WO1991016016A1 - Hip prosthesis tail designed for cement-free implantation, and device therefor - Google Patents

Hip prosthesis tail designed for cement-free implantation, and device therefor Download PDF

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Publication number
WO1991016016A1
WO1991016016A1 PCT/FR1991/000297 FR9100297W WO9116016A1 WO 1991016016 A1 WO1991016016 A1 WO 1991016016A1 FR 9100297 W FR9100297 W FR 9100297W WO 9116016 A1 WO9116016 A1 WO 9116016A1
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WO
WIPO (PCT)
Prior art keywords
tail
hip prosthesis
channels
prosthesis tail
retentive
Prior art date
Application number
PCT/FR1991/000297
Other languages
French (fr)
Inventor
François Carton
Jean-Jacques Ficat
Arturo Tricarico
Original Assignee
Biotecnic
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Publication date
Application filed by Biotecnic filed Critical Biotecnic
Publication of WO1991016016A1 publication Critical patent/WO1991016016A1/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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4601—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
    • 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
    • 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
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3662—Femoral shafts
    • A61F2/3676—Distal or diaphyseal 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • 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
    • A61F2/28—Bones
    • A61F2002/2835—Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • A61F2002/30113—Rounded shapes, e.g. with rounded corners circular
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • A61F2002/30125—Rounded shapes, e.g. with rounded corners elliptical or oval
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/3082—Grooves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/3082—Grooves
    • A61F2002/30823—Grooves having the shape of a reverse dovetail
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/3625—Necks
    • A61F2002/3631—Necks with an integral complete or partial peripheral collar or bearing shoulder at its base
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/365—Connections of heads to necks
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • A61F2230/0006—Rounded shapes, e.g. with rounded corners circular
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • A61F2230/0008—Rounded shapes, e.g. with rounded corners elliptical or oval

Definitions

  • the invention relates to a hip prosthesis tail intended to be implanted without cement, and extends to a device intended to allow the implantation of this hip prosthesis tail.
  • the classic technique of implanting hip prosthesis tails is to fix them in the medullary cavity of the femur using cement.
  • this technique has several drawbacks leading to a high percentage of failures, namely, in particular, a defect in the holding of the prosthesis due to the risks of cement reactivation, or an intolerance of the body towards the foreign body that constitutes this cement.
  • hip prosthesis tails have made it possible to reduce the percentage of failures, they nevertheless have several drawbacks, one of which is directly linked to the mode of implantation of these prostheses which consists in seeking intimate cortical contact with hard friction. to ensure their stability.
  • the present invention aims to overcome this drawback of current hip prosthesis tails intended to be placed without cement, and has the essential objective of providing a hip prosthesis tail of simple design making it possible to obtain immediate and lasting stability of said tail. prosthesis without requiring excessive cortical friction during implantation.
  • Another object of the invention is to provide a prosthesis tail which can be extracted without particular difficulties, if necessary.
  • the invention relates to a hip prosthesis tail intended to be implanted without cement and comprising a femoral stem and an upper pivot arranged so that its axis forms an angle relative to the diaphyseal axis of the stem, said prosthesis stem being characterized in that it comprises, horizontally, channels extending at least partially along the femoral stem, each of said channels having in the metaphyseal zone a cross section of dimensions and retentive shape adapted to partially accommodate and ensuring the maintenance of a compressible biocompatible material, introduced into the latter before implantation of the prosthesis tail in order to increase the cross section of the metaphyseal zone of said prosthesis tail.
  • Such a hip prosthesis tail is therefore oversized transversely thanks to the presence of the compressible material held in the retentive canals. Therefore, it has longitudinally strips of compressible material playing the role of an elastic seal which comes to crash against the cortical wall thus ensuring perfect stability of the prosthesis tail without risk of fracture of this wall due to the compressible nature of said seal. It should also be noted that the efficiency of these longitudinal strips of compressible material is increased due to their positioning in areas of compressive stress.
  • the presence of retentive canals on the surface of the femoral stem leads to an increase in the bone / implant interface surface and, consequently, to an increase in the possibilities of bone fixation and to a reduction in stresses per unit of surface. .
  • each retentive channel has a depth of at least two millimeters and a width of at least four millimeters.
  • the channels have a retentive shape over a length corresponding substantially to the upper half of the femoral stem, and extend in the form of streaks in the lower half of said stem.
  • the channels have a length allowing the maintenance of a band of compressible material of satisfactory length, and, on the other hand, if a recovery proves necessary, the anchoring is mainly located in the metaphyseal area easily accessible during the intervention.
  • the tail of the hip prosthesis has decreasing dimensions from top to bottom, and the retentive canals have a bottom extending along a plane parallel to the anteroposterior median plane.
  • This arrangement makes it possible to produce retentive channels having a sufficient depth to ensure the maintenance of the compressible material, without excessively weakening the femoral stem.
  • the retentive canals are formed so as to open at the upper metaphyseal end of the femoral stem, in order to allow additional supply of compressible material if necessary.
  • the invention also extends to a device intended to allow cementless implantation of a hip prosthesis tail comprising:
  • e-graft pusher having a rod of shape conjugated with that of the canals of the hip prosthesis tail, adapted to be introduced into said canals by their open upper end, in order to provide additional intake of biocompatible material in these.
  • FIG. 1 is a perspective view of a hip prosthesis tail according to the invention
  • FIGS. 2 and 3 are cross-sections respectively through a plane A and a plane B
  • - Figure 4 is a perspective view of an instrument, called graft pushers, according to the invention.
  • the device represented in the figures consists of two elements: a hip prosthesis tail 1 intended to be introduced into the medullary cavity of a femur, and a graft pusher 2 intended to allow an additional supply of materials, cancellous bone or compressible biocompatible material, in the retentive channels of the prosthesis tail 1.
  • the prosthesis tail 1 represented in FIG. 1 is composed of a femoral stem 4 surmounted by a collar 5-
  • the latter is extended by a neck 6 itself extended by a conical pivot 7 of base diameter greater than that of said neck, delimiting a shoulder 7a with the latter.
  • the axis of the neck 6 also forms an angle of 130 ° with the axis "diaphyseal of the femoral stem 4.
  • the flange 5 extends beyond the internal side to form a support 5a with the calcar.
  • the femoral stem 4 consists of two parts each affecting approximately , half the length of this rod 4: a lower diaphyseal part 4a of circular section and a high metaphyseal part 4b of ovoid section. These two low parts 4a and high 4b have increasing dimensions from the bottom to the top, and they are connected without discontinuity.
  • the femoral stem 4 further comprises two channels 8 formed frontally symmetrically on either side of the anteroposterior median plane, and emerging at the upper metaphyseal end of this stem.
  • These channels 8 are, moreover, arranged so that their bottom extends along a plane parallel to the anteroposterior median plane. They therefore have maximum dimensions at their high opening and accessible end, and decreasing from top to bottom.
  • these channels 8 Over a length corresponding substantially to the upper half of the femoral stem 4, these channels 8 have a retentive shape, while they extend in the form of streaks in the lower half of the stem 4-
  • these channels 8 are obtained by shaping the latter so that they have a generally oblong shape, and have a flat bottom connected to the external surface of the femoral stem 4 by two walls in the form of rounded sectors.
  • this femoral stem 4 is provided in the upper part, and parallel to each retentive groove 8, with two longitudinal ridges 9, 10.
  • the graft pusher 2 is intended to allow additional supply of cancellous bone or compressible biocompatible material inside the retentive canals 8, once the prosthesis tail 1 is implanted in the medullary cavity of a femur. "This graft pusher comprises a tabular handle 11 in the extension of which extends a rod 12 of dimensions substantially smaller than the maximum dimensions of the retentive channels 8.

Abstract

A tail (1) for a hip prosthesis designed for cement-free implantation and comprising a femoral shaft (4) and an upper pivot (6, 7) arranged so that its axis is at an angle to the diaphysial axis of the shaft. The front of said tail includes canals (8) extending at least partially along the length of the femoral shaft (4), each of said canals having in the metaphysial region a cross-sectional shape and size which are suitable for partially accommodating and holding a compressible biocompatible material inserted therein prior to the implantation of the tail in order to increase the cross-sectional area of the metaphysial region of said tail.

Description

QUEUE DE PROTHESE DE HANCHE DESTINEE A ETRE IMPLANTEE SANS CIMENT ET DISPOSITIF DESTINE A PERMETTRE L'IMPLANTATION DE CETTE QUEUE DE PROTHESE DE HANCHE. TAIL OF HIP PROSTHESIS INTENDED TO BE IMPLANTED WITHOUT CEMENT AND DEVICE INTENDED TO ENABLE THE ESTABLISHMENT OF THIS TAIL OF HIP PROSTHESIS.
L'invention concerne une queue de prothèse de hanche destinée à être implantée sans ciment, et s'étend à un dispositif destiné à permettre l'implantation de cette queue de prothèse de hanche. La technique classique d'implantation de queues de prothèse de hanche consiste à fixer ces dernières dans la cavité médullaire du fémur au moyen d'un ciment. Toutefois, cette technique présente plusieurs inconvénients conduisant à un pourcentage élevé d'échecs, à savoir, notamment, un défaut de tenue de la prothèse dû aux risques de ractionnement du ciment, ou une intolérance de l'organisme vis à vis du corps étranger que constitue ce ciment.The invention relates to a hip prosthesis tail intended to be implanted without cement, and extends to a device intended to allow the implantation of this hip prosthesis tail. The classic technique of implanting hip prosthesis tails is to fix them in the medullary cavity of the femur using cement. However, this technique has several drawbacks leading to a high percentage of failures, namely, in particular, a defect in the holding of the prosthesis due to the risks of cement reactivation, or an intolerance of the body towards the foreign body that constitutes this cement.
Pour ces raisons, les recherches se sont orientées vers la conception de prothèses pouvant être implantées sans ciment, et ont abouti à la mise au point de queues de prothèses, telles que décrites dans les brevets français FR 2.356.465, FR 2.529=077, FR 2.637-494, le brevet allemand DE 837294 ou le brevet US 3-905.047, présentant une surface externe adaptée pour permettre le développement du tissu osseux et assurer ainsi l'ancrage de ces queues de prothèse dans l'os.For these reasons, research has focused on the design of prostheses that can be implanted without cement, and has led to the development of prosthesis tails, as described in French patents FR 2,356,465, FR 2,529 = 077, FR 2,637-494, the German patent DE 837294 or the US patent 3-905.047, having an external surface adapted to allow the development of bone tissue and thus ensure the anchoring of these prosthesis tails in the bone.
Bien que de telles queues de prothèse de hanche aient permis de réduire le pourcentage d'échecs, elles présentent toutefois plusieurs inconvénients, dont un notamment est directement lié au mode d'implantation de ces prothèses qui consiste à rechercher un contact cortical intime à frottement dur en vue d'assurer leur stabilité.Although such hip prosthesis tails have made it possible to reduce the percentage of failures, they nevertheless have several drawbacks, one of which is directly linked to the mode of implantation of these prostheses which consists in seeking intimate cortical contact with hard friction. to ensure their stability.
Dans la pratique, en effet, on constate que, malgré la minutie des chirurgiens, la recherche de ce contact intime conduit à deux types d'"accidents" post-opératoires. En premier lieu, si la queue de prothèse est légèrement sous- dimensionnée par rapport au fut diaphysaire, il s'ensuit un enfoncement progressif de la tige fémorale dans ce fut diaphysaire qui expose le patient à un raccourcissement du membre concerné et à une luxation secondaire de la prothèse par instabilité". En second lieu, si au contraire la queue de prothèse est légèrement surdimensionnée, il s'ensuit un frottement trop important qui expose le patient à une fracture fémorale particulièrement à craindre pour une personne âgée en raison de l'amincissement cortical lié au vieillissement.In practice, in fact, we note that, despite the thoroughness of the surgeons, the search for this intimate contact leads to two types of post-operative "accidents". First, if the prosthesis tail is slightly undersized compared to the diaphyseal shaft, it follows a progressive sinking of the femoral stem in this diaphyseal shaft which exposes the patient to a shortening of the limb concerned and to secondary dislocation prosthesis by instability " . Secondly, if, on the contrary, the prosthesis tail is slightly oversized, this results in excessive friction which exposes the patient to a femoral fracture which is particularly feared for an elderly person due to the cortical thinning linked to aging.
La présente invention vise à pallier cet inconvénient des queues de prothèse de hanche actuelles destinées à être posées sans ciment, et a pour objectif essentiel de fournir une queue de prothèse de hanche de conception simple permettant d'obtenir une stabilité immédiate et durable de ladite queue de prothèse sans nécessiter un frottement cortical trop important lors de l'implantation.The present invention aims to overcome this drawback of current hip prosthesis tails intended to be placed without cement, and has the essential objective of providing a hip prosthesis tail of simple design making it possible to obtain immediate and lasting stability of said tail. prosthesis without requiring excessive cortical friction during implantation.
Un autre objectif de l'invention est de fournir une queue de prothèse pouvant être extraite sans difficultés particulières, en cas de nécessité.Another object of the invention is to provide a prosthesis tail which can be extracted without particular difficulties, if necessary.
(Pour faciliter la compréhension et simplifier la terminologie, la prothèse sera décrite et définie ci-après en la supposant dans sa position d'implantation).(To facilitate understanding and simplify the terminology, the prosthesis will be described and defined below, assuming it in its implantation position).
A cet effet, l'invention vise une queue de prothèse de hanche destinée à être implantée sans ciment et comportant une tige fémorale et un pivot supérieur agencé de façon que son axe forme un angle par rapport à l'axe diaphysaire de la tige, ladite queue de prothèse étant caractérisée en ce qu'elle comprend, f rontalement , des canaux s'étendant au moins partiellement le long de la tige fémorale, chacun desdits canaux présentant en zone métaphysaire une section transversale de dimensions et de forme rétentive adaptées pour loger partiellement et assurer le maintien d'un matériau biocompatible compressible, introduit dans ces derniers avant implantation de la queue de prothèse en vue d'augmenter la section transversale de la zone métaphysaire de ladite queue de prothèse. Lors de son implantation, une telle queue de prothèse de hanche est donc surdimensionnée transversalement grâce à la présence du matériau compressible maintenu dans les canaux rétentifs. De ce fait, elle possède longitudinalement des bandes de matériau compressible jouant le rôle d'un joint élastique qui vient s'écraser contre la paroi corticale assurant ainsi une stabilité parfaite de la queue de prothèse sans risque de fracture de cette paroi en raison de la nature compressible dudit joint. II est à noter, en outre, que l'efficacité de ces bandes longitudinales de matériau compressible est accrue du fait de leur positionnement dans des zones de contrainte en compression.To this end, the invention relates to a hip prosthesis tail intended to be implanted without cement and comprising a femoral stem and an upper pivot arranged so that its axis forms an angle relative to the diaphyseal axis of the stem, said prosthesis stem being characterized in that it comprises, horizontally, channels extending at least partially along the femoral stem, each of said channels having in the metaphyseal zone a cross section of dimensions and retentive shape adapted to partially accommodate and ensuring the maintenance of a compressible biocompatible material, introduced into the latter before implantation of the prosthesis tail in order to increase the cross section of the metaphyseal zone of said prosthesis tail. During its implantation, such a hip prosthesis tail is therefore oversized transversely thanks to the presence of the compressible material held in the retentive canals. Therefore, it has longitudinally strips of compressible material playing the role of an elastic seal which comes to crash against the cortical wall thus ensuring perfect stability of the prosthesis tail without risk of fracture of this wall due to the compressible nature of said seal. It should also be noted that the efficiency of these longitudinal strips of compressible material is increased due to their positioning in areas of compressive stress.
Par ailleurs, la présence de canaux rétentifs en surface de la tige fémorale conduit à une augmentation de la surface d'interface os/implant et, par conséquent, à une augmentation des possibilités de fixation osseuse et à une diminution des contraintes par unité de surface.Furthermore, the presence of retentive canals on the surface of the femoral stem leads to an increase in the bone / implant interface surface and, consequently, to an increase in the possibilities of bone fixation and to a reduction in stresses per unit of surface. .
Selon un mode de réalisation préférentiel, chaque canal rétentif présente une profondeur d'au moins deux millimètres et une largeur d'au moins quatre millimètres.According to a preferred embodiment, each retentive channel has a depth of at least two millimeters and a width of at least four millimeters.
Selon une autre caractéristique de l'invention, les canaux présentent une forme rétentive sur une longueur correspondant sensiblement à la moitié supérieure de la tige fémorale, et se prolongent sous la forme de stries dans la moitié inférieure de ladite tige.According to another characteristic of the invention, the channels have a retentive shape over a length corresponding substantially to the upper half of the femoral stem, and extend in the form of streaks in the lower half of said stem.
De ce fait, d'une part, les canaux présentent une longueur permettant le maintien d'une bande de matériau compressible de longueur satisfaisante, et, d'autre part, si une reprise s'avère nécessaire, l'ancrage se situe principalement dans la zone métaphysaire facilement accessible lors de l'intervention.Therefore, on the one hand, the channels have a length allowing the maintenance of a band of compressible material of satisfactory length, and, on the other hand, if a recovery proves necessary, the anchoring is mainly located in the metaphyseal area easily accessible during the intervention.
Selon une autre caractéristique de l'invention, la queue de prothèse de hanche présente des dimensions décroissantes du haut vers le bas, et les canaux rétentifs comportent un fond s'étendant selon un plan parallèle au plan médian antéro-postérieur.According to another characteristic of the invention, the tail of the hip prosthesis has decreasing dimensions from top to bottom, and the retentive canals have a bottom extending along a plane parallel to the anteroposterior median plane.
Cette disposition permet de réaliser des canaux rétentifs présentant une profondeur suffisante pour assurer le maintien du matériau compressible, sans fragiliser en excès la tige fémorale.This arrangement makes it possible to produce retentive channels having a sufficient depth to ensure the maintenance of the compressible material, without excessively weakening the femoral stem.
Par ailleurs, selon un mode de réalisation préférentiel, les canaux rétentifs sont ménagés de façon à déboucher au niveau de l'extrémité haute métaphysaire de la tige fémorale, en vue de permettre un complément d'apport de matériau compressible si nécessaire.Furthermore, according to a preferred embodiment, the retentive canals are formed so as to open at the upper metaphyseal end of the femoral stem, in order to allow additional supply of compressible material if necessary.
L'invention s'étend, en outre, à un dispositif destiné à permettre l'implantation sans ciment d'une queue de prothèse de hanche comprenant :The invention also extends to a device intended to allow cementless implantation of a hip prosthesis tail comprising:
- une queue de prothèse de hanche telle que décrite ci-dessus, dont les canaux rétentifs débouchent au niveau de l'extrémité haute métaphysaire de la tige fémorale,a hip prosthesis tail as described above, the retentive channels of which open at the upper metaphyseal end of the femoral stem,
- un instrument, dit pouss e- greffons présentant une tige de forme conjuguée de celle des canaux de la queue de prothèse de hanche, adaptée pour être introduite dans lesdits canaux par leur extrémité supérieure débouchante, en vue de réaliser un complément d'apport de matériau biocompatible dans ces derniers. D'autres caractéristiques, buts et avantages de l'invention ressortiront de la description détaillée qui suit en référence aux dessins annexés qui en représentent, à titre d'exemple non limitatif, un mode de réalisation préférentiel. Sur ces dessins qui font partie intégrante de la présente description :- an instrument, called e-graft pusher having a rod of shape conjugated with that of the canals of the hip prosthesis tail, adapted to be introduced into said canals by their open upper end, in order to provide additional intake of biocompatible material in these. Other characteristics, objects and advantages of the invention will emerge from the detailed description which follows with reference to the appended drawings which represent, by way of non-limiting example, a preferred embodiment. On these drawings which form an integral part of this description:
- la figure 1 est une vue en perspective d'une queue de prothèse de hanche conforme à l'invention,FIG. 1 is a perspective view of a hip prosthesis tail according to the invention,
- les figures 2 et 3 en sont des coupes transversales respectivement par un plan A et un plan B, - la figure 4 est une vue en perspective d'un instrument, dit pousse-greffons, conforme à l'invention.- Figures 2 and 3 are cross-sections respectively through a plane A and a plane B, - Figure 4 is a perspective view of an instrument, called graft pushers, according to the invention.
Le dispositif représenté aux figures se compose de deux éléments : une queue de prothèse de hanche 1 destinée à être introduite dans la cavité médullaire d'un fémur, et un pousse-greffons 2 destiné à permettre un complément d'apport de matériaux, os spongieux ou matériau biocompatible compressible, dans les canaux rétentifs de la queue de prothèse 1.The device represented in the figures consists of two elements: a hip prosthesis tail 1 intended to be introduced into the medullary cavity of a femur, and a graft pusher 2 intended to allow an additional supply of materials, cancellous bone or compressible biocompatible material, in the retentive channels of the prosthesis tail 1.
En premier lieu, la queue de prothèse 1 représentée à la figure 1 est composée d'une tige fémorale 4 surmontée d'une collerette 5- Cette dernière est prolongée par un col 6 lui-même prolongé par un pivot conique 7 de diamètre de base supérieur à celui dudit col, délimitant un épaulement 7a avec ce dernier. L'axe du col 6 forme en outre un angle de 130° avec l'axe "diaphysaire de la tige fémorale 4. De plus, en l'exemple, la collerette 5 déborde du côté interne pour former un appui 5a avec le calcar. La tige fémorale 4 se compose de deux parties affectant chacune approximativement, la moitié de la longueur de cette tige 4 : une partie basse diaphysaire 4a de section circulaire et une partie haute métaphysaire 4b de section ovoïde . Ces deux parties basse 4a et haute 4b présentent des dimensions croissantes depuis le bas vers le haut, et elles se raccordent sans discontinuité.Firstly, the prosthesis tail 1 represented in FIG. 1 is composed of a femoral stem 4 surmounted by a collar 5- The latter is extended by a neck 6 itself extended by a conical pivot 7 of base diameter greater than that of said neck, delimiting a shoulder 7a with the latter. The axis of the neck 6 also forms an angle of 130 ° with the axis "diaphyseal of the femoral stem 4. In addition, in the example, the flange 5 extends beyond the internal side to form a support 5a with the calcar. The femoral stem 4 consists of two parts each affecting approximately , half the length of this rod 4: a lower diaphyseal part 4a of circular section and a high metaphyseal part 4b of ovoid section. These two low parts 4a and high 4b have increasing dimensions from the bottom to the top, and they are connected without discontinuity.
La tige fémorale 4 comprend, en outre, deux canaux 8 ménagés frontalement symétriquement de part et d'autre du plan médian antéro-postérieur, et débouchant au niveau de l'extrémité supérieure métaphysaire de cette tige.The femoral stem 4 further comprises two channels 8 formed frontally symmetrically on either side of the anteroposterior median plane, and emerging at the upper metaphyseal end of this stem.
Ces canaux 8 sont, en outre, ménagés de façon que leur fond s'étende selon un plan parallèle au plan médian antéro-postérieur. Ils présentent par conséquent des dimensions maximales au niveau de leur extrémité haute débouchante et accessible, et décroissantes depuis le haut vers le bas.These channels 8 are, moreover, arranged so that their bottom extends along a plane parallel to the anteroposterior median plane. They therefore have maximum dimensions at their high opening and accessible end, and decreasing from top to bottom.
Sur une longueur correspondant sensiblement à la moitié supérieure de la tige fémorale 4, ces canaux 8 présentent une forme rétentive, tandis qu'ils se prolongent sous la forme de stries dans la moitié inférieure de la tige 4-Over a length corresponding substantially to the upper half of the femoral stem 4, these channels 8 have a retentive shape, while they extend in the form of streaks in the lower half of the stem 4-
Le caractère rétentif de ces canaux 8 est obtenu en conformant ces derniers de façon qu'ils présentent une forme générale oblongue, et comportent un fond plat relié à la surface externe de la tige fémorale 4 par deux parois en forme de secteurs arrondis.The retentive nature of these channels 8 is obtained by shaping the latter so that they have a generally oblong shape, and have a flat bottom connected to the external surface of the femoral stem 4 by two walls in the form of rounded sectors.
Enfin, cette tige fémorale 4 est dotée en partie haute, et parallèlement à chaque rainure rétentive 8 de deux stries 9, 10 longitudinales.Finally, this femoral stem 4 is provided in the upper part, and parallel to each retentive groove 8, with two longitudinal ridges 9, 10.
Le pousse-greffons 2 est destiné à permettre un complément d'apport d'os spongieux ou de matériau biocompatible compressible à l'intérieur des canaux rétentifs 8, une fois la queue de prothèse 1 implantée dans la cavité médullaire d'un fémur. " Ce pousse-greffons comporte un manche tabulaire 11 dans le prolongement duquel s'étend une tige 12 de dimensions sensiblement inférieures aux dimensions maximales des canaux rétentifs 8. The graft pusher 2 is intended to allow additional supply of cancellous bone or compressible biocompatible material inside the retentive canals 8, once the prosthesis tail 1 is implanted in the medullary cavity of a femur. "This graft pusher comprises a tabular handle 11 in the extension of which extends a rod 12 of dimensions substantially smaller than the maximum dimensions of the retentive channels 8.

Claims

REVENDICATIONS
1/ - Queue de prothèse de hanche (1 ) destinée à être implantée sans ciment et comportant une tige fémorale (4) et un pivot supérieur (6, 7) agencé de façon que son axe forme un angle par rapport à l'axe diaphysaire de la tige, ladite queue de prothèse étant caractérisée en ce qu'elle comprend, f rontale ent , des canaux (8) s'étendant au moins partiellement le long de la tige fémorale (4), chacun desdits canaux présentant en zone métaphysaire une section transversale de dimensions et de forme rétentive adaptées pour loger partiellement et assurer le maintien d'un matériau biocompatible compressible, introduit dans ces derniers avant implantation de la queue de prothèse en vue d'augmenter la section transversale de la zone métaphysaire de ladite queue de prothèse.1/ - Hip prosthesis tail (1) intended to be implanted without cement and comprising a femoral stem (4) and an upper pivot (6, 7) arranged so that its axis forms an angle relative to the diaphyseal axis of the stem, said prosthesis tail being characterized in that it comprises, frontally, channels (8) extending at least partially along the femoral stem (4), each of said channels having in the metaphyseal zone a cross section of dimensions and retentive shape adapted to partially accommodate and ensure the maintenance of a compressible biocompatible material, introduced into the latter before implantation of the prosthesis tail in order to increase the cross section of the metaphyseal zone of said tail of prosthesis.
2/ - Queue de prothèse de hanche (1 ) selon la revendication 1 , caractérisée en ce que chaque canal rétentif (8) présente une profondeur d'au moins deux millimètres et une largeur d'au moins quatre millimètres.2/ - Hip prosthesis tail (1) according to claim 1, characterized in that each retentive channel (8) has a depth of at least two millimeters and a width of at least four millimeters.
3/ - Queue de prothèse de hanche (1) selon l'une des revendications 1 ou 2; caractérisée en ce que les canaux (8) présentent une forme rétentive sur une longueur correspondant sensiblement à la moitié supérieure de la tige fémorale (4), et se prolongent sous la forme de stries dans la moitié inférieure de ladite tige.3/ - Hip prosthesis tail (1) according to one of claims 1 or 2 ; characterized in that the channels (8) have a retentive shape over a length corresponding substantially to the upper half of the femoral stem (4), and extend in the form of grooves in the lower half of said stem.
4/ - Queue de prothèse de hanche (1) selon l'une des revendications 1, 2 ou 3 comportant une tige fémorale (4) de dimensions décroissantes depuis le haut vers le bas, caractérisée en ce que les canaux rétentifs (8) présentent un fond s'étendant selon un plan parallèle au plan médian antéro-postérieur.4/ - Hip prosthesis tail (1) according to one of claims 1, 2 or 3 comprising a femoral stem (4) of decreasing dimensions from top to bottom, characterized in that the retentive channels (8) have a bottom extending along a plane parallel to the antero-posterior median plane.
5/ - Queue de prothèse de hanche (1) selon l'une des revendications 1 à 4, caractérisée en ce que les canaux rétentifs (8) présentent une forme générale oblongue et comportent un fond plat relié à la surface externe de la tige fémorale (4) par deux parois en forme de secteurs arrondis.5/ - Hip prosthesis tail (1) according to one of claims 1 to 4, characterized in that the retention channels (8) have a generally oblong shape and have a flat bottom connected to the external surface of the femoral stem (4) by two walls in the shape of rounded sectors.
6/ - Queue de prothèse de hanche (1) selon l'une des revendications 1 à ~, caractérisée en ce qu'elle comprend deux canaux rétentifs (8) ménagés frontalement, symétriquement par rapport au plan médian antéro-postérieur.6/ - Hip prosthesis tail (1) according to one of claims 1 to ~ , characterized in that it comprises two retentive channels (8) provided frontally, symmetrically in relation to the anteroposterior median plane.
7/ - Queue de prothèse de hanche (1) selon l'une des revendications 1 à 6, caractérisée en ce que les canaux rétentifs (8) sont ménagés de façon à déboucher au niveau de l'extrémité haute métaphysaire de la tige fémorale7/ - Hip prosthesis tail (1) according to one of claims 1 to 6, characterized in that the retentive channels (8) are provided so as to open at the level of the upper metaphyseal end of the femoral stem
(4).(4).
8/ - Dispositif destiné à permettre l'implantation sans ciment d'une queue de prothèse de hanche, caractérisé en ce qu'il comprend :8/ - Device intended to allow the implantation without cement of a hip prosthesis tail, characterized in that it comprises:
- une queue de prothèse de hanche (1) conforme à la revendication 7,- a hip prosthesis tail (1) according to claim 7,
- un instrument (2), dit pousse-greffons présentant une tige (12) de forme conjuguée de celle des canaux (8) de la queue de prothèse de hanche (1), adaptée pour être introduite dans lesdits canaux par leur extrémité supérieure débouchante, en vue de réaliser un complément d'apport de matériau biocompatible dans, ces derniers. - an instrument (2), called a graft pusher, having a rod (12) of shape combined with that of the channels (8) of the hip prosthesis tail (1), adapted to be introduced into said channels through their opening upper end , with a view to providing additional biocompatible material in the latter.
PCT/FR1991/000297 1990-04-13 1991-04-11 Hip prosthesis tail designed for cement-free implantation, and device therefor WO1991016016A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR90/05159 1990-04-13
FR9005159A FR2660854A1 (en) 1990-04-13 1990-04-13 DEVICE FOR ALLOWING THE CEMENTITIOUS IMPLANTATION OF A HIP PROSTHESIS TAIL, AND FOR ACCELERATING THE OSTEOGENESIS.

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FR (1) FR2660854A1 (en)
WO (1) WO1991016016A1 (en)

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WO1999003429A3 (en) * 1997-07-14 1999-04-08 Volkmar Jansson Compression endoprosthesis system

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US6371991B1 (en) 1996-12-23 2002-04-16 Depuy Orthopaedics, Inc. Alignment guide for fluted prosthetic stems
CA2225375A1 (en) * 1996-12-23 1998-06-23 Mark Manasas Alignment guide for insertion of fluted or keyed orthopedic components

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GB549999A (en) * 1941-09-06 1942-12-17 Cecil Cooke Hand-pressure surgical bone gouge
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FR2578738A1 (en) * 1985-03-14 1986-09-19 Alfieri Antoine Self-stable femoral rod with maximum support for hip prosthesis
DE8705921U1 (en) * 1987-04-21 1988-05-19 Mecron Medizinische Produkte Gmbh, 1000 Berlin, De
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WO1999003429A3 (en) * 1997-07-14 1999-04-08 Volkmar Jansson Compression endoprosthesis system

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FR2660854B1 (en) 1995-03-31
AU7771791A (en) 1991-11-11
FR2660854A1 (en) 1991-10-18

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