U.S. patent application number 09/815405 was filed with the patent office on 2001-09-20 for bone implant and method of securing.
Invention is credited to Bonutti, Peter M..
Application Number | 20010023371 09/815405 |
Document ID | / |
Family ID | 21942246 |
Filed Date | 2001-09-20 |
United States Patent
Application |
20010023371 |
Kind Code |
A1 |
Bonutti, Peter M. |
September 20, 2001 |
Bone implant and method of securing
Abstract
The present invention is an implant for securing to a bone to
form a plurality of cement cells. The implant has a bone engagement
portion for engagement with the bone. The implant has surfaces
defining a first plurality of cement compartments in the bone
engagement portion for alignment with a second plurality of cement
compartments in the bone to form a plurality of cement cells
extending between the implant and the bone when the implant is
secured to the bone. The cement cells receive cement therein to
form plugs of cement extending between the implant and the bone to
secure the implant to the bone.
Inventors: |
Bonutti, Peter M.;
(Effingham, IL) |
Correspondence
Address: |
TAROLLI, SUNDHEIM & COVELL
TUMMINO & SZABO
1111 LEADER BLDG.
CLEVELAND
OH
44114-1400
US
|
Family ID: |
21942246 |
Appl. No.: |
09/815405 |
Filed: |
March 22, 2001 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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09815405 |
Mar 22, 2001 |
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08735916 |
Oct 24, 1996 |
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6217617 |
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08735916 |
Oct 24, 1996 |
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08377759 |
Jan 24, 1995 |
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5624462 |
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08735916 |
Oct 24, 1996 |
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08046220 |
Apr 12, 1993 |
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5441538 |
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Current U.S.
Class: |
623/23.48 ;
623/23.55 |
Current CPC
Class: |
A61F 2250/0097 20130101;
A61F 2/3877 20130101; A61F 2002/30617 20130101; A61F 2002/30795
20130101; Y10S 623/908 20130101; A61F 2002/3082 20130101; A61B
17/8802 20130101; A61F 2002/4631 20130101 |
Class at
Publication: |
623/23.48 ;
623/23.55 |
International
Class: |
A61F 002/28 |
Claims
I claim:
1. An implant for securing to a bone, said implant having a bone
engagement portion for engagement with the bone and having surfaces
defining a first plurality of cement compartments in said bone
engagement portion for alignment with a second plurality of cement
compartments in the bone to form a plurality of cement cells
extending between said implant and the bone when said implant is
secured to the bone, said cement cells for receiving cement therein
to form plugs of cement extending between said implant and the bone
to secure said implant to the bone.
2. An implant as set forth in claim 1 including surface means for
defining at least one fill port in fluid communication with at
least one of said cement compartments in said implant, said fill
port for receiving cement through said fill port and for
communicating the cement to said at least one cement
compartment.
3. An implant as set forth in claim 2 including a plurality of fill
ports numbering one for each respective cement compartment in said
implant.
4. An implant as set forth in claim 1 wherein said cement
compartments in said implant are each generally cylindrical in
shape, having a cylindrical wall extending about an axis extending
generally in a direction between said implant and the bone.
5. An implant as set forth in claim 1 including means for allowing
excess cement to flow from said cement cells away from the
interface between said bone engagement portion of said implant and
the bone, comprising at least one exit channel in said implant
extending from said first plurality of cement compartments in a
direction away from said bone engagement portion of said
implant.
6. An implant as set forth in claim 1 including ridge portions
around said cement compartments in said implant to block flow of
cement out of said cement compartments and between said implant and
the bone.
7. In combination, an implant having a bone engagement portion for
engagement with a bone, said implant having surfaces defining a
first plurality of cement compartments in said bone engagement
portion; a bone having surfaces defining a second plurality of
cement compartments; said cement compartments in said implant being
aligned with said cement compartments in said bone to form cement
cells extending between said implant and said bone; and plugs of
cement in said cement cells extending between said implant and said
bone and securing said implant to said bone.
8. A combination as set forth in claim 7 including respective
alignment markers on said bone and on said implant for aligning
said cement compartments in said implant with said cement
compartments in said bone.
9. A combination as set forth in claim 7 including means for
dividing the interface between said implant and said bone into at
least two discrete parts, comprising a portion of a surface of said
bone engagement portion of said implant in abutting engagement with
the bone whereby there is not a continuous layer of cement between
said implant and said bone across the full extent of the interface
between said implant and said bone.
10. A combination as set forth in claim 7 wherein said implant
includes surface means for defining at least one fill port in fluid
communication with at least one of said cement compartments in said
implant, said fill port for receiving said cement through said fill
port and for communicating said cement to said cement
compartment.
11. A combination as set forth in claim 7 wherein said implant
includes ridge portions around said cement compartments in said
implant to block flow of cement out of said cement cells and
between said implant and said bone.
12. A method of securing an implant to bone comprising the steps
of: providing an implant having a bone engagement portion for
engagement with the bone and having surfaces defining a first
plurality of cement compartments in the bone engagement portion;
making a second plurality of cement compartments in the bone;
placing the bone engagement portion of the implant adjacent the
bone; aligning the cement compartments in the implant with the
cement compartments in the bone to form cement cells extending
between the implant and the bone; and placing cement in the cement
cells to form plugs of cement extending between the implant and the
bone to secure the implant to the bone.
13. A method as set forth in claim 12 including the step of
limiting the amount of cement entering between the bone engagement
portion of the implant and the bone to ensure that there is not a
continuous layer of cement between the implant and the bone over
the full extent of the interface between the implant and the
bone.
14. A method as set forth in claim 13 wherein said step of filling
the cement cells through one or more fill ports in the implant
includes filling the cement cells after performing said step of
placing the bone engagement portion of the implant adjacent the
bone.
15. A method as set forth in claim 14 wherein said step of filling
the cement cells through one or more fill ports includes filling
each cement cell through its own respective fill port.
16. A method as set forth in claim 12 wherein said step of placing
cement in the cement cells includes the steps of placing a quantity
of cement between the implant and the bone and moving the implant
and the bone toward each other to squeeze the cement into the
cement cells while the cement compartments in the implant and in
the bone are aligned.
17. A method as set forth in claim 12 including the steps of
providing at least one exit channel in the implant extending from
the cement compartments and allowing excess cement to flow through
the at least one exit channel.
18. A method as set forth in claim 12 wherein said step of aligning
the cement compartments in the implant with the cement compartments
in the bone includes the steps of placing an alignment marker on
the bone and aligning it with a second alignment member on the
implant.
19. A method as set forth in claim 12 wherein said step of placing
cement in the cement cells includes the step of filling the cement
cells through one or more fill ports in the implant.
20. A method as set forth in claim 12 wherein said step of making a
second plurality of cement compartments in the bone includes
drilling or broaching or pressing the cement compartments in the
bone.
21. A method of securing an implant to bone comprising the steps
of: placing a bone engagement portion of an implant adjacent a bone
to form cement cells extending between the implant and the bone;
and placing cement in the cement cells to form plugs of cement
extending between the implant and the bone, while preventing
formation of a continuous slab of cement between the bone
engagement portion of the implant and the bone.
22. A method as set forth in claim 21 wherein said step of placing
a bone engagement portion of an implant adjacent a bone includes
providing an implant having a bone engagement portion for
engagement with the bone and having surfaces defining a first
plurality of cement compartments in the bone engagement portion,
and said step of placing a bone engagement portion of an implant
adjacent a bone includes making a second plurality of cement
compartments in the bone and aligning the cement compartments in
the bone engagement portion of the implant with the cement
compartments in the bone.
Description
BACKGROUND OF THE INVENTION
[0001] 1. Technical Field
[0002] The present invention relates to an implant and to a method
of securing an implant to a bone. More particularly, the present
invention relates to an implant for securing to bone with bone
cement, and to a method of securing an implant to a bone with bone
cement.
[0003] 2. Description of the Prior Art
[0004] Implants are often secured to bone with a material such as
polymethylmethacrylate (PMMA), hereinafter referred to as "bone
cement" or simply "cement". The cement bonds between a surface of
the implant and a surface of the bone to secure the implant to the
bone.
[0005] Often the bone cement is applied as a slab, for example
between adjoining flat surfaces of a patellar implant and a
patella. There may be defects in the cement such as an air bubble,
an impurity or unreacted PMMA powder. It is known for slabs of bone
cement to crack. With bone cement as with many materials a crack
often initiates at the site of a defect. Or, a slab of bone cement
could fail and crack from other causes such as stress or trauma. If
bone cement is present in a continuous mass such as a slab, a crack
propagates through the slab, resulting in complete failure of the
cement system.
[0006] Another concern with bone cement is the maximum force (such
as torque) which can be transferred, through the cement, between
the implant and the bone. In the case of a slab, the maximum torque
is related to the adhesive interfacial shear stress between the
cement and the implant.
SUMMARY OF THE INVENTION
[0007] It is desirable to be able to minimize propagation through
the bone cement of any cracks which may unavoidably occur. To this
end, in accordance with the present invention, compartments are
formed in the face of the implant adjacent the bone, and in the
face of the bone. The two sets of compartments are aligned to form
cement cells extending between the implant and the bone when the
implant is secured to the bone. The cement cells receive cement
therein to form plugs of cement extending between the implant and
the bone to secure the implant to the bone.
[0008] In one embodiment the present invention is an implant for
securing to a bone to form a plurality of cement cells. The implant
has a bone engagement portion for engagement with the bone. The
implant has surfaces defining a first plurality of cement
compartments in the bone engagement portion for alignment with a
second plurality of cement compartments in the bone to form a
plurality of cement cells extending between the implant and the
bone when the implant is secured to the bone. The cement cells
receive cement therein to form plugs of cement extending between
the implant and the bone to secure the implant to the bone.
[0009] The implant may include one or more fill ports for supplying
cement to one or more of the cement compartments. The implant may
include means for allowing excess cement to flow from the cement
compartments away from the bone engagement portion, such as exit
channels extending from the cement compartments in a direction away
from the bone engagement portion. The implant may include ridge
portions around the cement compartments in the implant to block
flow of cement out of the cement compartments and between the
implant and the bone. There may be respective alignment markers on
the bone and on the implant for aligning the cement compartments in
the implant with the cement compartments in the bone.
[0010] The bone engagement portion of the implant is preferably in
abutting engagement with the bone so that there is not a continuous
layer of cement between the implant and the bone across the full
extent of the interface between the implant and the bone. This
discontinuity in the layer of bone cement inhibits crack
propagation.
[0011] In another embodiment, the present invention is a
combination including an implant having a bone engagement portion
for engagement with a bone and a first plurality of cement
compartments in the bone engagement portion; a bone having a second
plurality of cement compartments; the cement compartments in the
implant being aligned with the cement compartments in the bone to
form cement cells extending between the implant and the bone; and
plugs of cement in the cement cells extending between the implant
and the bone and securing the implant to the bone.
[0012] In another embodiment, the present invention is a method of
securing an implant to bone comprising the following steps:
providing an implant having a bone engagement portion for
engagement with the bone and having surfaces defining a first
plurality of cement compartments in the bone engagement portion;
making a second plurality of cement compartments in the bone;
placing the bone engagement portion of the implant adjacent the
bone; aligning the cement compartments in the implant with the
cement compartments in the bone to form cement cells extending
between the implant and the bone; and placing cement in the cement
cells to form plugs of cement extending between the implant and the
bone to secure the implant to the bone. Preferably, the method
includes blocking cement from entering between the implant and the
bone sufficiently to ensure that there is not a continuous layer of
cement between the implant and the bone over the full extent of the
interface between the implant and the bone.
[0013] The cement compartments in the bone may be formed by
drilling, broaching, or pressing into the bone. The cement
compartments are preferably cylindrical because that shape can
easily be made with a standard drill. However, other shapes are
possible.
[0014] With a compartmentalized system, the strength of the
implant/bone interface is governed by not only the adhesive shear
stress but also the pure shear stress of the plugs of bone cement.
The interface strength is enhanced by the pure shear strength of
the plugs of bone cement. For an aligned compartment system to fail
in shear the cement plugs must fail in shear which requires
substantially more stress than that needed to cause failure of a
slab.
BRIEF DESCRIPTION OF THE DRAWINGS
[0015] The foregoing and other features of the present invention
will become apparent to one skilled in the art to which the present
invention relates upon consideration of the following description
of the invention with reference to the accompanying drawings,
wherein:
[0016] FIG. 1 is a sectional view of an implant having three cement
compartments;
[0017] FIG. 2 is a sectional view of the implant of FIG. 1 being
applied to a bone having three matching cement compartments, and
bone cement between;
[0018] FIG. 3 is a view similar to FIG. 2 after the implant is
moved to a position against the bone to form cement cells filled
with bone cement;
[0019] FIG. 4 is an enlarged view of one filled cement cell;
[0020] FIG. 5 is an end view of an implant like the implant of FIG.
1 but having individual fill ports for three cement
compartments;
[0021] FIG. 6 is an end view of a bone portion having three cement
compartments;
[0022] FIG. 7 is a view taken along line 7-7 of FIG. 5;
[0023] FIG. 8 illustrates filling of one of the cement compartments
of the implant of FIGS. 5 and 7;
[0024] FIG. 9 is a view of an implant having one fill port and one
exit channel for three cement compartments;
[0025] FIG. 10 illustrates the filling of the cement compartments
of the implant of FIG. 9;
[0026] FIG. 11 is a sectional view taken along line 11-11 of FIG. 3
and showing areas of discontinuity in the layer of bone cement;
[0027] FIG. 12 is a sectional view similar to FIG. 4 and showing an
implant having a projecting ridge around its cement compartment to
block lateral cement flow;
[0028] FIG. 13 is a view taken along line 13-13 of FIG. 12; and
[0029] FIG. 14 is a view showing a rounded-bottom cement
compartment in an implant.
DESCRIPTION OF PREFERRED EMBODIMENT
[0030] The present invention relates to an implant and to a method
of securing an implant to a bone with bone cement. The present
invention is applicable to various implant constructions. As
representative of the present invention, FIG. 1 illustrates a
patellar implant 10. The implant 10 is made of a body of material
12. The material 12 is preferably a biocompatible plastic material.
A preferred material is ultra high molecular weight polyethylene
(UHMWPE). Alternatively, the implant 10 can be a metal backed
plastic component having a bone engagement portion made of metal
and an articulating surface made of plastic.
[0031] The implant 10 has an arcuate articulating surface 20 and a
planar bone engagement surface 22. The surfaces 20 and 22 intersect
at the outer periphery 24 of the implant 10.
[0032] A bone engagement portion 26 of the implant 10 includes the
portion of the implant 10 adjacent to or close to the bone
engagement surface 22. The bone engagement portion 26 includes
surfaces defining a plurality of cement compartments 30, 32, and 34
in the implant 10.
[0033] Each of the cement compartments 30, 32, and 34 is generally
cylindrical in shape, and extends inwardly into the body of
material 12 from the bone engagement surface 22. The cement
compartment 30 is defined by a cylindrical side wall 36 which
extends between a planar end wall 38 and the plane of the bone
engagement surface 22. The bone engagement surface 22 is removed
during formation of the cement compartment 30 at the location of
the cement compartment 30, within the boundaries of the cylindrical
side wall 36, so that cement (not shown in FIG. 1) can be placed
into the cement compartment 30 in a direction from the bone
engagement surface 22 toward the interior of the body of material
12 of the implant 10.
[0034] The cement compartments 32 and 34 are similar to the cement
compartment 30. The cement compartment 32 is defined by a
cylindrical side wall 40 extending between a planar end wall 42 and
the plane of the bone engagement surface 22. The cement compartment
34 is defined by a cylindrical side wall 44 extending between a
planar end wall 46 and the plane of the bone engagement surface
22.
[0035] The patellar implant 10 is designed to be implanted on a
resected patella (kneecap) 50 shown fragmentarily in FIG. 2. The
patella 50 is resected to provide a planar implant engagement
surface 52 for mating with the bone engagement surface 22 of the
implant 10.
[0036] In preparation for implanting the implant 10 on the patella
50, a plurality of cement compartments 54, 56, and 58 are formed in
the patella 50. The cement compartments 54, 56, and 58 are similar
in size and shape to the cement compartments 30, 32, and 34 in the
implant 10. Further, the cement compartments 54, 56, and 58 in the
patella 50 are located in the patella 50 so as to be aligned with
the respective cement compartments 30, 32, and 34 in the implant 10
when the implant 10 is placed adjacent the patella 50. For example,
there may be provided three cement compartments in an implant as
shown in FIG. 5, for alignment with three cement compartments in a
bone shown in FIG. 6.
[0037] To secure the implant 10 (FIG. 2) to the patella 50, a
quantity of bone cement 60 is placed between the implant and the
patella. The implant 10 and the patella 50 are then moved toward
each other in the direction indicated by the arrows 62 and 64 (FIG.
2).
[0038] The quantity of bone cement 60 may be placed on the implant
engagement surface 52 of the patella 50, with the implant 10 being
then moved in the direction indicated by the arrow 62 into
engagement with the bone cement. Alternatively, the bone cement 60
may be placed on the bone engagement surface 22 of the implant 10,
and the implant and bone cement then moved in the direction
indicated by the arrow 62 into engagement with the bone 50. There
may, of course, be movement of the patella 50 in the direction
indicated by the arrow 64 to join the patella with the implant 10;
such movement may be limited by the soft tissue attachment of the
patella to the patient's knee joint. Some cement 60 may be placed
on the implant 10 and the remainder of the cement placed on the
patella 50, with the implant and patella then being pressed or
squeezed toward each other.
[0039] When the implant 10 and the bone 50 are in the position
shown in FIG. 2, the bone engagement surface 22 of the implant is
spaced from the implant engagement surface 52 of the bone, with the
bone cement 60 disposed therebetween. A portion 70 of the bone
cement 60 is disposed in the cement compartment 30 in the implant
10. A portion 72 of the bone cement 60 is disposed in the cement
compartment 54 in the bone 50, which is aligned with the cement
compartment 30. A portion 76 of the bone cement 60 is disposed in
the cement compartment 32 of the implant 10. A portion 78 of the
bone cement 60 is disposed in the cement compartment 56 of the bone
50, which is aligned with the cement compartment 32. A portion 80
of the bone cement 60 is disposed in the cement compartment 34 in
the implant 10. A portion 82 of the bone cement 60 is disposed in
the cement compartment 58, which is aligned with the cement
compartment 34.
[0040] When the implant 10 and the bone 50 are in the relative
position shown in FIG. 2, there is some bone cement disposed
between the bone engagement surface 22 of the implant and the
implant engagement surface 52 of the bone. A portion 84 of the bone
cement 60 is disposed between the bone engagement surface 22 and
the bone 50 and extends outwardly from the aligned cement
compartments 30 and 54. Another portion 86 of the bone cement 60
extends between the aligned compartments 30 and 54 and the aligned
cement compartments 32 and 56. A further portion 88 of the bone
cement 60 is disposed between the aligned cement compartments 32
and 56 and the aligned cement compartments 34 and 58. Another
portion 90 of the bone cement 60 extends outwardly from the aligned
cement compartments 80 and 82 toward the outer edge 24 of the
implant 10.
[0041] The implant 10 is pressed or squeezed firmly against the
bone 50 as shown in FIG. 3 to remove as much bone cement as
possible from between the bone engagement surface 22 of the implant
and the implant engagement surface 52 of the bone. The amount of
excess bone cement 60, that is the bone cement which is not
disposed within the various cement compartments when the implant 10
and the bone 50 are adjacent each other as in FIG. 3, depends on
the amount of cement initially placed between the implant and the
bone, and its location. Ideally, all the cement flows into the
aligned cement compartments, but of course this may not be
possible.
[0042] When the implant 10 is adjacent the bone 50, the cement
compartment 30 in the implant is aligned with the cement
compartment 54 in the bone to form a cement cell 100. The cement
cell 100 extends between the implant 10 and the bone 50. Disposed
within the cement cell 100 (FIG. 4) is a plug or pin of cement 102
which includes the cement portion 70 in the cement compartment 30
of the implant 10 and the cement portion 70 in the cement
compartment 54 of the bone 50. The cement cell 100 extends between
the implant 10 and the bone 50 across the interface 104 between the
implant and the bone--that is, across the area of engagement
between the implant and the bone.
[0043] A very thin layer 106 of bone cement 60 may be disposed
between the bone engagement surface 22 of the implant 10 and the
implant engagement surface 52 of the bone 50. This can be for
several reasons. First, it may not be possible to provide matching
planar surfaces on the implant 10 and on the bone 50 so as to allow
complete contact of the two elements at all locations. Second, the
implant 10 and bone 50 may be pressed toward each other unevenly,
with more pressure at some locations and less at other locations.
In any event, it is desirable that there not be a continuous layer
of bone cement 60 between the implant 10 and the bone 50 for the
entire extent of the interface between the implant and the bone.
Thus, as seen in FIG. 11, areas of discontinuity of the bone cement
are preferably present, to block propagation of any cracks
throughout the entire interface. Any bone cement which squeezes out
to the other edge 24 of the implant, as indicated at 108 and 110 in
FIG. 3, is cleaned off.
[0044] With the prior art method of using a slab of cement between
the implant and the bone, it was necessary to hold the implant away
from the bone by at least some distance. With the present
invention, the cement plugs make it possible to put the implant
directly against the bone. This allows for minimizing the areas of
continuity of bone cement between the implant and the bone. This
minimizes the likelihood of propagation of a crack in the bone
cement and minimizes the chance of failure of the cement
system.
[0045] The plugs or pins of cement, such as the cement plug 102 in
the cement cell 100, provide additional stability to secure the
implant 10 to the bone 50. In the case of a slab of cement only
between an implant and a bone, the maximum force, such as torque,
which can be transferred through the cement between the implant and
the bone, is related to the adhesive interfacial shear stress
between the cement and the implant. With a compartmentalized
system, as illustrated in the drawings, the strength of the
implant/bone interface is governed by not only the adhesive shear
stress but also the pure shear stress of the plugs or pins or
cylinders of bone cement in the cement cells. For a system using
aligned compartments, as illustrated, to fail in shear, the cement
pins must fail in shear. This requires substantially more stress
than that needed to cause failure of the slab.
[0046] Bone cement may be placed in the cement cells in a manner
other than as described above. The implant 120 (FIGS. 5, 7 and 8)
has three cement compartments 122, 124, and 126 which are similar
in size, shape and location to the cement compartments 30, 32 and
34 of the implant 10 (FIGS. 1-4). However, the cement compartments
in the implant 120 are fillable through fill ports extending
between the respective cement compartments and the radially outer
edge 128 of the implant 120.
[0047] A first fill port 130 (FIG. 5) is defined by a partial
cylindrical surface 132 extending radially outwardly from the
cement compartment 122 to the implant periphery 128. A second fill
port 134 extends radially between the cement compartment 124 and
the periphery 128 and is partially defined by a partial cylindrical
surface 136. A third fill port 138, partially defined by a partial
cylindrical surface 140, extends radially between the cement
compartment 126 and the implant periphery 128.
[0048] The cement compartments 122, 124, and 126, with their
respective fill ports 130, 134, and 138, are disposed in a bone
engagement portion 142 of the implant 120. The bone engagement
portion 142 is the lower portion (as viewed in FIG. 7) of the
implant 120. The implant 120 also has an arcuate articulating
surface 144 and a generally planar bone engagement surface 146.
[0049] As can be seen in FIG. 5, the implant 120 has a circular
shape in plan. The cement compartments 122, 124, and 126 are spaced
equally about a central axis 150 of the implant 120. The cement
compartments 122, 124, and 126 are designed to mate with matching
cement compartments 154, 156, and 158 in a bone 160 (FIG. 6) having
an implant engagement surface 162.
[0050] To aid in alignment of the cement compartments in the
implant 120 with the cement compartments in the bone 160, one or
more alignment markers may be provided on either the implant or the
bone or both. The implant 120 (FIG. 5) has two alignment markers
170 and 172. The alignment marker 170 is a notch 174 cut into the
periphery 128 of the implant 120 and defined by two side lines 176
and 178. The alignment marker 172 is a notch 180 cut into the
periphery 128 of the implant 120 and defined by two side lines 182
and 184.
[0051] A template (not shown) is used to place alignment markers
186 and 188 (FIG. 6) on the bone 160, preferably at the same time
as the cement compartments 154, 156, and 158 are made. The
alignment marker 186 is a notch 190 defined by two side lines 192
and 194 scribed into the implant engagement surface 162 of the bone
160. The alignment marker 188 is a V-shaped notch 196 defined by
two side lines 198 and 200 scribed into the implant engagement
surface 162 of the bone 60.
[0052] The implant 120 in FIG. 5 is aligned with or placed on the
bone 160 in FIG. 6 by rotating or mirroring the implant 120 about
an imaginary line extending vertically on the sheet of drawings
between FIGS. 5 and 6. The alignment marker 172 is placed on and in
alignment with the alignment marker 186. The alignment marker 170
of the implant 120 is placed on and in alignment with the alignment
marker 188 on the bone 160.
[0053] When this is done, the cement compartment 124 of the implant
120 is aligned with the cement compartment 154 on the bone 160.
Similarly, the cement compartments 122 and 126 of the implant 120
are aligned with, respectively, cement compartments 158 and 156 of
the bone 160. The cement compartment 122 in the implant 120 aligns
with the cement compartment 154 in bone 160 to form a cement cell
164. The cement compartment 126 in the implant 120 aligns with the
cement compartment 156 in the bone 160 to form a second cement cell
166. The cement compartment 124 in the implant 120 aligns with the
cement compartment 158 in the bone 160 to form a third cement cell
168.
[0054] After the implant 120 is aligned with the bone 160 (FIG. 8),
the cement cells 164, 166, and 168 are filled with bone cement in a
manner as described below to secure the implant to the bone. The
cement cell 164 is filled through the fill port 130. The cement
cell 166 is filled through the fill port 138 (FIG. 5) for the
cement compartment 126. The cement cell 168 is filled through the
fill port 134.
[0055] As illustrated schematically in FIG. 8, a device is used to
introduce cement into the cement cells of the aligned implant 120
and bone 160. The device may be a syringe 210 having a needle 212
which is inserted into the fill port 134, for example. Bone cement
(not shown) is injected through the syringe 210 and the needle 212
to fill the cement cell 168. Excess bone cement will be present in
the fill port 134. Similarly, the cement cell 164 is filled through
the fill port 130, and the cement cell 166 is filled through the
fill port 138 (FIG. 5).
[0056] When the cement cells 164, 166, and 168 are filled, there
are plugs or pins or cylinders of bone cement in each of the cement
cells. These cement plugs are separated from each other by the
solid material of the bone engagement portion 142 of the implant
10. Thus, there is not a continuous layer of bone cement across the
interface between the implant 120 and the bone 160. Rather, there
are discrete, separated bone cement portions securing the implant
120 to the bone 160. These bone cement portions include plugs of
cement in the cement cells 164, 166, and 168. These plugs of cement
extend between the implant 120 and the bone 160, away from the bone
engagement surface 146 and the implant engagement surface 162.
These cement plugs block lateral movement of the implant 120
relative to the bone 160 in a manner superior to the blocking
effect obtained by a simple slab of bone cement between the implant
and the bone, as is done in the prior art.
[0057] FIGS. 9 and 10 illustrate another embodiment of the
invention in which an implant 230 has three cement compartments
232, 234, and 236 which are all filled via one fill port 238. The
fill port 238 includes a straight portion 240 extending from the
outer periphery 242 of the implant 230 to a first arcuate fill port
portion 242. The first arcuate fill port portion 232 extends
between and interconnects the cement compartments 234 and 236. A
second arcuate fill port portion 244 extends between and
interconnects the cement compartment 236 and the cement compartment
232. A third arcuate fill port portion 246 extends between and
interconnects the cement compartment 234 and the cement compartment
232. An exit channel 250 extends from the portion 244 of the fill
port 238 to the outer periphery 242 of the implant 230, at a
location diametrically opposite from the fill port portion 240. The
implant 230 has a bone engagement portion 252, a bone engagement
surface 254, and an articulating surface 256.
[0058] FIG. 10 illustrates the securing of the implant 230 to a
bone 260. The bone 260 has an implant engagement surface 262 which
is placed in mating engagement with the bone engagement surface 254
of the implant 230. The implant 230 is aligned with the bone 260 so
that the cement compartment 232 aligns with a cement compartment
264 in the bone 260 to form a cement cell 266 extending between the
implant 230 and the bone 260. The cement compartment 236 in the
implant 230 aligns with a cement compartment 268 in the bone 260 to
form a cement cell 270 extending between the implant and the bone.
The cement compartment 234 in the implant 230 aligns with a cement
compartment 272 in the bone 260 to form a cement cell 274 extending
between the implant and the bone.
[0059] The cement cells 266, 270 and 274 are filled by insertion of
bone cement 275 through a device such as a syringe 276 (FIG. 10)
having a needle 278. The needle 278 is placed in the fill port
portion 240 and bone cement 275 is injected into the fill port
portion 240. As bone cement 275 continuous to be injected, it flows
through the remaining portions 242, 244 and 246 of the fill port
238. The cement cells 266, 270 and 274 fill with bone cement 275.
Excess cement 275 flows outwardly from the fill port 238 through
the exit channel 250 and may be cleaned off the outer surface 256
of the implant 230.
[0060] FIG. 11 illustrates how the present invention can minimize
the possibility of there being a continuous layer of bone cement
across the entire extent of the interface between an implant and a
bone. The cement cell 100 (FIGS. 3 and 11) is filled with a plug or
pin of bone cement 102. Similarly, the cement compartments 34 and
58 (FIG. 3) form a cement cell 280 (FIGS. 3 and 11) filled with a
plug of cement 282. The cement compartments 32 and 56 (FIG. 3) form
a cement cell 284 (FIGS. 3 and 11) filled with a plug of bone
cement 286. The plugs of bone cement 102, 282, and 286 are discrete
and separate from each other. There is no continuous body of bone
cement extending between any two of the plugs of bone cement 102,
282, and 286. There may be other areas of bone cement disposed
between the bone engagement surface 22 of the implant 10 and the
implant engagement surface 52 of the bone 50, such as the areas of
bone cement indicated schematically at 288, 290 and 292 in FIG. 11.
However, these areas of bone cement again do not form one
continuous body of bone cement across the extent of the interface
between the implant 10 and the bone 50. Thus, any crack which might
originate in any one of the bodies of bone cement are not likely to
propagate across the entire extent of the interface between the
implant 10 and the bone 50.
[0061] An implant in accordance with the present invention may
include ridge portions around cement compartments in the implant to
block flow of cement out of the cement compartment between the
implant and the bone. One such ridge portion is illustrated
schematically in FIGS. 12 and 13. An implant 300 is disposed in
mating engagement with a bone portion 302. The implant 300 has a
bone engagement surface 304 disposed adjacent an implant engagement
surface 306 of the bone portion 302. A cement compartment 308 in
the implant 300 is aligned with a cement compartment 310 in the
bone portion 302.
[0062] The aligned cement compartments 308 and 310 together define
a cement cell 312 having a quantity of bone cement 314 therein. The
plug of bone cement 314 extends between the implant 300 and the
bone portion 302. The plug of bone cement 314 extends into the
implant 300 for a substantial distance in a direction away from the
interface or area of engagement 316 between the implant 300 and the
bone portion 302. The plug of cement 314 also extends into the bone
portion 302 in a direction away from the interface 316, the bone
engagement surface 304 and the implant engagement surface 306.
[0063] The implant 300 has a ridge portion 320 extending around the
cement compartment 308. The ridge portion 320 has an outer
cylindrical surface 322 extending outwardly from the implant bone
engagement surface 304; an annular end face 324 extending radially
inwardly from the surface 322; and an inner cylindrical surface 326
extending parallel to the outer cylindrical surface 322 from the
annular end face 324 to the plane of the bone engagement surface
304. The implant ridge portion 320 extends into the bone portion
302, below the implant engagement surface 306, as illustrated in
FIG. 12, when the implant 300 is positioned adjacent the bone
portion 302. The ridge portion 320 blocks the flow of cement out of
the cement cell 312 into the areas 328 and 330 adjacent the cement
cell and between the implant 300 and the bone 302. The ridge
portion 320 is pressed into the bone portion 302, below the implant
engagement surface 306, when the implant 300 is positioned adjacent
the bone 302. Ridge portions may also be provided on fill
ports.
[0064] The cement cells and the cement compartments need not have a
cylindrical configuration as illustrated above. FIG. 14 illustrates
a cement compartment 340 in an implant 342. The cement compartment
340 has a rounded bottom portion 344 to reduce stress
concentrations in the plug of bone cement and/or in the implant
itself. Also, the cement compartment 340 has a tapered side wall
346 and an arcuate entrance edge 348. The round cross-sectional
shape of the illustrated cement compartments is a result of the
drilling process used to form them. Other shapes could be used as
suitable and feasible.
[0065] As discussed, one embodiment of the invention is in a
patellar implant. Typical outer diameters of patellar implants
would be 32 mm, 35 mm, and 38 mm to fit different size patients.
The height of the implant would be between 6 mm and 8 mm.
[0066] Compartment diameters currently being considered are under
10 mm, with a preferred range being between 6 mm and 8 mm. The
compartments have a height of 1, 2, or 3 mm in each of the implant
and the bone. Thus, the cement cells have a height of 2 mm, 4 mm,
or 6 mm. The fill ports are preferably 3 mm to 5 mm in diameter
with a height of 2 mm to 3 mm.
[0067] The angular placement of the compartments and of the fill
ports depend on the number of each. The fill ports could be spaced
equally along an imaginary circle as illustrated in the drawings.
Alternatively, there could be a large number of smaller
compartments spread over the surface, as on the surface of a golf
ball.
[0068] The presently preferred implant design includes 3 cement
compartments with a height of 2 mm and a diameter of 7-8 mm,
providing cement cells with a height of 4 mm. Fill ports are not
used. The implant is solid UHMWPE with a maximum thickness of 6-8
mm and an outer diameter of 32, 35, or 38 mm depending on the bone
size. Alignment is made by two small notches 90.vertline. apart on
the implant and on the bone.
[0069] From the above description of the invention, those skilled
in the art will perceive improvements, changes and modifications in
the invention. Such improvements, changes and modifications within
the skill of the art are intended to be covered by the appended
claims.
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