U.S. patent number 3,848,276 [Application Number 05/356,816] was granted by the patent office on 1974-11-19 for knee implant device.
Invention is credited to Ysidore M. Martinez.
United States Patent |
3,848,276 |
Martinez |
November 19, 1974 |
KNEE IMPLANT DEVICE
Abstract
A joint prosthesis particularly useful in total knee
replacement, and capable of providing controlled motion about three
axes corresponding to the capabilities of a normal knee. A dual
centered pivot with contacting arcuate support blocks provides for
a combination of rotational and translational movement during knee
bending movements. Axial rotation of the femur (upper leg) relative
to the tibia (lower leg) is also possible through the normal range
of movements, and a bias toward the neutral position is provided to
signal the patient that such rotation exists. Flexure or bending of
the joint in an axis transverse to the normal knee axis is also
provided with a resilient bias toward the aligned orientation. The
joint is secured to the bone structure by self tapping connector
screws. The connector screws are locked in place by outrigger
screws. The entire knee joint is enclosed in a flexible
encapsulating cover to prevent damage to adjacent tissues and
contamination of body fluids.
Inventors: |
Martinez; Ysidore M. (San
Diego, CA) |
Family
ID: |
23403073 |
Appl.
No.: |
05/356,816 |
Filed: |
May 3, 1973 |
Current U.S.
Class: |
623/20.26 |
Current CPC
Class: |
A61F
2/384 (20130101); A61F 2002/30624 (20130101) |
Current International
Class: |
A61F
2/38 (20060101); A61F 2/30 (20060101); A61f
001/24 () |
Field of
Search: |
;3/1,22-29
;128/92C,92CA,92R,92BA,92BB,92BC |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Frinks; Ronald L.
Attorney, Agent or Firm: Brown and Martin
Claims
Having described my invention, I now claim.
1. A joint prosthesis comprising:
joint means,
attachment means for securing said joint means between relatively
movable skeletal members,
said joint means for constraining said skeletal members to a
combination of relative rotation and translation,
said joint means comprising at least two axially spaced pivot
bearings incorporating two pivot pins, a common pivot frame, and
two connector blocks,
said two pivot pins spaced axially in said joint means and carried
on said common pivot frame,
said pivot bearings being connected to said attachment means
through said connector blocks,
said connector blocks having an axial bore and receiving said pivot
pins through a transverse opening through said axial bore.
2. The joint prosthesis as claimed in claim 1 wherein:
said transverse opening in said connector block is enlarged to
provide a limited pivoting freedom of movement for said pivot pins
in said connector block.
3. The joint prosthesis as claimed in claim 2 wherein said opening
in said connector block has an arcuate surface for producing an
axial translation of said connector block relative to said pivot
pin upon axial rotation of said pivot pins.
4. The joint prosthesis as claimed in claim 1 wherein:
said attachment means comprise a connector screw and each connector
block is secured to said connector screw by a connector screw pivot
pin received in a transverse bore through said connector screw and
in said connector block.
5. The joint prosthesis as claimed in claim 4 wherein said
connector screw is received in an axial socket in said connector
block,
said axial socket having radially opposed sloping sides,
the radial line connecting said sloping portions being
substantially perpendicular to the axis of said connector screw
pivot pin.
6. The joint prosthesis of claim 1 wherein said axial bore in said
connector blocks accommodate opposed roller blocks carried on said
pivot pins,
said opposed roller blocks having a face-to-face contact in the
axially aligned orientation for said joint means, and having curved
surfaces in contact during bending movement of said knee.
7. A joint prosthesis according to claim 1 wherein:
said connector block includes an arcuate surface which contacts the
inner face of said pivot frame in the axially aligned orientation
of said joint means,
said arcuate surface on said connector block being pivotally moved
away from said inner face after a pre-determined amount of bending
in said joint means to allow limited relative axial rotation.
8. The joint prosthesis of claim 7 wherein:
said arcuate surface sccommodates relative axial rotation of plus
or minus 20.degree..
9. The joint prosthesis of claim 2 wherein:
said connector blocks have slide portions around the inner ends of
said connector blocks.
said slide portions accommodating limited relative axial
translation between said connector block and said slide.
10. The joint prosthesis of claim 9 wherein:
said slide portions contacting the inner face of said pivot frame
during approximately the first 20.degree. of bending in said joint
means.
11. In a joint prosthesis for providing relative movement between
skeletal members that improvement comprising:
attachment means comprising a connector screw adapted to be
threaded into the interior axial portion of said skeletal
members,
outrigger screws threaded into said connector screw near the
terminal end thereof at an acute angle to the longitudinal axis of
said connector screw and adapted to pass through bone of said
skeletal members.
12. In a joint prosthesis for providing a mechanism for relative
movement between skeletal members, that improvement comprising:
a joint mechanism,
an attachment system comprising a pair of saddle means comprising
substantially U-shaped saddle members with an attachment pad at the
base of said U-shaped saddle members,
said saddle means adapted to be cemented to bone structure and
secured to said joint mechanism through said attachment pad,
a plurality of bores through said attachment pad,
said bores having an axis at an acute angle to the axis of a
central bore through said attachment pad.
13. Apparatus for use in a joint prosthesis comprising:
joint means for producing a combined rotation and translation,
said joint means comprising at least two spaced pivot bearings,
said pivot bearings comprising pivot pins carrying, for rotation,
upper and lower connector block means,
said connector block means for securing said joint means to
relatively movable limbs,
each of said pivot pins carrying arcuate support blocks,
said support blocks having cooperating surfaces in contact during
rotation about the axis of said pivot bearings,
said connector block means includes a connector screw pivot pin and
a transverse bore for securing said connector block to a connector
screw,
connector screw pivot pin locking means comprising a locking slide
having a dovetail groove over a portion of one face thereof for
receiving a dovetail extension on said connector screw pivot
pin,
said lock slide having a locking shoulder for engaging a shoulder
in the lock slide recess in said connector block, and having a
wedge lock for locking said shoulder into interference with said
slot.
14. The joint prosthesis of claim 13 wherein:
said connector block receives said connector screw in a socket with
inclined sides to accommodate up to 10.degree. of tilting movement.
Description
BACKGROUND OF THE INVENTION
Numerous joint structures for knee endo-prosthesis and artificial
joints have been proposed. The most common such joint prosthesis
employs a single pivot bearing. The use of a single pivot bearing
is primarily prompted by simplicity, since a single pivot does not
duplicate the actual movements in a normal knee resulting in an
abnormal gait and in high stresses. Further, such joints are not
capable of bending to the full 120 to 135 degrees of rotation
corresponding to normal knee capability without pinching tissue.
Further, such structures have been susceptible to breakdown,
particularly at the point of attachment to skeletal structure.
Additionally, they may damage the adjacent tissues by entrapment of
tissues in the hinge mechanism. Those prior art devices which have
been proposed to provide for knee movement in three axes have been
unduly complex, or have required the removal of such a large
quantity of bone as to destroy the attachment points for some of
the ligaments that controlled knee movement.
Therefore, it is desirable to have a knee prosthesis useful in
total knee replacement, that is relatively strong and stable, and
which closely duplicates the rotational and translational
constraints and capabilities of a normal knee. Such a knee is
particularly to be desired if it provides for attachment to the
bone structure with the removal of a minimum amount of ligaments
and other supportive tissue, and without substantial weakening of
the bone structure. It is further desirable in such a knee that a
natural feel be provided in those motions that result in resistance
in the normal knee. A still further desirable characteristic of
such a knee is the protection of the body tissue surrounding the
prosthesis from damage by contact with the moving parts and the
exclusion of body fluids from the knee structure to avoid chemical
contamination of the body or corrosive damage to the knee
joint.
SUMMARY OF THE INVENTION
An exemplary embodiment of the invention utilizes a dual centered
pivot. However, it is to be understood that the invention is
applicable to knee prosthesis incorporating more than two pivots in
applications where such additional complexity is justified by the
additional flexibility attainable. The pivot bearing comprises a
pair of pivot pins carried in a pivot shield for supporting the
structure of the apparatus. Each pivot pin carries an arcuate
support block with opposed arcuate surfaces in a combination of
rolling and sliding contact during the knee bending function to
produce the combined bending and translational movements. A
connector block is fitted over the pivot pins through an enlarged
mounting opening having a curved surface and a flat surface. The
enlarged opening provides for a degree of relative rotation between
the upper leg and lower leg portions of the device. Since the
rotation takes place by twisting of the pivot pins across the
curved surfaces of the connector block mounting openings, the
pivoting results in an axial translation as well as a rotation. The
translation has the effect of compressing a spring washer and
thereby providing a spring bias. In use, the patient senses the
spring bias and thereby is provided with a sensation of
misalignment in the knee. The spring washer also serves to simulate
the "screw-in" effect. As weight is placed on the knee in the
aligned position, the spring washers on the roller blocks are
compressed and flattened against the connector block. This results
in the knee structure becoming quite rigid and also provides good
cushioning.
The joint structure is secured to the bone structure in the case of
a total knee prosthesis through self tapping screws and a bonded
saddle. The connector screw shape is a highly pitched undercut
thread which may be screwed into the central portion of the femur
and tibia to produce a sound support for the knee joint structure.
Three locking screws or outriggers are employed to lock the
attaching screw and saddle in position and prevent loosening in
use. The connector block is pinned to the screw and the pin locked
in place by a resiliently latched lock slide.
The joint structure is of a size that permits it to be installed
within the confines of the original bone dimensions. For this
purpose, the bone is surgically configured to the exterior
dimensions of upper and lower saddles. The saddles are cemented in
position. The saddles replace the removed hard bone surface and
thereby retain the monocoque reinforcing effect and maintain
adequate structural strength. Through the use of this technique, it
is not necessary to detach tendons or ligaments, and other tissue
adjacent to the joint and therefore these structures remain to
provide stability and control, and to strengthen the musculature
surrounding the prosthesis.
The final motion provided for in the joint will be referred to as a
tilting in the lateral plane of the joint, and is accomplished by
mounting the connector screw to the pivot bearing through a
connector pin. The connector screw is held by the pin in a socket
in a connector block. The socket is filled by material having
sufficient resiliency to permit the eight to ten degrees of tilting
that duplicates that obtainable in normal knees. The resilient
material is the same silicone rubber or other flexible substance
used in providing an encapsulation for the entire joint structure.
Encapsulating material is formed in two halves and joined to the
pivot shield around the periphery at the central portion of the
shield. The material is bonded to the metal to provide a permanent
seal against the admission of body fluids. Sufficient material is
provided to form a fold on the front face of the knee to permit
knee bending through the full travel desired. The rear face is
provided with paired opposed recesses to insure that the bending is
always along the same line.
It is therefore an object of the invention to provide a new and
improved joint prosthesis.
It is another object of the invention to provide a new and improved
joint prosthesis which closely approximates the motions obtainable
in normal knees.
It is another object of the invention to provide a new and improved
joint prosthesis which shields the motion of moving parts.
It is another object of the invention to provide a new and improved
joint prosthesis which is sealed from the body tissues and
fluids.
It is another object of the invention to provide a new and improved
joint prosthesis which has stable motion.
It is another object of the invention to provide a new and improved
joint prosthesis that provides a positional pressure during axial
rotation and tilting.
It is another object of the invention to provide a new and improved
joint prosthesis that is relatively small in overall
dimensions.
It is another object of the invention to provide a new and improved
joint prosthesis which is high in structural strength.
It is another object of the invention to provide a new and improved
joint prosthesis which includes provision for secure attachment to
bone structure.
It is another object of the invention to provide a new and improved
joint prosthesis which may be removed as necessary with minimal
damage to the bone or tissue.
It is another object of the invention to provide a new and improved
joint prosthesis that may be easily installed by relatively simple
surgical procedures.
It is another object of the invention to provide a new and improved
joint prosthesis that provides a screw-in effect to mimic normal
knee action.
It is another object of the invention to provide a new and improved
joint prosthesis with provision for reinforcing the bone which is
cut away for joint installation.
It is another object of the invention to provide a new and improved
joint prosthesis that may be installed without the removal of any
ligaments secured to the distal or proximal surfaces of the femur
or tibia except the anterior and posterior cinciate ligaments.
It is another object of the invention to provide a new and improved
joint prosthesis that locks in the upright or aligned position.
Other objects and many attendant advantages of the invention will
become more apparent upon a reading of the following detailed
description together with the drawings in which like reference
numerals refer to like parts throughout and in which:
FIG. 1 is a side elevation view of a knee joint prosthesis with
portions of the leg bones indicated in broken line.
FIG. 2 is a rear elevation view of the joint with portions of the
flexible encapsulating material cut away.
FIG. 3 is a sectional view taken on line 3--3 of FIG. 2.
FIG. 4 is a sectional view taken on line 4--4 of FIG. 3.
FIG. 5 is a sectional view taken on line 5--5 of FIG. 3.
FIG. 6 is a sectional view taken on line 6--6 of FIG. 5.
FIG. 7 is an enlarged prospective view of a connector pin and lock
slide.
FIG. 8 is a side elevation view partially cut away showing the
bending action.
FIG. 9 is a sectional view taken on line 9--9 of FIG. 5.
FIG. 10 is a sectional view similar to FIG. 9 showing the
rotational action.
FIG. 11 is a rear elevation view partially cut away showing the
compression effect of the rotation.
Referring now to the drawings and particularly to FIGS. 1 and 2,
the joint prosthesis 10 of the invention is illustrated. The joint
is shown as being secured to the femur 12 and tibia 14 by connector
screws 16 and 18. The connector screws are secured in position by
outrigger screws 20. Saddles 22 and 24 are employed by fitting them
within the cavity created through the condyles of the tibia and
femur, and cementing them to the soft bone thereby maintaining the
monocoque strength of the original bone structure. The saddles have
arcuate facing surfaces 23 and 25 to permit maximum bone contact
without interference during knee bending action.
A pivot shield 26 mounts pivot pins 28 and 30 which are held in
position through the pivot shield by retainers 32. The pivot pins
28 and 30 carry upper and lower connector blocks 34 and 36. The
entire joint structure is encapsulated by a flexible encapsulation
member 37 of silicone rubber including upper and lower portions 39
and 40.
Referring now most particularly to FIG. 3, there is illustrated the
pivot shield 26 which, at its rear facing edge, has a rear portion
44 of a peripheral channel to capture the locking portions of the
upper and lower encapsulation members 39 and 40. The front face of
the pivot shield has the corresponding front portion 46 of the
channel. The pivot shield 26 has rear facing arcuate portions 50
and 52 which cooperate to stabilize the movements of the connector
blocks as is described more fully hereinafter.
The upper and lower connector blocks 34 and 36 are identical and
will be described by reference to connector block 34. The connector
block has an axial bore 54 for receiving the arcuate support block
60. The arcuate support block 60 is constrained within the support
block bore 54 to axial movement and is resiliently biased away from
the bottom of the bore 54 by a spring washer 68 centered over a
protrusion 64 on the support block. The connector block 34 has
channels 61 and 62 to provide attachment and bonding points for the
encapsulation material 37 and a socket 58 which receives the
connector screw 16. The socket 58 has inclined sides as is best
illustrated in FIG. 5 and therefore receives an excess amount of
the silicone rubber 94 to provide for up to 10 degrees of tilting
movement of the connector screw 16 relative to the connector block
34. The connector screw 16 and block 34 are secured together by a
connector pin 80, and the assembly retained in position by a lock
slide 82.
A connector block slide 150 is received around the lower portion of
connector block 34. The slide 150 moves along the connector block
when pressure is placed on the knee in the aligned position to
accommodate movement of the roller blocks 60 in bore 54. The
connector block slide is carried on pin 28. The surface 56 on slide
150 contacts the pivot shield inner surface 50 during approximately
the first 20 degrees of bending in the joint, after which the
surface 56 rotates out of contact to permit axial rotation.
The connector screw 16 has threads 86 which are highly undercut and
have a pitch of approximately 37.degree. so that the screw is self
tapping. The screw is held locked into the bone by a plurality of
outriggers 20 which are secured in threaded bores near the end of
the connector screw. The connector screw carries a flange 17 which
is received in a recess in the attachment pad 23 of the saddle 22.
Pad 23 of saddle 22 also includes a plurality of angulated bores 88
which receive the outrigger screws 20 and are aligned so as to
position the outrigger screws for their eventual insertion into
threads in the outer circumference of the connector screw 16. The
mounting of the screw results in the primary stress being
transferred in tension and permits the use of caboneous silicon
alloyed isotopic carbon with its desirable non-reactivity to the
histology of the body. The pad 23 and screw 16 have a lateral
inclination of approximately 11 degrees to duplicate the angulation
of the femur.
The silicone rubber is bonded in the various channels directly to
the metal. The members 39 and 40 are provided with folds 43 and 45
on the front of the knee joint to permit full bending. The rear
face is provided with opposed paired indentation 123 and 125 on the
members 39 and 40 respectively which provides extra silicone rubber
for flexure. As is illustrated in FIGS. 8 and 9, the indentations
123 and 125 are substantially of flattened conical configuration.
During bending the conical indentations 123 and 125 are contacted
by the connector blocks 34 and 36. This contact pushes the
indentations 123 and 125 outwardly and thereby provides extra
silicone rubber substantially along a line connecting the apexes of
the cones. The extra silicone rubber insures that the bend line
will be regular and will be consistently along the same line. The
extra silicone rubber 94 filling in the sloping sides of socket 58
in the connector clock permits eight to ten degrees of relative
rotation about pin 80.
Referring to FIG. 7 the connector pin 80 is illustrated as
including a dovetail portion 100 which cooperates with the dovetail
portion 102 on the lock slide 82. The lock slide is retained in
position in the connector block slide recess 115 by the shoulder
106. The shoulder 106 is held in an expended position by the wedge
member 105. The wedge member itself is held in axial position by
engagement with shoulders 107 on slide tumblers 109.
IMPLANTATION AND USE
As provided for implantation, the device of the invention would
have an assembled pivot structure and bonded encapsulation.
However, the connector screws 16 and saddles 22 and 24 would be
left disassembled. The natural knee is surgically exposed and bone
is removed from the femur and tibia to produce a cavity
configuration corresponding to the exterior configuration for the
upper and lower saddles 22 and 24. The saddles are temporarily put
in place and holes for the outrigger screws 20 are drilled in the
bone structure by the use of the holes 88 as a guide. The central
bore for the connector screws 16 is also drilled at this time. Then
the saddles are removed and the connector screws turned into place.
The connector screws are highly pitched and are therefore self
tapping in the soft central bone structure. With the screws in
place, the saddles are positioned against the connector screw
flanges 17 and cemented to the cavity in the bone structure using
methyl methacrylate or similar cement. By securing the saddles over
the soft bone where hard bone has been removed, the monocoque
reinforcing effect is retained. Then outrigger screws 20 are
screwed in place through the drilled holes in the bone, and into
the threaded bores near the end of the connector screws 16. The
screws hold the saddle against the flange 17 and thus binds the
connector screw and saddle into an integral unit for transferring
tension, compression, rotational and bending forces.
With the connector screws in place, it is now possible to attach
the joint structure through the connector blocks 34 and 36. The
connector pin ends are received in the connector block sockets 58
and the pivot pin 80 inserted through the connector screw mounting
hole and into the opposite side of the connector block. The pivot
pin 80 is retained in position by the lock slide 82 which engages
the dovetail portion 100 on pin 80. The lock slide is retained in
the connector block 34 by squeezing the lock slide with a special
purpose tool and allowing the shoulder 106 to pass within the lock
slide recess 115 in the connector block 34, and then releasing
pressure on the tool to allow the shoulder 106 to engage the
corresponding shoulder on the channel in the lock slide recess 115.
The lock slide 82 is fixed against removal by the installation of
the wedge member 105 which engages the shoulders 107 on the end
tumblers 109 when it is fully inserted.
When the installation is complete, the incision may be closed. The
post operative recuperative period is minimized by the fact that
minimum tissue damage takes place during the operation. The bone
structure grows in and around all of the undercut threads on the
connector screws 16, and in and around the outrigger screws 20.
Thus a firm connecting support to the sound bone structure is
provided. The saddles 23 and 24 also transfer load to the bone
through the cemented surfaces which heal rapidly.
After recuperation, the joint is ready to operate in a manner
closely approximating the natural knee joint.
FIG. 3 illustrates the erect knee position. It will be noted that
the flat end surfaces of the roller blocks 60 are in contact, and
that the surfaces 56 on the connector blocks contact the curved
inner faces 50 and 52 of the pivot shield 26. Thus the knee is
locked. Rotational and other loads are transferred without joint
movement.
Referring to FIG. 8, the configuration of the knee bending is
illustrated. The surface 56 is now out of contact with the curved
inner face 52 of the pivot shield. The rotation of the surface 56
away from the pivot shield 26 permits relative axial rotation of
the tibia and femur, such as takes place in normal knees after
approximately 20 degrees of bending. Rotation is accommodated on
the curved arcuate surface 122 of enlarged opening 120. FIG. 10
illustrates the relative position of the pivot pin 28 relative to
the connector block 36 during joint rotation. FIG. 11 is
illustrative of the effect of rotation on the spring washer 68. The
pivot pin 28 is shown as rotating along the arcuate surface 122 so
that it is out of contact with the very bottom portion thereof, and
is positioned midway in the axial length of the opening 120. A
total of plus or minus 20 degrees is provided. The spring washer 68
is partially compressed thereby creating a bias and giving the user
a positional reference whereby a resistance sensation is produced
corresponding with knee rotation.
Lateral tilting is accommodated by the socket 58 which has sloping
sides to accommodate extra silicone rubber 94. The rubber serves to
provide a positional sensation to the user during the lateral
flexing action in a manner similar to that employed in axial
rotation.
The entire mechanism is encased in the encapsulation 37 thereby
excluding the tissues and fluids from the mechanism and preventing
contact or possible pinching between any of the moving parts. The
encapsulation serves as a surface on which the patella may slide so
that the important patellar functions are retained. The action of
the encapsulation during bending is illustrated in FIG. 8 wherein
the folds 43 are partially extended and the folds are being created
in the rear face of the encapsulation pairs 39 and 40 along a
regular bend line under the influence of indentations 123 and 125.
With maximum knee extension the connector blocks will contact the
rear portion of the pivot shield 26 limiting the total travel to
the selected figure of approximately 135.degree.. FIG. 8 also
illustrates that during bending, contact is maintained between the
roller surfaces and therefore extra stability is provided in the
movement.
Should it ever become necessary to remove the joint for repair or
replacement, the surgeon would remove the lock slides in reverse of
the above described locking procedure and back off the outrigger
screws 20 to make it possible to remove the connector screws 16.
This would be accomplished with minimum bone damage because it is
not necessary to break the bone in order to remove the screw once
the outriggers are removed.
* * * * *