FR2892922A1 - Trochanteric implant for forming femoral prosthesis, has hooks that allow fixation of femoral tuberosity part on implant by using encircling devices and with pin and throat respectively, where one of hooks enclose encircling devices - Google Patents

Abstract

The implant has a proximal part (5) comprising open hooks (9, 10) which have U shape. The hooks allow the fixation of a separated femoral tuberosity part on the implant by using three encircling devices e.g. cable. The hook (10) hooks one of the encircling devices during the fixation of the separated femoral tuberosity part on the implant. The hook (10) has an opening turned towards a medial part of the implant. The hook (9) comprises a pin (12) provided on a distal branch of the hook (9). The hook (10) comprises a throat that is provided for enclosing one of the enclosing devices.

Description

The present invention relates to a trochanteric implant intended to be

  associated with a shaft and a neck to form a femoral prosthesis for implantation in the proximal portion of a femur that has been separated from at least a portion of its femoral tuberosities for a hip arthroplasty surgical procedure. In the present application, the term "distal end of a part or device" means the end of the part or device which is farthest from the patient's heart and at the proximal end, the end closest to the patient's heart. heart of the patient. Similarly, in the present application, "distal direction" is understood to mean the direction from the heart of a patient to the extremities of the patient's body, such as the hands or the feet, and "proximal direction", meaning from these ends towards the heart. It may happen that a femur is separated from at least a part of its femoral tuberosities. The femoral tuberosities are essentially the greater trochanter and trochanter which are located at the upper end of the femur. The separation of at least a portion of its femoral tuberosities may result from several causes. In the elderly, it is often the result of a fracture due to aging of the bone, the fracture is usually the consequence or the cause of a fall of the patient. A separation of at least a portion of the femoral tuberosities may also be necessary in the case of a complex revision requiring significant resection of the upper end of the femur, in order to implant the patient a hip prosthesis. In both cases, at least a portion of the femoral tuberosities can be cut to allow better access to the medullary canal in which is then pressed and fixed the tail of the prosthesis. FIGS. 1a-1c show types of fracture leading to the separation of at least a portion of the femoral tuberosities, for example the greater trochanter 1a or the small trochanter 1b, from the rest of the femur 2.

  Whatever the cause of this separation, the part of the separated femoral tuberosity must be reinserted and consolidated on the femur and / or on a prosthesis after implantation of the latter. Several means have been proposed to fix the part of the femoral tubercle separated on the proximal part of the femur or the prosthesis. However, these means are not satisfactory to date because they do not allow a sufficiently stable fixation.

  Thus, it has been proposed to fix the separated femoral tubercle portion with nails, called gamma nails. However, such a solution poses problems of mechanical resistance in the long term. Any femoral prosthesis for hip arthroplasty generally comprises a proximal part, also called cervix, corresponding to the femoral neck and head, an intermediate portion corresponding to the trochanteric mass, and a distal portion, also called stem, corresponding to the femoral shaft. It has been proposed femoral prostheses whose intermediate portion is traversed by holes through which is passed a cable attachment. Such a method is however difficult to implement: in fact, once the part of the femoral tubercle separated is reported on the intermediate portion of the femoral prosthesis to be implanted, the holes are obstructed by the soft masses of said portion of femoral tuberosity and it is particularly difficult and tedious for the surgeon to introduce the cable into these holes. In particular, the operation site must be particularly clear to allow the surgeon to see all the anatomical parts involved and the prosthesis. The surgeon must use both hands for such an operation and it may even happen that it must be repeated several times before successfully pass the cable in the holes provided in the intermediate portion of the prosthesis. Thus, there remains the need for a femoral prosthesis which would make it possible, peroperatively, a quick, easy, solid, effective and immediate hooking of the part of the femoral tuberosity separated on the intermediate portion of said prosthesis, and this without traumatizing the neighboring muscle masses, or even allowing this operation to be performed without the aid of an operative assistant. The present invention aims to remedy this need by proposing a trochanteric implant intended to be associated with a neck and a rod to form a femoral prosthesis, said trochanteric implant allowing easy attachment, in particular not requiring the surgeon to see it. set of implant or prosthesis. In particular, the trochanteric implant according to the invention makes it possible to attach any part of the femoral tubercle separated blind, in other words, in particular, without the surgeon does not necessarily see the anterior part of the implant or the prosthesis .

  The present invention relates to a trochanteric implant adapted to be associated with a shaft and a neck to form a femoral prosthesis for implantation in the proximal portion of a femur that has been separated from at least a portion of its femoral tuberosities. , hereinafter referred to as the separated femoral tubercle portion, said trochanteric implant comprising at least a proximal portion intended to be received in the trochanteric mass of said femur, and characterized in that said proximal portion comprises hooking means, arranged to allow blind attachment of said separated femoral tubercle portion to said implant by means of at least one first strapping device. By separate femoral tubercle part is meant any part of the femoral tuberosity, such as part of the greater trochanter and / or part of the small trochanter or all these tuberosities, which has been separated from the femur or which has at least has been removed or removed, voluntarily or not, the femur on at least a portion of its natural attachment surface to said femur, even if this tuberosity portion is not completely separated from said femur. By strapping device is meant any wire, in particular single strand, any cable, in particular composed of several braided strands, any tape, of any nature, biocompatible, to fix between them, generally by encircling and / or surrounding two elementary pieces such as parts of anatomy and / or parts of prostheses. Preferably, the strapping device has sufficient strength to support a permanent tension.

  The implant according to the invention makes it possible in particular to hook and fix effectively and immediately the part of femoral tubercle separated on a femoral prosthesis without the surgeon has full access to the visibility of the implant or the prosthesis. In addition, the implant according to the invention makes it possible to attach the non-traumatic separated femoral tubercle portion to the neighboring muscle parts. Patients can resume walking as quickly as possible. The autonomy of the patient is returned to him and his quality of life is greatly improved. In view of its ease of use, the trochanteric implant according to the invention can be used to make a prosthesis for all indications of hip arthroplasty with separation of at least a portion of the femoral tuberosities from the upper part of the hip. femur. In one embodiment of the invention, said attachment means comprise securing means, arranged to prevent the stall of said part of the femoral tubercle separated after fixation. Thus, the separated femoral tubercle portion is permanently and effectively attached to the trochanteric implant. In a preferred embodiment of the invention, said hooking means comprise at least one first open hook, of overall U-shaped shape, whose opening is turned towards the medial portion of said implant, said first hook being disposed at around the upper lateral corner of said proximal portion. Preferably, this first hook is disposed at the upper lateral corner of said proximal portion. In one embodiment of the invention, said securing means comprise at least one groove formed on the internal face of a branch of the U of said first hook, said groove being intended to trap said strapping device to prevent the exit of this last of said first hook. In another embodiment, said securing means comprise at least one lug disposed on the inner face of one of the branches of the U of said first hook, said lug being intended to retain said strapping device and to prevent the exit of the latter. said first hook. In another embodiment, said hooking means comprise at least one second open hook, of overall recumbent U shape, whose opening is turned towards the medial portion of said implant, said second hook being arranged at the distal medial base said implant. In one embodiment of the invention, the lateral face of said implant, also called extrados, is lateralised, that is to say that it is slightly offset in the lateral direction relative to the lateral distal base of said implant. Preferably, this side face, or extrados, is composed of two walls giving it a slightly convex outer shape. The stability of fixation of the separated femoral tubercle portion is thus improved. In one embodiment of the invention, said side face, or extrados, has undergone a surface treatment to increase its bone gripping properties. Indeed, this lateral face, or extrados, is intended to be in contact with said part of the femoral tuberosity separated. For example, this face has been roughened by the presence of pimples or scales. Alternatively, this face may have been treated using a titanium projection. The stability of the part of the femoral tuberosity separated on the implant and the bone integration of the implant are thus improved. Preferably, the trochanteric implant according to the invention further comprises support means located at the distal base of said trochanteric implant and arranged to allow the support of said distal base on the intertrochanteric bone section wafer of said femur.

  In one embodiment, said support means comprise a projecting peripheral shoulder disposed at the distal base of said implant. This shoulder is supported on the slice of trochanteric bone section of the femur. Preferably, the medial portion of said peripheral shoulder forms at least in part said second hook.

  The trochanteric implant according to the invention can be associated with any form of diaphyseal stem of femoral prosthesis for hip arthroplasty, monobloc or modular, and any form of neck of femoral prosthesis for hip arthroplasty monoblock or modular, to achieve such a femoral prosthesis for hip arthroplasty.

  Thus, the present invention also relates to a femoral prosthesis, in particular for hip arthroplasty, comprising at least one trochanteric implant as above, at least one rod and at least one neck. In one embodiment of the invention, said femoral prosthesis is modular, that is to say that the stem parts, trochanteric implant according to the invention, and neck, are separate parts that are made integral with each other prior to the surgical implantation procedure. In another embodiment of the invention, said femoral prosthesis is monobloc, that is to say that the rod parts, trochanteric implant according to the invention and neck are made in one piece.

  The present invention also relates to an assembly for implantation of a femoral prosthesis intended to be implanted in the proximal portion of a femur which has been separated from at least a part of its femoral tuberosities, characterized in that comprises at least one trochanteric implant as above or at least one femoral prosthesis as above and at least one first strapping device.

  In one embodiment of the invention, said first strapping device is a single strand wire. In another embodiment of the invention, said first strapping device is a cable composed of several braided strands between them. In one embodiment of the invention, said implant comprises at least a first hook and at least a second hook and the assembly according to the invention comprises at least one second strapping device. In another embodiment of the invention, said assembly 10 further comprises at least one third strapping device. The present invention also relates to a method for implanting a femoral prosthesis in the proximal portion of a femur that has been separated from at least a portion of its femoral tuberosities, comprising the steps of: a) providing a modular femoral prosthesis or monoblock comprising a trochanteric implant as above, - b) is placed in the medullary canal of said femur the femoral prosthesis of step a), said medullary canal having preferably been previously dug and / or filled with cement, 20 - c) the part of the femoral tuberosity separated is reported on the proximal part of said trochanteric implant, in particular against the lateral or extrados face of said implant, - d) the part of the separated femoral tuberosity is fixed on said implant using at least a first strapping device that is hooked 25 to said first hook. In one embodiment of the method according to the invention, said trochanteric implant comprises at least a first hook and at least a second hook and the part of the separated femoral tuberosity is fixed on said proximal part using at least one first strapping device, in particular a single wire, which is hooked to said first hook and said second hook, making an eight, according to the technique of the single stay or the guy stay. In another embodiment of the method according to the invention, the separated femoral tubercle portion is fixed by means of a first strapping device, in particular a single wire, which is hooked to said first hook and to said second hook by providing a stay and a horizontal strapping, the horizontal strapping being located at the second hook. In another embodiment of the method according to the invention, the part of the separated femoral tuberosity is fixed by means of a first strapping device, in particular a wire, which is hooked to said first hook in a horizontal strapping. and a second strapping device, in particular a wire, which is hooked to said second hook, also according to a horizontal strapping. In such a case, we can add a third strapping device, in particular a wire, which is hooked to the first and second hooks according to the technique of the guy. Alternatively, this third wire can be hooked only to the first hook and pass under the bone section slice of the femur. At the end of the operation, the strapping device is closed according to conventional methods and well known to those skilled in the art, for example by twisting said device on itself or with the aid of meshes or dominoes that we crush. Other advantages and variations of the present invention will be specified with the aid of the following description and the appended drawings in which: FIGS. 1a to 1c are side views of the upper end of FIG. a femur which has been separated from at least a portion of its femoral tuberosities; FIG. 2 is a three quarter view of a trochanteric implant according to the invention; FIG. 3 is a view of three quarters of a Modular femoral prosthesis according to the invention comprising a neck, a stem and a trochanteric implant according to the invention; FIG. 4 is a perspective view of a monobloc femoral prosthesis according to the invention; FIG. 5 is a posterior view. of the prosthesis according to FIG. 4; FIG. 6 is a side view of the prosthesis according to FIG. 4; FIGS. 7 to 12 are three-quarter views of a femoral prosthesis according to the invention implanted in a femur with the trochanter reported and fixed according to different variants of the method according to the invention.

  FIG. 2 shows a trochanteric implant 3 according to the invention intended to be associated with a rod 7 and a neck 6, as shown in FIG. 3, to form a femoral prosthesis 4. The femoral prosthesis 4 of FIG. is a modular prosthesis, that is to say that the stem portions 7, 6 neck and trochanteric implant 3, or intermediate portion, are separated. These parts are assembled prior to the hip arthroplasty procedure. Such a femoral prosthesis 4 is intended to be implanted in the proximal portion of a femur which has been separated from at least a portion of its femoral tuberosities (see FIGS. 1a-1c). The trochanteric implant 3 shown in Figure 2 may be any biocompatible material, such as titanium or stainless steel. The trochanteric implant of FIG. 2 comprises a proximal portion intended to be received in the trochanteric mass (see FIGS. 7 to 12). The proximal portion 5 of the trochanteric implant 3 comprises a first open hook 9, of overall recumbent U shape, the opening of which is turned towards the medial part of the implant 3. This first hook 9 is arranged generally around the upper lateral corner 24, precisely at the upper lateral corner 24 as shown, of said proximal portion. Alternatively, this first hook 9 could be slightly offset with respect to this wedge 24, for example in the medial direction, on the proximal face of the implant 3. As it appears from FIG. 2, the internal face of the upper branch of the A lying down of the first hook 9 comprises at least one groove 23. This groove 23 is intended to trap the strapping device (see FIGS. 7 to 12) to prevent the latter from emerging from said first hook 9 after fixing the femoral tubercle portion. separated on said implant 3. The trochanteric implant 3 of Figures 2 and 3 further comprises a second hook 10, overall shape in coated U, the opening is also facing the medial portion of the implant 3. This second hook is disposed at the distal medial base 25 of the implant 3.

  As will be readily apparent from FIGS. 7 to 12, this second hook 10 will be used to hook the strapping device (s) during attachment of the separated femoral tubercle portion to said implant 3. The implant of FIG. 2 comprises a lateral face 13, also called extrados, slightly offset in the lateral direction relative to the distal lateral base 26 of the implant. Said lateral face 13 is composed of two walls 13a and 13b which provide this lateral face with a slightly convex external shape. Preferably, this lateral face 13, and in particular its two walls 13a and 13b, have undergone a surface treatment intended to increase their bone-catching properties. Indeed, this side face 13 is directly in contact with the separated tuberosity portion after fixation. Its roughness, for example obtained by the presence of pimples or scales, improves the attachment of the bone part of femoral tubercle separated that is desired to report on the femur. Alternatively, this surface treatment can be a titanium projection. FIGS. 4 to 6 show a femoral prosthesis 4 according to the invention, in one piece, intended to be implanted in the proximal portion of a femur 2 which has been separated from at least a portion of its femoral tuberosities (see FIGS. 1c). The femoral prosthesis 4 may be any biocompatible material suitable for hip prostheses in general such as for example titanium or even stainless steel. The femoral prosthesis 4 comprises a trochanteric implant 3, corresponding to the intermediate part of the prosthesis 4, a neck portion 6, or morse cone, extending obliquely in the medial and proximal direction from the trochanteric implant 3, and a stem portion 7 extending in the distal direction from the trochanteric implant 3. The intermediate portion, or trochanteric implant 3, comprises a proximal portion 5. In the femoral prosthesis 4 integral of Figures 4 to 6, the stem portions 7, neck 6, and trochanteric implant 3, are made in one piece. The trochanteric implant 3 comprises at least one proximal portion 5 intended to be received in the trochanteric mass of said femur 2 as will be seen from FIGS. 7 to 12. The neck portion 6 is intended to receive a femoral head (not shown), and the rod portion 7 is intended to be received in the body of the femur 2 as shown in Figures 7 to 12. The trochanteric implant 3 of Figures 4 to 6 further comprises an outer peripheral shoulder 8 disposed at the distal base of the implant 3 .

  The implant 3 also comprises a first hook 9 and a second hook 10, each of generally U-shaped coated, and whose respective openings are turned towards the medial portion of the implant 3. In embodiments of the invention not shown, the implant 3 may comprise only one hook.

  Said first hook 9 is disposed at the upper lateral corner 24 of said proximal portion 5. Said second hook 10 is disposed at the distal medial base of the implant 3. The medial portion 11 of the shoulder 8 forms the distal branch of the U forming said second hook 10. Said first hook 9 comprises, on the distal branch of the U forming it, a lug 12 whose function will be explained later.

  The implant 3 has a lateral face 13, also called extrados, visible in FIG. 5. As it appears from FIG. 6, this lateral face 13, or extrados, is slightly offset in the lateral direction with respect to the lateral distal base. 26 of the implant 3, thus allowing a better stability of the part of femoral tubercle separated after fixation.

  As shown in Figure 5, this side face 13, or extrados, has two walls 13a and 13b which provide a slightly convex shape. Preferably, this side face 13 has undergone a surface treatment to make it rough: for example, this side face has been treated using a titanium projection. The stability of the femoral tubercle portion on the implant 3 is thus favored. In Figures 4 to 6, said stem portion 7 preferably has a substantially square section. Such a configuration makes it possible to avoid the rotation of the prosthesis 4 in the body of the femur 2. Said rod portion 7 comprises a longitudinal groove 14 on each of its lateral faces 15. The distal end 16 of said stem portion 7 is bevelled. Such a configuration allows a better introduction of the prosthesis 4 in the cement present in the body of the femur for implantation, then a better fixation of the prosthesis 4 in this cement. For the same reasons, said stem portion 7 is preferably glossy polished.

  The attachment of a part of femoral tuberosity separated on a femoral prosthesis 4, in particular at the level of the trochanteric implant 3 according to the invention will now be explained with reference to FIGS. 7 to 12 in which the trochanteric implant 3 and / or the prosthesis 4 are shown in phantom. The femur 2 and the separated femoral tubercle portion 1 are shown in fine lines. The strapping device or devices (20, 21, 22) are shown in thick lines when they are directly visible and in dotted lines when they are hidden by the femur 2 and / or the part of the separate femoral tubercle 1. The or the strapping devices (20, 21, 22) are not shown when they are hidden by the prosthesis 4 and / or the implant 3.

  The references have been taken from FIGS. 2 to 6.

  As it appears in these Figures 7 to 12, the shaft portion 7 of the femoral prosthesis 4 has been driven into the medullary canal (not shown) of the femur 2, the medullary canal having been previously dug and / or filled with cement. The shoulder 8 bears on the intertrochanteric bone section slice 18 of the femur 2. The separated femoral tubercle portion 1 has been reported on the lateral face 13 of the trochanteric implant 3 of the femoral prosthesis 4. The femoral tubercle portion separated 1 was then fixed on said implant 3 with a first and / or a second and / or a third strapping device (s), son (20, 21, 22) in the examples shown. The wires (20, 21, 22) may be of any biocompatible material sufficiently strong to support a permanent tension, such as for example stainless steel. Thus, in FIG. 7, the separated femoral tubercle portion 1 has been fixed by means of a first single wire 20 which has been hooked to said first hook 9 and to said second hook 10 by making an eight, according to the technical of the single guy. In Figure 8 is shown a variant of the attachment technique of Figure 7 wherein the single stay is replaced by a guy stay.

  In FIG. 9, the separated femoral tubercle portion 1 has been fixed by means of a first single wire 20 which has been hooked to said first hook 9 and to said second hook 10 by producing a stay and a horizontal strapping, the strapping. horizontal line located at the second hook 10. In Figure 10, the part of the femoral tubercle separated 1 was fixed using a first wire 20, which was hooked to said first hook 9 in a horizontal strapping, and d a second wire 21, which has been hooked to said second hook 10, also in a horizontal strapping. In Figure 11 is shown a variant of the attachment technique of Figure 10, which was added a third wire 22 which was hooked to the first and second hooks (9, 10) according to the technique of the guy. FIG. 12 shows a variant of the hooking technique of FIG. 11, in which the third wire 22 is hooked only at the first hook 9 and passes under the bone section edge 18 of the femur 2.

  In one embodiment of the invention, at least one of the first, second or third strapping devices is stainless steel. In yet another embodiment of the invention not shown, the implant comprises only a first hook and the surgeon fixes the part of the femoral tubercle separated on said proximal portion using a single first wire that it hooks to said first hook. In the examples shown in FIGS. 7 to 12, the surgeon being on the side of the posterior part of the implant 4 or of the prosthesis 3, the use of threads (20, 21, 22) to be hooked on the hooks ( 9, 10) is particularly useful for successful hooking and fixation of the separated femoral tubercle portion 1, even without any visibility of the anterior part of the implant 3 or the prosthesis 4. It is sufficient for the surgeon to pass the or the wire (s) over the implant 3 and it will necessarily hook the hook (9, 10) adequate.

  Moreover, because of the presence of the groove 23 (see Figure 2) or alternatively of the lug 12 (see Figure 6), the son or son (20, 21, 22) can not come out of said first hook 9 in which he is or they are prisoner (s). The definitive and effective fixation of the separated tuberosity portion 1 on the trochanteric implant 3 is therefore entirely ensured.

  The trochanteric implant 3 and the femoral prosthesis 4 according to the invention provide a real improvement on prostheses and methods of attachment of parts of femoral tuberosities already known. Indeed, thanks to the implant and the prosthesis according to the invention, it is possible to fix a part of femoral tuberosity on said implant in a particularly simple, fast, effective, non-traumatic and cheap way. In particular, it is possible to fix any part of the femoral tubercle separated on the implant or prosthesis blind, that is to say without the front portion of said proximal portion of the implant or the prosthesis is visible by the surgeon performing the operation.30

Claims (22)

  A trochanteric implant (3) for associating with a shaft (7) and a neck (6) to form a femoral prosthesis (4) to be implanted in the proximal portion of a femur (2) which has been separated from at least a portion of its femoral tuberosities, hereinafter referred to as the separate femoral tubercle portion (1), said trochanteric implant (3) comprising at least a proximal portion (5) to be received in the trochanteric trunk of said femur, and being characterized in that said proximal portion (5) comprises hooking means (9, 10), arranged to allow the blind attachment of said separated femoral tubercle portion (1) to said implant (3) at means of at least a first strapping device (20).   2. Implant (3) according to claim 1, characterized in that said attachment means (9, 10) comprise securing means (12; 23), arranged to prevent the stall of said part of the femoral tubercle separated (1). ) after fixation.   3. Implant (3) according to claim 1 or 2, characterized in that said attachment means comprise at least one first (9) open hook, overall shape U coated, whose opening is turned towards the medial part said implant (3), said first hook (9) being disposed around the upper lateral corner (24) of said proximal portion (5).   4. Implant according to claim 3, characterized in that said securing means comprise at least one groove (23) formed on the inner face of a U-branch of said first hook (9), said groove (23) being intended for trapping said strapping device (20, 21, 22) to prevent the exit of the latter from said first hook (9).   5. Implant (3) according to claim 3, characterized in that said securing means comprise at least one lug (12) disposed on the inner face of one of the branches of the U of said first hook (9), said lug (12). ) being adapted to retain said strapping device (20, 21, 22) and to prevent the exit of the latter from said first hook (9).   6. Implant (3) according to any one of claims 3 to 5, characterized in that said attachment means comprise at least one second open hook (10), overall shape U coated, whose opening is turned to the medial portion of said implant (3), said second hook (10) being disposed at the distal medial base (25) of said implant (3).   7. Implant (3) according to any one of the preceding claims, characterized in that its lateral face (13) is slightly offset in the lateral direction relative to the distal lateral base (26) of said implant (3).   8. Implant (3) according to the preceding claim, characterized in that said lateral face (13) is composed of two walls (13a, 13b) giving it a slightly convex outer shape.   9. Implant (3) according to any one of claims 7 or 8, characterized in that said side face (13) has undergone a surface treatment 10 to increase its bone gripping properties.   10. Implant (3) according to any one of the preceding claims, characterized in that it further comprises support means (8), located at the distal base of said trochanteric implant (3) and arranged to allow the supporting said distal base on the intertrochanteric bone section wafer (18) of said femur (2).   11. Implant (3) according to the preceding claim, characterized in that said support means comprise a projecting peripheral shoulder (8) disposed at the distal base of said implant (3).   12. Implant (3) according to claims 6 and 11, characterized in that the medial portion (11) of said shoulder (8) peripheral forms at least partly said second hook (10).   13. Femoral prosthesis (4), in particular for hip arthroplasty, characterized in that it comprises at least one trochanteric implant (3) according to any one of claims 1 to 12, at least one rod (7) and at least one collar (6).   14. Prosthesis (4) according to the preceding claim, characterized in that it is modular.   15. Prosthesis (4) according to claim 13, characterized in that it is monobloc. 30   16. A set for implanting a femoral prosthesis (4) intended to be implanted in the proximal portion of a femur (2) which has been separated from at least a portion of its femoral tuberosities, characterized in that it comprises at least one trochanteric implant (3) according to any one of claims 1 to 12, or at least one femoral prosthesis (4) according to one of claims 13 to 15, and at least one first strapping device ( 20).   17. Assembly according to the preceding claim, characterized in that said first strapping device (20) is a single-strand wire.   18. The assembly of claim 16, characterized in that said first strapping device (20) is a cable composed of several strands 5 braided together.   19. Assembly according to any one of claims 16 to 17, characterized in that said implant (3) comprising at least a first hook (9) and at least a second hook (10), said assembly comprises at least a second device strapping (21). 10   20. The assembly of claim 16, further comprising at least one third strapping device.   21. An assembly according to the preceding claim, characterized in that at least one of the first, second or third strapping devices (20, 21, 22) is made of stainless steel. 15