WO2009053650A2 - Femoral component for a hip prosthesis, and total hip prosthesis comprising same - Google Patents

Femoral component for a hip prosthesis, and total hip prosthesis comprising same Download PDF

Info

Publication number
WO2009053650A2
WO2009053650A2 PCT/FR2008/051870 FR2008051870W WO2009053650A2 WO 2009053650 A2 WO2009053650 A2 WO 2009053650A2 FR 2008051870 W FR2008051870 W FR 2008051870W WO 2009053650 A2 WO2009053650 A2 WO 2009053650A2
Authority
WO
WIPO (PCT)
Prior art keywords
pivot
cervical
hip prosthesis
femoral component
distal portion
Prior art date
Application number
PCT/FR2008/051870
Other languages
French (fr)
Other versions
WO2009053650A3 (en
Inventor
Levon Doursounian
Pascal Hourtoulle
Philippe Metge
Original Assignee
Levon Doursounian
Pascal Hourtoulle
Philippe Metge
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 Levon Doursounian, Pascal Hourtoulle, Philippe Metge filed Critical Levon Doursounian
Priority to EP08841513A priority Critical patent/EP2205187A2/en
Publication of WO2009053650A2 publication Critical patent/WO2009053650A2/en
Publication of WO2009053650A3 publication Critical patent/WO2009053650A3/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3662—Femoral shafts
    • A61F2/367—Proximal or metaphyseal parts of shafts
    • 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
    • A61F2/30744—End caps, e.g. for closing an endoprosthetic cavity
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30224—Three-dimensional shapes cylindrical
    • A61F2002/30233—Stepped cylinders, i.e. having discrete diameter changes
    • A—HUMAN NECESSITIES
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
    • 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
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30354—Cylindrically-shaped protrusion and recess, e.g. cylinder of circular basis
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
    • A61F2002/30364—Rotation about the common longitudinal axis
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
    • A61F2002/30364—Rotation about the common longitudinal axis
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
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    • A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
    • A61F2002/3037—Translation along the common longitudinal axis, e.g. piston
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
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    • 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
    • A61F2002/30538—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting angular orientation
    • A61F2002/3054—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting angular orientation about a connection axis or implantation axis for selecting any one of a plurality of radial orientations between two modular parts, e.g. Morse taper connections, at discrete positions, angular positions or continuous positions
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    • 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
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2002/3233—Joints for the hip having anti-luxation means for preventing complete dislocation of the femoral head from the acetabular cup
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/3611—Heads or epiphyseal parts of femur
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/365—Connections of heads to necks
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/3652—Connections of necks to shafts
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/3662—Femoral shafts
    • A61F2/3672—Intermediate parts of shafts
    • A61F2002/3674—Connections of proximal parts to distal parts
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4631—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor the prosthesis being specially adapted for being cemented
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    • 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
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
    • A—HUMAN NECESSITIES
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
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    • A—HUMAN NECESSITIES
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    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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    • 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
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    • 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
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    • 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
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    • A61F2310/00029—Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
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    • 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
    • A61F2310/00161—Carbon; Graphite
    • A61F2310/00173—Graphite
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • 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
    • A61F2310/00179—Ceramics or ceramic-like structures

Definitions

  • Femoral hip prosthesis element and total hip prosthesis comprising it.
  • the invention relates to orthopedic surgery, and more specifically to the femoral elements of hip prostheses.
  • Hip prostheses are implants commonly used in human surgery to treat fractures of the upper end of the femur, as well as advanced rheumatic diseases of the hip. They may be femoral only, that is to say have only one element intended to replace the upper end of the femur and provided at its end with a spherical head intended to fit into the natural acetabulum of the acetabulum. patient. They can also be total, that is to say include, in addition to the femoral component, an artificial acetabulum that the surgeon implants in the patient's iliac bone, instead of the natural acetabulum.
  • the femoral element comprises in the usual way:
  • the stem and the head may be two parts of the same monobloc element, or be two initially separated elements, the neck then being terminated by a Morse taper on which the head is placed during the installation of the prosthesis.
  • a frequent complication of the use of hip prostheses is the possibility of dislocation of the joint. Indeed, the movements of the prosthesis-bearing member are transmitted to the prosthesis, and, in particular, the axial rotation movements of the limb cause axial rotation of the neck of the prosthesis. When rotary movements are important, dislocation of the prosthetic head can occur. This is particularly common in elderly, bedridden or demented patients.
  • the object of the invention is to propose a new design of a hip prosthesis femoral element, which considerably reduces the risk of dislocation of the joint, while remaining of a relatively simple and standardized configuration. in order to facilitate its choice and placement by the surgeon.
  • the subject of the invention is a hip prosthesis femoral element, comprising a distal portion intended to be inserted into the medullary cavity of a patient's femur, and a cervical part comprising or capable of supporting a cervix at the hip. end of which is placed or can be placed a spherical head, characterized in that said distal portion and said cervical portion are constituted by two separate parts, in that said distal portion has at its proximal end a pivot-forming protrusion, and in that said cervical portion comprises means for assembling the cervical portion on the pivot of the distal portion retaining the possibility of free relative rotation of the cervical portion around the pivot after implantation of the prosthesis.
  • Said means for assembling the cervical portion on the pivot of the distal portion may comprise a longitudinal perforation formed in the cervical portion and allowing it to fit onto the pivot.
  • Said pivot may be cylindrical.
  • the femoral element may include a ring separating the pivot and the cervical portion promoting their sliding during their relative rotations.
  • It may comprise means preventing or limiting the relative longitudinal sliding of the pivot and the cervical portion.
  • Said means preventing or limiting the relative longitudinal sliding of the pivot and the cervical portion may be constituted by a cap attached to the proximal end of the pivot.
  • the pivot-shaped outgrowth and the proximal end of the distal portion may have angulation relative to the longitudinal axis of the distal portion.
  • the pivot can then have an angulation of 5 to 20 ° with respect to the longitudinal axis of the distal portion.
  • the femoral element may comprise a stud on one of the proximal end of the distal portion and the lower face of the cervical portion and a groove in which is inserted the stud, formed in the other of the proximal end of the distal portion and the underside of the cervical portion.
  • the invention also relates to a total hip prosthesis, comprising a femoral element and an artificial acetabulum for receiving a spherical head of the femoral component, characterized in that said femoral element is of the above type.
  • the invention consists in producing the stem of the femoral component of a hip prosthesis in two parts.
  • the first part is the distal part intended to be inserted into the medullary cavity of the femur. It is of a conventional design, except at its proximal end which is constituted by a rotationally symmetrical pivot element. On this pivot is placed, free in rotation around him, the second part of the stem, which is a cervical piece generally comprising:
  • FIG. 1 which shows schematically and axially the right hip of a patient equipped with a total hip prosthesis conventional neutral position of the lower limb;
  • FIG. 2 shows the same hip as Figure 1, equipped with the same prosthesis, the latter having a primer dislocation
  • FIG. 5 which shows in front of and in section a human femur equipped with a hip prosthesis femoral component according to the invention
  • FIGS. 6 and 7 which correspond to FIGS. 1 and 2 in the case where a femoral hip prosthesis element according to the invention is used;
  • Figures 1 and 2 very schematically illustrate the manner in which dislocation of the hip can occur with a conventional rigid femoral prosthesis, representative of the prior art that the invention aims to improve.
  • FIG. 1 represents the articulation, in a neutral position of the lower limb represented by the position of the foot 1 with respect to the pelvic bone 2 in which is placed an artificial acetabulum 3 (in the case where, as shown, an total hip prosthesis).
  • the femoral element 4 conventionally comprises a spherical head 5 inserted in the acetabulum 3 and mounted on the neck 6 rigidly connected to the one-piece rod 7 inserted in the femur of the patient. In this neutral position, the spherical head is well centered inside the acetabulum 3.
  • Figure 2 shows the same joint after a movement of the lower limb with a strong rotational component.
  • rigidity of the femoral element causes that if it encounters any obstacle during the rotation, by leverage there is the possibility that the head 5 out of its nominal location in the acetabulum 3. This may, in the end result in complete dislocation of the joint.
  • FIG. 3 shows very schematically the general principle of constitution of the stem of a hip prosthesis femoral component 4 according to the invention.
  • This stem consists of two parts initially separated as in FIG.
  • the cervical portion 11 is provided with a central longitudinal perforation 13 allowing the cervical portion 11 to fit onto the pivot 10 of the distal portion 8, with a possibility of relative free rotation, according to the arrow 14, of the cervical portion 11 around the pivot 10.
  • the cervical portion 11 then rests on the proximal flat end 9 (in the example shown) of the distal portion 8. This possibility of a relative free rotation of the cervical portion 11 around the pivot 10 is retained after implantation of the prosthesis.
  • Figure 5 shows schematically how the femoral element 4 according to the invention can be implanted in the medullary cavity 15 of the femur 16 of a patient, previously prepared by the surgeon in a conventional manner to allow this implantation with or without cement.
  • the distal portion 8 has a substantially cylindro-conical shape, tapered in its portion distal 17, but any other conventional shape for the distal parts of femoral elements would be usable.
  • the upper end 18 of the femur 16 has, in the example shown, been resected only partially, foraging a cavity 19 allowing a relative rotation14 without obstacle of the cervical portion 11 around the pivot 10.
  • resection of the end 18 more or less important than represented would be possible, at the option of the surgeon, depending in particular on the dimensions of the femoral element 4 and the state of the end 18.
  • FIGs 6 and 7 correspond to Figures 1 and 2, in the case of the use of a femoral element 4 according to the invention. It is seen that, this time, the rotation of the lower limb carrying the femoral element 4 was carried out without significant displacement of the cervical portion 11, therefore the neck 12 and the head 5 which are integral therewith. This rotation was only reflected by a rotation of the pivot 10 in the perforation 13 of the cervical portion 11. Under these conditions, the head 5 has not made movements that could have made it tend to leave the acetabulum 3, and dislocation of the joint is thus avoided.
  • the materials that can be used to form the various parts of the femoral component 4 according to the invention are biocompatible materials, in particular ceramics, metals and / or polymers, which can conventionally be used in hip prostheses.
  • the essential point in the context of the invention is that they have, due to their nature and / or the preparation of their surfaces, sufficiently low friction coefficients at the interface between the distal portion 8 and the cervical portion 11 to ensure easy rotation of one relative to the other.
  • FIG. 8 represents schematically (without the collar 12) a variant of the invention, in which the contact between the pivot 10 and the cervical part 11 is not done directly, but by means of a ring 20, made by exam- polyethylene or a self-lubricating material such as PTFE or graphite.
  • This configuration ensures a very good slip between the pivot 10 and the cervical portion 11 during their relative rotations. It can also be the part that experiences the greatest wear when using the prosthesis, and whose replacement, if it is necessary later in the patient's life, will be easier and less expensive than the replacement of the others.
  • this variant has another improvement (which may be present regardless of the previous) of providing a cap 21 at the end of the pivot 10, fixed by screwing, fitting or any other method.
  • This cap 21 makes it possible to avoid or limit the longitudinal relative movements of the distal portion 8 and of the cervical portion 11 of the femoral component 4 to a very small amplitude.
  • Other means that are functionally equivalent to this cap 21 may to be substituted.
  • the pivot 10 is of cylindrical shape, but it is obvious that it could take any other form, in particular tronconic, having a symmetry of revolution allowing the relative rotation of the cervical portion 11 around him. It may also be expected that it comprises at its base a spherical cap-shaped portion on which rest the lower portion of the cervical portion 11, which would itself be correspondingly shaped. Such configurations make it possible to strengthen the base of the pivot 10, and thus to limit the risks of shear failure at its level during the use of the prosthesis.
  • an example of sizing of a femoral element 4 according to the invention made of chromium-cobalt alloy or stainless steel would be: overall length of the distal portion 8 and its pivot 10: 140 mm, including 35 mm for the pivot 10, this dimension also corresponding substantially to the length of the cervical portion 11;
  • diameter of the distal portion 8 25 mm at its portion proximal to the base of the pivot 10, and 12 mm at its distal portion 17;
  • the pivot 10 and the proximal end 9 have an angulation ⁇ relative to the longitudinal axis of the distal portion 8 of the prosthesis. In this way, it is possible to automatically center the cervical portion 11 under the effect of the stresses to which the prosthesis is subjected.
  • This angulation ⁇ of the pivot 10 is preferably of the order of 5 to 20 ° with respect to the longitudinal axis of the distal portion 8.
  • the stud 22 in cooperation with a corresponding groove formed in the lower face of the cervical portion 11 of the prosthesis, acts as a guiding and abutment function during the relative rotation of the distal portion 8 and the cervical portion 11. respective positions of the stud 22 and the groove in which it is inserted could, of course, be reversed with respect to the configuration described and shown.

Abstract

Femoral component (4) for a hip prosthesis, comprising a distal part (8) intended to be inserted into the medullary cavity (15) of the femur (16) of a patient, and a cervical part (11) which comprises or which can support a neck (12) at the end of which a spherical head (5) is placed or can be placed, characterized in that said distal part (8) and said cervical part (11) are made up of two separate pieces, in that said distal part (8) comprises, at its proximal end (9), an outgrowth forming a pivot (10), and in that said cervical part (11) comprises means for assembling the cervical part (11) on the pivot (10) of the distal part (8), maintaining the possibility of free relative rotation of the cervical part (11) around the pivot (10) after implantation of the prosthesis. Total hip prosthesis of which the femoral component is of the above type.

Description

Elément fémoral de prothèse de hanche, et prothèse totale de hanche le comportant. Femoral hip prosthesis element, and total hip prosthesis comprising it.
L'invention concerne la chirurgie orthopédique, et plus précisément les éléments fémoraux des prothèses de hanche.The invention relates to orthopedic surgery, and more specifically to the femoral elements of hip prostheses.
Les prothèses de hanche sont des implants couramment utilisés en chirurgie humaine pour traiter les fractures de l'extrémité supérieure du fémur, ainsi que les affections rhumatismales évoluées de la hanche. Elles peuvent être uniquement fémorales, c'est-à-dire ne comporter qu'un seul élément destiné à remplacer l'extrémité supérieure du fémur et pourvu à son extrémité d'une tête sphérique destinée à s'insérer dans la cavité cotyloïdienne naturelle du patient. Elles peuvent aussi être totales, c'est-à-dire comporter, en plus de l'élément fémoral, un cotyle artificiel que le chirurgien implante dans l'os iliaque du patient, à la place de la cavité cotyloïdienne naturelle.Hip prostheses are implants commonly used in human surgery to treat fractures of the upper end of the femur, as well as advanced rheumatic diseases of the hip. They may be femoral only, that is to say have only one element intended to replace the upper end of the femur and provided at its end with a spherical head intended to fit into the natural acetabulum of the acetabulum. patient. They can also be total, that is to say include, in addition to the femoral component, an artificial acetabulum that the surgeon implants in the patient's iliac bone, instead of the natural acetabulum.
L'élément fémoral comporte de manière habituelle :The femoral element comprises in the usual way:
- une tige de forme générale rectiligne à section le plus souvent ovalaire ou parallélépipédique pour éviter sa rotation dans la cavité médullaire du fémur ; sa portion distale est ancrée dans la diaphyse fémorale après une résection plus ou moins complète de l'extrémité supérieure du fémur et une conformation adaptée de la cavité médullaire du fémur par le chirurgien, et qui se prolonge à son extrémité proximale par un col incliné d'un angle de 135° (le plus souvent, le choix de cette valeur pouvant être différent en fonction de la morphologie du patient) par rapport à l'orientation générale de la tige ;a rod of generally rectilinear shape with a section most often oval or parallelepipedic to avoid its rotation in the medullary cavity of the femur; its distal portion is anchored in the femoral diaphysis after a more or less complete resection of the upper end of the femur and a conformation adapted to the medullary cavity of the femur by the surgeon, and which extends at its proximal end by an inclined neck of the femur. an angle of 135 ° (most often, the choice of this value may be different depending on the morphology of the patient) relative to the general orientation of the rod;
- et une tête de forme générale sphérique placée à l'extrémité du col.and a head of spherical general shape placed at the end of the neck.
Selon les cas, la tige et la tête peuvent être deux parties d'un même élément monobloc, ou constituer deux éléments initialement séparés, le col étant alors terminé par un cône morse sur lequel la tête est placée lors de la pose de la prothèse.Depending on the case, the stem and the head may be two parts of the same monobloc element, or be two initially separated elements, the neck then being terminated by a Morse taper on which the head is placed during the installation of the prosthesis.
Une complication fréquente de l'utilisation des prothèses de hanche est la possibilité d'une luxation de l'articulation. En effet, les mouvements du membre porteur de la prothèse se transmettent à la prothèse, et, notamment, les mouvements de rotation axiale du membre provoquent une rotation axiale du col de la prothèse. Lorsque les mouvements rotatoires sont importants, une luxation de la tête prothétique peut se produire. Cela est particulièrement fréquent dans le cas de patients âgés, alités ou déments.A frequent complication of the use of hip prostheses is the possibility of dislocation of the joint. Indeed, the movements of the prosthesis-bearing member are transmitted to the prosthesis, and, in particular, the axial rotation movements of the limb cause axial rotation of the neck of the prosthesis. When rotary movements are important, dislocation of the prosthetic head can occur. This is particularly common in elderly, bedridden or demented patients.
Diverses configurations de prothèses fémorales ou totales ont été développées pour limiter ce risque de luxation. Elles conduisent cependant à la réalisation de prothèses de conception relativement complexes et/ou devant être finement adaptées à la morphologie exacte du patient pour être réellement efficaces.Various configurations of femoral or total prostheses have been developed to limit this risk of dislocation. However, they lead to the realization of relatively complex design prostheses and / or to be finely adapted to the exact morphology of the patient to be really effective.
Le but de l'invention est de proposer une nouvelle conception d'un élément fémoral de prothèse de hanche, permettant de diminuer de manière considérable les risques de luxation de l'articulation, tout en demeurant d'une configuration relativement simple et standardisée, de manière à faciliter son choix et sa pose par le chirurgien.The object of the invention is to propose a new design of a hip prosthesis femoral element, which considerably reduces the risk of dislocation of the joint, while remaining of a relatively simple and standardized configuration. in order to facilitate its choice and placement by the surgeon.
A cet effet, l'invention a pour objet un élément fémoral de prothèse de hanche, comportant une partie distale destinée à être insérée dans la cavité médullaire du fémur d'un patient, et une partie cervicale comportant ou pouvant supporter un col à l'extrémité duquel est placée ou peut être placée une tête sphérique, caractérisé en ce que ladite partie distale et ladite partie cervicale sont constituées par deux pièces séparées, en ce que ladite partie distale comporte à son extrémité proximale une excroissance formant pivot, et en ce que ladite partie cervicale comporte des moyens permettant l'assemblage de la partie cervicale sur le pivot de la partie distale conservant la possibilité d'une libre rotation relative de la partie cervicale autour du pivot après l'implantation de la prothèse.To this end, the subject of the invention is a hip prosthesis femoral element, comprising a distal portion intended to be inserted into the medullary cavity of a patient's femur, and a cervical part comprising or capable of supporting a cervix at the hip. end of which is placed or can be placed a spherical head, characterized in that said distal portion and said cervical portion are constituted by two separate parts, in that said distal portion has at its proximal end a pivot-forming protrusion, and in that said cervical portion comprises means for assembling the cervical portion on the pivot of the distal portion retaining the possibility of free relative rotation of the cervical portion around the pivot after implantation of the prosthesis.
Lesdits moyens permettant l'assemblage de la partie cervicale sur le pivot de la partie distale peuvent comporter une perforation longitudinale ménagée dans la partie cervicale et permettant son emmanchement sur le pivot.Said means for assembling the cervical portion on the pivot of the distal portion may comprise a longitudinal perforation formed in the cervical portion and allowing it to fit onto the pivot.
Ledit pivot peut être de forme cylindrique.Said pivot may be cylindrical.
L'élément fémoral peut comporter une bague séparant le pivot et la partie cervicale favorisant leur glissement lors de leurs rotations relatives.The femoral element may include a ring separating the pivot and the cervical portion promoting their sliding during their relative rotations.
Il peut comporter des moyens empêchant ou limitant le glissement longitudinal relatif du pivot et de la partie cervicale.It may comprise means preventing or limiting the relative longitudinal sliding of the pivot and the cervical portion.
Lesdits moyens empêchant ou limitant le glissement longitudinal relatif du pivot et de la partie cervicale peuvent être constitués par un capuchon fixé à l'extrémité proximale du pivot. L'excroissance formant pivot et l'extrémité proximale de la partie distale peuvent présenter une angulation par rapport à l'axe longitudinal de la partie distale.Said means preventing or limiting the relative longitudinal sliding of the pivot and the cervical portion may be constituted by a cap attached to the proximal end of the pivot. The pivot-shaped outgrowth and the proximal end of the distal portion may have angulation relative to the longitudinal axis of the distal portion.
Le pivot peut alors présenter une angulation de 5 à 20° par rapport à l'axe longitudinal de la partie distale.The pivot can then have an angulation of 5 to 20 ° with respect to the longitudinal axis of the distal portion.
L'élément fémoral peut comporter un plot sur l'une de l'extrémité proximale de la partie distale et de la face inférieure de la partie cervicale et une rainure dans laquelle vient s'insérer le plot, ménagée dans l'autre de l'extrémité proximale de la partie distale et de la face inférieure de la partie cervicale.The femoral element may comprise a stud on one of the proximal end of the distal portion and the lower face of the cervical portion and a groove in which is inserted the stud, formed in the other of the proximal end of the distal portion and the underside of the cervical portion.
L'invention a également pour objet une prothèse totale de hanche, comportant un élément fémoral et un cotyle artificiel pour la réception d'une tête sphéri- que de l'élément fémoral, caractérisée en ce que ledit élément fémoral est du type précédent.The invention also relates to a total hip prosthesis, comprising a femoral element and an artificial acetabulum for receiving a spherical head of the femoral component, characterized in that said femoral element is of the above type.
Comme on l'aura compris, l'invention consiste à réaliser la tige de l'élément fémoral d'une prothèse de hanche en deux parties. La première partie est la partie distale destinée à être insérée dans la cavité médullaire du fémur. Elle est d'une conception classique, sauf à son extrémité proximale qui est constituée par un élément formant pivot à symétrie de révolution. Sur ce pivot vient se placer, libre en rotation autour de lui, la deuxième partie de la tige, qui est une pièce cervicale comportant généralement :As will be understood, the invention consists in producing the stem of the femoral component of a hip prosthesis in two parts. The first part is the distal part intended to be inserted into the medullary cavity of the femur. It is of a conventional design, except at its proximal end which is constituted by a rotationally symmetrical pivot element. On this pivot is placed, free in rotation around him, the second part of the stem, which is a cervical piece generally comprising:
- une cavité centrale dans laquelle le pivot vient s'insérer ;a central cavity in which the pivot is inserted;
- et un col destiné à porter, de manière fixe ou amovible comme il est classique, la tête sphérique de l'élément fémoral.and a neck intended to carry, in a fixed or removable manner as is conventional, the spherical head of the femoral element.
De cette façon, lorsque le membre porteur de la prothèse effectue un mouvement de rotation axiale, cette rotation est, comme il est normal, transmise à la partie distale de la tige fémorale de la prothèse qui est solidaire du fémur. Mais si le col de la prothèse et la tête sphérique qu'il porte rencontrent une résistance lors de ce mouvement, leur propre rotation peut être interrompue. En revanche, le mouvement de rotation axiale du membre et de la partie distale de la tige fémorale peut se poursuivre, puisque le pivot (et donc la tige fémorale) peut tourner librement à l'intérieur de la pièce cervicale. Ainsi on évite la luxation de l'articulation. L'invention est applicable aussi bien aux prothèses totales de hanche qu'aux prothèses limitées au seul élément fémoral. Elle serait également adaptable à la chirurgie vétérinaire.In this way, when the prosthesis carrying member performs an axial rotational movement, this rotation is, as is normal, transmitted to the distal portion of the femoral stem of the prosthesis which is secured to the femur. But if the neck of the prosthesis and the spherical head that it carries resistance during this movement, their own rotation can be interrupted. In contrast, the axial rotational movement of the limb and the distal portion of the femoral stem can continue, since the pivot (and thus the femoral stem) can rotate freely within the cervical part. This prevents dislocation of the joint. The invention is applicable both to total hip prostheses and prostheses limited to the single femoral component. It would also be adaptable to veterinary surgery.
L'invention sera mieux comprise à la lecture de la description qui suit, donnée en référence aux figures annexées suivantes :The invention will be better understood on reading the description which follows, given with reference to the following appended figures:
- la figure 1 qui montre schématiquement et axialement la hanche droite d'un patient équipée d'une prothèse totale de hanche conventionnelle en position neutre du membre inférieur ;- Figure 1 which shows schematically and axially the right hip of a patient equipped with a total hip prosthesis conventional neutral position of the lower limb;
- la figure 2 qui montre la même hanche que la figure 1 , équipée de la même prothèse, celle-ci présentant une amorce de luxation ;- Figure 2 shows the same hip as Figure 1, equipped with the same prosthesis, the latter having a primer dislocation;
- les figures 3 et 4 qui montrent schématiquement en perspective les deux parties d'un élément fémoral de prothèse de hanche selon l'invention, à l'état séparé (figure 3) et à l'état assemblé (figure 4) ;- Figures 3 and 4 which show schematically in perspective the two parts of a femoral hip prosthesis element according to the invention, in the separated state (Figure 3) and in the assembled state (Figure 4);
- la figure 5 qui montre vu de face et en coupe un fémur humain équipé d'un élément fémoral de prothèse de hanche selon l'invention ;- Figure 5 which shows in front of and in section a human femur equipped with a hip prosthesis femoral component according to the invention;
- les figures 6 et 7 qui correspondent aux figures 1 et 2 dans le cas où on utilise un élément fémoral de prothèse de hanche selon l'invention ;FIGS. 6 and 7 which correspond to FIGS. 1 and 2 in the case where a femoral hip prosthesis element according to the invention is used;
- la figure 8 qui montre schématiquement vue en coupe longitudinale une autre variante de l'invention ;- Figure 8 which shows schematically in longitudinal sectional view another variant of the invention;
- la figure 9 qui montre schématiquement la partie fémorale d'une autre variante de prothèse selon l'invention.- Figure 9 which shows schematically the femoral part of another variant of prosthesis according to the invention.
Les figures 1 et 2 illustrent très schématiquement la manière dont une luxation de la hanche peut se produire avec une prothèse fémorale classique entièrement rigide, représentative de l'art antérieur que l'invention vise à améliorer.Figures 1 and 2 very schematically illustrate the manner in which dislocation of the hip can occur with a conventional rigid femoral prosthesis, representative of the prior art that the invention aims to improve.
La figure 1 représente l'articulation, dans une position neutre du membre inférieur représenté par la position du pied 1 par rapport à l'os iliaque 2 dans lequel est placé un cotyle artificiel 3 (dans le cas où, comme représenté, on utilise une prothèse totale de hanche). L'élément fémoral 4 comporte classiquement une tête sphérique 5 insérée dans le cotyle 3 et montée sur le col 6 relié rigidement à la tige 7 monobloc insérée dans le fémur du patient. Dans cette position neutre, la tête sphérique est bien centrée à l'intérieur du cotyle 3.FIG. 1 represents the articulation, in a neutral position of the lower limb represented by the position of the foot 1 with respect to the pelvic bone 2 in which is placed an artificial acetabulum 3 (in the case where, as shown, an total hip prosthesis). The femoral element 4 conventionally comprises a spherical head 5 inserted in the acetabulum 3 and mounted on the neck 6 rigidly connected to the one-piece rod 7 inserted in the femur of the patient. In this neutral position, the spherical head is well centered inside the acetabulum 3.
La figure 2 représente la même articulation après un mouvement du membre inférieur présentant une forte composante rotationnelle. On voit que la rigidité de l'élément fémoral entraîne que si celui-ci rencontre un obstacle quelconque au cours de la rotation, par un effet de levier il y a la possibilité que la tête 5 sorte de son emplacement nominal dans le cotyle 3. Cela peut, au final, aboutir à une luxation complète de l'articulation.Figure 2 shows the same joint after a movement of the lower limb with a strong rotational component. We see that rigidity of the femoral element causes that if it encounters any obstacle during the rotation, by leverage there is the possibility that the head 5 out of its nominal location in the acetabulum 3. This may, in the end result in complete dislocation of the joint.
Les figures 3 et 4 représentent très schématiquement le principe général de constitution de la tige d'un élément fémoral 4 de prothèse de hanche selon l'invention. Cette tige se compose de deux parties initialement séparées comme sur la figure 3 :Figures 3 and 4 show very schematically the general principle of constitution of the stem of a hip prosthesis femoral component 4 according to the invention. This stem consists of two parts initially separated as in FIG.
- une partie distale 8 représentée cylindrique sur les figures 3 et 4, mais pouvant présenter dans la réalité toute forme classique la rendant adaptée à son insertion et à son maintien dans la cavité médullaire du fémur ; à son extrémité proximale 9, elle présente une excroissance formant pivot 10, cylindrique dans l'exemple représenté ;- A distal portion 8 shown cylindrical in Figures 3 and 4, but may in fact have any conventional form making it suitable for insertion and maintenance in the medullary cavity of the femur; at its proximal end 9, it has a protrusion forming pivot 10, cylindrical in the example shown;
- et une partie 11 représentée cylindrique sur les figures 3 et 4 mais pouvant prendre toute forme extérieure compatible avec sa fonction, qui est de constituer la partie cervicale de l'élément fémoral ; à cet effet, elle présente, connecté à son extrémité proximale, un col 12, en forme de cône morse dans l'exemple représenté, et sur lequel est destiné à être connectée la tête sphérique 5 (non représentée) de l'élément fémoral 4 ; il doit être compris que ce col 12 peut être venu de matière avec la partie cervicale 11 , ou être rapporté sur celle-ci au cours de l'assemblage de l'élément fémoral 4 pour une plus grande modularité de celui-ci.- And a part 11 shown cylindrical in Figures 3 and 4 but can take any external form compatible with its function, which is to form the cervical portion of the femoral element; for this purpose, it has, connected at its proximal end, a neck 12, in the form of a Morse cone in the example shown, and on which is intended to be connected the spherical head 5 (not shown) of the femoral element 4 ; it should be understood that this neck 12 may be integral with the cervical portion 11, or be attached thereto during assembly of the femoral component 4 for greater modularity thereof.
La partie cervicale 11 est pourvue d'une perforation longitudinale centrale 13 permettant l'emmanchement de la partie cervicale 11 sur le pivot 10 de la partie distale 8, avec une possibilité de libre rotation relative, selon la flèche 14, de la partie cervicale 11 autour du pivot 10. La partie cervicale 11 repose alors sur l'extrémité proximale 9 plane (dans l'exemple représenté) de la partie distale 8. Cette possibilité d'une libre rotation relative de la partie cervicale 11 autour du pivot 10 est conservée après l'implantation de la prothèse.The cervical portion 11 is provided with a central longitudinal perforation 13 allowing the cervical portion 11 to fit onto the pivot 10 of the distal portion 8, with a possibility of relative free rotation, according to the arrow 14, of the cervical portion 11 around the pivot 10. The cervical portion 11 then rests on the proximal flat end 9 (in the example shown) of the distal portion 8. This possibility of a relative free rotation of the cervical portion 11 around the pivot 10 is retained after implantation of the prosthesis.
La figure 5 montre schématiquement comment l'élément fémoral 4 selon l'invention peut être implanté dans la cavité médullaire 15 du fémur 16 d'un patient, préalablement préparée par le chirurgien d'une manière classique pour permettre cette implantation avec ou sans ciment. Dans l'exemple représenté, la partie distale 8 a une forme sensiblement cylindro-conique, effilée dans sa portion distale 17, mais toute autre forme classique pour les parties distales d'éléments fémoraux serait utilisable. L'extrémité supérieure 18 du fémur 16 n'a, dans l'exemple représenté, été réséquée que de façon partielle, par ménagement d'une cavité 19 autorisant une rotation relative14 sans obstacle de la partie cervicale 11 autour du pivot 10. Bien entendu, une résection de l'extrémité 18 plus ou moins importante que représenté serait possible, au choix du chirurgien, en fonction notamment des dimensions de l'élément fémoral 4 et de l'état de l'extrémité 18.Figure 5 shows schematically how the femoral element 4 according to the invention can be implanted in the medullary cavity 15 of the femur 16 of a patient, previously prepared by the surgeon in a conventional manner to allow this implantation with or without cement. In the example shown, the distal portion 8 has a substantially cylindro-conical shape, tapered in its portion distal 17, but any other conventional shape for the distal parts of femoral elements would be usable. The upper end 18 of the femur 16 has, in the example shown, been resected only partially, foraging a cavity 19 allowing a relative rotation14 without obstacle of the cervical portion 11 around the pivot 10. Of course , resection of the end 18 more or less important than represented would be possible, at the option of the surgeon, depending in particular on the dimensions of the femoral element 4 and the state of the end 18.
Avec la conformation de l'élément fémoral 4 selon l'invention, on comprend qu'une rotation du fémur 16 selon la flèche 14 est transmise à la partie distale 8 de l'élément 4 puisqu'elle lui est solidaire, mais n'est pas nécessairement transmise à la partie cervicale 11 qui peut rester immobile, en particulier si le mouvement du fémur 16 pouvait tendre à faire sortir la tête sphérique 5 de l'élément fémoral 4 hors du cotyle 3, si cette tête 5 était rigidement liée à la partie distale 8 de l'élément fémoral 4 comme c'est le cas sur les figures 1 et 2, représentatives de l'art antérieur.With the conformation of the femoral element 4 according to the invention, it is understood that a rotation of the femur 16 along the arrow 14 is transmitted to the distal portion 8 of the element 4 since it is integral with it, but is not not necessarily transmitted to the cervical portion 11 which can remain motionless, in particular if the movement of the femur 16 could tend to cause the spherical head 5 to come out of the femoral component 4 out of the acetabulum 3, if this head 5 was rigidly connected to the distal portion 8 of the femoral component 4 as is the case in Figures 1 and 2, representative of the prior art.
Les figures 6 et 7 correspondent aux figures 1 et 2, dans le cas de l'utilisation d'un élément fémoral 4 selon l'invention. On y voit que, cette fois, la rotation du membre inférieur portant l'élément fémoral 4 s'est effectuée sans déplacement sensible de la partie cervicale 11 , donc du col 12 et de la tête 5 qui lui sont solidaires. Cette rotation s'est seulement traduite par une rotation du pivot 10 dans la perforation 13 de la partie cervicale 11. Dans ces conditions, la tête 5 n'a pas effectué de mouvements qui auraient pu la faire tendre à sortir du cotyle 3, et la luxation de l'articulation est ainsi évitée.Figures 6 and 7 correspond to Figures 1 and 2, in the case of the use of a femoral element 4 according to the invention. It is seen that, this time, the rotation of the lower limb carrying the femoral element 4 was carried out without significant displacement of the cervical portion 11, therefore the neck 12 and the head 5 which are integral therewith. This rotation was only reflected by a rotation of the pivot 10 in the perforation 13 of the cervical portion 11. Under these conditions, the head 5 has not made movements that could have made it tend to leave the acetabulum 3, and dislocation of the joint is thus avoided.
Les matériaux utilisables pour constituer les diverses parties de l'élément fémoral 4 selon l'invention sont les matériaux biocompatibles, notamment céramiques, métalliques et/ou polymères, classiquement utilisables dans les prothèses de hanche. L'essentiel dans le cadre de l'invention est qu'ils présentent, du fait de leurs natures et/ou de la préparation de leurs surfaces, des coefficients de frottement suffisamment faibles au niveau de l'interface entre la partie distale 8 et la partie cervicale 11 pour assurer une rotation aisée de l'une par rapport à l'autre.The materials that can be used to form the various parts of the femoral component 4 according to the invention are biocompatible materials, in particular ceramics, metals and / or polymers, which can conventionally be used in hip prostheses. The essential point in the context of the invention is that they have, due to their nature and / or the preparation of their surfaces, sufficiently low friction coefficients at the interface between the distal portion 8 and the cervical portion 11 to ensure easy rotation of one relative to the other.
La figure 8 représente schématiquement (sans le col 12) une variante de l'invention, dans laquelle le contact entre le pivot 10 et la partie cervicale 11 ne se fait pas directement, mais par l'intermédiaire d'une bague 20, réalisée par exem- pie en polyéthylène ou en un matériau autolubrifiant tel que le PTFE ou le graphite. Cette configuration permet d'assurer un très bon glissement entre le pivot 10 et la partie cervicale 11 lors de leurs rotations relatives. Elle peut également constituer la pièce subissant la plus grande usure lors de l'utilisation de la prothèse, et dont le remplacement, s'il est nécessaire ultérieurement au cours de la vie du patient, sera plus aisé et moins coûteux que le remplacement des autres parties 8, 11 de l'élément fémoral 4.FIG. 8 represents schematically (without the collar 12) a variant of the invention, in which the contact between the pivot 10 and the cervical part 11 is not done directly, but by means of a ring 20, made by exam- polyethylene or a self-lubricating material such as PTFE or graphite. This configuration ensures a very good slip between the pivot 10 and the cervical portion 11 during their relative rotations. It can also be the part that experiences the greatest wear when using the prosthesis, and whose replacement, if it is necessary later in the patient's life, will be easier and less expensive than the replacement of the others. parts 8, 11 of the femoral component 4.
Egalement, cette variante présente une autre amélioration (pouvant être présente indépendamment de la précédente) qui consiste à prévoir un capuchon 21 à l'extrémité du pivot 10, fixé par vissage, emmanchement ou tout autre procédé. Ce capuchon 21 permet d'éviter ou de limiter assurément à une amplitude très réduite les mouvements relatifs longitudinaux de la partie distale 8 et de la partie cervicale 11 de l'élément fémoral 4. D'autres moyens fonctionnellement équivalents à ce capuchon 21 peuvent lui être substitués.Also, this variant has another improvement (which may be present regardless of the previous) of providing a cap 21 at the end of the pivot 10, fixed by screwing, fitting or any other method. This cap 21 makes it possible to avoid or limit the longitudinal relative movements of the distal portion 8 and of the cervical portion 11 of the femoral component 4 to a very small amplitude. Other means that are functionally equivalent to this cap 21 may to be substituted.
Dans les exemples décrits et représentés, le pivot 10 est de forme cylindrique, mas il va de soi qu'il pourrait prendre toute autre forme, notamment tronconi- que, présentant une symétrie de révolution autorisant la rotation relative de la partie cervicale 11 autour de lui. Egalement on pourrait prévoir qu'il comporte à sa base une portion en forme de calotte sphérique sur laquelle reposerait la portion inférieure de la partie cervicale 11 , qui serait elle-même conformée de façon correspondante. De telles configurations permettent de renforcer la base du pivot 10, et donc de limiter les risques de rupture par cisaillement à son niveau au cours de l'utilisation de la prothèse.In the examples described and shown, the pivot 10 is of cylindrical shape, but it is obvious that it could take any other form, in particular tronconic, having a symmetry of revolution allowing the relative rotation of the cervical portion 11 around him. It may also be expected that it comprises at its base a spherical cap-shaped portion on which rest the lower portion of the cervical portion 11, which would itself be correspondingly shaped. Such configurations make it possible to strengthen the base of the pivot 10, and thus to limit the risks of shear failure at its level during the use of the prosthesis.
De manière générale, il faut comprendre que tout moyen permettant l'assemblage de la partie cervicale 11 sur une excroissance formant pivot 10 de l'extrémité proximale de la partie distale 8 avec possibilité d'une libre rotation relative des deux parties 8, 11 après l'implantation de la prothèse serait conforme à l'invention.In general, it should be understood that any means allowing the cervical portion 11 to be assembled on a pivot-shaped outgrowth 10 of the proximal end of the distal portion 8 with the possibility of relative free rotation of the two parts 8, 11 after implantation of the prosthesis would be in accordance with the invention.
A titre purement indicatif, un exemple de dimensionnement d'un élément fémoral 4 selon l'invention réalisé en alliage chrome-cobalt ou en acier inoxydable serait : - longueur globale de la partie distale 8 et de son pivot 10 : 140 mm, dont 35 mm pour le pivot 10, cette dimension correspondant également sensiblement à la longueur de la partie cervicale 11 ;By way of indication, an example of sizing of a femoral element 4 according to the invention made of chromium-cobalt alloy or stainless steel would be: overall length of the distal portion 8 and its pivot 10: 140 mm, including 35 mm for the pivot 10, this dimension also corresponding substantially to the length of the cervical portion 11;
- diamètre du pivot 10 : 10 mm ;- Pivot diameter 10: 10 mm;
- diamètre de la partie distale 8 : 25 mm à sa portion proximale à la base du pivot 10, et 12 mm à sa portion distale 17 ;diameter of the distal portion 8: 25 mm at its portion proximal to the base of the pivot 10, and 12 mm at its distal portion 17;
- diamètre extérieur de la partie cervicale : 25 mm ;- outer diameter of the cervical part: 25 mm;
- longueur du col 12 incluant le cône morse supportant la tête sphérique 5 : 35 mm.- length of the neck 12 including the Morse taper supporting the spherical head 5: 35 mm.
Egalement, dans une variante avantageuse de l'invention représentée sur la figure 9, le pivot 10 et l'extrémité proximale 9 présentent une angulation α par rapport à l'axe longitudinal de la partie distale 8 de la prothèse. On obtient de cette façon une possibilité de centrage automatique de la partie cervicale 11 sous l'effet des contraintes auxquelles la prothèse est soumise. Cette angulation α du pivot 10 est, de préférence, de l'ordre de 5 à 20° par rapport à l'axe longitudinal de la partie distale 8.Also, in an advantageous variant of the invention shown in Figure 9, the pivot 10 and the proximal end 9 have an angulation α relative to the longitudinal axis of the distal portion 8 of the prosthesis. In this way, it is possible to automatically center the cervical portion 11 under the effect of the stresses to which the prosthesis is subjected. This angulation α of the pivot 10 is preferably of the order of 5 to 20 ° with respect to the longitudinal axis of the distal portion 8.
On peut également prévoir comme représenté sur la figure 9 (et ceci est aussi valable pour la variante des figures 1 à 8) de disposer un plot 22 sur l'extrémité proximale 9 de la partie distale 8 de la prothèse.One can also provide as shown in Figure 9 (and this is also valid for the variant of Figures 1 to 8) to have a stud 22 on the proximal end 9 of the distal portion 8 of the prosthesis.
Le plot 22, en coopération avec une rainure correspondante ménagée dans la face inférieure de la partie cervicale 11 de la prothèse, joue un rôle de guidage et de butée lors de la rotation relative de la partie distale 8 et de la partie cervicale 11. Les positions respectives du plot 22 et de la rainure dans laquelle il s'insère pourraient, bien entendu, être inversées par rapport à la configuration décrite et représentée. The stud 22, in cooperation with a corresponding groove formed in the lower face of the cervical portion 11 of the prosthesis, acts as a guiding and abutment function during the relative rotation of the distal portion 8 and the cervical portion 11. respective positions of the stud 22 and the groove in which it is inserted could, of course, be reversed with respect to the configuration described and shown.

Claims

REVENDICATIONS
1. Elément fémoral (4) de prothèse de hanche, comportant une partie dis- taie (8) destinée à être insérée dans la cavité médullaire (15) du fémur (16) d'un patient, et une partie cervicale (11 ) comportant ou pouvant supporter un col (12) à l'extrémité duquel est placée ou peut être placée une tête sphérique (5), caractérisé en ce que ladite partie distale (8) et ladite partie cervicale (11 ) sont constituées par deux pièces séparées, en ce que ladite partie distale (8) comporte à son extrémité proximale (9) une excroissance formant pivot (10), et en ce que ladite partie cervicale (11 ) comporte des moyens permettant l'assemblage de la partie cervicale (11 ) sur le pivot (10) de la partie distale (8) conservant la possibilité d'une libre rotation relative de la partie cervicale (11 ) autour du pivot (10) après l'implantation de la prothèse.A hip prosthesis femoral component (4) having a distal portion (8) for insertion into the medullary cavity (15) of a patient's femur (16) and a cervical portion (11) comprising or capable of supporting a neck (12) at the end of which is placed or can be placed a spherical head (5), characterized in that said distal portion (8) and said cervical portion (11) are constituted by two separate pieces, in that said distal portion (8) has at its proximal end (9) a pivot-shaped outgrowth (10), and in that said cervical portion (11) comprises means for assembling the cervical portion (11) on the pivot (10) of the distal portion (8) retaining the possibility of a relative free rotation of the cervical portion (11) around the pivot (10) after implantation of the prosthesis.
2. Elément fémoral (4) de prothèse de hanche selon la revendication 1 , caractérisé en ce que lesdits moyens permettant l'assemblage de la partie cervicale (11 ) sur le pivot (10) de la partie distale (8) comportent une perforation longitudinale (13) ménagée dans la partie cervicale (11 ) et permettant son emmanchement sur le pivot (10).2. Hip prosthesis femoral component (4) according to claim 1, characterized in that said means for assembling the cervical portion (11) on the pivot (10) of the distal portion (8) comprise a longitudinal perforation (13) formed in the cervical portion (11) and allowing its fitting on the pivot (10).
3. Elément fémoral (4) de prothèse de hanche selon la revendication 1 ou 2, caractérisé en ce que ledit pivot (10) est de forme cylindrique.3. hip prosthesis femoral component (4) according to claim 1 or 2, characterized in that said pivot (10) is of cylindrical shape.
4. Elément fémoral (4) de prothèse de hanche selon l'une des revendications 1 à 3, caractérisé en ce qu'il comporte une bague (20) séparant le pivot (10) et la partie cervicale (11 ) favorisant leur glissement lors de leurs rotations relatives.4. Femoral component (4) of hip prosthesis according to one of claims 1 to 3, characterized in that it comprises a ring (20) separating the pivot (10) and the cervical portion (11) promoting their sliding during their relative rotations.
5. Elément fémoral (4) de prothèse de hanche selon l'une des revendications 1 à 4, caractérisé en ce qu'il comporte des moyens empêchant ou limitant le glissement longitudinal relatif du pivot (10) et de la partie cervicale (11 ).5. Femoral element (4) of hip prosthesis according to one of claims 1 to 4, characterized in that it comprises means preventing or limiting the relative longitudinal sliding of the pivot (10) and the cervical portion (11). .
6. Elément fémoral (4) de prothèse de hanche selon la revendication 5, caractérisé en ce que lesdits moyens empêchant ou limitant le glissement longitudinal relatif du pivot (10) et de la partie cervicale (11 ) sont constitués par un capuchon (21 ) fixé à l'extrémité proximale du pivot (10). Hip prosthesis femoral component (4) according to claim 5, characterized in that said means preventing or limiting the relative longitudinal sliding of the pivot (10) and the cervical part (11) consist of a cap (21). attached to the proximal end of the pivot (10).
7. Elément fémoral (4) de prothèse de hanche selon l'une des revendications 1 à 6, caractérisé en ce que l'excroissance formant pivot (10) et l'extrémité proximale (9) de la partie distale (8) présentent une angulation par rapport à l'axe longitudinal de la partie distale (8).Hip prosthesis femoral component (4) according to one of claims 1 to 6, characterized in that the pivot-shaped protrusion (10) and the proximal end (9) of the distal portion (8) have a angulation with respect to the longitudinal axis of the distal portion (8).
8. Elément fémoral (4) de prothèse de hanche selon la revendication 7, caractérisé en ce que le pivot (10) présente une angulation (α) de 5 à 20° par rapport à l'axe longitudinal de la partie distale (8).Hip prosthesis femoral component (4) according to claim 7, characterized in that the pivot (10) has an angulation (α) of 5 to 20 ° with respect to the longitudinal axis of the distal portion (8). .
9. Elément fémoral (4) de prothèse de hanche selon l'une des revendications 1 à 8, caractérisé en ce qu'il comporte un plot (22) sur l'une de l'extrémité proximale (9) de la partie distale (8) et de la face inférieure de la partie cervicale (11 ) et une rainure dans laquelle vient s'insérer le plot (22), ménagée dans l'autre de l'extrémité proximale (9) de la partie distale (8) et de la face inférieure de la partie cervicale (11 ).9. Femoral element (4) of hip prosthesis according to one of claims 1 to 8, characterized in that it comprises a stud (22) on one of the proximal end (9) of the distal portion ( 8) and the underside of the cervical portion (11) and a groove in which the stud (22) engages in the other of the proximal end (9) of the distal portion (8) and from the underside of the cervical portion (11).
10. Prothèse totale de hanche, comportant un élément fémoral (4) et un co- tyle artificiel (3) pour la réception d'une tête sphérique (5) de l'élément fémoral (4), caractérisée en ce que ledit élément fémoral (4) est du type selon l'une des revendications 1 à 9. 10. Total hip prosthesis, comprising a femoral component (4) and an artificial cotylate (3) for receiving a spherical head (5) of the femoral component (4), characterized in that said femoral component (4) is of the type according to one of claims 1 to 9.
PCT/FR2008/051870 2007-10-17 2008-10-16 Femoral component for a hip prosthesis, and total hip prosthesis comprising same WO2009053650A2 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP08841513A EP2205187A2 (en) 2007-10-17 2008-10-16 Femoral component for a hip prosthesis, and total hip prosthesis comprising same

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR0758383A FR2922436B1 (en) 2007-10-17 2007-10-17 FEMORAL ELEMENT OF HIP PROSTHESIS, AND TOTAL HIP PROSTHESIS COMPRISING IT.
FR0758383 2007-10-17

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WO2009053650A2 true WO2009053650A2 (en) 2009-04-30
WO2009053650A3 WO2009053650A3 (en) 2009-07-16

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EP (1) EP2205187A2 (en)
FR (1) FR2922436B1 (en)
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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE202010005333U1 (en) 2010-04-29 2010-06-24 Aesculap Ag Endoprosthesis, in particular for an artificial hip joint, and hip prosthesis
DE102010016695A1 (en) 2010-04-29 2011-11-03 Aesculap Ag Endoprosthesis for use in hip implant at hip region of patient, has coupling element acting in axial direction and gripped at proximal and distal parts, so that proximal part is held at distal part in unlocked position

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0220803A2 (en) * 1985-09-16 1987-05-06 Dow Corning Corporation Multiple component hip femoral prosthesis
FR2605514A1 (en) * 1986-10-27 1988-04-29 Dufour Guillaume Hip prosthesis
EP0485311A1 (en) * 1990-11-06 1992-05-13 Merck Biomaterial France Stem for hip prosthesis
US5286260A (en) * 1986-08-15 1994-02-15 Depuy Inc. Modular hip prosthesis
EP1013242A2 (en) * 1998-12-18 2000-06-28 Benoist Girard Et Cie Femoral component
WO2005087142A2 (en) * 2004-03-11 2005-09-22 Amit Mor Rotatable head of enarthrotic prosthesis

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0220803A2 (en) * 1985-09-16 1987-05-06 Dow Corning Corporation Multiple component hip femoral prosthesis
US5286260A (en) * 1986-08-15 1994-02-15 Depuy Inc. Modular hip prosthesis
FR2605514A1 (en) * 1986-10-27 1988-04-29 Dufour Guillaume Hip prosthesis
EP0485311A1 (en) * 1990-11-06 1992-05-13 Merck Biomaterial France Stem for hip prosthesis
EP1013242A2 (en) * 1998-12-18 2000-06-28 Benoist Girard Et Cie Femoral component
WO2005087142A2 (en) * 2004-03-11 2005-09-22 Amit Mor Rotatable head of enarthrotic prosthesis

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE202010005333U1 (en) 2010-04-29 2010-06-24 Aesculap Ag Endoprosthesis, in particular for an artificial hip joint, and hip prosthesis
DE102010016695A1 (en) 2010-04-29 2011-11-03 Aesculap Ag Endoprosthesis for use in hip implant at hip region of patient, has coupling element acting in axial direction and gripped at proximal and distal parts, so that proximal part is held at distal part in unlocked position

Also Published As

Publication number Publication date
WO2009053650A3 (en) 2009-07-16
FR2922436B1 (en) 2010-01-08
EP2205187A2 (en) 2010-07-14
FR2922436A1 (en) 2009-04-24

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