the two wedges (6, 7) is a screw (14), with a countersunk head (15).
7. Implant selon la revendication 5, caractérisé en ce que la cale distale (6) est munie de plots d'angle chaπfreinés (16) pouvant venir en appui sur la surface intérieure (25) du condyle (3).7. Implant according to claim 5, characterized in that the distal wedge (6) is provided with chamfered angle pads (16) which can come to bear on the inner surface (25) of the condyle (3).
8. Implant selon l'une quelconque des revendications 3 à 7, caractérisé en ce qu'il est pourvu d'une vis à tète plate adaptée à la fixation uniquement de la cale postérieure (7), ladite tête pouvant prendre appui sur le bossage (12) et sur la partie terminale (22ç). 8. Implant according to any one of claims 3 to 7, characterized in that it is provided with a flat head screw suitable for fixing only the posterior wedge (7), said head being able to bear on the boss (12) and on the terminal part (22c).
PCT/FR1999/002503 1998-10-16 1999-10-14 Revision femoral component for knee joint prosthesis WO2000023010A1 (en)

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EP99947582A EP1121073A1 (en) 1998-10-16 1999-10-14 Revision femoral component for knee joint prosthesis
CA002347138A CA2347138A1 (en) 1998-10-16 1999-10-14 Revision femoral component for knee joint prosthesis
JP2000576788A JP2002527192A (en) 1998-10-16 1999-10-14 Modified femoral implant for knee prostheses
AU60976/99A AU6097699A (en) 1998-10-16 1999-10-14 Revision femoral component for knee joint prosthesis

Applications Claiming Priority (2)

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FR9813024A FR2784577B1 (en) 1998-10-16 1998-10-16 FEMALE IMPLANT FOR KNEE PROSTHESIS
FR98/13024 1998-10-16

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JP (1) JP2002527192A (en)
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US8048163B2 (en) 2002-02-20 2011-11-01 Zimmer, Inc. Knee arthroplasty prosthesis
US9072605B2 (en) 2002-02-20 2015-07-07 Zimmer, Inc. Knee arthroplasty prosthesis
US8535383B2 (en) 2004-01-12 2013-09-17 DePuy Synthes Products, LLC Systems and methods for compartmental replacement in a knee
US8002840B2 (en) 2004-01-12 2011-08-23 Depuy Products, Inc. Systems and methods for compartmental replacement in a knee
US9675463B2 (en) 2004-01-12 2017-06-13 Paul A. Lotke Patello-femoral prosthesis
US8852195B2 (en) 2004-07-09 2014-10-07 Zimmer, Inc. Guide templates for surgical implants and related methods
US9750612B2 (en) 2005-06-15 2017-09-05 P Tech, Llc Methods and systems for providing gender specific pharmaceuticals
US9301845B2 (en) 2005-06-15 2016-04-05 P Tech, Llc Implant for knee replacement
US9592127B2 (en) 2005-12-15 2017-03-14 Zimmer, Inc. Distal femoral knee prostheses
US10433966B2 (en) 2005-12-15 2019-10-08 Zimmer, Inc. Distal femoral knee prostheses
US9173744B2 (en) 2010-09-10 2015-11-03 Zimmer Gmbh Femoral prosthesis with medialized patellar groove
US10322004B2 (en) 2010-09-10 2019-06-18 Zimmer Gmbh Femoral prosthesis with lateralized patellar groove
US9867708B2 (en) 2010-09-10 2018-01-16 Zimmer Gmbh Femoral prosthesis with lateralized patellar groove
US9060868B2 (en) 2011-06-16 2015-06-23 Zimmer, Inc. Femoral component for a knee prosthesis with bone compacting ridge
US9308095B2 (en) 2011-06-16 2016-04-12 Zimmer, Inc. Femoral component for a knee prosthesis with improved articular characteristics
US9993345B2 (en) 2011-06-16 2018-06-12 Zimmer, Inc. Femoral prosthesis system
US10045850B2 (en) 2011-06-16 2018-08-14 Zimmer, Inc. Femoral component for a knee prosthesis with improved articular characteristics
US10070966B2 (en) 2011-06-16 2018-09-11 Zimmer, Inc. Femoral component for a knee prosthesis with bone compacting ridge
US9629723B2 (en) 2011-06-16 2017-04-25 Zimmer, Inc. Femoral component for a knee prosthesis with improved articular characteristics
US8932365B2 (en) 2011-06-16 2015-01-13 Zimmer, Inc. Femoral component for a knee prosthesis with improved articular characteristics
US10441429B2 (en) 2011-06-16 2019-10-15 Zimmer, Inc. Femoral component for a knee prosthesis with improved articular characteristics
US11246710B2 (en) 2011-06-16 2022-02-15 Zimmer, Inc. Femoral component for a knee prosthesis with improved articular characteristics
US10869676B2 (en) 2014-01-08 2020-12-22 Depuy Ireland Unlimited Company System for use in knee surgery
US10130375B2 (en) 2014-07-31 2018-11-20 Zimmer, Inc. Instruments and methods in performing kinematically-aligned total knee arthroplasty
US10939923B2 (en) 2014-07-31 2021-03-09 Zimmer, Inc. Instruments and methods in performing kinematically-aligned total knee arthroplasty
US10136997B2 (en) 2015-09-29 2018-11-27 Zimmer, Inc. Tibial prosthesis for tibia with varus resection
US10631991B2 (en) 2015-09-29 2020-04-28 Zimmer, Inc. Tibial prosthesis for tibia with varus resection
US11491018B2 (en) 2015-09-29 2022-11-08 Zimmer, Inc. Tibial prosthesis for tibia with varus resection
US11491013B2 (en) 2019-07-11 2022-11-08 Howmedica Osteonics Corp. Augment and means for connecting the same to a joint prosthesis

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FR2784577A1 (en) 2000-04-21
FR2784577B1 (en) 2001-03-09
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CA2347138A1 (en) 2000-04-27
AU6097699A (en) 2000-05-08
JP2002527192A (en) 2002-08-27

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