U.S. patent number 3,889,665 [Application Number 05/338,931] was granted by the patent office on 1975-06-17 for apparatus and method for pressurizing gap-filling cement to a concavely relieved site in a bone.
This patent grant is currently assigned to National Research Development Corporation. Invention is credited to Alan John Clive Lee, Robin Sydney Mackwood Ling.
United States Patent |
3,889,665 |
Ling , et al. |
June 17, 1975 |
APPARATUS AND METHOD FOR PRESSURIZING GAP-FILLING CEMENT TO A
CONCAVELY RELIEVED SITE IN A BONE
Abstract
The securement of gap-filling cement to a concavely relieved
site in bone is significantly improved, and the risk of mechanical
failure correspondingly reduced when the cement is used to secure a
prosthetic device in the site, by locating the cement to the site,
and pressurizing the cement by forcibly applying an extrusion
member to cement in one area within the site while sealing or
covering the remaining area of the site to obviate or reduce
outward escape of cement. Apparatus for this purpose can comprise
an extrusion member having a resilient annular sealing member fixed
around one end of the former member, the seal preferably being
inflatable by a piston-and-cylinder assembly operated like a
syringe at the other end. Another form of apparatus comprises a
tapered stem longitudinally movable in sealing relation through a
separate U-shaped cover plate.
Inventors: |
Ling; Robin Sydney Mackwood
(Teignmouth, EN), Lee; Alan John Clive (Exeter,
EN) |
Assignee: |
National Research Development
Corporation (London, EN)
|
Family
ID: |
9974392 |
Appl.
No.: |
05/338,931 |
Filed: |
March 7, 1973 |
Foreign Application Priority Data
|
|
|
|
|
Mar 8, 1972 [GB] |
|
|
10794/72 |
|
Current U.S.
Class: |
606/94;
606/91 |
Current CPC
Class: |
A61B
17/8802 (20130101); A61F 2/4614 (20130101); A61F
2002/30581 (20130101); A61F 2002/4693 (20130101); A61F
2/30723 (20130101); A61B 17/8808 (20130101) |
Current International
Class: |
A61F
2/46 (20060101); A61F 2/30 (20060101); A61f
005/00 () |
Field of
Search: |
;3/1
;128/92G,92R,349,344,83,245,246,2,218 ;264/69,70,323 ;141/12,73
;18/12 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Attorney, Agent or Firm: Cushman, Darby & Cushman
Claims
We claim:
1. Apparatus for pressurizing gap-filling cement applied to a
concavely relieved site in a bone, said apparatus comprising
a. means for extruding said cement into said bone by longitudinal
application thereof to said cement in one area of said site, said
means comprising an elongate extrusion member having a solid end
portion thereof for forcible application to said cement, and
b. an inflatable resilient annular sealing member fixably and
sealably connected around said extrusion member adjacent said solid
end portion thereof to cover the remaining area of said site around
said extrusion member for reducing the outward escape of cement
therefrom when pressurized by application of said extrusion
member.
2. Apparatus as recited in claim 1 further comprising a piston and
cylinder assembly for inflating said sealing member, said assembly
being located on the end of said extrusion member remote from said
solid end portion and said assembly being in fluid communication
with said sealing member by a passageway extending through said
extrusion member, one of said piston and cylinder components being
fixably connected with said extrusion member, and the other of said
components being coupled with said extrusion member for
longitudinal movement relative thereto.
3. Apparatus as recited in claim 2 wherein said extrusion member
and one of said components extends further from said sealing member
than said other component, the former being with a palm-engageable
handle part, the latter being formed with a finger-engageable
handle part, and said assembly being arranged to inflate said
sealing member by mutual closing of said handle parts.
4. The method of applying gap-filling cement to a concavely
relieved site with a single access opening in a bone, said method
comprising the steps of
a. applying gap-filling cement to said site through said single
access opening, and simultaneously
b. pressurizing said cement in said site to extrude cement into
cancellous bone material in said site and
c. substantially covering the whole of said access opening to
prevent outward escape of said cement.
5. The method recited in claim 4 wherein said step of pressurizing
said cement in said site is accomplished by introducing a
solid-ended instrument through said single access opening therein
and applying a longitudinal force thereto to extrude said cement
into said bone.
6. The method as recited in claim 4 wherein said step of
substantially covering the whole of said access openings to prevent
outward escape of said cement is accomplished by introducing an
inflatable sealing element into said site through said single
access opening and inflating said sealing element with a fluid.
7. A method of securing a prosthetic device to a bone comprising
the steps of:
a. preparing a concavely relieved site with a single access opening
in the bone exposing thereby cancellous bone material in said
site,
b. applying gap-filling cement to said site through said single
access opening,
c. pressurizing said cement in said site to extrude cement into
said cancellous bone material in said site,
d. substantially covering the whole of said access opening to
prevent outward escape of said cement, and
e. applying a prosthetic device to said site.
8. Apparatus for pressurising gap-filling cement applied to a
concavely relieved site in a bone, said apparatus comprising:
a. an elongate extrusion member having a solid head part at one end
thereof with a stem part extending therefrom to form a generally
mushroom shaping, for extruding said cement into said bone by
longitudinal application of said stem part to forcibly apply said
head part to said cement in one area of said site, and
b. a resilient annular sealing member in the form of the radially
outer part of a torous fixably and sealably connected around said
stem part behind said head part to cover the remaining area of said
site and reduce the outward escape of cement therefrom when
pressurised by application of said head part.
9. Apparatus for pressurising gap-filling cement applied to a
concavely relieved site in a bone, said apparatus comprising:
a. an elongate extrusion member longitudinally tapered towards a
solid end portion for extruding said cement into said bone by
longitudinal application of said member to forcibly apply said
solid end portion to said cement in one area of said site, and
b. means for covering the remaining area of said site around said
extrusion member to reduce the outward escape of cement therefrom
when pressurised by application of said solid end portion, such
means including a U-shaped plate having a correspondingly shaped
resilient rim extending in sealing connection circumferentially
therearound and radially inwardly from the inner periphery of said
plate to receive said extrusion member in wiping engagement
therewith during longitudinal movement of said extrusion member
through said plate.
10. Apparatus as recited in claim 9 wherein said extrusion member
is an intramedullary stem forming part of a prosthetic device.
Description
This invention concerns cement fixation and more particularly a
method and apparatus for improved fixation of prosthetic bone joint
devices and other implantable devices which are to be fixed to
natural bone by the use of acrylic or other suitable cements.
It is now well-known practice to secure prosthetic bone joint
devices by way of stems, ribs and grooves, and other formations
which are bonded in intramedullary canals, preformed bores or other
suitably prepared sites in natural bone by the use of acrylic
cement. The best known examples of this are probably found among
total hip joint replacements in which a ball-headed stem is
cemented into the medullary canal of an appropriately sectioned
femur for cooperation with a hemispherical cup which is cemented
into an appropriately reamed site in the acetabulum.
However, while the practice of cement fixation offers various
advantages over other techniques, difficulty can sometimes arise as
a result of mechanical failure in the fixation and it is an object
of the present invention to reduce this difficulty.
The invention centres around an investigation of such failures to
determine their cause. There is not, in fact, a single cause but
several possible causes. A first possible cause arises from an
insufficient extrusion of the cement into the bone and around the
appropriate part of the device in the gap between that part and the
adjacent bone. In this connection it is to be noted that the
practice to date is to simply apply the cement to the fixation site
with a syringe or some other tool, and then extrude the cement by
pushing the device into the cement.
Another cause can arise from lamination formation within the cement
and this can, in turn, result from a blood-cement inerface.
It is now proposed, according to one aspect of the present
invention, that these causes of potential difficulty in the
application of gap-filling cement to a concavely relieved site in a
bone be alleviated by locating the cement in the site and applying
positive pressure to the cement located in an area within the site
while sealing or covering substantially the whole of the remaining
area of the site to obviate or reduce outward escape of cement from
the site.
It will be appreciated that the proposed pressurisation of the
cement serves to extrude the same into a more intimate contact with
the bone of the site than is otherwise the case with existing
techniques, and this is particularly true for a site including
exposed cancellous bone into the pores of which the pressurised
cement travels to a significantly deeper extent. Also, the
pressurisation reduces the likelihood of lamination in the cement
by forming the same to a more homogeneously dispersed body, while
the pressurisation additionally `pushes` any blood present to the
remote borders of the cement and thereby reduces the possibility of
lamination-initiating blood-cement interfaces within the body of
cement.
Also, it will be appreciated that the present invention is intended
principally for use in the securement of a prosthetic device to
bone and the invention will be discussed in this context
hereinafter. However, the invention is not intended to be limited
to such use since there are other circumstances in which the
invention may be of benefit, such as when building-up a relieved
bone site caused by a tumor.
In any event, in another aspect, the present invention provides
apparatus for carrying out the above-proposed procedure which
apparatus comprises an elongate extrusion member for forcible
longitudinal application to the cement in the area within the site,
and an ancillary member for location around the extrusion member to
seal or cover substantially the whole of the remaining area of the
site.
The invention has been developed initially for use in association
with an acetabular or similar site which is wholly bounded by a
prepared bone surface and a single outermost access space. In this
case, pressurisation of the cement is desired in all directions
towards the site and it is accordingly appropriate for the
ancillary member to be of annular form sealably connected around
the extrusion member, and to be of resilient form to allow relative
longitudinal movement of the extrusion member while tending to
effect a seal at its periphery around the site. At present it is
preferred that this ancillary member be of inflatable form.
However, there are other cases in which the form of the site does
not equate with that just discussed, and the more common form of
this second kind of site is that of a medullary canal which extends
significantly further than the required cement penetration
therealong. Indeed, in this case an important requirement is for
cement penetration in a lateral sense and it is appropriate to
employ an elongate tapered extrusion member to effect a wedging
action on the applied cement. The associated ancillary member is
then suitably a rigid plate of U-shape to cover the remainder of
the site while the extrusion member passes therethrough with the
plate being moved to accomodate changes in the extrusion member by
virtue of its taper. Preferably, the aperture of the plate is
provided with a resilient seal connected therearound.
A fuller understanding of these aspects and forms of the invention
can be gained from the following description of specific
embodiments given by way of example and with reference to the
accompanying drawings, in which:
FIG. 1 is a longitudinal sectional view of one embodiment;
FIG. 2 is a view of the embodiment of FIG. 1 from one end as
indicated by an arrow; and
FIG. 3 schematically illustrates another embodiment.
The embodiment of FIGS. 1 and 2 has been developed for use in
association with fixation of the acetabular component during total
hip joint replacement by the so-called Southern approach, but it
will be appreciated that the same general form, or similar forms of
such apparatus can be used in other approaches and for similar
prosthesis fixation requirements.
The more detailed construction of this embodiment includes an
extrusion member comprising a nose piece 10 of generally mushroom
form and a shaft 11 which is threadably engaged at one end with the
free end of the stem of the nose piece 10 to extend co-axially
therefrom. The shaft 11 terminates at its other end in a handle
body 12 with which it is threadably engaged to form a generally
T-shaped structure.
The embodiment also comprises an inflatable sealing arrangement
including a resilient sealing member 13 in the form of the radially
outer part of a torous. This sealing member is located around the
stem of the nose piece as shown with one side wall held against the
undersurface of the nose piece head by an annular spacer 14, and
the other side wall being held against the spacer by a washer 15
and nut 16, the spacer, washer and nut also being located around
the stem of the nose piece, and the nut being threadably engaged
therewith.
The sealing member 13 is inflatable by way of a piston-and-cylinder
assembly in the handle body 12 which communicates with the interior
of the sealing member by way of an axial bore 17 through the shaft
11, an axial bore 18 extending partway along the nose piece stem
from its free end, a diametral bore 19 through such stem, an
annular groove 20 around such stem, and a diametral bore 21 through
the spacer 14. The piston-and-cylinder assembly in the handle body
comprises two cylinders 22 formed in respectively opposite ends of
the handle relative to the shaft, each aligned parallel to the
shaft axis, and each opening towards the nose piece. Each cylinder
receives a respective piston 23 mounted on one end of a strip 24
which is apertured at its centre to receive the shaft. Sealing
between the pistons and cylinders is effected by the provision of
O-rings 25 seated in circumferential grooves around the cylinders
adjacent their open ends.
The cylinders communicate with the shaft bore 17 by way of a bore
26 therebetween, and an axial bore 27. The bore 26 is conveniently
made from one end of the handle and then closed at that end by a
plug 28, while the bore 27 passes through the handle and is
threaded at one end to receive the shaft and at the other end to
receive a filler cap 29.
Remaining components of the embodiment comprise bolts 30 which pass
slidably through apertures in the strip 24 on respectively opposite
sides of the shaft 11 to threaded engagement with the handle body
12. These bolts serve as stops to limit the outward movement of the
pistons from their cylinders.
In use of the embodiment of FIGS. 1 and 2, the space within the
sealing member, the cylinders and bores communicating the same is
primed with a liquid, and then the handle gripped to forcibly apply
the nose piece over cement in the relevant reamed acetabular
cavity, while at the same time squeezing the strip towards the
handle. This last action pushes the pistons into their cylinders,
pressurises the liquid therein, and inflates and stiffens the
sealing member to firmly engage the rim of the cavity. The nose
piece can still move axially forwards relative to the inflated
sealing member and this increases the sealing member/cavity rim
engagement while extruding the cement into the adjacent cancellous
bone.
It is preferred that the liquid used be of the same or medically
equivalent form to that used for flushing the fixation site so that
any leakage is not harmful.
Also, it is preferred that, with the cements in current usage, the
apparatus be used to pressurise cement for a minute or two to
effect a good extrusion of the cement into cancellous bone while
still leaving the cement sufficiently plastic for the purposes of
subsequent receipt of a prosthetic component therein.
Regarding materials: a prototype of the illustrated embodiment has
been made substantially wholly of nylon, except the sealing member
and O-rings, which were of a suitable rubber, and the shaft, which
was of aluminium. However, this choice of materials is not critical
and others can be used. It is useful though to bear in mind whether
the materials of the nose piece and sealing member will release
readily from cement extruded thereby. If there is any tendency to
pull away some cement after extrusion, it is desirable to separate
the apparatus and cement by a sheet of material which does readily
release.
In the case of cement fixation of an intramedullary stem, such as
in the femoral component of a total hip joint replacement, it is
preferred that a different form of apparatus be used for the
purposes of enhanced extrusion. FIG. 3 schematically illustrates
one embodiment of such apparatus comprising a generally U-shaped
cover member 40 formed by two like, superposed metal plates 41
having a rubber sheet 42 sandwiched therebetween. The sheet 42 is
of similar U-shaping to the plates 41 but extends circumferentially
around and radially inwardly from the inner periphery of this
shaping to provide a U-shaped resilient rim 43.
The cover member is also provided with an elongate handle 44
extending therefrom as shown.
The associated extrusion member is in the form of an elongate
tapered stem 45 similar to, or provided as, that of a femoral head
or other stemmed prosthetic component.
In use of this embodiment, cement is applied into the medullary
canal of a sectioned bone, and the cover plate is then held on the
sectioned face of the bone with the space bounded by the rim 43
located over, but off-set relative to, the exposed canal mouth.
Then the associated extrusion member 45 is pushed into the canal
while the cover member is progressively moved across the sectioned
bone face to retain the resilient rim engaged with the stem. This
operation will afford an enhanced extrusion of the cement into the
surrounding bone and around the stem since the cover plate and its
rim will reduce any tendency for the cement to escape directly from
the canal.
* * * * *