U.S. patent number 3,846,846 [Application Number 05/401,103] was granted by the patent office on 1974-11-12 for hip joint prosthesis.
Invention is credited to Artur Fischer.
United States Patent |
3,846,846 |
Fischer |
November 12, 1974 |
HIP JOINT PROSTHESIS
Abstract
A ball-shaped portion is to form part of the hip joint and a
second portion extends from this ball-shaped portion and is to be
inserted into an opening in an human femur. The second portion is
provided with a passage through which an elongated expander rod is
extended which is also to be inserted into the opening of the
femur, and on the expander rod is arranged a series of expansion
elements in form of a row which, as the expander rod is moved
longitudinally of the row, are all expanded to anchor the
prosthesis in the femur.
Inventors: |
Fischer; Artur (D-7241
Tumlingen, DT) |
Family
ID: |
46319465 |
Appl.
No.: |
05/401,103 |
Filed: |
September 26, 1973 |
Foreign Application Priority Data
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|
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Sep 28, 1972 [DT] |
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2247560 |
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Current U.S.
Class: |
623/23.18;
606/313; 606/323; 606/327; 411/33 |
Current CPC
Class: |
A61F
2/3662 (20130101); A61F 2002/30367 (20130101); A61F
2310/00023 (20130101); A61F 2/36 (20130101); A61F
2/3676 (20130101); A61F 2002/30332 (20130101); A61F
2002/3611 (20130101); A61F 2002/30599 (20130101); A61F
2220/0025 (20130101); A61F 2002/30507 (20130101); A61F
2220/0033 (20130101); A61F 2250/0063 (20130101); A61F
2002/30579 (20130101); A61F 2002/30217 (20130101); A61F
2002/30594 (20130101); A61F 2230/0067 (20130101); A61F
2002/30836 (20130101) |
Current International
Class: |
A61F
2/36 (20060101); A61f 001/00 () |
Field of
Search: |
;128/92B,92BC,92BB,92CA,92BA,92R,92C ;85/67,69 ;3/1 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Attorney, Agent or Firm: Striker; Michael S.
Claims
I claim:
1. A hip joint prosthesis, comprising first means, including a
ball-shaped portion which is to form part of a hip joint, and a
second portion which is to be inserted into a human femur and
extends from said first portion; and second means for anchoring
said second portion in the femur, comprising an elongated expander
rod inserted through said second portion and insertable into the
femur longitudinally thereof, a row of tubular expansion elements
each surrounding said rod and being angularly displaceable with
reference to the longitudinal axis of the same, and actuating means
on said expander rod for effecting axial movement of said rod with
reference to said row and for thereby causing expansion of said
expansion elements into anchoring contact with the femur.
2. A prosthesis as defined in claim 1, said rod having a leading
end provided with an expander portion; and said row including a
leading expansion member into which said expander portion is drawn
in response to said axial movement.
3. A prosthesis as defined in claim 2, wherein each of said
elements has a leading end and a trailing end, a center passage
through which said rod extends which conically diverges towards
said leading end, and a slot in its peripheral wall extending from
said leading towards said trailing end.
4. A prosthesis as defined in claim 2, wherein each of said
elements has a leading end and a part-spherical trailing end, and a
center passage through which said rod extends and which conically
diverges towards said leading end, said trailing end of each of
said elements extending into said center passage at the leading end
of the respective axially adjacent element for expanding the
latter, in response to said movement of said rod.
5. A prosthesis as defined in claim 4, wherein said elements have
an exterior configuration which coaxially converges toward the
respective leading end.
6. A prosthesis as defined in claim 1, wherein said elements have
outer surfaces which are roughened.
7. A prosthesis as defined in claim 1, wherein said row includes a
leading and a trailing element; and wherein at least said trailing
element has an exterior configuration which conically converges in
direction towards said leading element.
8. A prosthesis as defined in claim 1, the femur having a curved
internal channel; and wherein said rod is curved in longitudinal
direction for facilitating its accommodation of said channel.
9. A prosthesis as defined in claim 1, said second portion having
an inner end remote from said first portion; and wherein said row
includes a leading element, and a trailing element which is
adjacent said second portion, said trailing element having an end
face provided with a recess into which said inner end extends.
10. A prosthesis as defined in claim 1, said second portion
extending at an angle to said first portion and having a bore for
said rod, and a surface which faces outwardly from the femur; and
said rod having an outer end adapted to bear against said
surface.
11. A prosthesis as defined in claim 1, said second portion
extending at an angle to said first portion and having a bore for
said rod, and a surface which faces outwardly away from the femur;
said rod having a trailing portion provided with screw threads; and
further a cap nut threadedly engageable with the screw threads of
said trailing portion and provided with a head which bears against
said surface.
12. A prosthesis as defined in claim 11, wherein said cap nut has
an axial length which is at least equal to the distance through
which said rod must be moved with reference to said row in order to
cause said expansion of said elements.
13. A prosthesis as defined in claim 1, wherein said elements each
have a center passage through which said rod extends, said passages
and said rod having respective non-circular mating cross-sections
for preventing undesired relative angular displacement.
Description
Background of the Invention
The present invention relates generally to a surgical prosthesis,
and more particularly to a hip joint prosthesis.
There are instances where a hip joint prosthesis is required, for
instance in the event of destruction of the ball of the hip joint
which may be the result of arthrosis. Hip joints for this purpose
are already known. The problem with the prior-art constructions is
primarily the manner in which they must be anchored in the femur.
Most commonly used heretofore has been a method involving the
cementing of a portion of the artificial hip joint into the channel
of the femur. It is known to use a special cement for this purpose,
namely methylmentharcrylate. Unfortunately, when this cement
hardens after having been applied, it tends to develop a not
inconsiderable amount of heat. This, in turn, can be dangerous in
the particular area in which a hip joint prosthesis--which is,
after all, the articulation between the femur and the innominate
bone--must be installed and which could lead to damage to the bone
substance and to adjacent tissue. For this reason, special
complicated measures must be taken by the surgeon to cool and thus
protect the bone substance and the adjacent tissue during the
liberation of heat resulting from hardening of the aforementioned
cement.
This is evidently highly undesirable, and a further disadvantage is
added to this prior-art approach, namely the fact that the constant
stresses to which the artificial hip joint will be exposed after
installation, lead to a loosening of the cemented-in portion of the
joint and to a constant if slow sliding of the joint deeper into
the femur. The prior art has attempted to avoid this, or at least
to reduce it, by providing at the junction of the ball-shaped
portion of the prosthesis and of the portion which is inserted into
the channel of the femur an abutment surface which provides an
abutment for the prosthesis against the corticalis of the femur.
However, in the long run this also is not sufficient to prevent the
undesired shifting of the prosthesis with reference to the femur,
so that over a period of time the bone becomes damaged. Of course,
when this takes place, the prosthesis becomes unuseable. Aside from
the fact that this would at the very least involve a further
operation to insert another prosthesis, there exists the danger
that the femur may have become damaged to such an extent that it is
incapable of supporting another prosthesis.
SUMMARY OF THE INVENTION
It is, accordingly, a general object of the present invention to
overcome the disadvantages of the prior art.
More particularly, it is an object of the present invention to
provide an improved hip joint prosthesis which avoids the
aforementioned disadvantages.
Still more particularly, it is an object of the invention to
provide such an improved hip joint prosthesis which can be readily
inserted and anchored in the femur without any difficulties.
Another object of the invention is to provide such a hip joint
prosthesis which can also be readily removed, for instance in the
event of infection.
An additional object of the invention is to provide such a hip
joint prosthesis which affords a uniform pressure distribution upon
the femur, so as to protect the bone material as much as possible
against damage and to prevent shifting of the prosthesis into the
bone under simultaneous destruction of the bone substance.
In keeping with the above objects and with others which will become
apparent hereafter, one feature of the invention resides in a hip
joint prosthesis, which, briefly stated, comprises first means
including a ball-shaped portion which is to form part of the hip
joint, and a second portion which is to be inserted into the human
femur and extends from the first portion. Second means is provided
for anchoring the second portion in the femur, and this second
means comprises an elongated expander rod insertable through the
second portion and into the femur longitudinally thereof, a row of
tubular expansion elements each surrounding the rod and being
angularly displaceable with reference to the longitudinal axis of
the same, and actuating means for effecting axial movement of the
rod with reference to the row and for thereby causing expansion of
the expansion elements into anchoring contact with the femur.
The axially successive expansion elements of the row of such
elements cooperate with one another, so that each of them expands
on axially adjacent one, with the leading element of the row
becoming expanded by an expander portion which is provided at the
leading end of the expander rod and which is drawn into the leading
element. The number of elements in the row can of course be
selected at will, for instance in dependence upon the size and/or
weight of the patient on whom the operation is to be performed, or
upon other factors such as the activities to be performed by the
patient.
It might be conceivable to use a single expansion element instead
of a row of them. However, in such case, the entire outwardly
directed force resulting from expansion of the expansion elements
and which acts upon the surrounding bone material, would all be
concentrated upon a very small area of the bone and would very
likely crack the bone. With the arrangement according to the
present invention, however, the pressures resulting from expansion
are distributed over several areas of the bone which are spaced
from one another, so that no particular area is subjected to unduly
high pressure and cracking of the bone need not be feared.
Moreover, the tubular expansion elements can be permitted to become
angularly displaced with reference to the longitudinal axis of the
expander rod, so that they can more readily adapt themselves to the
contour of the bone channel, that is the channel in the femur
which, as is well known, is a hollow bone. The channel is usually
somewhat curved, and this also militates against the use of a
single and rather long expansion element, so that the insertion of
a row of shorter expansion elements is much simpler and in many
instances is the only manner in which such elements can be inserted
at all. The outer diameter of the expansion elements in the
unexpanded condition thereof, may--but need not--be so selected as
to correspond to the inner diameter of the channel in the bone.
Even if this is not the case and the channel is rather large in its
diameter as compared to the tubular expansion elements, a reliable
anchoring is still obtainable because the individual elements can
then engage the inner wall bounding the channel, in zig-zag
fashion.
When the individual expansion elements are expanded, they each form
with respect to the axially preceding element a step at which they
dig into the wall of the bone. These various steps in conjunction
with the frictional engagement of the elements against the bone
wall, prevent the undesired lowering of the prosthesis into the
bone that is the gradual sliding of the prosthesis axially of the
bone with the resultant destruction of the material of the bone.
This means that the position of the prosthesis with reference to
the femur remains the same, even over a prolonged period of time
and under constant stress. If the individual expansion elements are
so turned with reference to one another, that is angularly offset
relative to one another, that their axially extending slots which
are provided to facilitate expansion are offset through 90.degree.
from element to element, the formation of the steps and the
distribution of the pressure can be further improved.
The novel features which are considered as characteristic for the
invention are set forth in particular in the appended claims.
The invention itself, however, both as to its construction and its
method of operation, together with additional objects and
advantages thereof, will be best understood from the following
description of specific embodiments when read in connection with
the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWING
FIG. 1 is an axial section through the upper portion of a human
femur, showing a hip joint prosthesis according to the present
invention anchored in the bone; and
FIG. 2 is a fragmentary axial sectional detail view, showing the
leading one of the expansion elements of FIG. 1 in expanded
condition.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring now to the specific embodiment illustrated in FIGS. 1 and
2, it will be seen that reference character F designates the femur,
that is the tubular bone in which the novel prosthesis is to be
anchored. The prosthesis is designated in toto with reference
numeral 1 and has a ball-shaped portion which is to form part of
the hip-joint, and a second portion which is to be inserted into
the femur F as shown, and which extends from the first portion at
an angle thereto. The portion 4 is provided with a bore as
illustrated, and it has an end face which faces outwardly away from
the femur F, and against which the head of a hollow cap nut 6
abuts, the cap nut 6 constituting the actuating means which meshes
with external screw threads on the trailing end of an expander rod
7 to thereby draw the rod outwardly, that is upwardly in FIG. 1, to
effect expansion of the expansion elements. The leading end of the
rod is provided with an expander portion 8 of the illustrated
configuration (compare FIGS. 1 and 2).
The rod is surrounded by a row of tubular expansion elements,
including a trailing expansion element 9a, a leading expansion
element 9a which is located adjacent the expander portion 8, and
intermediate expansion elements 9. When the rod 7 is drawn upwardly
in FIG. 1 by requisite turning of the nut 6, the expander portion 8
is drawn into the element 9b, expanding the same. The trailing end
of the element 9b is in turn drawn into the leading end of the next
adjacent element 9 which is expanded as a result of this, and this
continues from element to element until finally the trailing
element 9a is also expanded.
Each of the elements 9, 9a and 9b is provided with at least one
axially extending slot 10 extending from its respective leading
towards its trailing end to facilitate the desired expansion. The
number and axial length of these slots 10 depend upon the hardness
and resistance of the material to spreading of the elements 9, 9a
and 9b. If, for instance, titanium is used, which is a material
that is widely favored for such surgical insertions but is
difficult to work, the simplicity of configuration of the expansion
elements and consequently, the simplicity of the manufacture of
them, is advantageous. The extent to which the elements 9, 9a and
9b can be angularly displaced with reference to the longitudinal
axis of the rod 7 depends upon the difference of the diameter of
their central passage 11 on the one hand, and the outer diameter of
the rod 7 on the other hand. A large difference provides for a
significant angular displaceability and a small difference for a
lesser displaceability. The particular relationship will be
selected by the surgeon in dependence upon the diameter and the
curvature of the channel in the femur.
The passages 11 through which the rod 7 extends conically diverge
in the direction towards the respective leading end, that is
downwardly in FIG. 1 and in FIG. 2, so that the trailing end of
each axially following expansion element can enter into the passage
of each preceding element. The trailing ends, incidentally, are
part-spherical in configuration as indicated by reference numeral
12, to facilitate their introduction into the passages 11, and to
reduce the force which is applied to be exerted for spreading
purposes by the rod 7. Furthermore, this also facilitates the
angular displacement of the expansion elements with reference to
the longitudinal axis of the rod 7.
When the rod 7 is drawn upwardly in FIG. 1 by turning of the nut 6,
the elements 9 can accommodate themselves to the curvature of the
passage in the femur F by angularly shifting about the longitudinal
axis of the rod 7. This means that if the width of the bone passage
is greater than the expansion capability of the elements 9, the
latter can assume a zig-zag shaped configuration in that alternated
ones of them become inclined to opposite sides of the rod 7. In
this manner, the arrangement can still be reliably anchored due to
the wedging action resulting from such inclination, in which the
opposite axial ends of the respective elements 9 become wedged
against the bone at opposite sides of the passage.
If the channel 14 in the femur F is curved to a substantial extent,
a further improvement in the accommodation of the elements 9, 9a
and 9b to this curvature can be achieved by making the rod 7 itself
curved, in accommodation to the curvature of the channel 14. As a
general rule, all channels in the various femurs are curved to a
greater or lesser extent; it is very rare that a completely
straight channel is encountered. Curving the rod 7 has the
advantage not only of facilitating the introduction of the rod and
of the elements 9, 9a, 9b into the channel 14, but also if the
latter is curved significantly, the angular displaceability of the
expansion elements about the longitudinal axis of the rod 7 is in
some circumstances no longer sufficient to compensate for this
curvature.
If the rod 7 is itself curved, then the nut 5 is used so that the
rod 7 need not be turned. It will be appreciated that if the rod 7
is straight or curved only to a very slight extent, it will be
possible to eliminate the nut 6 and instead to merely provide the
outer end portion of the rod 7 itself with a head having a slot or
the like, by means of which the rod could be turned due to
engagement with an appropriate tool. It would then be this head
that would bear against the outer surface of the portion 4. In that
case, it will be appreciated that the portion 8 would not be of one
piece with the rod 7, but instead the rod 7 would have to be
threaded into the portion 8 and, as the rod 7 would be turned, the
portion 8 would be drawn into the leading expansion element 9b, in
the manner described earlier.
If, however, the nut 6 is used, then the portion 8 can be of one
piece with the rod 7. In such an instance, which is illustrated in
FIGS. 1 and 2, the axial length of the nut 6 is somewhat greater
than the distance through which the nut 6 must be drawn outwardly
(upwardly in FIG. 1) to effect complete expansion of all of the
expansion elements 9, 9a, and 9b. This assures that the outer end
of the rod 7, will be located within the central passage of the nut
6 at all times, and that the possiblity of a development of a
painful pressure point resulting from engagement of an outwardly
extending end portion of the rod with the surrounding tissue is
avoided.
The cross section of the portion 4 corresponds at least
approximately to the form of the channel 14 at the upper end of the
femur F, which cross sectional configuration is usually somewhat
elliptical. Also, the trailing expansion element 9a is configurated
to accommodate itself to the conically converging contour of the
channel 14. This facilitates the support and anchoring of the
element 9a in the channel 14. The trailing end of the element 9a is
provided with a recess 15 into which the adjacent end portion of
the portion 4 extends, to prevent relative turning of the element
9a with reference to the portion 4.
The portion 4 extends at an angle of approximately 120.degree. with
reference to the axis of the base part on which the ball-shaped
portion 2 is provided and this angle corresponds approximately to
the natural angle of the hip joint. A spring washer or the like can
be used intermediate the outerwardly directed surface of the
portion 4 and ahead of the rod 7, or, as in the illustrated
embodiment, the head of the nut 6, to fix them in place against
undesired turning. Such spring washers serve, incidentally, also to
compensate for the effect of pulling forces acting upon the rod 7
and provide a certain amount of elastic yieldability when a load is
placed upon the hip joint prosthesis.
FIG. 2 shows the leading expansion element 9b in axial section. It
will be seen that it has the portion 8 is drawn into the passage 11
of the element 9b, the latter is spread apart, i.e. expanded, which
is made possible by the provision of the slot 10. At the same time,
the trailing end 12 of the element 9b is drawn into the passage 11
of the axially adjacent element 9, thereby expanding the latter. As
this takes place for all of the elements 9, 9a, and 9b, adjacent
elements form steps with one another, which steps are identified
with reference numeral 16. At these steps the elements bite into
the bone material surrounding the channel 14 and this in
combination with the frictional engagement of the outer surfaces of
the elements 9, 9a and 9b with the surrounding bone material
provides for a reliable anchoring and prevents the sliding with
reference to the femur, which, as outlined earlier can lead to the
destruction of the bone material.
Undesired relative turning between the rod 7 and the element 9 can
be prevented by making the cross-section of the rod 7 and of the
passages 11 non-circular and mating, without, however, thereby
interfering with the desired angular displaceability of the
elements 9. In the illustrated embodiment a spring portion 17 is
provided on the rod 7 which engages the corresponding groove 18 of
the element 9, as shown in FIG. 2. However, a simple use of a
non-circular mating cross-section, for instance quadratic or the
like, can suffice also.
Finally, it is also possible to roughen the outer surfaces of the
elements 9, 9a and 9b for instance by knurling them or by providing
fluting or the like to increase the friction betweem them and the
bone material of the femur F and to thereby improve the anchoring
effect.
It will be understood that each of the elements described above, or
two or more together, may also find a useful application of other
types of constructions differing from the types described
above.
While the invention has been illustrated and described as embodied
in a hip joint prosthesis, it is not intended to be limited to the
details shown, since various modifications and structural changes
may be made without departing in any way from the spirit of the
present invention.
Without further analysis, the foregoing will so fully reveal the
gist of the present invention that others can, by applying current
knowledge, readily adapt it for various applications without
omitting features that, from the standpoint of prior art, fairly
constitute essential characteristics of the generic or specific
aspects of this invention and, therefore, such adaptations should
and are intended to be comprehended within the meaning and range of
equivalence of the following claims.
What is claimed as new and desired to be protected by Letters
Patent is set forth in the appended claims.
* * * * *