U.S. patent number 3,859,669 [Application Number 05/355,298] was granted by the patent office on 1975-01-14 for artificial hip-joint and a method for its installation.
Invention is credited to Yakov Isaevich Shersher.
United States Patent |
3,859,669 |
Shersher |
January 14, 1975 |
ARTIFICIAL HIP-JOINT AND A METHOD FOR ITS INSTALLATION
Abstract
An artificial hip-joint in which there is provided an
endoprosthesis of the acetabulum and an endoprosthesis of the
proximal portion of the femur coupled therewith by a hinged joint.
The endoprosthesis of the proximal portion of the femur is formed
by a head passing into a neck, then into an intertrochantric
section and ending in a shaft inserted into the femoral medullary
canal. The intertrochanteric section of the prosthesis is similar
in shape to the inner canal of the femoral intertrochanteric region
and is bounded in its proximal portion by two planes, with one
roughly perpendicular to the intertrochanteric axis and the other
roughly perpendicular to the femoral neck axis.
Inventors: |
Shersher; Yakov Isaevich
(Saratov, SU) |
Family
ID: |
26665465 |
Appl.
No.: |
05/355,298 |
Filed: |
April 27, 1973 |
Foreign Application Priority Data
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May 4, 1972 [SU] |
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1776054 |
May 4, 1972 [SU] |
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1776055 |
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Current U.S.
Class: |
623/22.44 |
Current CPC
Class: |
A61F
2/30739 (20130101); A61F 2/32 (20130101); A61F
2002/30785 (20130101); A61F 2002/30879 (20130101); A61F
2002/3621 (20130101); A61F 2002/4619 (20130101); A61F
2002/368 (20130101); A61F 2002/30789 (20130101); A61F
2/3676 (20130101); A61F 2002/3403 (20130101); A61F
2002/30673 (20130101); A61F 2002/30332 (20130101); A61F
2220/0033 (20130101); A61F 2/367 (20130101); A61F
2002/30354 (20130101); A61F 2002/30845 (20130101); A61F
2002/3631 (20130101); A61F 2002/3414 (20130101); A61F
2310/00029 (20130101); A61F 2002/3401 (20130101); A61F
2002/365 (20130101); A61F 2002/30787 (20130101) |
Current International
Class: |
A61F
2/32 (20060101); A61F 2/30 (20060101); A61F
2/00 (20060101); A61F 2/34 (20060101); A61F
2/46 (20060101); A61F 2/36 (20060101); A61f
001/24 () |
Field of
Search: |
;3/1
;128/92C,92CA,92R |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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1,912,630 |
|
Oct 1969 |
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DT |
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1,215,737 |
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Dec 1970 |
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GB |
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Primary Examiner: Frinks; Ronald L.
Attorney, Agent or Firm: Holman & Stern
Claims
What is claimed is:
1. An artificial hip-joint, comprising, in combination:
a. an endoprosthesis of the acetabulum formed as a seat;
b. an endoprosthesis of the proximal portion of femur hinged to the
endoprosthesis of the acetabulum, and including:
i. a head engageable with the seat;
ii. a neck rigidly connected to said head and having a straight
axis; and
iii. an intertrochanteric section provided as an extension
corresponding to the like axis of a femur of the neck and defining
an intertrochanteric axis, the section being similar in shape to an
inner canal of a femoral intertrochanteric region and bounded in a
proximal part thereof by two planes, a first of the planes arranged
substantially perpendicularly to the intertrochanteric axis, and a
second of the planes being substantially perpendicular to the axis
of the neck.
2. An articifial hip-joint as set forth in claim 1, wherein an
orifice is provided in and arranged perpendicular to the first of
the planes, and locking means is arranged entering the orifice for
attaching to the intertrochanteric section the trochanter major of
a femur, and the endoprosthesis of the acetabulum being provided
with a plurality of protruding blades on an exterior surface
thereto, the blades arranged for attachment to the bone tissue of a
patient's acelabulum.
3. An artificial hip-joint as set forth in claim 2, wherein a rod
is provided as the intertrochanteric section, the rod being a
direct extension of the intertrochanteric section and arranged for
insertion into the medullary canal of a patient's femur, and a
bearing pad in the form of an extension of the second of the
planes, the pad provided with a plurality of openings arranged for
helping regeneration processes and lugs arranged for strengthening
the endoprosthesis at the point of passage of the neck into the
intertrochanteric section.
4. An artificial hip-joint as set forth in claim 1 wherein a rod is
provided as the intertrochanteric section, the rod being a direct
extension of the intertochanteric section and arranged for
insertion into the medullary canal of a patient's femur, and a
bearing pad in the form of an extension of the second of the
planes, the pad provided with a plurality of openings arranged for
helping regeneration processes and lugs arranged for strengthening
the endoprosthesis at the point of passage of the neck into the
intertrochanteric section.
5. A method for installing an artificial hip-joint, comprising the
steps of:
a. exposing and cutting out the trochanter major of a patient at
the base thereof along a plane substantially perpendicular to the
intertrochanteric axis of the femur;
b. drawing upwardly the trochanter major and exposing the
joint;
c. dislocating the head of the joint and cutting out same along a
plane at the base roughly perpendicular to the axis of the
neck;
d. preparing the patient's acetabulum for a required size of the
endoprosthesis of the acetabulum to be installed;
e. reaming the medullary canal to the size and shape conforming to
the size and shapes of a proximal part of an endoprosthesis to be
installed;
f. inserting an interchrochanteric section of the endoprosthesis
into the femur, and arranging a first plane of the section parallel
to the cutting plane of the head and a second plane of the section
parallel to the cutting plane of the trochanter major;
g. installing an endoprosthesis of the acetabulum into the cavity
prepared in step (d);
h. affixing the trochanter cut out in step (a) in the proper
position thereof by locking the trochanter to the intertrochanteric
section; and
i. suturing the wound.
Description
BACKGROUND OF THE INVENTION
The present invention relates to artificial joints employed in
intra-articular prosthetic replacement, and more particularly to an
artificial hip-joint for arthroplasty. It is designed as a means of
regaining mobility in the hip-joint after such mobility has been
lost due to such diseases an ankylosing spondylitis, arthritis
deformans, arthritis infectiosa and aceptic necrosis of the femoral
head, as well as femoral neck fractures in the aged.
PRIOR ART
Known in the art are artificial hip-joints comprising an
endoprosthesis of the acetabulum and an endoprosthesis of the
proximal section of the femur coupled therewith by a hinged joint.
The endoprosthesis of the proximal section of the femur is formed
by a head and neck passing into an intertrochanteric section and
then into an intraosteal fenestrated shaft and is provided with a
bearing pad and a lock for the trochanter major.
The known artificial hip-joint is installed in the following
manner:
The upper end of the femur is exposed by a lateral incision. The
trochanter major is cut off and drawn up together with the muscles
attached thereto. The femur is cut off at the level of the lower
end of the trochanter minor. Then the femoral head together with
the neck is removed and the femoral medullary canal and the
depressions in the acetabulum are prepared for arthroplasty.
The shaft of the endoprosthesis is immersed in the femur. The
endoprosthesis of the acetabulum is impacted in the prepared
actabulum. The trochanter major is impacted to the outer surface of
the upper end of the femur. Finally the wound is tightly sutured in
layers.
The prosthetic replacement employing the known artifical hip-joint
provides for the removal of the intertrochanteric region with the
result that the affected limb loses in length, and the bearing pad
is disposed on the cortical layer of the transverse section in the
upper third of the femoral diaphysis. The trochanter major is
attached to the prosthesis on the outer surface of the femur,
rather than at its normal site.
The fact that the intertrochanteric region where muscles are
attached is removed and the trochanter major to which an important
muscle is likewise attached changes its site of attachment,
substantially disturbs the function of the affected limb. After
surgery the patient acquires a swinging gate, for the artificial
hip-joint is detached from the muscles, and the sole muscle
normally attached to the trochanter major now adheres to the
femur.
With the removal of the intertrochanteric region, a spacious cavity
is formed around the long neck of the endoprosthesis, in which a
large amount of blood is accumulated after the operation, thereby
adding to the menace of postoperative suppuration.
The shortening of the limb as a result of the operation makes
orthopaedic footwear unavoidable as a means of compensating the
newly acquired leg length defect.
In case of a complication necessitating the removal of the
endoprosthesis, the union of the hip and pelvis is very difficult
to achieve.
Furthermore, with the bearing pad disposed on the transverse
section of the upper third of the femur, the endoprosthesis is not
totally secure from swivelling.
OBJECTS AND SUMMARY OF THE INVENTION
It is an object of the present invention to provide an artificial
hip-joint which does not require the intertrochanteric region of
the femur to be removed.
It is another object of the invention to provide an artificial
hip-joint which does not lead to the shortening of the affected
limb.
It is yet another object of the invention to provide an artificial
hip-joint which permits of fixing the trochanter major at its
normal site.
It is still another object of the invention to provide an
artificial hip-joint such that would be impacted to the femur
without recourse to cementing agents.
One more object of the invention is to provide a method for the
installation of the aforementioned artificial hip-joint.
These objects are accomplished by that in an artificial hip-joint,
comprising an endoprosthesis of the acetabulum connected by a
hinged joint with an endoprosthesis of the proximal portion of the
femur formed by a head passing into a neck passing into an
intertrochanteric section and ending in a shaft, of which the
intertrochanteric section has a shape similar to that of the inner
canal of the femoral intertrochanteric region and is bounded by two
planes, with one roughly perpendicular to the intertrochanteric
axis of the femur and the other roughly perpendicular to the axis
of the femoral neck.
The bearing pad of such artificial hip-joint should serve as an
extension of the plane roughly perpendicular to the axis of the
femoral neck.
An orifice for the fixation of the lock of the trochanter major
should be preferably provided in the plane roughly perpendicular to
the intertrochanteric axis.
The objects of the invention are also attained by a method for the
installation of said artificial hip-joint, which, in accordance
with the invention, comprises exposing and cutting off the
trochanter major, cutting off the femoral neck at the base thereof
at right angles to the axis thereof and removing said neck together
with the femoral head, reaming the medullary canal of the femur to
a specified size; milling the acetabulum to the specified size,
inserting part of the endoprosthesis of the proximal portion of the
femur comprising the shaft and the intertrochanteric section into
the prepared medullary canal along the axis thereof, inserting part
of the endoprosthesis of the acetabulum into the prepared
depression of the acetabulum, and finally impacting the trochanter
major to the intertrochanteric section of the endoprosthesis of the
proximal portion of the femur.
The artificial hip-joint of this invention does not call for the
removal of the intertrochanteric region to be installed. The
trochanter major is immobilized at its normal site; the function of
the affected limb is not disturbed, what with all the muscles
attached at their normal points; the cavity in which blood can
accumulate is substantially reduced; the limb does not lose in
length and the need to wear orthopaedic shoes is obviated.
The endoprosthesis is secure against swivelling in the hip; in case
of failure, arthrodesis is feasible, as well as any other
subsequent plastic surgery.
Apart from all the above advantages, the present artificial
hip-joint provides for the impaction of the endoprosthesis to the
femur and pelvis without recourse to cementing agents.
An embodiment of the present invention will now be described, by
way of example, with reference to the accompanying drawings,
wherein:
FIG. 1 is a view partly in elevation and partly in cross-section of
an artificial hip-joint in accordance with the invention;
FIG. 2 is a sectional view taken along line II--II of FIG. 1, the
view looking in the direction of the arrows.
DETAILED DESCRIPTION OF THE INVENTION
FIG. 1 shows an artificial hip-joint, comprising an endoprosthesis
1 of the acetabulum connected by a hinge with an endoprosthesis 2
of the proximal portion of the femur. The endoprosthesis 1 of the
acetabulum is formed as a seat, of which the exterior surface is
defined by tiered blades 3 with sharp edges and orifices 4 formed
therein for the advancement of burgeoning bony tissue therethrough.
The interior surface of the endoprosthesis 1 of the acetabulum has
an irregular through hole to receive two split bushings 5
enveloping more than half of a head 6 of the endoprosthesis 2 of
the proximal portion of the femur, thereby forming a hinged joint
for the endoprostheses 1 and 2. Apart from the head 6, the
endoprosthesis 2 of the proximal portion of the femur comprises a
neck 7 on which the head 6 is securely fitted.
The neck 7 directly passes into an intertrochanteric section 8
which in turn passes into a conical shaft 9 with fenestras 10
through which burgeoning bony tissue can advance, with the shaft 9
having a shape similar to that of the femoral medullary canal (not
shown).
The intertrochanteric section 8 is similar in shape to the inner
canal of the femoral intertrochanteric region and is bounded in its
proximal part by two planes 11 and 12, with the plane 11
perpendicular (or roughly perpendicular) to an intertrochanteric
axis 13 and the plane 12 perpendicular (or roughly perpendicular)
to an axis 14 of the neck 7. There is an orifice 15 in the plane
11, and in which orifice a lock 16 for the trochanter major is
fixed, with the lock 16 comprising a screw 17 provided with a
locking nut 18. The endoprosthesis 2 of the proximal portion of the
femur also has a bearing pad 19 which is an extension of the plane
12. There is an orifice 20 provided in the proximal part of the
intertrochanteric section 8 for the convenience of the surgeon
during the operation, for example if the endoprosthesis 2 is to be
removed.
FIG. 2 which is a section of FIG. 1 taken in the plane II--II shows
the bearing pad 19 in plan comprising openings or orifices 21
provided to help regeneration processes. At the base of the neck 7
lugs 22 are provided to strengthen the endoprosthesis 2 at the
point of passage of the neck 7 into the intertrochanteric section
8.
The artificial hip-joint is made of titanium, while the hinged
joint, the head 6 (FIG. 1) and the bushing 5, of an alloy
comprising cobalt, chromium and molybdenum.
The proposed artificial hip-joint may be manufactured by several
methods, for example precision casting, pressing or machining.
The method of installing the proposed artificial hip-joint is as
follows:
With the patient lying on his side or back, the trochanter major is
exposed by a lateral incision, cut off at the base thereof at right
angles to the intertrochanteric axis and together with the muscles
attached thereto drawn up, thereby exposing the joint. Then the
femoral neck is sawed off at the base at right angles to the axis
thereof and the head and neck of the patient's femur are removed.
Thereafter the medullary canal of the femur is reamed to a required
size and shape conforming to the size and shape of the proximal
part of the endoprosthesis 2 (FIG. 1), and the patient's acetabulum
is prepared by milling. The shaft 9 of the endoprosthesis 2 is
inserted into the medullary canal of the femur strictly along the
axis thereof until the endoprosthesis 2 has been firmly immobilized
in the prepared inner femoral canal, with the bearing pad 19
abutted against the femoral plane formed after the neck has been
sawn off. With the intertrochanteric section 8 of the
endoprosthesis 2 and the inner canal of the patient's femoral
intertrochanteric region having similar configurations, the
endoprosthesis 2 is secure against turning about the longitudinal
axis thereof.
This completed, the endoprosthesis 1 of the acetabulum is installed
with the help of special guides, and the diameter of the
endoprosthesis 1 is slightly larger than the prepared depression in
the acetabulum.
The trochanter major together with the muscles attached thereto is
installed on the plane 11 and immobilized thereon with the lock 16
of the trochanter major. The wound is rinsed with a solution of
antibiotics and tightly sutured in layers.
* * * * *