FR2839879A1 - Apparatus for positioning of femoral implant for hip replacement has compacting projections to compact spongy bone at front and rear of femur - Google Patents
Apparatus for positioning of femoral implant for hip replacement has compacting projections to compact spongy bone at front and rear of femur Download PDFInfo
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- FR2839879A1 FR2839879A1 FR0206297A FR0206297A FR2839879A1 FR 2839879 A1 FR2839879 A1 FR 2839879A1 FR 0206297 A FR0206297 A FR 0206297A FR 0206297 A FR0206297 A FR 0206297A FR 2839879 A1 FR2839879 A1 FR 2839879A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/885—Tools for expanding or compacting bones or discs or cavities therein
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1664—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip
- A61B17/1668—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip for the upper femur
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/32—Joints for the hip
- A61F2/36—Femoral heads ; Femoral endoprostheses
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4601—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1659—Surgical rasps, files, planes, or scrapers
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
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- A61F2/36—Femoral heads ; Femoral endoprostheses
- A61F2/3662—Femoral shafts
- A61F2/367—Proximal or metaphyseal parts of shafts
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- A—HUMAN NECESSITIES
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/32—Joints for the hip
- A61F2/36—Femoral heads ; Femoral endoprostheses
- A61F2/3662—Femoral shafts
- A61F2/3676—Distal or diaphyseal parts of shafts
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30108—Shapes
- A61F2002/3011—Cross-sections or two-dimensional shapes
- A61F2002/30112—Rounded shapes, e.g. with rounded corners
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30108—Shapes
- A61F2002/3011—Cross-sections or two-dimensional shapes
- A61F2002/30138—Convex polygonal shapes
- A61F2002/30158—Convex polygonal shapes trapezoidal
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
- A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/32—Joints for the hip
- A61F2/36—Femoral heads ; Femoral endoprostheses
- A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
- A61F2002/3625—Necks
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/32—Joints for the hip
- A61F2/36—Femoral heads ; Femoral endoprostheses
- A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
- A61F2002/365—Connections of heads to necks
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0004—Rounded shapes, e.g. with rounded corners
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
- A61F2230/0026—Angular shapes trapezoidal
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- Orthopedic Medicine & Surgery (AREA)
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- Animal Behavior & Ethology (AREA)
- Surgery (AREA)
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- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Cardiology (AREA)
- Vascular Medicine (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Physical Education & Sports Medicine (AREA)
- Dentistry (AREA)
- Prostheses (AREA)
- Surgical Instruments (AREA)
Abstract
Description
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La présente invention concerne un ensemble pour la mise en place d'un implant fémoral de prothèse de hanche sur un fémur, cet ensemble comprenant cet implant fémoral d'une part et les instruments de mise en place de cet implant d'autre part. The present invention relates to an assembly for the establishment of a femoral implant of hip prosthesis on a femur, this assembly comprising this femoral implant on the one hand and the instruments for positioning this implant on the other hand.
Un implant fémoral de prothèse de hanche subit des contraintes importantes et répétées transmises par le poids du patient. De ce fait, il doit être parfaitement stabilisé par rapport à l'os, tant en rotation que dans le sens de son enfoncement par rapport à cet os et en basculement. A femoral implant of hip prosthesis undergoes significant and repeated stresses transmitted by the weight of the patient. Therefore, it must be perfectly stabilized with respect to the bone, both in rotation and in the direction of its insertion relative to this bone and in tilting.
Le défaut de stabilité de l'implant entraîne, outre des douleurs, une fragilisation progressive de l'os voire même l'apparition de fractures secondaires dans ce dernier. Une intervention délicate doit alors être opérée pour implanter une prothèse "de reprise". The lack of stability of the implant leads, in addition to pain, to a progressive weakening of the bone or even the appearance of secondary fractures in the latter. A delicate intervention must then be made to implant a "recovery" prosthesis.
La fixation d'un implant fémoral au moyen d'un ciment polymérisable est une technique classique, mais qui n'est pas dénuée d'inconvénients tels que l'incertitude de la tenue à long terme du ciment et la nécrose osseuse que provoque la polymérisation de ce ciment. Fixing a femoral implant using a polymerizable cement is a classic technique, but it is not without drawbacks such as the uncertainty of the long-term hold of the cement and the bone necrosis that polymerization causes. of this cement.
La fixation d'un implant fémoral par croissance des cellules osseuses au travers d'un revêtement poreux permet d'obtenir une bonne stabilité de l'implant mais à condition que ce dernier soit parfaitement stabilisé par rapport à l'os le temps que cette croissance s'opère. The fixation of a femoral implant by growth of bone cells through a porous coating makes it possible to obtain good stability of the implant but on condition that the latter is perfectly stabilized with respect to the bone while this growth is taking place. takes place.
Sur les tiges fémorales existantes, cette stabilité est recherchée par une étroite complémentarité de forme entre la partie métaphysaire de l'implant et la cavité aménagée dans la région métaphysaire de l'os. On existing femoral stems, this stability is sought by a close form complementarity between the metaphyseal part of the implant and the cavity arranged in the metaphyseal region of the bone.
L'aménagement de cette cavité est toutefois effectué au moyen de râpes qui compactent ou liment plus ou moins grossièrement l'os spongieux. La forme obtenue reste relativement imprécise et de telles râpes présentent le risque, lorsqu'elles sont impactées au marteau dans le canal médullaire de l'os, de se bloquer dans la cavité, voire de provoquer une fracture de l'os en cas d'os fragilisé. The arrangement of this cavity is however carried out by means of rasps which compact or more or less coarsely file the cancellous bone. The shape obtained remains relatively imprecise and such rasps present the risk, when impacted with a hammer in the medullary canal of the bone, of jamming in the cavity, or even of causing a fracture of the bone in the event of weakened bone.
L'imprécision de forme de la cavité conduit à une mauvaise complémentarité de forme entre la partie métaphysaire de l'implant et la cavité. Il en résulte des micromouvements de l'implant qui compromettent la croissance des cellules osseuses au travers dudit revêtement poreux et amènent au risque de prise de jeu plus important entre cet implant et l'os. The imprecise shape of the cavity leads to poor shape complementarity between the metaphyseal part of the implant and the cavity. This results in micromovements of the implant which compromise the growth of bone cells through said porous coating and lead to the risk of greater clearance between this implant and the bone.
D'autres techniques d'aménagement d'implants "sur mesure" ou d'usinage mécanisé tridimensionnel ont été proposées. Ces techniques Other techniques for fitting "custom-made" implants or three-dimensional mechanized machining have been proposed. These techniques
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ont toutefois pour inconvénient d'être coûteuses et d'être relativement difficiles à mettre en oeuvre. have the disadvantage of being expensive and of being relatively difficult to implement.
Par la demande de brevet Français n 99 15686, est divulgué un ensemble comprenant : - un premier instrument pourvu d'une fraise de forme évasée permettant d'usiner l'os cortical interne du fémur, - un deuxième instrument comprenant une fraise basculante de forme cylindro-conique, permettant d'usiner les parois antérieure, postérieure et externe de la zone métaphysaire du fémur, et - l'implant fémoral, qui présente un bord interne dont la courbure correspond précisément à la courbure de la paroi interne de l'os telle qu'usinée au moyen dudit premier instrument, et un renflement de forme correspondant à celle de la cavité aménagée dans l'os au moyen dudit deuxième instrument. By French patent application No. 99 15686, a set is disclosed comprising: - a first instrument provided with a flared cutter making it possible to machine the internal cortical bone of the femur, - a second instrument comprising a tilting cutter cylindro-conical, making it possible to machine the anterior, posterior and external walls of the metaphyseal zone of the femur, and - the femoral implant, which has an internal edge whose curvature precisely corresponds to the curvature of the internal wall of the bone as machined by means of said first instrument, and a bulge of shape corresponding to that of the cavity formed in the bone by means of said second instrument.
Cet ensemble a pour objectif d'usiner l'os spongieux jusqu'à l'os cortical dur, afin d'aménager une cavité délimitée par des parois d'os cortical dur ayant une forme correspondant précisément à celle de l'implant. The purpose of this assembly is to machine the cancellous bone up to the hard cortical bone, in order to create a cavity delimited by walls of hard cortical bone having a shape corresponding precisely to that of the implant.
Cet usinage a toutefois pour inconvénient de retirer une quantité substantielle d'os spongieux, ce qui n'est pas particulièrement avantageux en ce qui concerne l'ancrage de l'implant par croissance des cellules osseuses. However, this machining has the drawback of removing a substantial amount of cancellous bone, which is not particularly advantageous as regards the anchoring of the implant by growth of the bone cells.
De plus, l'implant fémoral présente, au niveau de sa zone métaphysaire, une forme qui correspond à la juxtaposition des volumes aménagés au moyen desdits premier et deuxième instruments, et présente par conséquent des zones renfoncées sur ses faces antérieure et postérieure, le long de son bord interne. Cette forme est relativement complexe et a pour inconvénient de rendre l'implant relativement difficile à fabriquer. In addition, the femoral implant has, at its metaphyseal zone, a shape which corresponds to the juxtaposition of the volumes arranged by means of said first and second instruments, and consequently has recessed zones on its anterior and posterior faces, along from its internal edge. This shape is relatively complex and has the drawback of making the implant relatively difficult to manufacture.
Les instruments selon cette technique antérieure ont également pour inconvénient d'être relativement complexes dans leur structure, et donc d'être relativement complexes à fabriquer et à utiliser. The instruments according to this prior art also have the drawback of being relatively complex in their structure, and therefore of being relatively complex to manufacture and to use.
La présente invention vise à remédier à l'ensemble des inconvénients exposés ci-dessus. The present invention aims to remedy all of the drawbacks set out above.
L'ensemble d'éléments qu'elle concerne comprend, de manière connue en soi : The set of elements which it concerns comprises, in a manner known per se:
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- un instrument cylindrique d'alésage, propre à aléser, jusqu'à atteindre l'os cortical, le canal médullaire d'un fémur et la partie métaphysaire de ce fémur située dans le prolongement de ce canal médullaire ; - un instrument d'usinage comprenant (i) une embase formant une tige diaphysaire dont le diamètre correspond à celui de l'alésage réalisé au moyen dudit instrument cylindrique d'alésage, de sorte que cette tige diaphysaire est conformée pour être engagée dans le canal médullaire de l'os, et (ii) une fraise adaptée pour usiner la zone métaphysaire du fémur au niveau de la paroi interne de ce fémur, jusqu'à atteindre l'os cortical, et - un implant fémoral. - a cylindrical reaming instrument, suitable for reaming, until reaching the cortical bone, the medullary canal of a femur and the metaphyseal part of this femur located in the extension of this medullary canal; a machining instrument comprising (i) a base forming a diaphyseal rod whose diameter corresponds to that of the bore produced by means of said cylindrical bore instrument, so that this diaphyseal rod is shaped to be engaged in the channel bone marrow, and (ii) a cutter adapted to machine the metaphyseal area of the femur at the level of the internal wall of this femur, until reaching the cortical bone, and - a femoral implant.
Selon l'invention, - l'implant fémoral présente, au niveau de sa zone métaphysaire, une section transversale de forme ovaloïde, sans solution de continuité, cette zone métaphysaire présentant une partie externe de forme partiellement cylindrique, qui correspond en majeure partie à la forme de l'alésage réalisé au moyen dudit instrument cylindrique d'alésage, et une partie interne de forme correspondant en majeure partie à la forme de la cavité réalisée au moyen dudit l'instrument d'usinage, et - l'ensemble comprend un instrument de compactage de l'os spongieux, reproduisant la forme de l'implant fémoral et pourvu de saillies, telles que des nervures ou des picots, propres à compacter, au niveau des parois antérieure et postérieure du fémur, l'os spongieux non retiré par ledit instrument cylindrique d'alésage et ledit instrument d'usinage. According to the invention, the femoral implant has, at the level of its metaphyseal zone, a cross section of ovaloid shape, with no solution of continuity, this metaphyseal zone having an external part of partially cylindrical shape, which corresponds mainly to the shape of the bore made by means of said cylindrical bore instrument, and an internal part of shape corresponding mainly to the shape of the cavity made by means of said machining instrument, and - the assembly comprises an instrument compaction of the cancellous bone, reproducing the shape of the femoral implant and provided with projections, such as ribs or spikes, suitable for compacting, at the level of the anterior and posterior walls of the femur, the cancellous bone not removed by said cylindrical boring instrument and said machining instrument.
En pratique, le canal médullaire d'un fémur et la portion de la partie métaphysaire de ce fémur située dans le prolongement de ce canal médullaire sont tout d'abord alésés au moyen dudit instrument cylindrique d'alésage, puis ledit instrument d'usinage est engagé à coulissement dans le canal médullaire ainsi alésé jusqu'à ce que ladite fraise viennent usiner la paroi interne de la partie métaphysaire du fémur et atteindre l'os cortical ; l'instrument d'usinage est alors retiré et l'instrument de compactage est introduit dans la cavité pour compacter les zones d'os spongieux se situant, sur les parois antérieures et postérieures, en dehors des zones alésées et usinées ; l'implant est alors introduit dans la cavité et prend place étroitement contre les parois délimitant celles-ci. In practice, the medullary canal of a femur and the portion of the metaphyseal part of this femur located in the extension of this medullary canal are first bored by means of said cylindrical boring instrument, then said machining instrument is engaged in sliding in the medullary canal thus reamed until said cutter machine the internal wall of the metaphyseal part of the femur and reach the cortical bone; the machining instrument is then withdrawn and the compacting instrument is introduced into the cavity to compact the areas of cancellous bone lying, on the anterior and posterior walls, outside the bored and machined areas; the implant is then introduced into the cavity and takes place tightly against the walls delimiting these.
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L'ensemble selon l'invention permet ainsi de former des surfaces d'appui résistant en os cortical au niveau de la paroi interne et de la paroi externe du fémur, tout en conservant des zones d'os spongieux au niveau des parois antérieures et postérieures de ce fémur et en permettant de compacter ces zones conservées au moyen dudit instrument de compaction. Cette compaction s'avère très favorable à la parfaite immobilisation de l'implant en position et à la -croissance ultérieure des cellules osseuses permettant l'ancrage de l'implant. The assembly according to the invention thus makes it possible to form resistant bearing surfaces of cortical bone at the level of the internal wall and of the external wall of the femur, while preserving zones of cancellous bone at the level of the anterior and posterior walls. of this femur and making it possible to compact these conserved areas by means of said compaction instrument. This compaction turns out to be very favorable for the perfect immobilization of the implant in position and for the subsequent growth of the bone cells allowing the anchoring of the implant.
De plus, l'implant et les instruments ont des formes et des structures simples à fabriquer et à utiliser. En particulier, la fraise de l'instrument d'usinage n'a pas à être mobile selon l'axe de la tige diaphysaire de l'embase de cet instrument ni à être mobile axialement selon son axe de rotation. In addition, the implant and the instruments have shapes and structures that are simple to manufacture and use. In particular, the milling cutter of the machining instrument does not have to be movable along the axis of the diaphyseal rod of the base of this instrument nor to be axially movable along its axis of rotation.
Avantageusement, la fraise est conformée de telle sorte que sa génératrice soit placée dans le prolongement de la génératrice de la tige diaphysaire de l'embase de l'instrument d'usinage, ce qui permet de n'avoir aucune solution de continuité dans le bord interne de la cavité aménagée dans le fémur et donc dans le bord interne de l'implant. Advantageously, the cutter is shaped so that its generator is placed in the extension of the generator of the diaphyseal rod of the base of the machining instrument, which allows to have no solution of continuity in the edge internal cavity in the femur and therefore in the internal edge of the implant.
Pour sa bonne compréhension, l'invention est à nouveau décrite ci-dessous en référence au dessin schématique annexé représentant, à titre d'exemple non limitatif, une forme de réalisation préférée de l'ensemble qu'elle concerne. For a good understanding, the invention is again described below with reference to the appended diagrammatic drawing representing, by way of nonlimiting example, a preferred embodiment of the assembly which it relates to.
Les figures 1 et 2 sont des vues de côté respectivement d'un instrument cylindrique d'alésage et d'un instrument d'usinage qu'il comprend, mis en place sur l'extrémité supérieure d'un fémur réséqué, vue en coupe longitudinale, destinée à recevoir un implant fémoral de prothèse de hanche ; la figure 3 est une vue en coupe longitudinale de cette extrémité supérieure du fémur, après traitement au moyen de ces instruments ; les figures 4 à 6 sont des vues de cette extrémité supérieure du fémur en coupe respectivement selon les lignes IV-IV, V-V et VI-VI de la figure 3 ; la figure 7 est une vue de côté d'un instrument de compactage que comprend ledit ensemble, mis en place sur l'extrémité supérieure du fémur, vue en coupe longitudinale ; Figures 1 and 2 are side views respectively of a cylindrical reaming instrument and a machining instrument which it comprises, placed on the upper end of a resected femur, seen in longitudinal section , intended to receive a femoral implant of hip prosthesis; Figure 3 is a longitudinal sectional view of this upper end of the femur, after treatment with these instruments; Figures 4 to 6 are views of this upper end of the femur in section respectively along the lines IV-IV, V-V and VI-VI of Figure 3; Figure 7 is a side view of a compacting instrument that includes said assembly, placed on the upper end of the femur, seen in longitudinal section;
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la figure 8 est une vue de côté de l'implant fémoral que comprend ledit ensemble, et les figures 9 à 11 sont des vues de cet implant fémoral en coupe respectivement selon les lignes IX-IX, X-X et XI-XI de la figure 8. Figure 8 is a side view of the femoral implant that comprises said assembly, and Figures 9 to 11 are views of this femoral implant in section respectively along lines IX-IX, XX and XI-XI of Figure 8 .
Les figures représentent un ensemble pour la mise en place d'un implant fémoral 2 de prothèse de hanche sur un fémur 1, comprenant cet implant fémoral 2 d'une part et les instruments 3,4, 5 de mise en place de cet implant 2 d'autre part. The figures represent a set for the installation of a femoral implant 2 of hip prosthesis on a femur 1, comprising this femoral implant 2 on the one hand and the instruments 3,4, 5 for positioning this implant 2 on the other hand.
Comme le montre la figure 1, l'un de ces instruments 3,4, 5 est un instrument cylindrique d'alésage 3, propre à aléser, jusqu'à atteindre l'os cortical, le canal médullaire du fémur 1 et la portion de la partie métaphysaire 1a de ce fémur 1 située dans le prolongement de ce canal médullaire. As shown in FIG. 1, one of these instruments 3, 4, 5 is a cylindrical instrument for reaming 3, suitable for reaming, until it reaches the cortical bone, the medullary canal of the femur 1 and the portion of the metaphyseal part 1a of this femur 1 located in the extension of this medullary canal.
Un autre de ces instruments 3,4, 5 est un instrument d'usinage 4, montré sur la figure 2, qui comprend une embase 10 et une fraise 11. Another of these instruments 3, 4, 5 is a machining instrument 4, shown in FIG. 2, which comprises a base 10 and a cutter 11.
L'embase 10 forme une tige diaphysaire 12 dont le diamètre correspond à celui de l'alésage réalisé au moyen de l'instrument 3, de sorte que cette tige 12 peut être engagée à coulissement dans le canal médullaire alésé du fémur 1. L'embase 10 comprend également un trou de réception d'un tourillon que comporte la fraise 11, une poignée de manipulation 14 et un palier 15 de guidage de l'axe 16 d'entraînement de la fraise 11, cet entraînement étant réalisé au moyen d'un moteur 17. The base 10 forms a diaphyseal rod 12 whose diameter corresponds to that of the bore produced by means of the instrument 3, so that this rod 12 can be slidably engaged in the bored medullary canal of the femur 1. The base 10 also includes a hole for receiving a pin which the cutter 11 includes, a handling handle 14 and a bearing 15 for guiding the axis 16 of drive of the cutter 11, this drive being carried out by means of an engine 17.
La fraise 11 présente une forme évasée, ayant un diamètre réduit au niveau de sa partie inférieure. Ce diamètre va en se réduisant très légèrement jusqu'au niveau du tiers inférieur de la fraise 11 puis en augmentant jusqu'à la partie supérieure de celle-ci, de telle sorte que la fraise 11présente une génératrice courbe. La base de la fraise 11est en outre dimensionnée de telle sorte que cette génératrice se trouve, sur le côté interne de l'instrument 4, sensiblement dans le prolongement de la génératrice de la tige 12. The cutter 11 has a flared shape, having a reduced diameter at its lower part. This diameter is reduced very slightly up to the level of the lower third of the cutter 11 and then increases up to the upper part thereof, so that the cutter 11 has a curved generatrix. The base of the cutter 11 is also dimensioned such that this generator is located, on the internal side of the instrument 4, substantially in the extension of the generator of the rod 12.
Comme cela résulte de ce qui précède et se comprend à partir de la figure 2, l'instrument 4 peut être coulissé dans le fémur 1 de telle sorte que la fraise 11usine la paroi interne 1 b du fémur 1 au niveau de la zone métaphysaire 1a, jusqu'à atteindre l'os cortical. As follows from the above and is understood from FIG. 2, the instrument 4 can be slid into the femur 1 so that the cutter 11 machines the internal wall 1 b of the femur 1 at the metaphyseal zone 1a , until reaching the cortical bone.
La cavité obtenue au moyen des instruments 3 et 4 est représentée sur les figures 3 à 6, sur lesquelles il apparaît que le volume The cavity obtained by means of instruments 3 and 4 is represented in FIGS. 3 to 6, in which it appears that the volume
<Desc/Clms Page number 6><Desc / Clms Page number 6>
alésé 20 et le volume usiné 21 permettent d'éliminer l'os spongieux le long de la paroi interne 1 b de la partie métaphysaire 1a, le long de la paroi externe 1 c de celle ci et le long des portions externes des parois antérieure 1 d et postérieure 1e. Par contre, l'alésage et l'usinage réalisés épargnent l'os spongieux au niveau de deux zones longitudinales situées entre ces volumes, créant ainsi deux nervures 22 d'os spongieux, ayant des sections transversales globalement triangulaires et aplaties. reamed 20 and the machined volume 21 make it possible to eliminate the cancellous bone along the internal wall 1 b of the metaphyseal part 1a, along the external wall 1 c thereof and along the external portions of the anterior walls 1 d and later 1e. On the other hand, the bore and the machining carried out spare the cancellous bone at the level of two longitudinal zones situated between these volumes, thus creating two ribs 22 of cancellous bone, having generally triangular and flattened cross sections.
En référence aux figures 8 à 11, il apparaît que l'implant fémoral 2 présente, au niveau de sa zone métaphysaire 2a, une section transversale de forme ovaloïde, sans solution de continuité. Cette zone métaphysaire 2a présente une partie externe 2a1 de forme partiellement cylindrique, qui correspond en majeure partie à la forme de l'alésage réalisé au moyen de l'instrument 3, et une partie interne 2a2 de forme partiellement évasée, qui correspond en majeure partie à la forme de la cavité réalisée au moyen de l'instrument 4. Referring to Figures 8 to 11, it appears that the femoral implant 2 has, at its metaphyseal zone 2a, a cross section of ovaloid shape, without continuity. This metaphyseal zone 2a has an external part 2a1 of partially cylindrical shape, which corresponds mainly to the shape of the bore produced by means of the instrument 3, and an internal part 2a2 of partially flared shape, which corresponds mainly to the shape of the cavity produced by means of the instrument 4.
L'implant 2 comprend en outre une tige diaphysaire 2b dont le diamètre correspond à celui de l'alésage réalisé au moyen de l'instrument 3. The implant 2 further comprises a diaphyseal rod 2b whose diameter corresponds to that of the bore produced by means of the instrument 3.
Le troisième instrument 5 dudit ensemble est un instrument de compactage de l'os spongieux. Cet instrument 5 reproduit la forme de l'implant 2 et est pourvu sur sa zone métaphysaire de saillies telles que des nervures et des picots, propres à compacter, au niveau des parois antérieure 1 d et postérieure 1 e du fémur 1, l'os spongieux non retiré par les instruments 3 et 4, particulièrement les nervures 22 précitées. The third instrument 5 of said set is an instrument for compacting the cancellous bone. This instrument 5 reproduces the shape of the implant 2 and is provided on its metaphyseal zone with projections such as ribs and spikes, suitable for compacting, at the level of the anterior 1 d and posterior 1 e walls of the femur 1, the bone cancellous not removed by instruments 3 and 4, particularly the aforementioned ribs 22.
En pratique, comme cela résulte de ce qui précède, le canal médullaire du fémur 1 et la portion de la partie métaphysaire 1a de ce fémur située dans le prolongement de ce canal médullaire sont tout d'abord alésés au moyen de l'instrument 3, puis l'instrument 4 est engagé à coulissement dans le canal médullaire ainsi alésé jusqu'à ce que la fraise 11 viennent usiner la paroi interne 1 b et atteindre l'os cortical ; l'instrument 4 est alors retiré et l'instrument 5 est introduit dans la cavité pour compacter les nervures 22 ; l'implant 2 est alors introduit dans la cavité et prend place étroitement contre les parois 1 b à 1 e délimitant celle-ci. In practice, as follows from the above, the medullary canal of the femur 1 and the portion of the metaphyseal part 1a of this femur situated in the extension of this medullary canal are first bored by means of the instrument 3, then the instrument 4 is slidably engaged in the medullary canal thus reamed until the cutter 11 comes to machine the internal wall 1b and reach the cortical bone; the instrument 4 is then removed and the instrument 5 is introduced into the cavity to compact the ribs 22; the implant 2 is then introduced into the cavity and takes place tightly against the walls 1 b to 1 e delimiting the latter.
L'invention fournit ainsi un ensemble pour la mise en place d'un implant fémoral de prothèse de hanche sur un fémur qui permet de The invention thus provides an assembly for the placement of a femoral implant of hip prosthesis on a femur which makes it possible to
<Desc/Clms Page number 7><Desc / Clms Page number 7>
remédier à de nombreux inconvénients des ensembles homologues de la technique antérieure. En effet, cet ensemble permet ainsi de former des surfaces d'appui résistant en os cortical tout en conservant des zones d'os spongieux au niveau des parois antérieures et postérieures du fémur et en permettant de compacter ces zones conservées au moyen dudit instrument de compaction. Cette compaction s'avère très favorable à la parfaite immobilisation de l'implant en position et à la croissance ultérieure des cellules osseuses permettant l'ancrage de l'implant. remedy many disadvantages of homologous sets of the prior art. Indeed, this assembly thus makes it possible to form resistant bearing surfaces in cortical bone while preserving areas of cancellous bone at the level of the anterior and posterior walls of the femur and making it possible to compact these preserved areas by means of said compaction instrument. . This compaction turns out to be very favorable for the perfect immobilization of the implant in position and for the subsequent growth of bone cells allowing the anchoring of the implant.
De plus, l'implant et les instruments ont des formes et des structures simples à fabriquer et à utiliser. En particulier, la fraise de l'instrument d'usinage n'a pas à être mobile selon l'axe de l'implant diaphysaire de l'embase de cet instrument ni à être mobile axialement selon son axe de rotation. In addition, the implant and the instruments have shapes and structures that are simple to manufacture and use. In particular, the cutter of the machining instrument does not have to be movable along the axis of the diaphyseal implant of the base of this instrument nor to be axially movable along its axis of rotation.
Il va de soi que l'invention n'est pas limitée à la forme de réalisation décrite ci-dessus à titre d'exemple mais qu'elle en embrasse, au contraire, toutes les variantes de réalisation. Ainsi, la fraise 11pourrait ne pas être évasée mais être simplement conique ou cylindrique. It goes without saying that the invention is not limited to the embodiment described above by way of example but that it embraces, on the contrary, all the variant embodiments. Thus, the cutter 11 could not be flared but be simply conical or cylindrical.
Claims (3)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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FR0206297A FR2839879A1 (en) | 2002-05-23 | 2002-05-23 | Apparatus for positioning of femoral implant for hip replacement has compacting projections to compact spongy bone at front and rear of femur |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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FR0206297A FR2839879A1 (en) | 2002-05-23 | 2002-05-23 | Apparatus for positioning of femoral implant for hip replacement has compacting projections to compact spongy bone at front and rear of femur |
Publications (1)
Publication Number | Publication Date |
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FR2839879A1 true FR2839879A1 (en) | 2003-11-28 |
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ID=29415014
Family Applications (1)
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FR0206297A Withdrawn FR2839879A1 (en) | 2002-05-23 | 2002-05-23 | Apparatus for positioning of femoral implant for hip replacement has compacting projections to compact spongy bone at front and rear of femur |
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FR (1) | FR2839879A1 (en) |
Citations (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4670015A (en) * | 1984-04-13 | 1987-06-02 | Finsbury (Instruments) Limited | Hip implant |
US4865608A (en) * | 1987-11-20 | 1989-09-12 | Brooker Jr Andrew F | Grooved endoprosthesis |
FR2658071A1 (en) * | 1990-02-09 | 1991-08-16 | Implants Instr Ch Fab | Device for preparing a bone cavity for the purpose of positioning an implant |
US5062854A (en) * | 1988-10-07 | 1991-11-05 | Pfizer Hospital Products Group | Prosthetic device and method of implantation |
US5540694A (en) * | 1993-06-01 | 1996-07-30 | Joint Medical Products Corporation | Instrument for cutting bone |
FR2802080A1 (en) * | 1999-12-13 | 2001-06-15 | Jacques Afriat | ASSEMBLY FOR PLACING A HIP PROTHESIS FEMALE ROD ON A FEMUR |
EP1201191A1 (en) * | 1993-05-27 | 2002-05-02 | Stryker Technologies Corporation | Flexible medullary reaming system |
-
2002
- 2002-05-23 FR FR0206297A patent/FR2839879A1/en not_active Withdrawn
Patent Citations (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4670015A (en) * | 1984-04-13 | 1987-06-02 | Finsbury (Instruments) Limited | Hip implant |
US4865608A (en) * | 1987-11-20 | 1989-09-12 | Brooker Jr Andrew F | Grooved endoprosthesis |
US5062854A (en) * | 1988-10-07 | 1991-11-05 | Pfizer Hospital Products Group | Prosthetic device and method of implantation |
FR2658071A1 (en) * | 1990-02-09 | 1991-08-16 | Implants Instr Ch Fab | Device for preparing a bone cavity for the purpose of positioning an implant |
EP1201191A1 (en) * | 1993-05-27 | 2002-05-02 | Stryker Technologies Corporation | Flexible medullary reaming system |
US5540694A (en) * | 1993-06-01 | 1996-07-30 | Joint Medical Products Corporation | Instrument for cutting bone |
FR2802080A1 (en) * | 1999-12-13 | 2001-06-15 | Jacques Afriat | ASSEMBLY FOR PLACING A HIP PROTHESIS FEMALE ROD ON A FEMUR |
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