WO1994026211A1 - Articular surface prosthesis - Google Patents

Articular surface prosthesis Download PDF

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Publication number
WO1994026211A1
WO1994026211A1 PCT/DE1994/000578 DE9400578W WO9426211A1 WO 1994026211 A1 WO1994026211 A1 WO 1994026211A1 DE 9400578 W DE9400578 W DE 9400578W WO 9426211 A1 WO9426211 A1 WO 9426211A1
Authority
WO
WIPO (PCT)
Prior art keywords
replacement
joint surface
joint
bone
articular surface
Prior art date
Application number
PCT/DE1994/000578
Other languages
German (de)
French (fr)
Inventor
Ulrich Gross
Original Assignee
Ulrich Gross
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 Ulrich Gross filed Critical Ulrich Gross
Priority to AU67929/94A priority Critical patent/AU6792994A/en
Publication of WO1994026211A1 publication Critical patent/WO1994026211A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30907Nets or sleeves applied to surface of prostheses or in cement
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    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
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    • A61F2/30756Cartilage endoprostheses
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    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/32Joints for the hip
    • A61F2/36Femoral heads ; Femoral endoprostheses
    • A61F2/3601Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices
    • A61F2/3603Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices implanted without ablation of the whole natural femoral head
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    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/28Materials for coating prostheses
    • A61L27/30Inorganic materials
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    • A61F2/00Filters 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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    • A61F2002/30004Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
    • A61F2002/30011Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis differing in porosity
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    • A61F2/00Filters 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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    • A61F2002/30003Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006Properties of materials and coating materials
    • A61F2002/30062(bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
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    • A61F2/00Filters 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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    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30563Special structural features of bone or joint prostheses not otherwise provided for having elastic means or damping means, different from springs, e.g. including an elastomeric core or shock absorbers
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    • A61F2/30749Fixation appliances for connecting prostheses to the body
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    • A61L2430/00Materials or treatment for tissue regeneration
    • A61L2430/24Materials or treatment for tissue regeneration for joint reconstruction

Definitions

  • the invention relates to an at least partial joint surface replacement according to the preamble of claim 1.
  • both joint surfaces are usually replaced by artificially coordinated before joint parts are replaced in order to ensure a suitable pairing of the joint surfaces.
  • the layer forming the bearing material also differs from an area designed especially for anchoring in the bone. In this case, however, the sliding surface of the joint replacement is formed exclusively by a foreign material.
  • a further disadvantage is that the healthy counter surface of a diseased joint part also has to be replaced in many cases, that large parts of healthy bone tissue must also be removed when full stem prostheses are inserted, and that the result is an unphysiological introduction of the forces occurring during loading into the bearing tissue .
  • the invention is based on the object of specifying an articular surface replacement for an at least partially cartilaged articular surface of a joint, in particular a chronically degenerative disease, in which the articular surface is relieved and at the same time the cartilaginous area of the articular surface is essentially preserved or restored in order to to maintain a physiological pairing of the sliding surfaces - and thus optimal storage conditions.
  • the invention includes the knowledge that a thin-walled covering provided with recesses or passages Layering, or a corresponding spatial area, which is arranged directly on or directly in the partially cartilaged joint surface, enables the ingrowth and / or growth of cartilage or a cartilage generator through the perforated wall, so that a pairing of two at least partially cartilaginous articular surfaces can be maintained, even when an articular surface replacement is used. Grafting in the manner of a dowel is also possible. It is particularly important here that the over-cartilage and the joint capsule producing the joint lubricant are preserved as completely as possible.
  • the partial replacement of the joint surface leads to relief of the remaining joint surface, since the forces acting on it are largely derived through it.
  • the part of the articular surface that is also relieved of pressure can regenerate and a cartilage regenerate can grow through the pores to the surface of the joint surface replacement.
  • the internal openings and the porous structure ensure integration into the natural bone substance. Furthermore, the forming cartilage structure is also supplied by connection to the body's own vascular system.
  • abrasion elements of the cartilage can remain on the joint surface according to the invention, such as the body's own tissue, in the joint space. Even in the long term, these do not impair the joint function.
  • the invention takes into account in particular that the natural joint of articulating articular surfaces, which are covered with a pressure-resistant support tissue - the cartilage - in the support area, of a joint capsule, which consists of an outer fibrous layer of tight collagenous connective tissue, which is located on the edge of the cartilaginous surfaces in the periosteum is formed, and consists of an inner joint skin, which secretes a synovial fluid, a fluid that nourishes the superficial cartilage layer (synovia). With the measures according to the invention, these conditions for the diseased and replaced joint surface are largely restored in terms of function.
  • the layers of the joint surface replacement are matched to those of the adjacent bone / cartilage tissue.
  • the joint replacement according to the invention can preferably be used in osteoarthritis, a chronic degenerative joint disease in which the mobility of the joint is considerably restricted with simultaneous permanent pain.
  • osteoarthritis a chronic degenerative joint disease in which the mobility of the joint is considerably restricted with simultaneous permanent pain.
  • an imbalance between the stress and the condition or performance of the individual joint parts and the joint tissue can occur, whereby an inferior condition of the biological materials involved in the joint apparatus can be acquired or acquired.
  • the functionality of the joint capsule as a producer of joint lubrication, by means of which the superficial cartilage layers are nourished by diffusion, is also of considerable importance since insufficiently nourished cartilage layers degenerate and can no longer serve as pressure-resistant support tissue. nen. Wear damage occurs in the event of long-term disturbances in the performance stress balance.
  • Direct overuse damage is caused by heavy work, sport or excessive body weight. Indirect overuse damage is caused by a reduction in the performance of the joint capsule to produce joint lubrication, by endogenous disorders, which can occur in particular as a result of increasing age or in the case of metabolic changes and inflammation.
  • the originally restricted joint function can largely be restored and also permanently maintained by the measures according to the invention, because the targeted partial replacement of joint areas eliminates the centers which are responsible for the symptoms, with the result that the function of the joint is harmonized again is, so that there is no longer any reason for further pathological changes in response to the previous malfunction.
  • the erosion of the articular cartilage which is degenerated due to overstressing, furthermore leads to the fact that pressure and friction cause particles from the pathologically altered articular cartilage to get into the moving parts of the joint, the biologically active components of which then cause inflammation of the synovial membrane producing the synovial fluid cause and thus cause pain. Furthermore, this inflammation leads to fibrillation and de-marking of the cartilage substance.
  • the cartilage substance is abraded under stress and / or movement of the joint - in many cases to the point of complete abrasion Narrowing of the joint gap in the area of the strongest pressure and the formation of bulges in the stress-free edge zones can occur. Initially, feelings of tension and stiffness appear in the affected joints, which then change into initial pain during joint movements. These are probably due to the joint partners sticking together if the amount of joint lubrication is insufficient. Finally, stress and permanent pain can occur.
  • the joint surface replacement according to the invention can be used in particular in the region of a concave outer surface of a joint surface, such as, for example, in a socket in a hip joint socket and / or in the region of a convex outer surface of a joint surface, such as, for example, in a bowl-like manner on a femoral head.
  • the joint surface replacement has a semi-rigid or flexible lattice or rust-like or cancellous, i.e. spongy, structure on.
  • a base body made of titanium sheet can serve as a carrier material for both layers.
  • Other body-compatible metals or metal alloys are also suitable.
  • the joint surface replacement is designed in the manner of an expanded metal which has slots which extend exclusively in one direction.
  • the expanded metal expands in a direction transverse to the slot extension, the slot width widens in the direction of expansion.
  • inorganic material in particular calcium carbonate and / or phosphate with a lamellar structure and porous structure, especially in the form of (de-proteinated) coralline material - is used, which was expediently impregnated with pieces of cartilage.
  • this material acts as a pioneering material in the sense of a "guided tissue regeneration” and can be resorbed in the course of the tissue regeneration directed by it, so that it can no longer be detected as such several months after an implantation .
  • bone tissue was formed on the side of the implant facing the bone - in a neutral to slightly acidic environment via the stages of penetration and organization of blood, colonization with bone cells and the build-up of trabeculae with the biophysical stress of the corresponding spatial structure, so that there is a strong anchoring between the implant and the bone.
  • Mineralization of the cartilage tissue (introduced by the impregnation) has occurred in the interior of the implant, and a (non-mineralized) cartilage layer has formed in the surface area. This represents a regenerative structure that is appropriately graduated in depth.
  • cartilage structure it can be expedient to prevent an undesired deep growth of the cartilage structure by providing a - preferably likewise resorbable - release film or adhesive proteins and / or by replacing part of the synovial fluid with a resorptive fluid. mass that can be displaced postoperatively to displace blood cells or organizational tissue from the joint.
  • a felt, lamellar polymer structures for example made of PTFE
  • resorbable glasses or cements with a corresponding spatial structure or composites can be used, the surface of which, on the one hand, has a good bone connection and, on the other hand, over-cartilage with regard to the pore size and, if necessary, depth-grading allows.
  • the (micro) pores are at least partially filled with a reactive and resorbable material which, over time, when the replacement of the articular surface on the articular surface grows through cartilage generat in the over-cartilaginous part or through bone tissue in deeper areas of the sub - chondral joint region is displaced.
  • a reactive and resorbable material which, over time, when the replacement of the articular surface on the articular surface grows through cartilage generat in the over-cartilaginous part or through bone tissue in deeper areas of the sub - chondral joint region is displaced.
  • This can be, for example, a synthetic synovial fluid which prevents an undesired accumulation of blood and / or fat tissue cells (organizational tissue) in the area of cartilage growth postoperatively.
  • the joint surface replacement preferably has layers that overlap both the cartilaginous and the articulating joint surfaces.
  • the joint surface replacement is fastened to the prepared joint surface by means of particularly resorbable pins which are inserted into the bone through these tabs.
  • resorbable sticks When resorbable sticks are used, they are completely resorbed by the body at a point in time when they are no longer required as fastening devices. The point in time is reached as soon as sufficient bone tissue or cartilage generation has grown into the micropores of the joint surface replacement to give the joint surface replacement a secure hold on the subchondral bone.
  • pins are lowered into the corresponding recesses within the joint surface.
  • the side of the joint surface replacement according to the invention facing the at least partially cartilaged joint surface before the bone is preferably coated with hydroxylapatite, bioactive glass or glass ceramic in order to promote the anchoring of the joint surface replacement.
  • the replacement of the articular surface can also consist of a composite material which forms a biomechanical situation adapted to the bone and which favors the growth of cartilage or a cartilage regenerate close to the surface.
  • FIG. 1 shows a frontal section through a hip joint provided with an exemplary embodiment of the joint surface replacement according to the invention
  • FIG. 2 shows an enlarged detailed illustration of the exemplary embodiment according to FIG. 1 in a section of the femur
  • FIG. 3 shows a further exemplary embodiment of the joint surface replacement according to the invention when used in the region of the knee joint
  • FIG. 4 shows a further exemplary embodiment of the joint surface replacement according to the invention in use in the area of the shoulder corner joint, in section,
  • FIG. 4a shows a (simplified) top view of the joint surface replacement according to FIG. 4,
  • Figure 5 is a cross-sectional view of a modified joint surface replacement for the knee joint
  • FIG. 6 shows a cross-sectional representation of a further joint surface replacement for the knee joint that is modified compared to FIG. 3.
  • FIGS. 1 and 2 show a section in the area of the femur, with both parts (femur part 1 and acetabulum 2) of the hip joint being shown together in FIG. 1.
  • the hip bone 3 has an approximately acetabular cup-shaped hip socket 2, of which only a crescent-shaped zone 4 is cartilaginous.
  • the non-cartilaginous cup depth 7 is filled with loose connective tissue and fat tissue 8 as well as blood vessels and also bears the attachment point of the femoral head band 9.
  • This non-cartilaginous cup depth 7 is covered by a synovial membrane which secretes the synovial fluid, synovia, and the like continues ventrally on the femoral head band 9.
  • the fat and connective tissue bodies 8 have the function of a shock absorber and, depending on the prevailing pressure conditions, are pulled out or drawn in under the femoral head band 9.
  • FIG. 1 An embodiment of the joint surface replacement 10 according to the invention for the femur (FIG. 1) is highlighted in its position by a frame II.
  • the partial joint surface replacement 10 has a multi-layer structure, as can be seen from the illustration in FIG. 2, which forms an enlarged representation.
  • Layer 11 provided on the surface has a structure with relatively narrow pores or openings 12, which allows over-cartilage, while a further layer 13, which has a surface facing the adjacent bone, has a cancellous bone designed for growing in or growing on the adjacent bones Has structure with relatively larger openings 14.
  • the joint surface replacement forms a columnar insert which tapers slightly towards the bone side.
  • the joint surface replacement shown has in particular a thin-walled, cap-shaped outer layer or coating which replaces the corresponding natural joint layer. This is adapted to the nature, abrasion resistance and slidability of its surface of the body's own cartilage substance facing the opposite joint surface in the relevant joint surface area in such a way that the action on it essentially corresponds to that of a natural joint surface.
  • the partial replacement of the articular surface - as it is also shown in more detail in the following figures - corresponds to a (convex or concave) shell-shaped envelope surface with respect to the articular surface, which, in contrast to the previous concepts, does not have a continuous wall, but one with holes or free spaces excellent perforated membrane or cancellous structure.
  • the perforated shell or pan is in particular designed in such a way that it fits on the correspondingly trimmed bone and that a grafting with cartilage material is also possible.
  • the side of the implant facing the bone enables the anchoring of bone material and thus contributes to a stable situation of the prosthesis.
  • a coating is particularly favorable - preferably with calcium phosphate and / or carbonate, with bioactive glass or glass ceramic.
  • the prosthesis consists of a composite material which simulates a biomechanical situation adapted to the bone and thereby promotes the growth of cartilage or a cartilage regenerate.
  • FIG. 3 shows, as a further embodiment, a joint surface replacement 20 used in the area of the knee joint in a lateral sectional illustration. This is designed as a replacement of the articular surface for the tibia 5 in the form of a cap.
  • the basic structure of the thin-walled joint surface replacement 20 is preferably made of titanium sheet and has micropores 22 or a spongy structure across the entire surface of the wall 21.
  • the concave inner surface of the joint surface replacement 20 facing it is provided with a coating 23 which has pores 25 with a larger diameter than the micropores 22 and the growth of bone material favored on the joint surface replacement 20.
  • Suitable materials for such coatings 25 are, for example, calcium phosphates (approximately Aragonite) and / or phosphates, bioactive glass or glass ceramic.
  • the joint surface replacement 20 is first inserted by flush insertion into a correspondingly created recess by pressing in with a firm fit in the damaged area of the joint surface. This is followed by an additional connection by the growth of bone material on the one hand and by cartilage in the area of the joint surface on the other hand, so that overall a defect structure corresponding to the function and strength of the natural bone and joint tissue is produced. By filling pores with resorbable material, the growth can be promoted by replacing this material with newly acquired bone substance.
  • micropores 22 can also be filled with a resorbable material 24 which is displaced by cartilage 6 on the one hand and bone material on the other hand.
  • the articular surface elements which are solid in the embodiments shown so far, are inserted into the bore or recess thus created after drilling out or otherwise clearing out a corresponding volume, such as dowels.
  • Primary fixation which can already withstand pressure loads due to bearing forces, is thus initially ensured by flush contact of the lateral surfaces. The fixation is then supported by the further secondary fixation, which takes place through the growth and ingrowth using the inner pores and breakthroughs.
  • FIGS. 4 and 4a show a further preferred embodiment of the joint surface replacement 30 according to the invention for use in the area of the shoulder corner joint 31 (part of the upper arm).
  • the round cross-sectional shape of the cup-like insert, which is shown in section in FIG. 4, can be seen in the top view shown in FIG. 4a.
  • a likewise thin-walled, pan-like and perforated titanium sheet body forms the basis of the joint surface replacement 30 here.
  • a large part of the crescent-shaped over-cartilage joint surface 34 is retained or is newly formed as a natural replacement (cartilage regenerate) within the surface layer of the replacement region 30.
  • the tissue structure and the structure of the implant otherwise correspond to the illustration in FIG. 3, so that a detailed inscription and description can be dispensed with.
  • the attachment is carried out by driving in, with the existing bone material penetrating into the "cup" in places and ensuring fixation and gradual growth there.
  • FIG. 5 shows a modification of the embodiment shown in FIG. 3, in which a one-piece implant 20 'consisting of de-proteinated and coraline calcium carbonate (aragonite) soaked with cartilage particles is used as a joint surface replacement in the knee joint.
  • a one-piece implant 20 'consisting of de-proteinated and coraline calcium carbonate (aragonite) soaked with cartilage particles is used as a joint surface replacement in the knee joint.
  • the implant is chemically homogeneous, and the size and shape distribution of the pores 22 'filled with cartilage tissue 24' in the mineral framework 23 'is statistical.
  • a differentiation of - not sharply delimited - spatial areas 20a 1 , 20b 'and 20c' in the implant results in this embodiment from the proximity to different body tissue, to the cartilage tissue 6 in the near surface area and to the bone tissue 26 in the lower area, and from the type of interaction with these tissues in the course of ingrowth.
  • FIG. 6 A further modification of this embodiment is shown in FIG. 6:
  • an implant there is a three-layer body 20 "with an upper, cartilage-impregnated layer 20a” made of coral material, a collagen separating layer 20b "and a lower, non-impregnated layer 20c” made of coral material Material provided.
  • the waxing-in takes place in a manner similar to that described above in relation to FIG. 5, but the collagen layer prevents any undesired growth of cartilage in the depth and ensures that the area is secured the layer 20c "can form undisturbed bone tissue. It is also resorbed in the course of ingrowth.
  • the task of the collagen layer in FIG. 6 can also be fulfilled by special adhesive proteins, and the joint gap can be partially filled with a liquid (for example the synthetic joint liquid Sinudal) which displaces the blood cells and thus additionally promoting the formation of a tissue layer structure with functionally advantageous depth grading.
  • a liquid for example the synthetic joint liquid Sinudal
  • attachment can optionally be carried out with, in particular, resorbable pins, which gradually lose their holding force after the implant is fixed by waxing.
  • hip joint will be the most important application for the joint surface replacement according to the invention, this can also be used in connection with all other joint surfaces of conventional joint endoprostheses, by which one of the joint surfaces is replaced, while the opposite joint surface in its natural one Function can be retained. If necessary, when replacing areas of both articular surfaces, the replaced articular surface areas can also overlap one another in whole or in part and thereby interact.
  • the embodiment of the invention is not limited to the preferred exemplary embodiment specified above. Rather, a number of variants are conceivable which make use of the solution shown, even in the case of fundamentally different types.

Abstract

An at least partial articular surface prosthesis has an open-pore three-dimensional structure with a three-dimensional area whose surface at least partially replaces an articular surface, the structure of which being so designed that during ingrowth a coverage of cartilage is formed, and a second three-dimension area with a surface opposite the adjacent bone in which the structure is so designed that it produces the ingrowth or surface growth of bone tissue, and/or forms a hollow body open only towards the bone for receiving the grown bone structure. The surface which replaces the articular surface has a convex or concave rounded shape which substantially corresponds to the local articular surface geometry in the vicinity of the articular surface prosthesis.

Description

Gelenkflächenersatz Joint replacement
B e s c h r e i b u n gDescription
Die Erfindung betrifft einen mindestens partiellen Gelenk¬ flächenersatz nach dem Oberbegriff des Anspruchs 1.The invention relates to an at least partial joint surface replacement according to the preamble of claim 1.
Bei den bekannten Gelenkprothesen werden üblicherweise beide Gelenkflächen durch aufeinander abgestimmte künstli- ehe Gelenkteile ersetzt, um eine geeignete Paarung der Ge¬ lenkoberflächen sicherzustellen. Zwar unterscheidet sich hierbei auch die den Lagerwerkstoff bildende Schicht von einem insbesondere für die Verankerung im Knochen ausge- stalteten Bereich. Hierbei wird die Gleitfläche des Gelen- kersatzes jedoch ausschließlich durch einen körperfremden Werkstoff gebildet.In the known joint prostheses, both joint surfaces are usually replaced by artificially coordinated before joint parts are replaced in order to ensure a suitable pairing of the joint surfaces. The layer forming the bearing material also differs from an area designed especially for anchoring in the bone. In this case, however, the sliding surface of the joint replacement is formed exclusively by a foreign material.
Nachteilig ist ferner, daß dabei vielfach auch die gesunde Gegenfläche eines erkrankten Gelenkteils ersetzt werden muß, daß beim Einsetzen von vollständigen Schaftprothesen große Teile auch gesunden Knochengewebes entfernt werden müssen und daß dann auch eine unphysiologische Einleitung der bei Belastung auftretenden Kräfte in das Lagergewebe die Folge ist.A further disadvantage is that the healthy counter surface of a diseased joint part also has to be replaced in many cases, that large parts of healthy bone tissue must also be removed when full stem prostheses are inserted, and that the result is an unphysiological introduction of the forces occurring during loading into the bearing tissue .
Der Erfindung liegt die Aufgabe zugrunde, einen Gelenkflä¬ chenersatz für eine mindestens teilweise überknorpelte Ge¬ lenkoberfläche eines insbesondere chronisch degenerativ erkrankten Gelenks anzugeben, bei der die Gelenkoberfläche entlastet und gleichzeitig der überknorpelte Bereich der Gelenkoberfläche im wesentlichen erhalten bzw. wiederher¬ gestellt wird, um eine physiologische Paarung der Gleit¬ flächen - und damit optimale Lagerverhältnisse - aufrecht- zuerhalten.The invention is based on the object of specifying an articular surface replacement for an at least partially cartilaged articular surface of a joint, in particular a chronically degenerative disease, in which the articular surface is relieved and at the same time the cartilaginous area of the articular surface is essentially preserved or restored in order to to maintain a physiological pairing of the sliding surfaces - and thus optimal storage conditions.
Diese Aufgabe wird mit den kennzeichnenden Merkmalen des Anspruchs 1 gelöst.This object is achieved with the characterizing features of claim 1.
Die Erfindung schließt die Erkenntnis ein, daß eine dünn¬ wandige, mit Ausnehmungen oder Durchlässen versehene Be- Schichtung, oder ein entsprechender räumlicher Bereich, der direkt auf oder unmiitelbar bei der teilweise über- knorpelten Gelenkoberfläche angeordnet ist, das Einwachsen und/oder Wachstum von Knorpel bzw. eines Knorpelgenerats durch die perforierte Wandung hindurch ermöglicht, so daß eine Gleitpaarung von zwei mindestens teilweise überknor- pelten Gelenkoberflächen, selbst bei eingesetztem Gelenk¬ flächenersatz, aufrechterhalten werden kann. Außerdem ist auch eine Pfropfung nach Art einer Dübelung möglich. Wich- tig hierbei ist insbesondere, daß die Überknorpelung und die die Gelenkschmiere produzierende Gelenkkapsel mög¬ lichst vollständig erhalten werden. Der partielle Gelenk¬ flächenersatz führt zur Entlastung der verbliebenen ge¬ wachsenen Gelenkoberfläche, da über ihn die einwirkenden Kräfte zum größten Teil abgeleitet werden. Der somit eben¬ falls entlastete überknorpelte Teil der Gelenkoberfläche kann sich regenerieren und ein Knorpelregenerat kann durch die Poren hindurch, bis zur Oberfläche des Gelenkfläche- nersatzs wachsen.The invention includes the knowledge that a thin-walled covering provided with recesses or passages Layering, or a corresponding spatial area, which is arranged directly on or directly in the partially cartilaged joint surface, enables the ingrowth and / or growth of cartilage or a cartilage generator through the perforated wall, so that a pairing of two at least partially cartilaginous articular surfaces can be maintained, even when an articular surface replacement is used. Grafting in the manner of a dowel is also possible. It is particularly important here that the over-cartilage and the joint capsule producing the joint lubricant are preserved as completely as possible. The partial replacement of the joint surface leads to relief of the remaining joint surface, since the forces acting on it are largely derived through it. The part of the articular surface that is also relieved of pressure can regenerate and a cartilage regenerate can grow through the pores to the surface of the joint surface replacement.
Durch die inneren Durchbrüche und die poröse Struktur fin¬ det eine Einbindung in die natürliche Knochensubstanz statt. Ferner erfolgt auch eine Versorgung der sich bil¬ denden KnorpelStrukt r durch Anbindung an das körpereigene Gefäßsystem.The internal openings and the porous structure ensure integration into the natural bone substance. Furthermore, the forming cartilage structure is also supplied by connection to the body's own vascular system.
Insbesondere können hierbei auch Abriebelemente des Knor¬ pels bei der erfindungsgemäßen Gelenkoberfläche wie körpereigenes Gewebe im Gelenkraum verbleiben. Diese füh- ren auch langfristig nihct zu Beeinträchtigungen der Ge¬ lenkfunktion. Die Erfindung berücksichtigt dabei insbesondere, daß das natürliche Gelenk aus artikulierenden Gelenkflächen, die mit einem druckfesten Stützgewebe - dem Knorpel - im Auf¬ lagebereich überzogen sind, aus einer Gelenkkapsel, die aus einer äußeren fibrösen Schicht aus straffem kollagenen Bindegewebe, die sich am Rand der überknorpelten Flächen in die Knochenhaut fortsetzend ausgebildet ist, und aus einer Gelenkinnenhaut besteht, welche eine Gelenkschmiere, eine die oberflächliche Knorpelschicht ernährendene Flüs- sigkeit (Synovia), absondert. Durch die erfindungsgemäßen Maßnahmen werden diese Verhältnisse für die erkrankte und zu ersetzende Gelenkfläche funktionsmäßig weitgehend wie¬ derhergestellt. Die Schichtungen des Gelenkflächenersatzes sind denjenigen des benachbarten Knochen-/Knorpelgewebes angepaßt.In particular, abrasion elements of the cartilage can remain on the joint surface according to the invention, such as the body's own tissue, in the joint space. Even in the long term, these do not impair the joint function. The invention takes into account in particular that the natural joint of articulating articular surfaces, which are covered with a pressure-resistant support tissue - the cartilage - in the support area, of a joint capsule, which consists of an outer fibrous layer of tight collagenous connective tissue, which is located on the edge of the cartilaginous surfaces in the periosteum is formed, and consists of an inner joint skin, which secretes a synovial fluid, a fluid that nourishes the superficial cartilage layer (synovia). With the measures according to the invention, these conditions for the diseased and replaced joint surface are largely restored in terms of function. The layers of the joint surface replacement are matched to those of the adjacent bone / cartilage tissue.
Der erfindungsgemäße Gelenkersatz kann bevorzugt Anwendung finden bei Arthrose, einer chronischen degenerativen Ge¬ lenkerkrankung, bei der die Beweglichkeit des Gelenks bei gleichzeitigen Dauerschmerzen erheblich eingeschränkt ist. Im Verlauf einer Arthrose kann sich ein Mißverhältnis zwi¬ schen Beanspruchung und Beschaffenheit bzw. Leistungsfä¬ higkeit der einzelnen Gelenkanteile und des Gelenkgewebes einstellen, wobei eine minderwertige Beschaffenheit der am Gelenkapparat beteiligten biologischen Materialien angebo¬ ren oder erworben sein kann. Die Funktionstüchtigkeit der Gelenkkapsel als Produzentin der Gelenkschmiere, durch welche die oberflächlichen Knorpelschichten mittels Diffu¬ sion ernährt werden, ist auch von erheblicher Bedeutung, da nicht ausreichend ernährte Knorpelschichten degenerie¬ ren und nicht mehr als druckfestes Stützgewebe dienen kön- nen. Abnutzungsschäden treten bei langdauernden Störungen der Leistungsbeanspruchungsbilanz auf. Direkte Überbean¬ spruchungsschäden werden durch Schwerarbeit, Sport oder zu großes Körpergewicht verursacht. Indirekte Überbeanspru¬ chungsschäden werden durch eine Verminderung der Lei¬ stungsfähigkeit der Gelenkkapsel, Gelenkschmiere zu produ¬ zieren, durch endogene Störungen verursacht, die insbeson¬ dere infolge zunehmenden Alters oder bei Stoffwechselver¬ änderungen sowie Entzündungen eintreten können.The joint replacement according to the invention can preferably be used in osteoarthritis, a chronic degenerative joint disease in which the mobility of the joint is considerably restricted with simultaneous permanent pain. In the course of osteoarthritis, an imbalance between the stress and the condition or performance of the individual joint parts and the joint tissue can occur, whereby an inferior condition of the biological materials involved in the joint apparatus can be acquired or acquired. The functionality of the joint capsule as a producer of joint lubrication, by means of which the superficial cartilage layers are nourished by diffusion, is also of considerable importance since insufficiently nourished cartilage layers degenerate and can no longer serve as pressure-resistant support tissue. nen. Wear damage occurs in the event of long-term disturbances in the performance stress balance. Direct overuse damage is caused by heavy work, sport or excessive body weight. Indirect overuse damage is caused by a reduction in the performance of the joint capsule to produce joint lubrication, by endogenous disorders, which can occur in particular as a result of increasing age or in the case of metabolic changes and inflammation.
Durch die erfindungsgemäßen Maßnahmen kann die ursprüng¬ lich eingeschränkte Gelenkfunktion weitgehend wiederherge¬ stellt und auch permanent aufrechterhalten werden, weil durch den gezielten partiellen Ersatz von Gelenkbereichen die für die Beschwerden ursächlichen Zentren beseitigt werden, mit der Folge, daß damit die Funktion des Gelenks wieder harmonisiert ist, so daß zu weiteren krankhaften Umbildungen als Reaktion auf die bisherige Fehlfunktion kein Anlaß mehr besteht.The originally restricted joint function can largely be restored and also permanently maintained by the measures according to the invention, because the targeted partial replacement of joint areas eliminates the centers which are responsible for the symptoms, with the result that the function of the joint is harmonized again is, so that there is no longer any reason for further pathological changes in response to the previous malfunction.
Die Erosion des aufgrund einer Überbeanspruchung degene¬ rierten Gelenkknorpels führt weiterhin dazu, daß durch Druck und Reibung Partikel aus dem pathologisch veränder¬ ten Gelenkknorpel in den bewegten Teilen des Gelenks ge- langen, deren biologisch aktive Bestandteile dann eine Entzündung der die Gelenkschmiere produzierende Membrana synovialis hervorrufen und somit Schmerzen verursachen. Weiterhin führt diese Entzündung zur Auffaserung und De¬ markation der Knorpelsubstanz. Die Knorpelsubstanz wird bei Belastung und/oder Bewegung des Gelenks - vielfach bis zum vollständigen Aufrieb - abgeschliffen, wobei es zur Verengung des Gelenkspalts im Bereich des stärksten Drucks und zur Wulstbildung in den belastungsfreien Randzonen kommen kann. Anfänglich treten Spannungsgefühle und Stei- figkeit in den betroffenen Gelenken auf, die dann in An¬ fangsschmerzen bei Gelenkbewegungen übergehen. Diese sind wahrscheinlich auf eine Verklebung der gelenkigen Partner bei nicht ausreichender Gelenkschmierenmenge zurückzufüh¬ ren. Schließlich können Belastungs- und Dauerschmerzen auftreten.The erosion of the articular cartilage, which is degenerated due to overstressing, furthermore leads to the fact that pressure and friction cause particles from the pathologically altered articular cartilage to get into the moving parts of the joint, the biologically active components of which then cause inflammation of the synovial membrane producing the synovial fluid cause and thus cause pain. Furthermore, this inflammation leads to fibrillation and de-marking of the cartilage substance. The cartilage substance is abraded under stress and / or movement of the joint - in many cases to the point of complete abrasion Narrowing of the joint gap in the area of the strongest pressure and the formation of bulges in the stress-free edge zones can occur. Initially, feelings of tension and stiffness appear in the affected joints, which then change into initial pain during joint movements. These are probably due to the joint partners sticking together if the amount of joint lubrication is insufficient. Finally, stress and permanent pain can occur.
Der erfindungsgemäße Gelenkflächenersatz ist insbesondere anwendbar im Bereich einer konkaven Außenfläche einer Ge¬ lenkoberfläche, wie beispielsweise pfannenartig in einer Hüftgelenkpfanne und/oder im Bereich einer konvexen Außen- fläche einer Gelenkoberfläche, wie beispielsweise schalen¬ artig auf einem Femurkopf.The joint surface replacement according to the invention can be used in particular in the region of a concave outer surface of a joint surface, such as, for example, in a socket in a hip joint socket and / or in the region of a convex outer surface of a joint surface, such as, for example, in a bowl-like manner on a femoral head.
Der Gelenkflächenersatz weist in einer speziellen Ausbil¬ dung eine halbstarre oder flexible gitter- oder rostartige oder spongiöse, d.h. schwammartige, Struktur auf. Es kann etwa ein solcher Grundkörper aus Titanblech als Trägerma¬ terial für beide Schichten dienen. Weiterhin kommen auch andere körperverträgliche Metalle oder Metallegierungen in Betracht.In a special design, the joint surface replacement has a semi-rigid or flexible lattice or rust-like or cancellous, i.e. spongy, structure on. Such a base body made of titanium sheet can serve as a carrier material for both layers. Other body-compatible metals or metal alloys are also suitable.
Bei einer weiteren Ausführungsform ist der Gelenkfläche¬ nersatz nach Art eines Streckmetalls ausgebildet, welches sich ausschließlich in eine Richtung erstreckende Schlitze aufweist. Bei einer Ausdehnung des Streckmetalls in einer quer zur Schlitzerstreckung verlaufenden Richtung erwei¬ tert sich die Schlitzbreite in Ausdehnungsrichtung. In einer bevorzugten Ausführungsform wird anorganisches Material - insbesondere Calciumcarbonat und/oder -phosphat mit lamellarem Aufbau und poröser Struktur, speziell etwa in Gestalt von (enteiweißtem) korallinem Material - einge- setzt, das vorab zweckmäßigerweise mit Knorpelstückchen getränkt wurde. Dieses Material wirkt - wie der Erfinder festgestellt hat - als wegweisendes Material im Sinne ei¬ ner "guided-tissue regeneration" und kann im Laufe der von ihm gelenkten Gewebsregeneration resorbiert werden, so daß es mehrere Monate nach einer Implantation nicht mehr als solches nachweisbar ist.In a further embodiment, the joint surface replacement is designed in the manner of an expanded metal which has slots which extend exclusively in one direction. When the expanded metal expands in a direction transverse to the slot extension, the slot width widens in the direction of expansion. In a preferred embodiment, inorganic material - in particular calcium carbonate and / or phosphate with a lamellar structure and porous structure, especially in the form of (de-proteinated) coralline material - is used, which was expediently impregnated with pieces of cartilage. As the inventor has determined, this material acts as a pioneering material in the sense of a "guided tissue regeneration" and can be resorbed in the course of the tissue regeneration directed by it, so that it can no longer be detected as such several months after an implantation .
In dieser Zeit wurde an der dem Knochen zugewandten Seite des Implantats - in neutraler bis leicht saurer Umgebung über die Stufen des Eindringens und der Organisation von Blut, der Besiedlung mit Knochenzellen und des Aufbaus von Knochenbälkchen mit der biophysikalischen Beanspruchung entsprechender Raumstruktur Knochengewebe gebildet, so daß eine belastungsfähige Verankerung zwischen Implantat und Knochen erfolgt. Im Innenbereich des Implantats hat sich eine Mineralisierung des (durch die Tränkung eingebrach¬ ten) Knorpelgewebes vollzogen, und im Oberflächenbereich hat sich eine (nicht mineralisierte) Knorpelschicht ausge¬ bildet. Dies stellt eine zweckmäßig in der Tiefe gestaf- feite Regeneratstruktur dar.During this time, bone tissue was formed on the side of the implant facing the bone - in a neutral to slightly acidic environment via the stages of penetration and organization of blood, colonization with bone cells and the build-up of trabeculae with the biophysical stress of the corresponding spatial structure, so that there is a strong anchoring between the implant and the bone. Mineralization of the cartilage tissue (introduced by the impregnation) has occurred in the interior of the implant, and a (non-mineralized) cartilage layer has formed in the surface area. This represents a regenerative structure that is appropriately graduated in depth.
Zu deren Erzielung kann es zweckmäßig sein, durch Vorsehen einer - vorzugsweise ebenfalls resorbierbaren - Trennfolie oder von Haft-Proteinen ein nicht erwünschtes Tiefenwachs- turn der Knorpelstruktur zu unterbinden und/oder durch Er¬ satz eines Teiles der Gelenkflüssigkeit durch eine resor- bierbare Masse postoperativ Blutzellen bzw. Organisations¬ gewebe aus dem Gelenk zu verdrängen.To achieve this, it can be expedient to prevent an undesired deep growth of the cartilage structure by providing a - preferably likewise resorbable - release film or adhesive proteins and / or by replacing part of the synovial fluid with a resorptive fluid. mass that can be displaced postoperatively to displace blood cells or organizational tissue from the joint.
In anderen Ausführungsformen können ein Filz, lamellare Polymerstrukturen (etwa aus PTFE), resorbierbare Gläser oder Zemente mit entsprechender Raumstruktur bzw. Komposi- te verwendet werden, deren Oberfläche bezüglich der Poren¬ größe und ggfs. -tiefenstaffeiung einerseits eine gute Knochenanbindung und andererseits eine Überknorpelung zu- läßt.In other embodiments, a felt, lamellar polymer structures (for example made of PTFE), resorbable glasses or cements with a corresponding spatial structure or composites can be used, the surface of which, on the one hand, has a good bone connection and, on the other hand, over-cartilage with regard to the pore size and, if necessary, depth-grading allows.
Bei einer anderen vorteilhaften Weiterbildung sind die (Mikro-)Poren mindestens zum Teil mit einem reaktiven und resorbierbaren Material ausgefüllt, welches mit der Zeit beim Anwachsen des Gelenkflächenersatzes an die Gelenk¬ oberfläche durch Knorpelgenerat im überknorpelten Teil bzw. durch Knochengewebe in tieferen Bereichen der sub- chondralen Gelenkregion verdrängt wird. Dies kann etwa ei¬ ne synthetische Gelenkflüssigkeit sein, die postoperativ eine unerwünschte Anreicherung von Blut- und/oder Fettge¬ webezellen (Organisationsgewebe) im Knorpelanwachsbereich unterbindet.In another advantageous further development, the (micro) pores are at least partially filled with a reactive and resorbable material which, over time, when the replacement of the articular surface on the articular surface grows through cartilage generat in the over-cartilaginous part or through bone tissue in deeper areas of the sub - chondral joint region is displaced. This can be, for example, a synthetic synovial fluid which prevents an undesired accumulation of blood and / or fat tissue cells (organizational tissue) in the area of cartilage growth postoperatively.
Der Gelenkflächenersatz weist bevorzugt an seinem Rand La- sehen auf, die sowohl die überknorpelten als auch die ar¬ tikulierenden Gelenkoberflächen übergreifen. Mittels ins¬ besondere resorbierbarer Stifte, die durch diese Laschen hindurch in den Knochen eingeführt werden, wird der Ge¬ lenkflächenersatz auf der vorbereiteten Gelenkoberfläche befestigt. Bei der Verwendung von resorbierbaren Stiften werden diese mit der Zeit, zu einem Zeitpunkt, zu dem sie nicht mehr als Befestigungsvorrichtungen benötigt werden, vom Körper vollständig resorbiert. Der Zeitpunkt wird erreicht, so- bald genügend Knochengewebe bzw. Knorpelgenerat in die Mi- kroporen des Gelenkflächenersatzes eingewachsen sind, um dem Gelenkflächenersatz einen sicheren Halt am subchondra- len Knochen zu geben.At its edge, the joint surface replacement preferably has layers that overlap both the cartilaginous and the articulating joint surfaces. The joint surface replacement is fastened to the prepared joint surface by means of particularly resorbable pins which are inserted into the bone through these tabs. When resorbable sticks are used, they are completely resorbed by the body at a point in time when they are no longer required as fastening devices. The point in time is reached as soon as sufficient bone tissue or cartilage generation has grown into the micropores of the joint surface replacement to give the joint surface replacement a secure hold on the subchondral bone.
Bei einer weiteren vorteilhaften Ausbildung des erfin¬ dungsgemäßen Gelenkflächenersatzes werden Stifte innerhalb der Gelenkoberfläche in entsprechende Aussparungen ver¬ senkt.In a further advantageous embodiment of the joint surface replacement according to the invention, pins are lowered into the corresponding recesses within the joint surface.
Selbst bei beidseitiger Anordnung eines Gelenkflächener¬ satzes wirken die überknorpelten Gelenkoberflächen aufein¬ ander, so daß stets physiologische Lagerverhältnisse bei¬ behalten werden können bei einer gleichzeitigen Aufrecht¬ erhaltung der Gleitschmiereproduktion in der Gelenkkapsel, die weiterhin durch die mikroporigen Durchquerungen des erfindungsgemäßen Gelenkflächenersatzes bis zu den über¬ knorpelten Gelenkoberflächen durchdringen kann.Even when a joint surface replacement is arranged on both sides, the cartilaged joint surfaces act on one another, so that physiological bearing conditions can always be maintained while at the same time maintaining the lubricating lubricant production in the joint capsule, which is further increased by the microporous traversals of the joint surface replacement according to the invention can penetrate cartilaginous joint surfaces.
Die der mindestens teilweise überknorpelten Gelenkoberflä- ehe des Knochens zugewandte Seite des erfindungsgemäßen Gelenkflächenersatzes ist vorzugsweise mit Hydroxylapatit, bioaktivem Glas oder Glaskeramik beschichtet, um die Ver¬ ankerung des Gelenkflächenersatzes zu begünstigen. Der Ge¬ lenkflächenersatz kann aber auch aus einem kompositen Ma- terial bestehen, das eine dem Knochen angepaßte biomecha¬ nische Situation bildet und das oberflächennahe Wachstum von Knorpel bzw. eines Knorpelregenerats begünstigt. Andere vorteilhafte Weiterbildungen der Erfindung sind in den Unteransprüchen gekennzeichnet bzw. werden nachstehend zusammen mit der Beschreibung der bevorzugten Ausführung der Erfindung anhand der Figuren näher dargestellt. Es zeigen:The side of the joint surface replacement according to the invention facing the at least partially cartilaged joint surface before the bone is preferably coated with hydroxylapatite, bioactive glass or glass ceramic in order to promote the anchoring of the joint surface replacement. However, the replacement of the articular surface can also consist of a composite material which forms a biomechanical situation adapted to the bone and which favors the growth of cartilage or a cartilage regenerate close to the surface. Other advantageous developments of the invention are characterized in the subclaims or are shown in more detail below together with the description of the preferred embodiment of the invention with reference to the figures. Show it:
Figur 1 ein frontaler Schnitt durch ein mit einem Aus¬ führungsbeispiel des erfindungsgemäßen Gelenkflächenersat¬ zes versehenen Hüftgelenk,FIG. 1 shows a frontal section through a hip joint provided with an exemplary embodiment of the joint surface replacement according to the invention,
Figur 2 eine vergrößerte Detaildarstellung des Ausfüh¬ rungsbeispiel gemäß Figur 1 in einem Schnitt des Femurs,FIG. 2 shows an enlarged detailed illustration of the exemplary embodiment according to FIG. 1 in a section of the femur,
Figur 3 ein weiteres Ausführungsbeispiel des erfindungs- gemäßen Gelenkflächenersatzes in der Anwendung im Bereich des Kniegelenks,FIG. 3 shows a further exemplary embodiment of the joint surface replacement according to the invention when used in the region of the knee joint,
Figur 4 ein weiteres Ausführungsbeispiel des erfindungsge¬ mäßen Gelenkflächenersatzes in der Anwendung im Bereich des Schultereckgelenks im Schnitt,FIG. 4 shows a further exemplary embodiment of the joint surface replacement according to the invention in use in the area of the shoulder corner joint, in section,
Figur 4a eine (vereinfachte) Draufsicht des Gelenkflächen¬ ersatzes gemäß Figur 4,FIG. 4a shows a (simplified) top view of the joint surface replacement according to FIG. 4,
Figur 5 eine Querschnittsdarstellung eines gegenüber Fig. 3 modifizierten Gelenkflächenersatzes für das Kniege¬ lenk undFigure 5 is a cross-sectional view of a modified joint surface replacement for the knee joint and
Figur 6 eine Querschnittsdarstellung eines weiteren ge- genüber Fig. 3 modifizierten Gelenkflächenersatzes für das Kniegelenk. Die Figuren 1 und 2 zeigen einen Schnitt im Bereich des Femurs, wobei in Figur 1 beide Teile (Femurteil l und Acetabulum 2) des Hüftgelenks gemeinsam dargestellt sind.FIG. 6 shows a cross-sectional representation of a further joint surface replacement for the knee joint that is modified compared to FIG. 3. FIGS. 1 and 2 show a section in the area of the femur, with both parts (femur part 1 and acetabulum 2) of the hip joint being shown together in FIG. 1.
Der Hüftknochen 3 weist eine annäherend hohlkugelaus- schnittförmige Hüftpfanne 2 auf, von der nur eine im Schnitt mondsichelförmige Zone 4 überknorpelt ist. Der Fe- murkopf 5, der auf seiner gesamten Gelenkfläche Knorpel 6 aufweist, stützt sich gegen die mondsichelförmige über- knorpelte Zone 4 ab. Die nicht überknorpelte Pfannentiefe 7 ist von lockerem Binde- und Fettgewebe 8 sowie Blutgefä¬ ßen angefüllt und trägt außerdem die Anheftungsstelle des Femurkopfbands 9. Diese nicht überknorpelte Pfannentiefe 7 wird von einer Synovialmembran überzogen, die die Ge- lenkschmiere, Synovia, absondert, und die sich ventral auf das Femurkopfband 9 fortsetzt. Die Fett- und Bindegewebs- körper 8 besitzen die Funktion eines Stoßdämpfers und wer¬ den je nach den herrschenden Druckverhältnissen unter dem Femurkopfband 9 ausgestülpt oder eingezogen.The hip bone 3 has an approximately acetabular cup-shaped hip socket 2, of which only a crescent-shaped zone 4 is cartilaginous. The femoral head 5, which has cartilage 6 on its entire joint surface, is supported against the crescent-shaped cartilage zone 4. The non-cartilaginous cup depth 7 is filled with loose connective tissue and fat tissue 8 as well as blood vessels and also bears the attachment point of the femoral head band 9. This non-cartilaginous cup depth 7 is covered by a synovial membrane which secretes the synovial fluid, synovia, and the like continues ventrally on the femoral head band 9. The fat and connective tissue bodies 8 have the function of a shock absorber and, depending on the prevailing pressure conditions, are pulled out or drawn in under the femoral head band 9.
Ein Ausführungsbeispiel des erfindungsgemäßen Gelenkflä¬ chenersatzes 10 für das Femur (Figur 1) ist in seiner Po¬ sition durch eine Umrahmung II hervorgehoben.An embodiment of the joint surface replacement 10 according to the invention for the femur (FIG. 1) is highlighted in its position by a frame II.
Der partielle Gelenkflächenersatz 10 weist dabei einen mehrschichtigen Aufbau auf, wie er anhand der Darstellung von Figur 2, die eine vergrößerte Wiedergabe bildet, er¬ kennbar ist.The partial joint surface replacement 10 has a multi-layer structure, as can be seen from the illustration in FIG. 2, which forms an enlarged representation.
Dabei weist eine erste, mit einer der Gelenkfläche zuge¬ wandten und diese im Bereich der Gelenkbewegung kontaktie- renden Oberfläche versehene Schicht 11 eine Struktur mit relativ engen Poren oder Durchbrüchen 12 auf, welche eine Überknorpelung erlaubt, während eine weitere, eine dem be¬ nachbarten Knochen zugewandte Oberfläche aufweisende Schicht 13 eine zum Ein- oder Anwachsen an den benachbar¬ ten Knochen ausgestaltete spongiöse Struktur mit relativ größeren Durchbrüchen 14 besitzt. Der Gelenkflächenersatz bildet einen säulenförmigen Einsatz, welcher sich zur Kno¬ chenseite hin geringfügig verjüngt.A first one, which faces the articular surface and contacts it in the region of the articulation movement, Layer 11 provided on the surface has a structure with relatively narrow pores or openings 12, which allows over-cartilage, while a further layer 13, which has a surface facing the adjacent bone, has a cancellous bone designed for growing in or growing on the adjacent bones Has structure with relatively larger openings 14. The joint surface replacement forms a columnar insert which tapers slightly towards the bone side.
Der dargestellte Gelenkflächenersatz weist insbesondere eine dünnwandige kappenförmige äußere Schicht bzw. oder Beschichtung auf, welche die entsprechende natürliche Ge¬ lenkschicht ersetzt. Diese ist der Beschaffenheit, Abrieb- festigkeit und Gleitfähigkeit ihrer der gegenüberliegenden Gelenkfläche zugewandten Oberfläche der körpereigenen Knorpelsubstanz im betreffenden Gelenkflächenbereich der¬ art angepaßt, daß die Einwirkung auf diese derjenigen ei¬ ner natürlichen Gelenkoberfläche im wesentlichen ent- spricht.The joint surface replacement shown has in particular a thin-walled, cap-shaped outer layer or coating which replaces the corresponding natural joint layer. This is adapted to the nature, abrasion resistance and slidability of its surface of the body's own cartilage substance facing the opposite joint surface in the relevant joint surface area in such a way that the action on it essentially corresponds to that of a natural joint surface.
Der partielle Gelenkflächenersatz - wie er auch in den folgenden Figuren näher dargestellt ist - entspricht dabei bezüglich der Gelenkfläche einer (konvexen bzw. konkaven) schalenförmigen Hüllfläche, die allerdings abweichend von den bisherigen Konzepten keine durchgehende Wandung auf¬ weist, sondern eine durch Löcher oder Freiräume ausge¬ zeichnete perforierte Membran oder spongiöse Struktur. Da¬ bei ist in den Perforationen die Möglichkeit der Knorpel- regeneration und somit für die konvexe Schale des Kopfes und für die konkave Pfanne eine Gleitpaarung von Knorpel¬ regeneraten gegeben. Die perforierte Schale bzw. Pfanne ist dabei insbesondere derart ausgestaltet, daß sie auf den entsprechend getrimm¬ ten Knochen paßt und daß darüber hinaus auch eine Pfrop¬ fung mit Knorpelmaterial möglich ist. Die dem Knochen zu- gewandte Seite des Implantats ermöglicht die Verankerung von Knochenmaterial und trägt somit zu einer stabilen Si¬ tuation der Prothese bei. Günstig ist insbesondere eine Beschichtung - vorzugsweise mit Calciumphospaten und/oder carbonaten, mit bioaktivem Glas oder Glaskeramik. Bei ei- ner anderen vorteilhaften Weiterbildung besteht die Prot¬ hese aus einem kompositen Material, das eine dem Knochen angepaßte biomechenische Situation simuliert und dabei das Wachstum von Knorpel bzw. eines Knorpelregenerates begün¬ stigt.The partial replacement of the articular surface - as it is also shown in more detail in the following figures - corresponds to a (convex or concave) shell-shaped envelope surface with respect to the articular surface, which, in contrast to the previous concepts, does not have a continuous wall, but one with holes or free spaces excellent perforated membrane or cancellous structure. At the same time, there is the possibility of cartilage regeneration in the perforations and thus a pairing of cartilage regenerates for the convex shell of the head and for the concave pan. The perforated shell or pan is in particular designed in such a way that it fits on the correspondingly trimmed bone and that a grafting with cartilage material is also possible. The side of the implant facing the bone enables the anchoring of bone material and thus contributes to a stable situation of the prosthesis. A coating is particularly favorable - preferably with calcium phosphate and / or carbonate, with bioactive glass or glass ceramic. In another advantageous development, the prosthesis consists of a composite material which simulates a biomechanical situation adapted to the bone and thereby promotes the growth of cartilage or a cartilage regenerate.
In Figur 3 ist als weitere Ausführungsform ein im Bereich des Kniegelenks eingesetzter Gelenkflächenersatz 20 in ei¬ ner seitlichen Schnittdarstellung gezeigt. Dieser ist als Gelenkflächenersatz für die Tibia 5 kappenförmig ausgebil- det. Der dünnwandige Gelenkflächenersatz 20 ist in seiner Grundstruktur bevorzugt aus Titanblech hergestellt und weist über seine gesamte Fläche die Wandung 21 durchque¬ rende Mikroporen 22 bzw. eine spongiöse Struktur auf. Um eine dauerhafte feste Verankerung des Gelenkflächenersat- zes 20 im Gelenkkopf 5 herbeizuführen, ist die diesem zu¬ gewandte konkave Innenfläche des Gelenkflächenersatzes 20 mit einer Beschichtung 23 versehen, die Poren 25 mit grö¬ ßerem Durchmesser als die Mikroporen 22 aufweist und das Anwachsen von Knochenmaterial an den Gelenkflächenersatz 20 begünstigt. Geeignete Materialien für derartige Be¬ schichtungen 25 sind beispielsweise Calciumphosphate (etwa Aragonit) und/oder -phosphate, bioaktives Glas oder Glas¬ keramik.FIG. 3 shows, as a further embodiment, a joint surface replacement 20 used in the area of the knee joint in a lateral sectional illustration. This is designed as a replacement of the articular surface for the tibia 5 in the form of a cap. The basic structure of the thin-walled joint surface replacement 20 is preferably made of titanium sheet and has micropores 22 or a spongy structure across the entire surface of the wall 21. In order to bring about permanent permanent anchoring of the joint surface replacement 20 in the joint head 5, the concave inner surface of the joint surface replacement 20 facing it is provided with a coating 23 which has pores 25 with a larger diameter than the micropores 22 and the growth of bone material favored on the joint surface replacement 20. Suitable materials for such coatings 25 are, for example, calcium phosphates (approximately Aragonite) and / or phosphates, bioactive glass or glass ceramic.
Der Gelenkflächenersatz 20 wird zunächst durch bündiges Einfügen in eine entsprechend geschaffene Ausnehmung durch Einpressen mit festem Sitz in den geschädigten Bereich der Gelenkoberfläche eingefügt. Anschließend erfolgt eine zu¬ sätzliche Anbindung durch Anwachsen von Knochenmaterial einerseits und durch Überknorpeln im Bereich der Gelenk- fläche andererseits, so daß insgesamt eine der Funktion und der Festigkeit des natürlichen Knochen- und Gelenkge¬ webes entsprechende Defektüberbauung entsteht. Durch die Ausfüllung von Poren mit resorbierbarem Material kann das Anwachsen unter Ersatz dieses Materials durch neu hinzuge- wonnene Knochensubstanz begünstigt werden.The joint surface replacement 20 is first inserted by flush insertion into a correspondingly created recess by pressing in with a firm fit in the damaged area of the joint surface. This is followed by an additional connection by the growth of bone material on the one hand and by cartilage in the area of the joint surface on the other hand, so that overall a defect structure corresponding to the function and strength of the natural bone and joint tissue is produced. By filling pores with resorbable material, the growth can be promoted by replacing this material with newly acquired bone substance.
Bei einer anderen vorteilhaften (nicht dargestellten) Wei¬ terbildung dieser bevorzugten Ausführungsform können eini¬ ge Mikroporen 22 auch mit einem resorbierbaren Material 24 gefüllt sein, welches beim Einwachsen einerseits von Knor¬ pel 6 und andererseits von Knochenmaterial verdrängt wird.In another advantageous (not shown) further development of this preferred embodiment, some micropores 22 can also be filled with a resorbable material 24 which is displaced by cartilage 6 on the one hand and bone material on the other hand.
Die Gelenkflächenelemente, welche in den bisher darge¬ stellten Ausführungsformen massiv ausgebildet sind, werden nach Ausbohren oder anderweitigem Ausräumen eines entspre¬ chenden Volumens wie Dübel in die so entstandene Bohrung oder Ausnehmung eingefügt. Damit ist durch bündiges Anlie¬ gen der Mantelflächen zunächst für eine primäre Fixierung gesorgt, welche bereits auch schon Druckbelastungen auf Grund von Lagerkräften ertragen kann. Die Fixierung wird dann unterstützt durch die weitere sekundäre Fixierung, welche durch das An- und Einwachsen unter Ausnutzung der inneren Poren und Durchbrüche stattfindet.The articular surface elements, which are solid in the embodiments shown so far, are inserted into the bore or recess thus created after drilling out or otherwise clearing out a corresponding volume, such as dowels. Primary fixation, which can already withstand pressure loads due to bearing forces, is thus initially ensured by flush contact of the lateral surfaces. The fixation is then supported by the further secondary fixation, which takes place through the growth and ingrowth using the inner pores and breakthroughs.
In den Figuren 4 und 4a ist eine weitere bevorzugte Aus- führungsform des erfindungsgemäßen Gelenkflächenersatzes 30 zur Anwendung im Bereich des Schultereckgelenks 31 (Teil des Oberarms) dargestellt. Bei der in Figur 4a wie¬ dergegebenen Draufsicht ist die runde Querschnittsform des becherartigen Einsatzes zu erkennen, der in Figur 4 im Schnitt dargestellt ist.FIGS. 4 and 4a show a further preferred embodiment of the joint surface replacement 30 according to the invention for use in the area of the shoulder corner joint 31 (part of the upper arm). The round cross-sectional shape of the cup-like insert, which is shown in section in FIG. 4, can be seen in the top view shown in FIG. 4a.
Ein ebenfalls dünnwandiger, pfannenartiger und perforier¬ ter Titanblechkörper bildet hier die Basis des Gelenkflä¬ chenersatzes 30. Ein großer Teil der mondsichelförmigen überknorpelten Gelenkfläche 34 bleibt erhalten bzw. wird - innerhalb der Oberflächenschicht des Ersatzbereiches 30 - neu als natürlicher Ersatz (Knorpelregenerat) gebildet. Die GewebsStruk ur und der Aufbau des Implantats entspre¬ chen im übrigen der Darstellung in Fig. 3, so daß auf eine detaillierte Beschriftung und Beschreibung verzichtet wer¬ den kann. Die Befestigung erfolgt bei dieser Ausführung durch Eintreiben, wobei mit dem Eintreiben das vorhandene Knochenmaterial stellenweise in den "Becher" eindringt und dort für eine Fixation und ein allmähliches Anwachsen sorgt.A likewise thin-walled, pan-like and perforated titanium sheet body forms the basis of the joint surface replacement 30 here. A large part of the crescent-shaped over-cartilage joint surface 34 is retained or is newly formed as a natural replacement (cartilage regenerate) within the surface layer of the replacement region 30. The tissue structure and the structure of the implant otherwise correspond to the illustration in FIG. 3, so that a detailed inscription and description can be dispensed with. In this embodiment, the attachment is carried out by driving in, with the existing bone material penetrating into the "cup" in places and ensuring fixation and gradual growth there.
In Fig. 5 ist eine Abwandlung der in Fig. 3 dargestellten Ausführungsform gezeigt, bei der ein aus enteiweißtem und mit Knorpelpartikeln getränktem korallinem Calciumcarbonat (Aragonit) bestehendes einstückiges Implantat 20' als Ge¬ lenkflächenersatz im Kniegelenk verwendet wird. Hier be- steht weder hinsichtlich des Materials noch hinsichtlich der Porengröße eine definierte Schichtstruktur, sondern das Implantat ist chemisch homogen, und die Größen- und Gestaltverteilung der mit Knorpelgewebe 24' gefüllten Po- ren 22' im mineralischen Gerüst 23' ist statistisch. Eine Differenzierung von - nicht scharf abgegrenzten - räumli¬ chen Bereichen 20a1, 20b' und 20c' im Implantat ergibt sich bei dieser Ausführungsform aus der Nachbarschaft zu unterschiedlichem körpereigenem Gewebe, zum Knorpelgewebe 6 im oberflächennahen und zum Knochengewebe 26 im tieferen Bereich, und aus der Art der Wechselwirkung mit diesen Ge¬ weben im Verlaufe des Einwachsens.FIG. 5 shows a modification of the embodiment shown in FIG. 3, in which a one-piece implant 20 'consisting of de-proteinated and coraline calcium carbonate (aragonite) soaked with cartilage particles is used as a joint surface replacement in the knee joint. Here there is neither a defined layer structure with regard to the material nor with regard to the pore size, but the implant is chemically homogeneous, and the size and shape distribution of the pores 22 'filled with cartilage tissue 24' in the mineral framework 23 'is statistical. A differentiation of - not sharply delimited - spatial areas 20a 1 , 20b 'and 20c' in the implant results in this embodiment from the proximity to different body tissue, to the cartilage tissue 6 in the near surface area and to the bone tissue 26 in the lower area, and from the type of interaction with these tissues in the course of ingrowth.
Im Tiefenbereich 20c' findet nach dem Einsetzen zunächst ein Eindringen von Blutzellen in die interkonnektierenden Hohlräume des korallinen Materials und danach eine Besied¬ lung mit Knochenzellen aus dem umgebenden Knochengewebe statt. Aus diesen bilden sich - unter gewissermaßen geome¬ trischer Wegleitung durch die Porenwandungen das koralli- nen Materials und dynamischer Wegleitung durch die bei Be¬ anspruchung des Gelenks auftretenden Kraftvektoren - bio¬ physikalisch korrekt aufgebaute Knochenbälkchen- Strukturen. Diese verdichten sich nach und nach unter min¬ destens teilweiser Resorption des korallinen Materials zu Knochengewebs-Regenerat. Im Oberflächenbereich 20a' findet auf der Grundlage des durch die Tränkung eingebrachten Knorpelsubstrats unter dem Einfluß des benachbarten körpe¬ reigenen Knorpelgewebes eine Überknorpelung statt, und im mittleren Bereich 20b' wird das Knorpelsubstrat in den Im- plantatporen unter gleichzeitiger mindestens teilweiser Resorption des Implantats mineralisiert. Eine weitere Abwandlung dieser Ausführungsform ist in Fig. 6 gezeigt: Hier ist als Implantat ein dreischichtiger Körper 20" mit einer oberen, knorpelgetränkten Schicht 20a" aus korallinem Material, einer Collagen-Trennschicht 20b" und einer unteren, nicht getränkten Schicht 20c" aus korallinem Material vorgesehen. (Die hier nicht genannten Bezugsziffern entsprechen denen bei Fig. 5.) Das Einwach¬ sen erfolgt ähnlich wie oben zu Fig. 5 beschrieben, wobei jedoch die Collagenschicht ein eventuelles, unerwünschtes Wachstum von Knorpel in die Tiefe verhindert und sichert, daß sich im Bereich der Schicht 20c" ungestört Knochenge¬ webe bilden kann. Sie wird im Verlaufe des Einwachsens ebenfalls resorbiert.In the deep region 20c ', after insertion, blood cells first penetrate into the interconnecting cavities of the coral material and then colonize with bone cells from the surrounding bone tissue. From these - with a certain geometric guidance through the pore walls the coral material and dynamic guidance through the force vectors that occur when the joint is stressed - biologically and physically correctly constructed trabecular structures. These gradually condense to at least partial resorption of the coral material to regenerate bone tissue. Over-cartilage takes place in the surface area 20a 'on the basis of the cartilage substrate introduced by the impregnation under the influence of the adjacent body's own cartilage tissue, and in the middle area 20b' the cartilage substrate in the implant pores is mineralized with simultaneous at least partial absorption of the implant. A further modification of this embodiment is shown in FIG. 6: Here, as an implant, there is a three-layer body 20 "with an upper, cartilage-impregnated layer 20a" made of coral material, a collagen separating layer 20b "and a lower, non-impregnated layer 20c" made of coral material Material provided. (The reference numerals not mentioned here correspond to those in FIG. 5). The waxing-in takes place in a manner similar to that described above in relation to FIG. 5, but the collagen layer prevents any undesired growth of cartilage in the depth and ensures that the area is secured the layer 20c "can form undisturbed bone tissue. It is also resorbed in the course of ingrowth.
Die Aufgabe der Collagenschicht in Fig. 6 kann in weiter abgewandelten Ausführungsformen auch durch spezielle Haft- Proteine erfüllt werden, und der Gelenkspalt kann teilwei¬ se mit einer Flüssigkeit (etwa der synthetischen gelenk- flüssigkeit Sinudal) gefüllt werden, die Blutzellen ver- drängt und damit die Ausbildung einer Gewebs-Schichtstruk- tur mit funktional vorteilhafter Tiefenstaffelung zusätz¬ lich fördert.In further modified embodiments, the task of the collagen layer in FIG. 6 can also be fulfilled by special adhesive proteins, and the joint gap can be partially filled with a liquid (for example the synthetic joint liquid Sinudal) which displaces the blood cells and thus additionally promoting the formation of a tissue layer structure with functionally advantageous depth grading.
Bei anderen - nicht dargestellten - Ausführungsformen kann eine Befestigung gegebenenfalls mit - insbesondere resor¬ bierbaren - Stiften erfolgen, welche ihre Haltekraft nach und nach verlieren, nachdem das Implantat durch Einwachsen fixiert ist.In other embodiments (not shown), attachment can optionally be carried out with, in particular, resorbable pins, which gradually lose their holding force after the implant is fixed by waxing.
Bei allen Ausführungsformen des erfindungsgemäßen Gelenk¬ flächenersatzes werden nach dem Einwachsen und Überknor- peln im Gelenk Lagerverhältnisse geschaffen, die den phy¬ siologischen Lagerverhältnissen weitestgehend entsprechen, da die überknorpelte Gelenkfläche in ihren physiologischen Eigenschaften der ursprünglichen Gelenkfläche entspricht und sich auch wie diese beständig regeneriert.In all embodiments of the joint surface replacement according to the invention, after waxing in and overcutting In the joint, storage conditions are created that largely correspond to the physiological storage conditions, since the cartilaginous articular surface corresponds in its physiological properties to the original articular surface and, like it, regenerates constantly.
Obwohl das Hüftgelenk die wichtigste Anwendung für den er¬ findungsgemäßen Gelenkflächenersatz sein wird, kann dieser auch im Zusammenhang mit allen anderen Gelenkflächen her- kömmlicher Gelenk-Endoprothesen verwendet werden, durch die eine der Gelenkflächen ersetzt wird, während die ge¬ genüberliegende Gelenkfläche in ihrer natürlichen Funktion erhalten bleiben kann. Gegebenenfalls können sich - bei Ersatz von Bereichen beider Gelenkflächen - die ersetzten Gelenkflächenbereiche gegenseitig aber auch ganz oder teilweise überlagern und dabei in Wechselwirkung treten.Although the hip joint will be the most important application for the joint surface replacement according to the invention, this can also be used in connection with all other joint surfaces of conventional joint endoprostheses, by which one of the joint surfaces is replaced, while the opposite joint surface in its natural one Function can be retained. If necessary, when replacing areas of both articular surfaces, the replaced articular surface areas can also overlap one another in whole or in part and thereby interact.
Die Erfindung beschränkt sich in ihrer Ausführung nicht auf das vorstehend angegebene bevorzugte Ausführungs- beispiel. Vielmehr ist eine Anzahl von Varianten denkbar, welche von der dargestellten Lösung auch bei grundsätzlich anders gearteten Ausführungen Gebrauch macht.The embodiment of the invention is not limited to the preferred exemplary embodiment specified above. Rather, a number of variants are conceivable which make use of the solution shown, even in the case of fundamentally different types.
* * * * * * * * * *

Claims

A n s p r ü c h e Expectations
1. Mindestens partieller Gelenkflächenersatz,1. At least partial replacement of the articular surface,
g e k e n n z e i c h n e t d u r c hmarked by
eine offenporige räumliche Struktur mit einem ersten, eine mindestens teilweise die stelle einer Gelenkfläche einneh- mende Oberfläche aufweisenden räumlichen Bereich, in dem die Struktur so ausgebildet ist, daß beim Einwachsen eine Überknorpelung erfolgt, und einem zweiten, eine dem be¬ nachbarten Knochen zugewandte Oberfläche aufweisenden räumlichen Bereich, in dem die Struktur so ausgebildet ist, daß ein Ein- oder Anwachsen von Knochengewebe er¬ folgt, und/oder der einen zum Knochen hin einseitig offe¬ nen Hohlkörper zur Aufnahme der gewachsenen Knochenstruk¬ tur bildet, wobei die die Stelle einer Gelenkfläche ein¬ nehmende Oberfläche im wesentlichen entsprechend der loka- len Gelenkflächengeometrie in der Umgebung des Gelenkflä¬ chenersatzes konvex oder konkav verrundet ist.an open-pore spatial structure with a first spatial area, at least partially occupying the place of an articular surface, in which the structure is designed such that overgrowth occurs during ingrowth, and a second surface facing the adjacent bone having a spatial area in which the structure is designed such that bone tissue grows in or grows in, and / or which forms a hollow body open on one side towards the bone for receiving the grown bone structure, the position a surface taking up an articular surface is rounded in a convex or concave manner in accordance with the local articular surface geometry in the vicinity of the articular surface replacement.
2. Gelenkflächenersatz nach Anspruch 1, d a d u r c h g e k e n n z e i c h n e t , daß die Struktur eine la- mellare und/oder poröse mineralische Struktur ist.2. Joint surface replacement according to claim 1, that the structure is a lamellar and / or porous mineral structure.
3. Gelenkflächenersatz nach Anspruch 1 oder 2, d a - d u r c h g e k e n n z e i c h n e t , daß die Struktur aus im wesentlichen resorbierbarem Material besteht. 3. joint surface replacement according to claim 1 or 2, - characterized in that the structure consists of essentially resorbable material.
4. Gelenkflächenersatz nach Anspruch 3, d a d u r c h g e k e n n z e i c h n e t , daß die Struktur im wesent¬ lichen aus Calciumcarbonat, vorzugsweise korallinen Ur¬ sprungs, und/oder Calciumphosphat gebildet ist.4. joint surface replacement according to claim 3, d a d u r c h g e k e n n z e i c h n e t that the structure is essentially formed from calcium carbonate, preferably coral origin and / or calcium phosphate.
5. Gelenkflächenersatz nach einem der Ansprüche 1 bis 3, d a d u r c h g e k e n n z e i c h n e t , daß die Struktur im wesentlichen aus bioaktivem Glas oder Glaske- ramik gebildet ist.5. replacement of the joint surface according to one of claims 1 to 3, that the structure is essentially formed from bioactive glass or glass ceramic.
6. Gelenkflächenersatz nach einem der vorangehenden Ansprüche, d a d u r c h g e k e n n z e i c h n e t , daß die Struktur Poren aufweist, welche im ersten räumli¬ chen Bereich einen kleineren mittleren Durchmesser aufwei¬ sen als im zweiten räumlicher Bereich.6. replacement joint surface according to one of the preceding claims, that the structure has pores which have a smaller mean diameter in the first spatial area than in the second spatial area.
7. Gelenkflächenersatz nach Anspruch 6, d a d u r c h g e k e n n z e i c h n e t , daß die Porengröße im zwei¬ ten räumlichen Bereich der Porengröße des benachbarten Knochenmaterials angepaßt ist.7. replacement of the joint surface according to claim 6, so that the pore size in the second spatial region is adapted to the pore size of the adjacent bone material.
8. Gelenkflächenersatz nach einem der vorangehenden Ansprüche, d a d u r c h g e k e n n z e i c h n e t , daß die Struktur gitter- oder gitterrostartig bzw. in Art eines Streckmetalls ausgebildet ist. 8. joint surface replacement according to one of the preceding claims, characterized in that the structure is formed like a grid or grating or in the manner of an expanded metal.
9. Gelenkflächenersatz nach einem der vorangehenden Ansprüche, d a d u r c h g e k e n n z e i c h n e t , daß die räumlichen Bereiche der Struktur Schichten aus chemisch oder kristallografisch unterschiedlichem Material und/oder durch eine Trennschicht voneinander abgegrenzt sind.9. replacement joint surface according to one of the preceding claims, that the spatial areas of the structure are layers of chemically or crystallographically different material and / or are delimited from one another by a separating layer.
10. Gelenkflächenersatz nach Anspruch 9, d a d u r c h g e k e n n z e i c h n e t , daß eine den zweiten räum¬ lichen Bereich bildende Schicht aus Titan besteht und eine den ersten räumlicher Bereich bildende Schicht im wesent¬ lichen aus Hydroxylapatit, bioaktivem Glas oder Glaskera¬ mik besteht.10. Replacement of the joint surface according to claim 9, so that a layer forming the second spatial area consists of titanium and a layer forming the first spatial area consists essentially of hydroxyapatite, bioactive glass or glass ceramic.
11. Gelenkflächenersatz nach einem der vorangehenden Ansprüche, d a d u r c h g e k e n n z e i c h n e t , daß sich in mindestens einem Teil der Poren resorbierbares Material, insbesondere ein die Gelenkflüssigkeit ersetzen¬ des synthetisches Material, und/oder Knorpelgewebe befin¬ det.11. Replacement of the joint surface according to one of the preceding claims, that a resorbable material, in particular a synthetic material replacing the synovial fluid, and / or cartilage tissue are located in at least part of the pores.
12. Gelenkflächenersatz nach einem der Ansprüche 9 bis 11, d a d u r c h g e k e n n z e i c h n e t , daß die Trennschicht im wesentlichen aus resorbierbarem Material, vorzugsweise Collagen, gebildet ist.12. replacement of the articular surface according to one of claims 9 to 11, so that the separating layer is essentially formed from resorbable material, preferably collagen.
13. Gelenkflächenersatz nach einem der vorangehenden13. Joint surface replacement according to one of the preceding
Ansprüche, d a d u r c h g e k e n n z e i c h n e t , daß die Struktur eine Oberfläche eines Teils einer Schaft¬ prothese bildet.Claims, characterized, that the structure forms a surface of part of a shaft prosthesis.
14. Gelenkflächenersatz nach einem der vorangehenden Ansprüche, d a d u r c h g e k e n n z e i c h n e t , daß seine äußere Gestalt profilartig, insbesondere prisma¬ tisch, Säulen- oder quaderförmig, ausgebildet ist.14. Joint surface replacement according to one of the preceding claims, d a d u r c h g e k e n n z e i c h n e t that its outer shape is profile-like, in particular prismatic, columnar or cuboid-shaped.
15. Gelenkflächenersatz nach einem der vorangehenden Ansprüche, d a d u r c h g e k e n n z e i c h n e t , daß der zweite räumlicher Bereich als Hohlprofil ausgebil¬ det ist, dessen Längsachse parallel zur Normalen auf der durch eine Oberfläche des ersten räumlicher Bereiches ge¬ bildeten Gelenkfläche ist.15. Replacement of the joint surface according to one of the preceding claims, that the second spatial area is designed as a hollow profile, the longitudinal axis of which is parallel to the normal on the articular surface formed by a surface of the first spatial area.
* * * * * * * * * *
PCT/DE1994/000578 1993-05-19 1994-05-16 Articular surface prosthesis WO1994026211A1 (en)

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DE19934317448 DE4317448A1 (en) 1993-05-19 1993-05-19 Joint replacement

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DE4317448A1 (en) 1994-11-24
AU6792994A (en) 1994-12-12

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