U.S. patent number 3,829,904 [Application Number 05/291,160] was granted by the patent office on 1974-08-20 for hip joint prostheses.
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 |
3,829,904 |
Ling , et al. |
August 20, 1974 |
HIP JOINT PROSTHESES
Abstract
A prosthetic hip cup is provided which is generally similar to
the usual basically hemispherical form except that: the inner and
outer surfaces have their spherical centres displaced, rather than
coincident, to provide a greater wall thickness at the bottom of
the cup compared to the side; and the axes of symmetry of the inner
and outer surfaces are mutually angled to off-set the thickest part
of the cup relative to the axis of the outer surface. This overall
eccentricity provides greatest thickness in the main load bearing
region of the cup, without introducing any significant
disadvantage. An associated femoral device is also provided which
is again generally similar to the usual ball headed tapered stem
form except that: the ball is connected to the stem through a
necked part without introducing a flange; and the stem is tapered
in at least two different transverse directions. The absence of a
flange simplifies the associated sectioning requirements for the
femur, and the multiple tapering of the stem promotes better
extrusion of gap-filling cement.
Inventors: |
Ling; Robin Sydney Mackwood
(Teignmouth, EN), Lee; Alan John Clive (Exeter,
EN) |
Assignee: |
National Research Development
Corporation (London, EN)
|
Family
ID: |
10434423 |
Appl.
No.: |
05/291,160 |
Filed: |
September 22, 1972 |
Foreign Application Priority Data
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|
|
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Sep 24, 1971 [GB] |
|
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44709/71 |
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Current U.S.
Class: |
623/22.39 |
Current CPC
Class: |
A61F
2/30724 (20130101); A61B 90/39 (20160201); A61F
2/32 (20130101); A61B 17/025 (20130101); A61F
2002/30153 (20130101); A61F 2230/0019 (20130101); A61F
2230/0021 (20130101); A61F 2002/30571 (20130101); A61F
2002/4631 (20130101); A61F 2002/3071 (20130101); A61F
2250/0097 (20130101); A61F 2002/3008 (20130101); A61F
2250/0089 (20130101); A61F 2002/30617 (20130101); A61F
2002/30154 (20130101); A61F 2/3676 (20130101); A61F
2002/3082 (20130101); A61B 17/2833 (20130101); A61F
2/367 (20130101); A61F 2002/3241 (20130101); A61F
2002/3443 (20130101); A61F 2250/0098 (20130101) |
Current International
Class: |
A61B
17/88 (20060101); A61B 19/00 (20060101); A61F
2/32 (20060101); A61F 2/30 (20060101); A61B
17/02 (20060101); A61B 17/28 (20060101); A61F
2/00 (20060101); A61F 2/34 (20060101); A61F
2/46 (20060101); A61F 2/36 (20060101); A61f
001/24 () |
Field of
Search: |
;128/92CA,92C,92R,92BC
;3/1 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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|
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|
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1,047,640 |
|
Jul 1953 |
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FR |
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1,506,594 |
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Nov 1967 |
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FR |
|
Other References
Journal of Bone & Joint Surgery, British Vol. 53-B, No. 2, May
1971. Advertisement by Howmedica International, Inc. (Vitallium
Muller-Charnley, Type Total Hip Prosthesis, and Charnley-Type).
.
Journal of Bone & Joint Surgery, British Vol. 53-B, No. 2, May
1971, Advertisement pages (4) by Richards Mfg. Co., on Total Hip
Arthroplasty Using A Universal Joint Device - The Tronzo Total Hip
System..
|
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Frinks; Ronald L.
Attorney, Agent or Firm: Cushman, Darby & Cushman
Claims
We claim:
1. A prosthetic acetabular device comprising a cup having an inner
surface and an outer surface, which surfaces are of similar form
including a substantially hemispherical major surface portion
continuing into a crescent-shaped minor portion, said major surface
portions being mutually eccentrically disposed by relative
translation of their respective spherical centres and mutual
angling of their respective radial axes of symmetry, and said
crescent-shaped minor portions being disposed in mutually opposed
manner and each being intersected in similar medial manner by the
plane passing through said radial axes.
2. A device according to claim 1 wherein each of said inner and
outer surfaces comprises a cylindrical minor surface portion
located between the respective hemispherical and crescent-shaped
surface portions as a smooth continuation of the first of these
last-mentioned portions.
3. A device according to claim 1 wherein said outer surface is
grooved by the provision of a plurality of first grooves of annular
form disposed in transverse radial planes relative to said outer
surface axis of symmetry, and a plurality of second grooves of part
annular form disposed orthogonally relative to said first grooves
to intercommunicate at least some of said first grooves.
4. A device according to claim 1 comprising a radio-opaque member
of annular form connected around said cup in a plane substantially
tangential to said inner surface at the closed end region
thereof.
5. A device according to claim 1 in combination with a prosthetic
femoral device comprising a substantially spherically shaped head
part received in mutual bearing engagement with the inner surface
of said cup and joined by a necked part to an elongate stem, the
longitudinal direction of said head part and necked part being
angled relative to that of said stem, said stem having noncircular
cross-sectional shaping, and said stem being convergently tapered
away from said necked part in at least two lateral directions and
along a major longitudinal portion thereof.
6. A device according to claim 5 wherein said stem is of generally
rectangular cross-sectional form with the corners of such form
chamfered along a major longitudinal portion of said stem and to a
progressively increasing depth therealong towards said necked
portion.
7. A device according to claim 5 wherein said head part is off-set
relative to said necked part in a direction away from that of the
included angle of said necked part and said stem.
8. A device according to claim 5 wherein a major portion of said
stem remote from said necked part is of substantially symmetrical
form relative to a longitudinal axis through the former, and the
remaining part of said stem has a generally chamfered surface
remote from the included angle between said stem and necked part,
which chamfered surface defines a visibly detectable boundary
intersected by said longitudinal axis.
9. A device according to claim 5 wherein said stem is visibly
marked to define a succession of predetermined discrete positions
extending longitudinally therealong from a first position adjacent
said necked part.
10. A device according to claim 5 in combination with a spacer
device comprising an annular base member having at least three
spring members extending from mutually spaced positions around said
base member, said base member being engaged around and part way
along said stem, and each of said spring members extending in
directions having an outward radial component and a common axial
component relative to said base member.
11. A prosthetic acetabular device comprising: a cup having an
inner surface and an outer surface; said inner surface including a
substantially hemispherical major surface portion continuing
smoothly into a substantially cylindrical minor surface portion,
which latter portion itself continues smoothly into a
crescent-shaped further minor surface portion; and said inner and
outer surfaces having an eccentric relationship to define a varying
thickness for said cup, with a region of maximum thickness being
intersected by the radial axis of symmetry of said major surface
portion.
Description
The hip joint prostheses in more general current use involve an
acetabular cup component and a femoral ball-headed component which
co-operate to afford a ball-and-socket joint function. The bearing
surface or socket of the cup is invariably of substantially
hemispherical form complementary to the femoral component ball head
with which it co-operates. Moreover the cup is normally of
generally uniform radial thickness, the outer surface of the cup
also being substantially hemispherical and concentric with the
bearing surface, apart from the provision of grooving, ribs, studs,
spikes or other formulations whereby the cup can be secured by way
of cement or other means to serve as a prosthetic acetabular
cavity.
However, the consideration leading to development of the present
invention suggests that this basically hemispherical cup shaping is
not satisfactory in all respects. More particularly, it is
desirable that the outside diameter of the cup should not be too
large, otherwise extensive reaming of the acetabulum is necessary
to accommodate the cup. However, if the cup is not overlarge from
this point of view, it will itself only accommodate a relatively
small femoral component ball head and this is undesirable. In order
to achieve stability of a relatively small femoral head in its cup,
it is normally necessary to employ a particular form of surgical
approach involving detachment and subsequent re-attachment of the
greater trochanter of the femur, and this does not meet with
general favour among orthopaedic surgeons. Any attempt at a full
and proper compromise between these factors as applied to a
hemispherical cup will result in a wall thickness for the cup which
is so low as to introduce a risk of early penetration of the cup by
the head. This risk is more pronounced in relation to the central
region of the cup, over the top of the head, where the general
thrust and loading are at a maximum. Also, this risk is increased
with the current trend to the use of plastic materials, such as
high density polyethylene, for the cup in association with a metal
femoral component, such a combination having at least equal, and
normally better, frictional properties and, in addition, being
cheaper in manufacture than a metal-to-metal combination.
An object of the present invention is to reduce the difficulties of
this situation.
To this end the present invention provides, in one aspect thereof,
a prosthetic acetabular device comprising a cup having an outer
surface of substantially symmetrical form relative to a first axis
therethrough, and an inner surface of substantially symmetrical
form relative to a second axis therethrough, the inner surface
being eccentrically disposed relative to the outer surface to
provide a greater wall thickness in the closed end region of the
cup compared to that in the rim region, and the two axes being
mutually angled.
The proposed device has been developed with a view to fixation by
the use of cement. In this connection, the cup preferably has
generally spherical shaping over a major part of its outer surface
in order to maximize the area to be engaged with the cement while
minimizing the volume to be reamed from the acetabulum for a given
size cup. In the same connection, it is preferred that the cup
outer surface be grooved for purposes of keying the cement with the
device. This avoids the deeper penetration of the cancellous bone
which is otherwise necessary if long spike-like fixation members
are employed.
Turning to consideration of the femoral component in a hip joint
prosthesis, those used with acetabular components as discussed
above normally have an elongate stem tapered towards one end, in
one lateral direction, while being formed with notches, grooves,
ribs or the like to assist keying of the cement with the stem. At
its other end, the device is angled relative to the longitudinal
axis of the stem, flanged and terminated with a ball-form head at
the other end. The main body of the stem is intended for
intramedullary fixation, commonly by the use of cement, this being
terminated by engagement of the flange with a suitably sectioned
face of the femoral neck to determine the final disposition of the
head. However, the sectioning must be carried out before its
correctness in respect of head positioning can be checked by use of
the femoral component. At best, such a technique requires high
skill and experience if secure fixation is to be achieved without
comprising positioning of the head.
Another object of the present invention is to reduce the
difficulties of this last situation.
To this end the present invention provides, in another aspect
thereof, a prosthetic femoral device comprising a substantially
spherically shaped head part joined by a necked part to an elongate
stem, the longitudinal axis of said head part and necked part being
angled relative to that of said stem, and said stem having
noncircular cross-sectional shaping and being convergently tapered
away from said necked part in at least two lateral directions and
along a major longitudinal portion thereof.
The "double" taper of the stem of such a device enhances the
extrusion of cement into the femur during insertion and is formed
to make possible at least as efficient a fixation in terms of
stability and load transfer as prior devices, but without the
necessity for special cement-keying formations on the stem or the
provision of a flange. The absence of a flange is equally
advantageous in avoiding the necessity for sectioning of the
femoral neck at a predetermined position or angle.
However it is desirable to provide an aid to correct vertical
positioning of the proposed device to compensate for the absent
flange which otherwise serves this role in the prior devices.
Accordingly, it is proposed that the present device be used in
association with a like device having a series of apertures
therealong in the necked part and the adjacent stem region. This
last device is to be used for test purposes, before application of
cement to the femur, to gauge the appropriate depth for insertion
of the femoral device to be secured. Thus, the test device can be
supported at different depths by passing a pin through appropriate
ones of the apertures. Having determined a correct depth for the
device which is to be fitted, fitting can then proceed after
suitably marking the device in question against the finally
selected aperture of the test device.
More conveniently, for use of this last technique, the device to be
fitted is preferably manufactured with markings having
predetermined relation with the apertures of the test device.
A further consideration with the presently proposed femoral device
is that efficient fixation of the stem will normally require the
stem to be surrounded by a layer of cement which is not less than a
certain thickness at any point. Certainly the stem should not
contact the wall of bone in which it is to be secured, and ideally
the stem is centrally located with a uniform layer of cement
therearound.
A further object of the present invention is to facilitate
attainment of this requirement.
To this end the present invention provides, in a further aspect
thereof, a spacer device for use with such a stem, comprising an
annular base member having at least three spring members extending
from mutually spaced positions around the base member, each of the
spring members extending in directions having an outward radial
component and a common axial component relative to the base
member.
In the present instance, the base member of the spacer device is
dimensioned to pass around and partway along the associated stem
from the tip of the latter. The spacer device will be so disposed
with its spring members directed away from the stem tip. Then, when
the stem is implanted, the spring members will serve to space the
stem from the surrounding bone in the desired manner, while still
allowing extrusion of cement.
It will be appreciated that such a spacer device will find
application with other prosthetic orthopaedic devices involving
fixation by way of a tapered stem and cement.
In order that the above and other aspects and features of the
present invention may be fully understood, the same will now be
described, by way of example, with reference to the accompanying
drawings, in which:
FIG. 1 is a cross-sectional view of one embodiment of a prosthetic
acetabular device according to the invention,
FIGS. 2, 3 and 4 are respective views taken in the directions II,
III and IV, of the device of FIG. 1,
FIG. 5 illustrates in side elevation one embodiment of a prosthetic
femoral device according to the invention,
FIGS. 6 and 7 respectively illustrate the device of FIG. 5 as
viewed in the directions VI and VII,
FIGS. 8 and 9 are cross-sectional views taken respectively at VIII
-- VIII and IX -- IX in FIG. 5,
FIG. 10 illustrates one embodiment of a spacer device according to
the invention, and
FIG. 11 illustrates a surgical tool suitable for use in association
with the present invention.
The device of FIGS. 1 to 4 comprises a cup 1 having inner and outer
surfaces 2 and 3 which are substantially symmetrical about
respective axes 4 and 5. The inner surface has a major portion 2a
of hemispherical shaping which continues into a minor portion 2b of
cylindrical shaping and which, in turn, continues into a further
minor portion 2c of part-cylindrical, generally crescent shaping.
The outer surface has major, minor and further minor portions 3a,
3b and 3c of basically corresponding shaping, except that the first
two portions 3a and 3b have annular grooves 6 formed therein. The
grooves 6 are disposed in respective radial planes relative to the
axis 5 and they each penetrate the outer surface 3 in directions
which are radial relative to the centre 7 of the hemispherical
outer surface portion 3a. Groups of the grooves 6 are communicated
by further grooves 8 which are directed orthogonally relative to
the former.
The hemispherical inner surface 2a is centred on 9 and this centre
is eccentrically located relative to the centre 7 to provide
greater wall thickness for the closed end of the cup compared to
that in the region of its rim. Also, the axes 4 and 5 are mutually
inclined so that the thicker wall zone of the cup is off-set
relative to the axis 4. This off-set takes account of the finding
that the maximum likelihood of penetration by an associated femoral
device will occur at a position within a range of about 12.degree.
- 15.degree. from the axis 5 in the direction of axis 4, while at
the same time enhancing the stability of an associated femoral
device head in the cup. This dual purpose is served in the
illustrated cup by a mutual angling of about 20.degree. between the
axes 4 and 5.
It is also useful to note at this point that the axis 5 is not
vertical when the cup is implanted, but is inclined by clockwise
rotation of FIG. 1 while the associated femoral device extends
downwardly therefrom, first to the left and then generally
vertically. More particularly, it is preferred that the axis 5
assumes an angle of about 40.degree. with the vertical when
implanted, this orientation being found surgically advantageous in
facilitating insertion.
Since the inner surface 2 will, as with other acetabular devices,
closely approximate to a hemispherical shaping in the main part,
the mutual angling referred to above also gives rise to the
part-cylindrical crescent shaped portion 3c of the outer surface 3.
This can be expressed in another way by noting that the rim of the
cup will be chamfered relative to the outer surface axis 5. In any
event, this configuration is advantageous since the portion 3c and
associated rim chamfer can be located to afford full abduction of
the femur before the femoral neck abuts the cup, while still
affording full engagement of the femoral head in the cup.
Consideration of FIG. 1 in fact shows the rim of the cup to have,
in a currently preferred form, a compound chamfer 10 composed of
one planar portion 10a radial to the axis 4 and another planar
portion 10b radial to the axis 5.
A remaining feature of the illustrated cup is the provision of
marker wire 11 engaged in a groove around the cup outer surface.
This wire is chosen to be detectable by x-ray examination and
thereby indicates the relative positions of the cup and femoral
head after implantation. The marker is preferably disposed in a
plane tangential to the cup inner surface at the closed end region
so as to more readily indicate penetration of the cup by the
femoral head.
Normally the marker will be of a suitable metal, such as stainless
steel, while the cup is preferably made of high density
polyethylene.
Turning to consideration of the illustrated femoral device, this is
seen to comprise a stem 21 convergently tapered towards one end and
joined at its other end through a necked portion 22 to a
spherically shaped head part 23, the longitudinal axis of the
necked portion and head part being angled relative to that of the
stem.
The stem 21 is of rounded-corner rectangular cross-sectional form
and is tapered in both of the lateral directions which correspond
to the axes of the section form. The tapering is of a higher degree
in the lateral direction which corresponds to larger rectangular
dimension, so that the overall tapering terminates with a generally
square cross-sectional form.
In any event, as discussed above, this double tapering enhances the
extrusion of cement caused by penetration of the stem thereinto
during fixation, while the flat surfaces arising from the choice of
cross-sectional form reduce any tendency for rotation.
A feature of the rounding of the stem corners is that this
rounding, or effective chamfering is also tapered longitudinally of
the stem, but in the opposite sense to the main body of the stem in
order to facilitate extrusion of cement laterally around the stem
in its thicker regions.
It is also useful to consider the remaining parts of the femoral
device since these are additionally advantageous.
Thus, the stem is angled directly into the necked portion 22
without any provision of a flange. It has been mentioned above that
the commonly provided flange on a prosthetic device plays no
significant part in terms of enhancing fixation. Accordingly, the
omission of a flange is advantageous in simplifying the device and
so rendering it more economic in manufacture. An additional and
perhaps more important advantage is that positioning of the device
during fixation is not open to compromise by the need for special
sectioning of the femoral neck.
In connection with this question of positioning, it is proposed
that use of the illustrated device involves a similar "test"
device. The test device will differ by the provision of apertures
along its stem whereby it can be located, before insertion of
cement, in different positions as regards depth of penetration.
These different locations can be achieved by passing a pin through
different ones of the apertures to span the femoral neck and so
temporarily support the test device. In this way, a guide to the
optimum location of the device to be implanted can be obtained
vis-a-vis the associated acetabular cavity, be it natural or
prosthetic. This technique can involve marking of a device to be
fixed against the finally chosen aperture of the test device or,
more conveniently, by pre-marking the former device during
manufacture to provide visible markings related with the apertures
of the test device. Such markings are denoted at 25 in FIG. 5.
Further assistance in positioning of the device during insertion is
afforded by arranging the angular apex 26, towards the top of the
stem, to intersect the longitudinal axis of symmetry 27 of the main
body of the stem. This axis should be aligned with the longitudinal
axis of the femur and the afore-mentioned arrangement assists the
surgeon's visual assessment of when the desired positioning is
attained.
A further advantageous feature is found in the asymmetrical or
off-set nature of the necked portion relative to the head part.
This feature is not essential but is employed here for benefit in
association with a prosthetic acetabular device such as that also
illustrated and which is intended to be fixed at a lesser degree of
abduction than is more usually the case. In these last
circumstances, a greater degree of flexion and abduction is
afforded by the presently proposed off-set arrangement compared to
an equivalent, but symmetrical neck and head part.
The form and function of the spacer device of FIG. 10 is largely
self-explanatory from the illustration and the earlier description.
It is probably sufficient to note that the annular base member 30
of the device is generally rectangular for association with a stem
such as that in FIGS. 5 to 8. Similarly, there are four spring
members 31 extending from the central regions of respective sides
of the base member to act in association with corresponding sides
of the relevant stem.
Lastly reference has been made to a surgical tool suitable for use
in association with the present invention. More particularly, the
invention has been developed with a view to insertion by way of the
so-called Southern or Posterior Approach. This approach can involve
difficulty in the required separation of the femur and acetabulum
such that the surgeon must normally be assisted simply to retain
the operation site exposed.
The tool of FIG. 11 reduces this difficulty. The tool takes the
form of a pair of inverse tongs 40 whereby closure of the handles
41 opens the arms 42. The free end of one arm carries a pin 43 for
insertion into the ischium behind the sciatic nerve and the other
arm carries a hook 44 for engagement into the surface of the
femoral neck. The pin and hook can be so engaged, with the tool
handles open, that subsequent closure of the handles separates the
femur from the acetabulum while rotating the femur to expose the
head. The handles can then be held in the closed position by a
suitable clamp or bracket 45.
* * * * *