U.S. patent number 3,872,519 [Application Number 05/457,804] was granted by the patent office on 1975-03-25 for total ankle prosthesis.
Invention is credited to Nicholas J. Giannestras, Giacomo J. Sammarco.
United States Patent |
3,872,519 |
Giannestras , et
al. |
March 25, 1975 |
Total ankle prosthesis
Abstract
The total ankle prosthesis comprises a tibial member and a talar
member each having complementary bearing surfaces which are
constructed and arranged in such a manner that the normal axial
rotation of an ankle about the axis of a tibia during motion of the
talus relative to the tibia during flexion and extension is
reproduced by the prosthesis.
Inventors: |
Giannestras; Nicholas J.
(Cincinnati, OH), Sammarco; Giacomo J. (Cincinnati, OH) |
Family
ID: |
23818139 |
Appl.
No.: |
05/457,804 |
Filed: |
April 4, 1974 |
Current U.S.
Class: |
623/21.18 |
Current CPC
Class: |
A61F
2/4202 (20130101); A61F 2002/30179 (20130101); A61F
2002/30176 (20130101); A61F 2230/0086 (20130101); A61F
2230/0054 (20130101); A61F 2002/30276 (20130101); A61F
2230/0058 (20130101); A61F 2002/30879 (20130101); A61F
2002/3082 (20130101) |
Current International
Class: |
A61F
2/42 (20060101); A61F 2/00 (20060101); A61F
2/30 (20060101); A61f 001/24 () |
Field of
Search: |
;3/1
;128/92C,92CA,92R |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Frinks; Ronald L.
Attorney, Agent or Firm: Kinney, Jr.; J. Warren
Claims
What is claimed is:
1. An ankle prosthesis comprising a tibial member and a talar
member, wherein the talar member includes an upper bearing surface
characterized by a central, elongate, arcuate channel having
upstanding wing portions on opposite sides thereof, and wherein the
tibial member includes a complementary, lower bearing surface
characterized by a central depending rib having wing portions on
opposite sides thereof; the bearing surface of said talar member
being shaped so as to impart limited lateral rotation thereto as it
is moved from a central, neutral position to a position of
extension with respect to the tibial member, and to impart limited
medial rotation thereto as it is moved from a central, neutral
position to a position of flexion with respect to said tibial
member; said tibial and talar members each including means for
attachment to bone structures and providing for substantial
articulation thereof.
2. An ankle prosthesis as called for in claim 1, wherein the
arcuate channel and wing portions of the bearing surface of the
talar member make full and overall contact with the rib and wing
portions, respectively, of the bearing surface of the tibial member
throughout all positions of the talar member with the tibial
member.
3. An ankle prosthesis as called for in claim 1, wherein the
overall width of the bearing surface of the tibial member, between
its medial and lateral sides, is substantially equal to the overall
width of the bearing surface of the talar member between its medial
and lateral sides.
4. An ankle prosthesis as called for in claim 3, wherein the
overall length of the bearing surface of the talar member exceeds
the overall length of the bearing surface of the tibial member
whereby to provide flexion and extension movement of the talar
member relative to the tibial member while maintaining full contact
between the bearing surface of the tibial member with the bearing
surface of the talar member.
5. An ankle prosthesis as called for in claim 1, wherein the tibial
member is fabricated from a plastic, and wherein the talar member
is fabricated from metal.
6. An ankle prosthesis as called for in claim 1, wherein the medial
and lateral portions of the bearing surface of the talar member are
defined by a cone, the sides of which taper 11/2.degree..
7. A prosthesis as called for in claim 1, wherein the shape and
contour of the bearing surface of the talar member is such as to
impart about 4.degree. medial rotation of said member as it is
moved from a central, neutral position to a position of about
23.degree. flexion with respect to the bearing surface of the
tibial member.
8. An ankle prosthesis as called for in claim 1, wherein the shape
and contour of the bearing surface of the talar member is such as
to impart about 4.degree. lateral rotation to said member as it is
moved from a central, neutral position to a position of about
23.degree. extension with respect to the bearing surface of the
tibial member.
9. An ankle prosthesis as called for in claim 4, wherein the front
and rear edges of the bearing surface of the tibial member defined
the bases of upwardly and outwardly inclined anterior and posterior
faces of said member,
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The interrelationship of the mating surfaces of the tibia and talar
portion of the foot in a normal ankle are such that the foot is
subjected to medial rotation incident to flexion of the foot, and
to lateral rotation incident to extension thereof. Heretofore when
prostheses have been substituted for the damaged or diseased
portions of the bearing surfaces of the tibia and talus, the
resultant ankle action has not permitted the concurrent and
automatic medial and/or lateral rotation of the foot incident to
movement from positions of flexion to positions of extension.
The subject invention relates to a total ankle joint prosthesis
which comprises tibial and talar members, each of which are
provided with complementary bearing surfaces which are so
constructed and arranged that the movements of an ankle provided
with the subject prosthesis will closely simulate the movements of
a normal ankle between positions of flexion and extension.
2. Description of the Prior Art
Applicants are familiar with the prosthesis as disclosed in each of
the following U.S. Patents:
3,715,763 3,506,982 3,521,302 3,466,669 3,728,742 3,638,243
3,651,521 3,528,109 3,748,662 3,688,316 3,708,805 3,656,186
3,140,712 3,178,728 3,744,061 3,745,590
U.S. Pat. No. 3,715,763 discloses a knee prosthesis, as best
illustrated in FIGS. 1 and 2 of that patent, comprising a curved
steel implant 7 having polished outside surface which is adapted to
rockingly engage the upper surface of a second implant fabricated
from high polymer polyethylene. Implant 7 includes a pair of
outwardly projecting anchoring members 14 which are received within
anchoring holes milled into the natural bones where they are
retained in place with acrylic resin bone cement. Impact 8 is
provided with an anchoring bar 18 which is received within
anchoring holes milled or otherwise provided in the upper end of
the shin bone to which it is permanently affixed by the aforesaid
cement.
U.S. Pat. No. 3,748,662 discloses a replacement for the bicondylar
joints in human limbs wherein the prosthesis comprises two pairs of
co-acting male and female load-bearing condylar components 16 and
17 each of which include integrally formed pegs 20 and 21,
respectively, which are receivable in holes drilled into the bones
to which they are secured by a low friction synthetic resin,
plastic material.
U.S. Pat. No. 3,728,742 discloses a knee or elbow prosthesis which
includes an upper member comprising a pair of laterally spaced,
interconnected, intercondyloidal member each of which have a
spherically curved downwardly facing convex surface which engages a
spherically curved upwardly facing concave surface of each of a
pair of laterally spaced interconnected lower members for providing
articulation of the bones to which said members are secured in a
single plane.
The prosthesis disclosed in each of the three aforesaid patents
permits a rocking and/or sliding movement between the
adjacent-contacting, mating surfaces of the implant members.
SUMMARY OF THE INVENTION
The present invention relates to a total ankle prosthesis which
comprises a tibial member, preferably fabricated from biologically
compatible high density polyethylene, or the like, wherein said
member includes an elongate attachment or anchoring portion which
is adapted to be received within and permanently affixed within a
socket provided in the lower ends of the tibia and fibula, said
tibial member having a contoured lower bearing surface which is
adapted to continuously and at all times make complete contact
throughout its bearing surface with the complementary bearing
surface of a talar member, fabricated from a biologically
compatible metal. The talar member includes a lower anchoring
portion which is adapted to be permanently affixed to a socket
provided in the talar dome. The bearing surface of the talar member
is considerably longer than the length of the bearing surface of
the tibial member whereby to permit the talar member to be moved
relative to the tibial member for providing movement of the foot
from 23.degree. flexion to 23.degree. extension and wherein the
foot will be subjected to lateral rotation as it is moved to a
position of extension and wherein the foot will be subjected to
medial rotation as the foot is moved to a position of flexion.
The structural details of the two elements which collectively
constitute the prosthesis have been designed in such a manner as to
require a minimal amount of bone removal for securing the members
to the tibia and talar portions of the ankle and wherein the
function of the normal ligaments of the ankle are preserved.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is an exploded, perspective view illustrating the
relationship of the subject prosthesis relative to the lower end of
the tibia and fibula an the upper portion of the talus.
FIG. 2 is an enlarged view of the medial side of the tibal and
talar members of the subject prosthesis.
FIG. 3 is an anterior view of the prosthesis of FIG. 2 taken along
line 3--3 and with a protion of the tibial member in section for
clarity of detail and understanding.
FIG. 4 is a bottom elevational view of the lower surface of the
talar member as viewed from 4--4 of FIG. 3.
FIG. 5 is a partial, schematic representation of the lateral aspect
of an ankle illustrating certain of the ligaments thereof.
FIG. 6 is a top view of a foot showing the relationship of the
tibial and talar members of the prosthesis when the foot is in a
neutral position as when resting flat on a horizontal support
surface.
FIG. 7 is a lateral view, partly in section, of the foot and ankle
of FIG. 6.
FIG. 8 is a view, partly in section, from the back of the heel as
seen from the left side of the foot of FIG. 7.
FIG. 9 is a view similar to FIG. 6 showing the relationship of the
tibial and talar members of the prosthesis when the ankle has been
moved from the position of FIG. 6 to a position of flexion or
plantarflexion.
FIG. 10 is a view taken on line 10--10 of FIG. 9.
FIG. 11 is a lateral view of the foot and ankle of FIG. 9.
FIG. 12 is a view, partly in section, from the back of the heel as
seen from the left side of FIG. 11.
FIG. 13 is a view similar to FIG. 6 showing the relationship of the
tibial and talar members of the prosthesis when the ankle has been
moved from the position of FIG. 6 to a position of extension or
dorsiflexion.
FIG. 14 is a lateral view of the foot and ankle of FIG. 13.
FIG. 15 is a view, partly in section, from the back of the heel as
seen from the left side of FIG. 14.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
With particular reference now to FIGS. 1, 2, and 3, the letter A
designates, generally, the tibial prosthesis member and the letter
B designates the talar prosthesis member each of which embody the
teachings of the present invention. The letters T and F,
respectively, indicate the lower ankle-adjacent ends of the tibia
and fibula bones, whereas the letter J denotes the heel or
calcaneus bone and the letter W indicates the talar dome with a
portion removed to accommodate the talar member of the
prosthesis.
The tibia member may be fabricated from biologically compatible
high density polyethylene or high or ultra-high molecular weight
polyethylene and includes an upper, tapered, pyramidal shaped
attachment portion 20 having a plurality of laterally spaced,
circumferentially extending grooves 22 in the outer surface
thereof. The lower power 24 terminates in a lower bearing surface
26.
The talar member B may be fabricated from a biologically compatible
metal alloy consisting of cobalt, chromium, and molybdenum, and
includes an upper portion 40, a lower attachment portion 42,
wherein the upper portion is provided with a bearing surface 44
which is complementary to bearing surface 26 of the tibial member
A.
As best illustrated in FIGS. 2, 3, and 4, the lower portion 42 of
the talar member is provided with a transverse rib 46 and a
longitudinal rib 48 each of which are, in the preferred form of the
invention, provided with passageways 50, as illustrated. A groove
57 is also preferably provided on each side of the base of each of
ribs 46 and 48 of the talar member of the prosthesis. The medial
and lateral faces 52 and 54, respectively, of the talar member are
preferably provided with arcuate grooves 56. The lower surface 58
of the upper portion of the talar member is substantially flat.
With particular reference now to FIGS. 2 and 3, it will be noted
that the acruate shape of surface K on the medial side 52 of the
talar member is defined by radius 62, whereas the arcuate shape of
surface L on the lateral side 54 is defined by radius 60, it being
noted that radius 60 is greater than radius 62. As illustrated in
FIGS. 2 and 3, the centers from which radii 60 and 62 are swung are
indicated at 64 and 66, respectively, said centers being located on
an axis 63, which is inclined 7.5.degree. from a horizontal
reference plane 67, see FIG. 3.
As illustrated in FIG. 3, reference line 68, which is tangential
with the uppermost surface of the talar member as defined by radii
60 and 62, is parallel with bottom surface 58 of the talar member
and in parallelism with reference plane 67.
It will be noted that the length of the bearing surface of the
talar member when viewed from its medial side, as seen in FIG. 2,
is generally convex and as illustrated in FIG. 3 it is
characterized by a central, arcuate channel 70, which is flanked,
on its opposite sides, by upwardly and outwardly extending wing
portions 72.
The bearing surface of the tibial member, when viewed from its
medial side, as in FIG. 2, is generally concave and, as illustrated
in FIG. 3, is characterized by an elongate, central, depending rib
80 which is flanked, on opposite sides, by upwardly and outwardly
extending wing portions 82.
The aforesaid bearing surfaces of the talar and tibial members are
complementary to one another whereby the entire bearing surface 26
of the tibial member makes a 100% overall contact with the bearing
surface 44 of the talar member throughout all positions of relative
movement of the talar member with respect to the tibial member.
The bearing surface of the talar member as defined by the central,
arcuate channel 70 and wing portion 72 may be referred to as a
single groove, double-ridged, surface, whereas the central
depending rib 80 and wing portions 82 of the tibial member may be
referred to as a single-ridge, double grooved surface.
The complementary deep arcuate channel or single groove 70 at the
center of the talar member of the prosthesis maintains stability
while the patient is standing whereas the total contact
characteristics of the bearing surfaces allow for long and even
wear.
From the foregoing, it will be noted that the two contacting
surface areas are slightly conical in shape, wherein the axis of
the cone is 7.50.degree. down from the surface of the cone, as best
illustrated in FIG. 3.
The resultant action of the bearing surface of the talar member as
it slides upon the bearing surface of the tibial member produces
flexion and extension in the sagittal plane and internal and
external rotation in the transverse plane. This unique feature of
the subject prosthesis closely simulates the physiologic motion in
a normal ankle.
The pyramidal attachment portion 20 of the tibial member is adapted
to be inserted into socket 21 provided in and in open communication
with the lower end of the tibia T wherein the tibial prosthesis
will be permanently secured to the bone by means of a biologically
compatible cement M, such as methylmethacrylate or the like, as
noted, by way of example, in FIG. 7.
A suitable socket is provided in the talar dome W, dimensioned to
receive the lower portion 42 of the talar member, the fins 46 and
48 of which are adapted to be embedded within methylmethacrylate
which will also fill passageways 50 and various grooves 56. The
talar member is designed to sacrifice a minimal amount of joint
surface by retaining most of the capsule and ligaments around the
ankle for support.
The tibial member is made of plastic, such that cold flow of the
plastic can be effectively constrained within limits of the
tibia.
The ribs and grooves of the talar member and unique in the sense
that they prevent the prosthesis from being forced out of the
methylmethacrylate at the limits of motion or loosening from severe
torque about the ankle. With particular reference to FIG. 2, it
will be noted that the front and rear edges of the bearing surface
of the tibial member, which defined the anterior and posterior
limits of the sliding surface of the tibial member, are chamfered
as at 27 on its articular riding surface whereby to prevent
chipping of the adhesive cement at the limits of motion between the
prosthetic members, thus effectively preventing loosening of the
talar member.
FIG. 5 is a schematic representation of the lateral aspect of an
ankle with the ligaments illustrated. These ligaments are
preserved, if they are present at the time the prosthesis is
inserted. Likewise, the ligaments which hold the medial aspect of
the ankle together are preserved when the prosthesis is
inserted.
In FIGS. 6, 7 and 8, the supporting surface of the tibial member is
in 100% overall contact with the central portion of the supporting
surface of the talar member for thereby illustrating the
relationship of the tibial and talar members with the foot in a
neutral position or with the patient standing with his foot flat on
the floor. It will be noted from FIGS. 4, 6, 9 and 13 that the
medial side of the prosthesis is not quite as long as the lateral
side, because the prosthesis is shaped like a truncated cone with
the apex medial.
As clearly illustrated in FIG. 7, the attachment portion 20 of the
tibial member extends into the tibia for at least 11/4 inch whereas
the attachment portion of the talar member does not extend into the
talar dome more than 5/8 inch.
In FIG. 8, the axis of the truncated talar cone is shown as
7.50.degree. from the surfaces of the prothesis at the ankle joint,
and this relationship constitutes a unique and novel feature of the
subject ankle joint.
FIG. 9 illustrates the manner in which the talar member of the
prosthesis is simultaneously tilted forwardly and rotated inward
about the tibial member for providing, as illustrated in FIG. 11,
23.degree. flexion or plantarflexion and 4.degree. of adduction,
that is, movement of the foot toward the mid-line of the body. FIG.
12 illustrates the manner in which axis 63 of the cone of the talar
prosthesis is tilted 7.50.degree. below the horizontal from medial
to lateral when the foot is disposed in a position of flexion when
inclined 23.degree. from horizontal as in FIG. 11.
When the ankle is moved from a position of 23.degree. flexion
through its central neutral position to a position of 23.degree.
extension as in FIG. 14, with the foot inclined upwardly 23.degree.
relative to a horizontal plane approximately 4.degree. abduction is
produced in the ankle joint, that is, movement of the foot away
from the mid-line of the body. When the ankle is in a position of
extension the forward portion of the supporting surface of the
talar member will engage the lower surface of the tibial
member.
With reference to each of FIGS. 6-15, it should be understood that
the tibial member A is fixed or stationary at all times by reason
of its permanent attachment to the lower end of the tibia. The
talar member and the foot move relative to the lower bearing
surface of the tibial member.
From the foregoing, it will be noted that both extension
(dorsiflexion) and flexion (plantarflexion) movements are
maintained with physiologic limits which were determined through
radiographic studies on living humans. The subject prosthesis
permits approximately 23.degree. of extension and a like amount of
flexion accompanied by axial rotation of the ankle relative to the
axis of the tibia approximating 8.degree.. The tibial and talar
members of the prosthesis replace the tibial and talar surfaces,
respectively, in the horizontal plane in such a manner that the
medial and lateral malleoli of the ankle will not be sacrificed for
the prosthesis.
The bearing surfaces of the tibial and talar members are adapted
for substantially friction free relative sliding motion, and once
the prosthesis has been implanted the bearing surfaces will be
lubricated by patient's own synovial fluid.
* * * * *