FR2837093A1 - Ensemble prothetique pour l'articulation du genou - Google Patents

Ensemble prothetique pour l'articulation du genou Download PDF

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Publication number
FR2837093A1
FR2837093A1 FR0203345A FR0203345A FR2837093A1 FR 2837093 A1 FR2837093 A1 FR 2837093A1 FR 0203345 A FR0203345 A FR 0203345A FR 0203345 A FR0203345 A FR 0203345A FR 2837093 A1 FR2837093 A1 FR 2837093A1
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FR
France
Prior art keywords
assembly
tibial
implant
pins
femoral
Prior art date
Legal status (The legal status 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 status listed.)
Granted
Application number
FR0203345A
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English (en)
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FR2837093B1 (fr
Inventor
Philippe Asquier
Hubert Candavoine
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Medical Solution SARL
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Medical Solution SARL
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Filing date
Publication date
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Priority to FR0203345A priority Critical patent/FR2837093B1/fr
Publication of FR2837093A1 publication Critical patent/FR2837093A1/fr
Application granted granted Critical
Publication of FR2837093B1 publication Critical patent/FR2837093B1/fr
Anticipated expiration legal-status Critical
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
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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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30886—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts externally-threaded
    • 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
    • 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
    • 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
    • A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
    • 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
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0069—Three-dimensional shapes cylindrical

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

L'ensemble prothétique pour l'articulation du genou comprenant un implant tibial et un implant fémoral, est remarquable en ce que les implants tibial et/ ou fémoral présentent des agencements pour la fixation, d'une manière démontable, de quilles de stabilité (4) de différentes longueurs et aptes à être engagées dans le canal médullaire du tibia et/ ou du fémur, lesdites quilles (4) coopérant avec des organes de verrouillage (5) traversant ledit tibia et/ ou ledit fémur.

Description

L'invention se rattache au secteur technique des implants
orthopediques pour ['articulation du genou.
D'une maniere parfaitement connue pour un homme du metier, un ensemble orthopedique pour ['articulation du genou comprend un implant
femoral et un implant tibial.
L'implant tibial presente une embase, generalement metallique, 0 recevant un insert ou plateau, generalement en polyethylene. Cet insert est monte soit d'une maniere fixe, soit avec capacite de deplacement multidirectionnel. De meme ['insert tibial presente differents profies en section en fonction du type d' intervention a effectuer. A cet egard, on distingue generalement les inserts dits << standard >> et les inserts dits << de reprise >>. On a, a cet egard, propose de nombreux types de protheses et differentes solutions, notamment au niveau de ['implant tibial qui peut etre du type fixe avec conservation du croise posterieur, du type postero
stabilise, du type mobile avec ou sans mouvement antero-posterieur.
On a egalement propose d'equiper les implants tibial et/ou femoral de quilles d'ancrage apses a etre engagees dans le canal medullaire de l'os correspondent, tibia ou femur, en etant par ailleurs conformees pour
permettre une impaction avec ou non du ciment orthopedique.
Dans le cas d'une version non-cimentee, des risques d'instabilite de ['implant peuvent apparatre. Or l'instabilite des implants a une incidence tres importante sur le resultat de ['intervention a plus ou moins long terme,
2 2837093
dans le cas des deformations plus ou moins grandes, et dans le cas des
reprises plus ou moins simples.
En effet, selon l'etat anterieur de la technique, les quilles de stabilite, vent solidaires directement des parties correspondantes de ['implant femoral ou tibial, et ont une longueur unique, en fonction de la taille de ['implant. Il n'est done pas possible de jouer sur la longueur des quilles pour ameliorer la stabilite. En outre, aucun moyen de fixation des quilles dans le canal
medullaire de ltos considere, n'est reellement prevu.
L ' invention s ' est fixce pour but de remedier a ces inconvenients, de
maniere simple, sure, efficace et rationnelle.
Le probleme que se propose de resoudre ['invention est d'assurer une stabilite immediate des implants et d'obtenir un meilleur resultat
chirurgical, notamment dans le cas de reprise.
Pour resoudre un tel probleme, il a ete concu et mis au point un ensemble prothetique pour ['articulation du genou comprenant un implant
tibial et un implant femoral.
Selon ['invention, les implants tibial et/ou femoral presentent des agencements pour la fixation, d'une maniere demontable, de quilles de stabilite de differentes longueurs et apses a etre engagees dans le canal medullaire du tibia et/ou du femur, lesdites quilles cooperant avec des
organes de verrouillage traversant ledit tibia et/ou ledit femur.
3 2837093
Pour resoudre le probleme pose d'assurer la fixation des quilles, les agencements de fixation de ['implant tibial et de ['implant femoral, vent constitues par un plot cooperant avec l'extremite proximale d'une quille, ledit plot etant perce coaxialement pour le libre engagement d'un organe d'assemblage visse dans ladite extremite, ledit plot etant susceptible d'etre
obture temporairement par un bouchon.
Avantageusement, le plot est forme, pour ['implant tibial, en debordement de la face de dessous d'une embase tibiale recevant un insert 0 en polyethylene et, pour ['implant femoral, en debordement d'une partie de
sa face interne, sensiblement selon l'axe de l'echancrure intercondylienne.
Pour resoudre le probleme pose d'ameliorer la liaison entre le plot et la partie correspondante de la quille, I'extremite libre du plot presente une portee interne tronconique recevant une portee tronconique complementaire formee en bout de ltextremite proximale de la quille, pour constituer un
assemblage du type cone-morse.
Pour resoudre le probleme pose d'assurer une liaison durable et efficace, les organes d'assemblage entre 1'implant femoral et les quilles vent constituees par des vis, tandis que les organes d'assemblage entre ['implant tibial et les quilles vent constitues soit par des vis, soit par un pion dans le
cas d'un insert dit de reprise, ledit pion presentant une extremite filetee.
Pour resoudre le probleme pose d'assurer le verrouillage entre la quille de stabilite et l'os correspondent, tibia ou femur, chaque quille
4 2837093
presente transversalement au moins un trou debouchant pour ['engagement
des organes de verrouillage sous forme de vis ou de clavettes.
Selon une autre caracteristique, les quilles vent de section transversale sensiblement circulaire, et peuvent presenter deux meplats
diametralement opposes.
Pour resoudre le probleme pose d'ameliorer ltelasticite, les quilles,
au niveau de leurs extremites distales, vent fendues.
L'invention est exposee ci-apres plus en detail a ['aide des figures des dessins annexes dans lesquels: - la figure 1 est une vue en perspective avant assemblage des principaux elements de ['ensemble prothetique selon ['invention; - la fgure 2 est une vue de cote d'un implant femoral equipe d'une tige selon ['invention; - la figure 3 est une vue de face correspondent a la figure 2; - la figure 4 est une vue de face avec coupe partielle d'un implant tibial dans le cas d'un insert de reprise; - la fgure 5 est une vue semblable a la figure 4 dans le cas d'un insert standard; - la figure 6 est une vue en perspective de ['implant tibial selon la forme de realisation illustree figure 4, I'insert en polyethylene n'etant pas represente; - la figure 7 montre ['impaction d'un ensemble prothetique selon I'invention.
2837093
L'ensemble prothetique selon ['invention comporte, d'une maniere connue, un implant femoral (F) et un implant tibial (T). Chacun des implants vent de tout type connu et approprie et peuvent presenter differentes formes d'execution selon les cas pathologiques a traiter, par exemple au niveau des patins condyliens de ['implant femoral. Il en est de meme en ce qui concerne ['implant tibial (T) qui comprend, d'une maniere connue, une embase tibiale (1) apte a recevoir, d'une maniere fixe ou avec capacite de deplacement multidirectionnel, un plateau ou insert tibial (2) generalement en polyethylene. Par exemple, l'embase tibiale (1) peut 0 recevoir un plateau tibial (2) du type de ccux couramment utilise dans le cas
d'une reprise, ou bien un plateau tibial (3) du type standard.
Selon une caracteristique a la base de ['invention, ['implant tibial (T) et ['implant femoral (F) presentent des agencements pour la fixation, d'une maniere demontable, de quilles de stabilite (4) de differentes longueurs. Ces quilles (4) vent destinees a etre engagees dans le canal medullaire du tibia et/ou du femur, en etant verrouillees par des organes (5) traversant le tibia
et/ou le femur.
Dans ce but, ['implant femoral (F) presente un plot (6a) solidaire de la partie de la face interne du bouclier condylien (6). Ce plot (6a) est positionne sensiblement selon l' axe de l'echancrure inter-condylienne. De la meme fa$on, l'embase tibiale (1) presente, en debordement de sa face de dessous, un plot (la). Ces plots (6a) et (la) vent destines a cooperer avec l'extremite proximale de l'une des quilles (4). En outre, chacun des plots (6a) et (la) vent perces coaxialement pour le libre engagement d'un organe
6 2837093
d'assemblage apte a etre visse dans l'extremite proximale de l'une des tiges (4). Dans une forme de realisation preferee, I'extremite libre des plots (la) et (6a) presente une portee interne tronconique complementaire a une portee tronconique male (4a) formee en bout de 1'extremite proximale de
chacune des quill es (4) pour c onsti tu er un ass embl age du type c onemors e.
D'une maniere genera]e, les organes d'assemblage entre les plots (6a) et (la) et les quilles (4) vent constitues par des vis engagees librement dans les plots (la) et (6a) apres avoir ete introduites a partir de la face de dessus de l'embase tibiale (1) recevant 1'insert en polyethylene et a partir de
la face d'appui et de glissement du bouclier condylien (6).
Les vis (7) vent utilisees pour la fixation des quilles (4) par rapport a I'implant femoral (F) et par rapport a l'embase tibiale lorsque cette derriere
recoit un insert polyethylene (3) du type standard.
Par contre, lorsque l'embase tibiale (1) recoit un insert polyethylene (2) du type reprise, I'assemblage des quilles (4) peut s'effectuer par un pion (8) presentant une portee filetee (8a) vissee dans 1'extremite proximale de la quille correspondante (4). Le pion (8), par exemple sous forme d'une tige cylindrique, assure la butee de ['insert polyethylene, notamment dans le
plan posterieur.
D'une maniere importante, chaque quille (4) presente transversalement au moins un trou debouchant (4b) pour ['engagement des organes de verrouillage (5). Ces organes de verrouillage (5) vent constitues, par exemple, par des vis ou des clavettes. Ces organes de verrouillage (S)
7 2837093
traversent par consequent l'os correspondent et les quilles (4), permettant ainsi d'assurer une meilleure fixation primaire et une meilleure solidarisation du couple ox-implant. Le verrouillage peut s'effectuer a ['aide
d'un viseur, tent au niveau tibial qu'au niveau femoral.
Les quill es (4) v ent de section transvers ales sensiblement circulaires et peuvent presenter deux meplats diametralement opposes (4c) pour creer un effet anti-rotatoire. L'extremite distale de chacune des tiges (4) peut etre
biseautee et egalement presenter des fentes (4d) pour ameliorer l'elasticite.
Dans le cas ou il n'est pas necessaire d'utiliser des quilles pour ['implant femoral et/ou ['implant tibial, les trous debouchants des plots (6a)
et (1 a) peuvent etre obtures par un bouchon (9).
Les avantages ressortent bien de la description.
8 2837093

Claims (1)

    REVENDICATIONS -1- Ensemble prothetique pour ['articulation du genou comprenant un implant tibial et un implant femoral, caracteri se en ce qu e l es impl ants tibial et/ou femoral presentent des agencements pour la fixation, d'une maniere demontable, de quilles de stabilite (4) de differentes longueurs et apses a etre engagees dans le canal medullaire du tibia et/ou du femur, lesdites quilles (4) cooperant avec des organes de verrouillage (5) traversant ledit 0 tibia et/ou ledit femur. -2- Ensemble selon la revendication 1, caracterise en ce que les agencements de fixation de ['implant tibial et de ['implant femoral, vent constitues par des plots (la) et (6a) cooperant avec l'extremite proximale d'une quille (4), lesdits plots (la) et (6a) etant perces coaxialement pour le libre engagement d'un organe d'assemblage (7) visse dans ladite extremite, lesdits plots etant susceptibles d'etre obtures temporairement par un bouchon (9). -3- Ensemble selon la revendication 2, caracterise en ce que le plot (la) est forme, pour ['implant tibial, en debordement de la face de dessous d'une embase tibiale (1) recevant un insert en polyethylene, tandis que le plot (6a) est forme, pour ['implant femoral, en debordement d'une partie de sa face interne, sensiblement selon l'axe de l'echancrure intercondylienne. -4- Ensemble selon la revendication 2, caracterise en ce que l'extremite libre des plots presente une portee interne tronconique cooperant avec une
  1. 9 2837093
    portee tronconique complementaire formee en bout de l'extremite
    proximale de la quille (4), pour constituer un assemblage du type cone-
    morse. -S- Ensemble selon la revendication 2, caracterise en ce que les organes d'assemblage entre ['implant femoral et les quilles (4) vent constituees par
    des vis (7).
    - 6- Ensemble selon l a revendicati on 2, c aracteri se en ce que l es organes d'assemblage entre ['implant tibial et les quilles vent constitues soit par des vis (7), soit par un pion (8) dans le cas d'un insert dit de reprise, ledit pion
    (8) presentant une extremite fletee.
    -7- Ensemble selon la revendication 1, caracterise en ce que chaque quille (4) presente transversalement au moins un trou debouchant pour ['engagement des organes de verrouillage (S) sous forme de vis ou de clavettes. -8- Ensemble selon la revendication 1, caracterise en ce que les quilles (4) vent de section transversale sensiblement circulaire, et presentent deux
    meplats anti-rotatoires diametralement opposes.
    -9- Ensemble selon la revendication 1, caracterise en ce que les quilles (4),
    au niveau de leurs extremites distales, vent fendues.
FR0203345A 2002-03-14 2002-03-14 Ensemble prothetique pour l'articulation du genou Expired - Fee Related FR2837093B1 (fr)

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Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2347733A1 (fr) * 2010-01-21 2011-07-27 DePuy Products, Inc. Système de prothèse de genou
WO2011114024A1 (fr) * 2010-03-16 2011-09-22 Implanet Prothese du genou avec plaque meniscale mixte
US9204967B2 (en) 2007-09-28 2015-12-08 Depuy (Ireland) Fixed-bearing knee prosthesis having interchangeable components
US9398956B2 (en) 2007-09-25 2016-07-26 Depuy (Ireland) Fixed-bearing knee prosthesis having interchangeable components

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN109077833A (zh) * 2018-09-29 2018-12-25 北京爱康宜诚医疗器材有限公司 股骨髁假体组件

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4936853A (en) * 1989-01-11 1990-06-26 Kirschner Medical Corporation Modular knee prosthesis
EP0552950A1 (fr) * 1992-01-21 1993-07-28 Howmedica International Inc. Elément tibial pour une prothèse de remplacement du genou
US5397360A (en) * 1993-02-11 1995-03-14 Osteonics Corp. Modular components for prosthetic implants
US6171342B1 (en) * 1996-07-23 2001-01-09 Depuy Orthopaedics, Inc. Medical fastening system

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4936853A (en) * 1989-01-11 1990-06-26 Kirschner Medical Corporation Modular knee prosthesis
EP0552950A1 (fr) * 1992-01-21 1993-07-28 Howmedica International Inc. Elément tibial pour une prothèse de remplacement du genou
US5397360A (en) * 1993-02-11 1995-03-14 Osteonics Corp. Modular components for prosthetic implants
US6171342B1 (en) * 1996-07-23 2001-01-09 Depuy Orthopaedics, Inc. Medical fastening system

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9398956B2 (en) 2007-09-25 2016-07-26 Depuy (Ireland) Fixed-bearing knee prosthesis having interchangeable components
US9204967B2 (en) 2007-09-28 2015-12-08 Depuy (Ireland) Fixed-bearing knee prosthesis having interchangeable components
EP2347733A1 (fr) * 2010-01-21 2011-07-27 DePuy Products, Inc. Système de prothèse de genou
CN102133138A (zh) * 2010-01-21 2011-07-27 德普伊产品公司 膝假体系统
US9011547B2 (en) 2010-01-21 2015-04-21 Depuy (Ireland) Knee prosthesis system
EP2901970A1 (fr) * 2010-01-21 2015-08-05 DePuy (Ireland) Système de prothèse de genou
CN105640672A (zh) * 2010-01-21 2016-06-08 德普伊产品公司 膝假体系统
CN105640672B (zh) * 2010-01-21 2019-04-12 德普伊爱尔兰无限公司 膝假体系统
WO2011114024A1 (fr) * 2010-03-16 2011-09-22 Implanet Prothese du genou avec plaque meniscale mixte
FR2957518A1 (fr) * 2010-03-16 2011-09-23 Implanet Prothese du genou avec plaque meniscale mixte

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