U.S. patent number 3,795,922 [Application Number 05/307,557] was granted by the patent office on 1974-03-12 for complete knee prothesis.
Invention is credited to Marcel Henri Gros, Jules Jean-Marie Ernest Herbert.
United States Patent |
3,795,922 |
Herbert , et al. |
March 12, 1974 |
**Please see images for:
( Certificate of Correction ) ** |
COMPLETE KNEE PROTHESIS
Abstract
This prothetic device for replacing the articulation of a human
knee comprises two elements adapted to be inserted the one into the
femur and the other into the tibia, the femoral element having a
female articulation portion adapted to be engaged by the male
articulation portion of the tibial element so as to retain the
latter, the male portion being releasably engageable into the
female portion only when the two elements are disposed
substantially at right angles to each other ; the design is such
that a certain locking action is obtained in the fully stretched
leg position and that during the flexion movement a certain degree
of lateral movement is allowed.
Inventors: |
Herbert; Jules Jean-Marie
Ernest (Aix les Bains, FR), Gros; Marcel Henri
(Aix les Bains, FR) |
Family
ID: |
26216841 |
Appl.
No.: |
05/307,557 |
Filed: |
November 17, 1972 |
Current U.S.
Class: |
623/20.22;
403/76; 403/78 |
Current CPC
Class: |
A61F
2/3854 (20130101); A61F 2002/30574 (20130101); A61F
2002/30576 (20130101); Y10T 403/32196 (20150115); Y10T
403/32213 (20150115); A61F 2002/4631 (20130101); A61F
2002/30652 (20130101) |
Current International
Class: |
A61F
2/38 (20060101); A61F 2/30 (20060101); A61F
2/46 (20060101); A61f 001/24 () |
Field of
Search: |
;3/1,22
;128/92C,92CA,92R ;287/12,21,87 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
1,047,640 |
|
Jul 1953 |
|
FR |
|
1,122,634 |
|
May 1956 |
|
FR |
|
163,476 |
|
Jun 1958 |
|
SW |
|
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Frinks; Ronald L.
Attorney, Agent or Firm: Ross; Karl F. Dubno; Herbert
Claims
What is claimed as new is:
1. A prosthetic device for replacing the articulation of a human
knee, which comprises two elements, on the one hand an upper female
femoral element provided with an articular portion having a convex
front wall adapted to carry the human knee ball and forming
internally and behind said wall a cavity having a spherical contour
opening downwards and backwards and, on the other hand, a lower
male tibial element carrying at its upper end an integral articular
portion comprising two opposite generally hemispherical portions
interconnected by a cylindrical segment, said cavity and male
integral articular portion being dimensioned so that said male
articular portion is releasably engageable into said female femoral
element only when the two elements are disposed at 90.degree. to
each other, but remaining locked therein in any other relative
angular position in order to constitute an articulation that cannot
be released while permitting flexion and extension movements as
well as a slight lateral displacement as required for the normal
plays of the articulation.
2. A prosthetic device as set forth in claim 1, wherein said
spherical cavity of the femoral articular portion is open at the
rear through a circle having the same diameter as the cylindrical
segment of the male tibial articular portion.
3. Prosthetic device as set forth in claim 2, wherein said male
articular portion comprises a relatively bulky pivot of
substantially prismatic configuration with a trapezoidal base
having antero-posterior major sides and two vertical faces, namely
a front face and a rear face, the upper face of said pivot being
divided into two segments, that is, a front segment inclined
forwards and downwards, connected through an edge to the the front
face and adapted to lock the device in the fully stretched
position, and a rear segment carrying the articular portion
consisting of the pair of opposite generally hemispherical portions
interconnected by a cylindrical segment, said base having two
lateral non-parallel trapezoidal faces, the two lateral
non-parallel trapezoidal faces of said pivot acting as guide means
for locking the joint laterally in the stretched-leg position
thereof while permitting and limiting the lateral movements of the
knee in the flexion position.
4. Prosthetic device as set forth in claim 3, wherein said male
articular portion proper projects above said pivot of paralle
lipipedic irregular configuration, and consists of a first
generally hemispherical portion or cap, connected through a
cylindrical segment to another, opposite generally hemispherical
portion or cap, these two generally hemispherical portions or caps
having the same curvature but different centres, whereby the
vertical axis of the male articular assembly be shorter than the
theoretical diameter of the sphere.
5. Prosthetic device as set forth in claim 4, wherein each male and
female element carries a projecting plate to be located on the side
of the articulation proper and a rear tongue extending at right
angles to said plate and adapted to be fitted into the bony portion
located behind in order to improve the fastening of the
corresponding element.
6. Prosthetic device as set forth in claim 5, wherein each element
carries an integral shank adapted to be fitted or driven into the
femoral diaphysis or medullary groove and into the tibial
diaphysis, said shank being disposed on the same side of the male
or femal articular portion that said plate is located.
7. Prosthetic device as set forth in claim 1, wherein the walls of
the articular portions of said elements are lined with thin layers
of a suitable lubricant such as Teflon to prevent the seizing
between the interfitting surfaces.
Description
BACKGROUND OF THE INVENTION:
1. Field of the Invention:
This invention relates to a novel complete prosthesis of the knee
or, in other words, a prosthetics device for replacing completely
the articulation of a human knee either diseased or wounded, for
example as a consequence of an accident.
This device is based on the principle that movement of articulated
objects which has the maximum amplitude and constitutes the nearest
approach to perfection, that is, a movement that can take place in
all directions, is the movement obtained by combining a solid
sphere with hollow sphere the latter being rotatably fitted in the
solid sphere.
2. Description of the Prior Art:
In the human skeleton this universal movement is obtained more or
less completely in two joints : the hip articulation and the
shoulder articulation, wherein the joint surfaces in mutual contact
are com-parable to those of spherical segments. In prosthetics,
consequently, when the problem to be solved consisted in making
artificial joints or articulations, for example of plastic or
metal, a relatively simple solution was found for the hip. In fact,
it was only necessary to obtain the mutual engagement of two
spherical segments, i.e., a hollow spherical segments secured to
the hip-bone, as a substitute for the cotyle, and a solid spherical
segment secured by means of a rod to the diaphysis as a substitute
for the femoral apophysis.
The problem with which praticians were confronted consisted
essentially in fastening an inert material to a living bone. At
present this problem appears to be solved satisfactorily due to the
use of acrylic cement (methyl methacrylate).
However, the making of prostheses for the other joints, notably in
the case of human knees, is much more complicated. From the onset,
when we observe the mode of operation of a knee, it apparently
makes only flexure and extension movements about an axis.
Therefore, the prosthesis solution seemed rather simple : only a
hinge was required, i.e., a means permitting a movement of
revolution. Thus, nearly all knee prostheses made up to now were
based on this easy principle.
Yet, what occurs during a knee movement? If we observe the flexure
extension movement of the knee, we see that from the stretched
position a small movement of revolution obviously takes place
initially, which does not exceed 10.degree. about a point,
whereafter the tibia moves backwards little by little while
rotating about a point also undergoing a backward movement, whereby
each point taken individually has a different radius or curvature
with respect to the preceding point. If we trace the loci of the
centres of rotation, we see that they form or describe a line which
not only moves backwards and downwards but has radii of decreasing
lengths in the backward direction, so as to describe a spiral
curve.
The joint bony surfaces of femoral condyles describe in the
fore-and-aft direction (logarithmic) spiral paths which guide the
movement. As to the tibial plates, in the fore-and-aft direction
they are slightly convex (they should be concave to accommodate the
antero-posterior condylian camber ; therefore, they slide and
pitch). But in the transverse direction, they are concave to meet
the requirements of the transverse convexity of the femoral
condyles.
From the foregoing it will be seen that this compound movement is
far from the simple movement of revolution, i.e., a circular
movement about a point, but in addition and simultaneously with
this compound movement a torsional movement takes place which is
guided by the length of the internal condyle which is greater than
the length of the external condyle. It is this last-mentioned
movement that causes the leg to loose in flexion the abduction, the
valgum it had in the extended position.
Moreover, if in the fully stretched position the knee is rigid, as
it bends it can make slight lateral movements and torsional
movements, which can take place due to the transverse contour or
configuration of the joint surfaces (the femoral condyles are
strongly convex in the transverse direction, especially the
external one, and the tibial plates are concave transversely and
rise at their intermediate portion on the peripheries of the spines
of which the abutment function is of primary importance). This
movement is a kind of "rolling" movement.
To summarize the movements taking place during the flexion
extension of the human knee, one could say that in the
antero-posterior direction there is a "pitch" movement and in the
transverse direction a "rolling" movement. The words "pitch" and
"rolling" give a clear definition of the system of movements
performed by the knee articulation.
But what matters most is the manner in which this movement is
utilized when walking : the important fact is that the bearing
phase of the step occurs substantially without any flexion. When a
person is walking and the bearing phase begins, the limb engages
the ground ahead, in a fully stretched position, or if not fully
stretched, it assumes this position immediately when the plantar
bearing is complete, whereafter the other limb bends its knee and
moves forward while the bearing limb keeps its knee stretched and
oscillates about the hip. During this phase, the knee is stiff,
tensioned and the limb oscillates. When the limb under
consideration becomes posterior, the bearing engage-ment is
relieved, the knee is bent to permit the lifting of the foot which
is then thrown forwards, and the same cycle is resu-med. Under
these conditions it may be said that in the really dynamic phase of
walking the knee is not bent and when it is bent it does not bear
anymore. Therefore, the knee strength is required only in the
stretched position. To make walking more comfortable it is even
useful that the bent knee has a certain laxity. Now a hinge, due to
its rigidity in all positions, cannot conform to these various
notions.
SUMMARY OF THE INVENTION:
The improved knee prosthesis described hereinafter is designed for
meeting these various imperative requirements by attempting to
produce voluntary movements of the two types as explained in the
foregoing.
Nature made this achievement through a complex play, thanks to the
perfection potentialities governing all its constructions. Yet, a
close approach of this complex play may be obtained through the
prosthetic technique.
By way of preliminary explanation, let us consider firstly what
takes place in a hip, while bearing in mind the mechanical system
obtained by having a solid sphere movably housed in a hollow sphere
and provided with a rod (the femoral apophysis carried by the
diaphysal line).
This femoral sphere is movable in all directions in the fixed iliac
spherical segment. This system permits a 360.degree. movement in
all directions and about all axes.
The most logical method for measuring these movements consists
apparently in expressing the data in latitudes and longitudes. In
the language of space mechanics, assuming that the femoral
apophysis consists of the centre thereof, and that the femur of
thigh bone or lower limb is one of the radii extending from this
center, it is an easy matter to measure all the movements as a
functions of the latitudes and longitudes. Thus, for instance, all
of the flexion movements are expressed in latitudes and all the
lateral movements in longitudes. The only requirement is to take
from the onset two axes of origin or references axes.
The novel prosthesis of the knee according to this invention is
based accordingly on the principle of the spherical movement or
ball-joint, but within accurately defined limits : very extensive
latitudes, beyond 90.degree., but very limited longitudes, for
example 10.degree.. These 10.degree. will correspond to the
necessary "rolling" movement, the latitude reproducing the "pitch"
movement.
In actual practice, this novel prosthesis is obtained as follows :
in its essential structure it comprises a pair of relatively small
generally hemispherical portions i.e., a movable solid spherical
portion rolling in a fixed hollow spherical portion. The solid
spherical member has a cylindrical extension and the hollow
spherical member consists of a perfect sphere, therefore greater
than the male solid spherical member. To approach the pitch
movement and the rolling movement, the following solutions are
applied : in the case of the pitch movement, the solid spherical
member in its vertical position, as the leg is bent, slides at the
same time backwards because the cavity containing this solid
spherical member is spherical and therefore greater, so that as the
flexion takes place the member recedes slightly, thus simulating
the rolling and sliding movement (pitch). Regarding the rolling
movement, it is obtained as follows : in the fully stretched
position, the male member is locked in an antero-posterior cavity
the shape of which constitutes an important factor and may be
defined as being trapezoidal instead of rectangular. The minor base
of the trapeze is at the front and as the ball rolls and recedes,
since the groove is trapezoidal, it widens out and lateral
movements become possible, inasmuch as the flexion increases : this
is the "rolling" movement. From this basic diagram, the prosthetic
device of this invention consists essentially of a hollow sphere
and a solid sphere pivoting in the former, without any other
element, whether bolts or screws. It is only necessary to pivot the
two members to each other, they hold by themselves.
The arrangement may be described as follows : the femoral member is
the female hollow member ; it has a circular rear aperture having
the diameter of the male member. This aperture is such that the
male member must be presented in a perpendicular position with
respect to said aperture for engaging same. In other words, it can
penetrate only in this right-angle position. When it has thus
penetrated into the female member, it cannot be removed therefrom,
unless said perpendicular relative position is restored, with a
tolerance of a few minutes (max. 3 degrees), which cannot occur
under normal operating or walking conditions since the stretching
apparatus locks the parts together. Therefore, any risk of
posterior dislocation is safely precluded.
The male member is the tibial one comprising a shank adapted to be
sunk into the tibia ; a plate fitting to the tibial surface with a
transverse posterior spur bears on said shank. The essential
elements of the tibial prosthesis are disposed there over and
consist of a relatively bulky, substantially prismatic pivot member
having a trapezoidal configuration with an antero-posterior major
side and vertical faces, i.e., a front face and a rear face, and a
top face divided into two segments, namely an oblique anterior
segment inclined downwards and forwards, connected by an edge to
the rear face, for locking the prosthesis in the fully stretched
leg position, and a posterior segment carrying the joint member to
be described hereinafter, two non-parallel (trapezoidal) lateral
faces constituting the guide walls and locking the assembly
laterally in the stretched position, said two non-parallel faces
permitting and limiting in the flexion position a certain degree of
lateral movements.
The pivot member proper projects above this irregular
parallelipiped by forming firstly a generally hemispherical cap or
portion having its base on the top and connected to a cylindrical
segment carrying the other articular generally hemispherical cap or
portion constituting the spherical joint portion proper. These two
generally hemispherical portions or caps assembled by said
cylindrical segment have two different centres, whereby the length
of the vertical axis of the assembly is less than the theoretical
diameter of the sphere. This constitutes a very important feature
of the mechanism to be described presently.
The female member comprises likewise a shank adapted to be sunk
into the thigh-bone or femur, and carries thereunder the articular
member proper. The latter comprises essentially a spherical cavity
having the same radius as the generally hemispherical portions of
the male member, said cavity being therefore greater than the male
member pivotally fitted therein. Hence the possibility of
performing lateral and antero-posterior movements (retroposition in
the bent position). Finally, at the bottom, and this constitutes
one of the essential features of this prosthesis, the cavity opens
into a relatively large trapezoidal recess having an anterior minor
base. This recess is of primary importance because it is the key of
the holding device of the prosthetic device ; it is capital and
holds the complete device ; it replaces all locking and fastening
means hitherto contrived in known prostheses. Therefore, it must be
carefully studied and fitted with precision.
In the backward and upward direction this curved recess widens out
to constitute a cylindrical recess of which the opening diameter is
only slightly greater than that of the cylinder of the male member
disposed between the two generally hemispherical portions; It is
through this cylindrical passage, having its aperture in the
vertical plane, that the articular tibial head or apophyse which is
then retained therein, for as explained in the foregoing, when the
angle is + or - 90.degree., it is possible to remove this apophyse
from the femur. Considering the leg movement from the fully
stretched position and as the knee is bent, there is obtained on
the one hand by virtue of this trapezoidal arrangement and on the
other hand by means of the sphero-cylindrical combination of the
articular surfaces, on the other hand, the possibility of
accomplishing lateral (rolling) movements and retroposition (pitch)
movements. This system affords a movement approaching that of
normal physiology, through an amplitude of 130.degree..
Another advantageous feature characterising the novel prosthesis of
this invention lies in the fact that it requires but a minimum bone
sacrifice. This is due to the specific operating technique which is
as follows :
In practice, no particular difficulty is experienced ; The cut is
directed vertically, longitudinally, internally and parallel to the
knee-cap, to permit the luxation of the complete extension system
outwards. The chief points to be adhered to are :
The surgeon must carefully free the lower end of the femur,
including the popliteal surface, a very important factor because it
constitutes one of the bearing points of the femoral
prosthesis.
The surgeon must then resect all the rear segments of the condyles
which projects from the plane of said popliteal surface.
He must then attack the bone in the intercondylian notch, so that
all the lateral and anterior portions of the lower end of the
femur, notably the femoral trachlea, are left completely untouched.
Similarly, the lower portion of the femoral condyles will be
resected as little as possible(only a few millimeters).
The surgeon will then prepare the axis of the femoral prosthesis
about which he will subsequently dig the recess for the
substantially cylindrical (3 to 4 cm in diameter) femoral member.
This recess extended at its front portion by the shank channel, is
stopped laterally and at the rear by a plane to be engaged by the
prosthesis to be fitted into the rear portion of the femur by means
of a small vertical stud similar to the tibial one.
Upon completion of this sequence, the surgeon will test the femoral
prosthesis to ascertain whether it properly fits in its recess or
not.
Preparing the tibial end. After the femoral member has been
properly fitted in position, the surgeon may consider the tibial
end. The tibial resection in the vertical direction is more
important. A piece about one centimeter thick, perhaps slightly
more, must be removed from the upper end of the tibia ; the
resection depends on the lesions. Sometimes, very important
unflateral destructions are observed which make it compulsory to
effect more extensive resections. This resection is performed after
locating the tibial axis;
Then the surgeon prepares the groove for the pivot by using a drill
of variable size. At the rear, at a distance of about 15 mm from
this groove, he cuts a small channel to be used as an anchoring
means.
When the two members have been fitted separately in position,
thesurgeon tests the assembly. To do this, it is only necessary to
place the leg at right angle and to introduce the tibial apophysis
into the femoral cavity of the prosthesis.
Thus, the preparation is completed ; then all the tools are renewed
and the two members are placed in their final positions and sealed
with methyl methacryle cement.
From the foregoing it is clear that this invention can be regarded
as constituting a prosthetic apparatus acting as a substitute for
the human knee, this apparatus being remarkable in that it
comprises two elements ; on the one hand, the upper femoral and
female member fitted into the thigh-bone and provided with an
articular portion having a convex front face and defining
internally and behind this face a cavity of spherical contour
opening downwards and backwards, and, on the other hand, a lower
male tibial element formed at its upper end with an articular
portion comprising two opposite generally hemispherical portions or
caps interconnected by a cylindrical segment, this male articular
portion being engageable only in the above-defined 90.degree.
position at 90.degree. into the female femoral element but retained
therein in all the other angular position so as to constitute an
articulation or joint that cannot be disengaged by itself while
permitting the flexion-extension movements as well as a slight
lateral movement as required for the joint plays.
This prosthetic apparatus is characterised in general in that the
spherical cavity of the femoral articular portion is open at the
rear, this aperture forming a circle of same diameter as that of
the cylindrical portion of the male tibial articular portion.
According to a specific feature characterising this prosthetic
device, the male articular portion comprises a relatively bulky and
substantially prismatic pivot element with a trapezoidal base
having an antero-posterior side and two vertical faces namely a
front face and posterior face, the upper face of this pivot being
divided into two segments : namely a front segment extending
obliquely downwards and forwards, connected through an edge to the
upper face and adapted to lock the device in the fully stretched
leg position, and a rear segment carrying the articular portion
consisting of a pair of opposite generally hemispherical caps or
portions interconnected by a cylindrical segment, the two
non-parallel trapezoidal lateral faces of this pivot acting as
guide means for locking the joint in the stretched-leg position
while permitting and limiting in the bent position the lateral
movements of the knee.
According to another feature characterising this prosthetic device
the articular piece proper projects above the pivot having the
shape of an irregular parallelipiped, and consists of a first
generally hemispherical cap connected through a cylindrical segment
to another opposite generally hemispherical cap these two caps
having the same curvature but different centres so that the
vertical axis of the male articular assembly be smaller than the
theoretical diameter of the sphere.
According to a further distinguishing feature of this invention,
each male and female element carries a projecting plate located on
this side of the articulation proper and a rear tongue
perpendicular to said plate and adapted to be fitted into the bony
portion located behind, in order to ensure a proper anchorage.
According to a complementary feature of this prosthetic device,
each one of its two main component elements comprises a shank
adapted to be driven into the femoral diaphysis and into the tibial
diaphysis, respectively; They are disposed on this side of the male
or female articular portion and lie on a common axis, so that the
prosthesis can be used for one or the other leg, indifferently.
However, they can be inclined slightly, for example by an angle of
5.degree. to 10.degree. (either on the tibial side or on the
femoral side), in order to distinguish the right-hand prosthesis
from the left-hand one.
The shanks of the two prosthetic elements are engageable into the
medullary cavities, respectively, or into cavities specially formed
to this end in the patient's femur and tibia.
As already suggested hereinabove, these shanks may advantageously
be sealed in their corresponding cavities by using an acrylic
cement (such as methyl methacrylate cement).
The walls of the articular members of the prosthetic elements are
advantageously lined with thin layers of a suitable and known
lubricant such as Teflon, to avoid any seizing.
BRIEF DESCRIPTION OF THE DRAWING:
The diagrammatic drawing attached hereto illustrates a typical form
of embodiment of the novel complete prosthesis of the knee
according to this invention. In the drawing :
FIG. 1 is a perspective view showing the two main elements of this
prosthesis, the upper femoral element and the lower tibial element
being seen from the rear and separate from each other to afford a
clearer understanding of their relationship ;
FIG. 2 is a similar view of the same elements but in their
assembled condition ;
FIG. 3 is a front elevational view of the two elements in the
position shown in FIG. 2 ; and
FIG. 4 is a fragmentary sectional view showing the bending or
flexion movement of the joint, the section being taken along the
line IV--IV of FIG. 3.
DESCRIPTION OF THE PREFERRED EMBODIMENT:
As illustrated the novel prosthesis of the knee according to this
invention comprises two elements : an upper femoral female element
10 provided with an articular portion 11 having a convex front wall
12 providing internally of and behind this wall 12 a cavity 13
having a spherical wall open in the downward and backward
directions, and a lower tibial male element 14 formed at its upper
end with an articular portion 15 consisting of a pair of opposite
generally hemispherical portions or caps 16, 17 interconnected by a
cylindrical segment 18. This male articular portion 15 can
penetrate into the spherical cavity 13 of femoral element 10 only
when the former is presented in a 90-degree angular position with
respect to the latter, but it is retained in this cavity in all the
other permissible positions, so as to constitute an articulation
that cannot be separated while permitting the flexion and
stretching movements as well as a slight lateral movement as
necessary for normal articulation movements.
The spherical cavity 13 formed in the femoral articular portion 11
is open at the rear and this aperture is of circular configuration
as shown at 19 and has the same diameter as that of the cylindrical
portion 18 of the male tibial articular portion 15. This male
portion 15 comprises a relatively bulky and substantially prismatic
pivot having a trapezoidal base 20 with antero-posterior major side
and two vertical faces, namely a front face 21 and a rear face 22.
The top face of this pivot is divided into two segments, i.e., a
front segment inclined downwards and forwards, connected to the
front face 21 through an edge and adapted to lock the device in the
fully stretched position, and a rear segment carrying the articular
portion comprising the pair of opposite generally hemispherical
portions or caps 16, 17 interconnected by the cylindrical segment
18. The pair of nonparallel trapezoidal lateral faces of the pivot
thus formed act as guide means for locking laterally in the
stretched position the patient's leg while permitting and limiting
the lateral movements of the knee.
The articular portion 15 projects above the prismatic pivot 20 and
comprises the above-mentioned lower generally hemispherical cap 16
connected through a cylindrical segment 18 to the upper generally
spherical hemispherical 17, these two generally hemispherical caps
having the same curvature but different centres, so that the
vertical axis of the male articular assembly thus formed be shorter
than the theorectical diameter of the sphere.
Each element 10 and 14 of this prosthesis of the knee carries a
projecting plate designated by the reference numerals 23 and 24,
respectively, each plate being located on this side of the
articulation proper, and a rear tongue 25, 26 extending at right
angles to said plate and adapted to be fitted into the bony portion
located behind, in order to improve the anchoring action.
The two elements 10, 14 of this prosthesis are provided with shanks
27, 28 adapted to be driven into the femoral diaphysis or into the
medullary groove, and into the tibial diaphysis, on this side of
the male articular portion 15 or female articular portion 11,
respectively.
These shanks 27, 28 of the prosthesis elements are adapted to be
fitted into medullary cavities or cavities specially formed in the
patient's thigh-bone and tibia. Advantageously, the shanks 27, 28
of elements 10, 14 are sealed in their cavities by means of an
acrylic cement (methyl methacrylate).
The walls of the articular portions of the corresponding elements
10, 14 of this prosthesis are advantageously lined with thin layers
of a suitable lubricant such as tetrafluorethylene known under the
Trademark "TEFLON", to avoid any seizing.
The mode of operation and the specific method of positioning this
novel prosthesis in the knee area of the patient has already been
explained in detail in the foregoing.
Obviously, the component elements of this prosthesis may be made of
any suitable plastic material or metal or stainless alloy as a
function of the specific clinical applications and requirements,
and it is also clear that the various steps of the operation
necessary for fitting this prosthesis, as set forth hereinabove,
may be modified without departing from the basic principles of the
invention, as will be readily understood by those conversant with
the art.
* * * * *