U.S. patent number 3,889,300 [Application Number 05/501,296] was granted by the patent office on 1975-06-17 for articulated two-part prosthesis replacing the ankle joint.
This patent grant is currently assigned to Wright Manufacturing Company. Invention is credited to Richard C. Smith.
United States Patent |
3,889,300 |
Smith |
June 17, 1975 |
Articulated two-part prosthesis replacing the ankle joint
Abstract
A two-part ankle prosthesis comprises components which are
implanted, respectively, in the prepared distal end surface of the
tibia and the proximal end surface of the talus and which cooperate
to provide a substitute articulated ankle joint. The tibial
component has a sagittal fin which permits fixation insertion from
anterior to posterior into the distal tibial epiphysis and is
serrated or grooved at its sides for better fixation and increase
of the weight bearing surface area, and has a concave lower surface
matching the convex upper surface of the talar component
prosthesis, thus increasing the weight bearing surface and
improving the distribution of weight bearing. The flat under
surface of the talar component is supported on the prepared upper
surface of the talus, the original dome of which has been
osteotomized or removed. With the two prostheses in correct
positions the tibio-talar joint is converted into a ball and socket
type of joint. In a preferred form the tibial component is made of
316 LVM stainless steel and the talar component is fabricated from
ultra-high molecular weight polyethylene or other suitable implant
material.
Inventors: |
Smith; Richard C. (San Pedro,
CA) |
Assignee: |
Wright Manufacturing Company
(Arlington, TN)
|
Family
ID: |
23992945 |
Appl.
No.: |
05/501,296 |
Filed: |
August 28, 1974 |
Current U.S.
Class: |
623/21.18 |
Current CPC
Class: |
A61F
2/4202 (20130101); A61F 2002/30649 (20130101); A61F
2002/30884 (20130101); A61F 2002/30118 (20130101); A61F
2002/30904 (20130101); A61F 2002/30845 (20130101); A61F
2230/0006 (20130101) |
Current International
Class: |
A61F
2/42 (20060101); A61F 2/00 (20060101); A61F
2/30 (20060101); A61F 001/24 () |
Field of
Search: |
;3/1,1.9-1.913
;128/92C,92CA,92R |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Frinks; Ronald L.
Attorney, Agent or Firm: Scrivener Parker Scrivener and
Clarke
Claims
I claim:
1. A two-part prosthetic device for arthoplasty of the human ankle
joint, comprising a tibial component for replacing at least a part
of the prepared distal end of the tibia, and a talar component for
replacing at least a part of the prepared proximate surface of the
talus, the tibial component comprising a base part having a
downwardly facing concave surface of part-spherical shape and a
part extending upwardly from the base part and having spaced side
walls extending in an anterior-posterior direction when implanted
and having a notch in its distal posterior base to receive an
osteotomy slot prepared in the distal tibia to lock the component
in place, the talar component comprising a base part having an
upwardly facing convex surface which is part-spherical in shape and
has the same radius of curvature as that of the concave surface of
the tibial component and on which the concave surface rests when
the two-part prosthesis is in place, and means on the lower surface
of the talar component for engaging into the bone of the talus to
increase the connection of the component thereto.
2. As a new article of manufacture, a tibial prosthesis component
for replacing at least a part of the prepared distal end of the
tibia, the tibial component comprising a unitary integrally formed
device constructed and adapted to be connected to the distal end of
the tibia and to serve in lieu of the articulating surface thereof,
said tibial component comprising a lower base part of circular
shape having a polished downwardly facing bearing surface which is
spherically concave, and above the base part having an upwardly
directed bone fixation element for implantation in the tibial shaft
and having a notch in its distal posterior base part to receive an
osteotomy slot prepared in the distal tibia to thereby lock the
component in place, and a rounded downwardly facing edge surface
surrounding the bearing surface to provide smooth transitional
contact with a talar prosthesis, whereby the spherical concave
bearing surface provides all rotational and sliding capabilities
between a two-part prosthesis when implanted and operative.
3. As a new article of manufacture, a talar prosthesis for
cooperating with a tibial prosthesis to form an articulated
prosthesis replacing the ankle, said talar prosthesis comprising a
circular body having a generally flat lower surface for engagement
with and connection to a prepared proximate plateau surface of a
talus, curved ridges extending downwardly from the lower surface of
the talar component and having downwardly directed sharp lower
edges for better connection of the talar prosthesis to the prepared
surface of the talus, having a convex part-spherical upper surface
extending upwardly from the periphery of the lower surface and
forming a bearing surface to accept the downwardly facing part
spherical concave bearing surface of a tibial prosthesis, and at
least one recess formed in the body and opening to the lower
surface thereof to receive cement used in connecting the talar
prosthesis to the prepared proximate surface of the talus.
Description
BACKGROUND OF THE INVENTION
The normal human ankle is a joint which is constructed to permit
movement in flexion and extension, with some abduction, adduction
and rotation capability. Plantar flexion and dorsiflexion are the
major movements of the ankle and may be performed through an
angular movement of approximately 20.degree. dorsiflexion to
50.degree. plantar flexion. Rotation is the relative movement of
the tibia and talus about their substantially common vertical axis,
the normal rotation limit being approximately 5.degree. to either
side, an arc of approximately 10.degree..
Disease indications of the ankle joint include severe rheumatoid
arthritis, osteoarthritis, traumatic arthritis and painful failed
arthrodesis. The diseased ankle joint has heretofore been treated
by various local repair procedures or, in advanced cases, by
fusion. The desirability of replacement of the ankle joint has been
apparent, and momentum toward this end has been accelerated by the
successful invention and development of implants and procedures for
provision of total hip and total knee prostheses. However, until
the present invention no such prostheses or procedures were known
or available for providing a replacement for the complete ankle
joint.
SUMMARY OF THE INVENTION
In accordance with the invention an articulated two-part prosthesis
is substituted for the diseased tibio-talar joint, the structure
and implantation of which permits retention of the primary ankle
ligaments, and after implantation permits flexion, rotation and
sliding movements substantially reproducing the movements of the
normal human ankle. The components of the prosthesis are a distal
tibial implant having a concave part-spherical surface facing the
talus, and a proximal talar implant having a dome-shaped convex
part-spherical surface engaging and co-operating with the concave
surface of the tibial component. The tibial component is implanted
into a recess formed in the distal end of the tibia, and the talar
component rests on the prepared upper plateaued surface of the
talus, both components being formed with means to cause their
permanent, immobile attachment to their respective bones with the
use of a suitable cement. This two-part prosthesis permits
reproduction of the dorsi-flexion and plantar-flexion movements, as
well as some of the inversion, eversion and rotational movement
components of the joint, all at the level of the tibio-talar joint
of the normal human ankle.
DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of the bones forming, and adjacent to,
the human ankle joint, showing the two-part prosthesis provided by
the invention in place, in substitution for the human ankle;
FIG. 2 is a side elevational view of the two parts of the ankle and
the prosthesis shown in FIG. 1, with the ankle parts at
neutral;
FIG. 3 is a front view of the two components of the prosthesis, the
tibial component being shown in section;
FIG. 4 is a side elevational view of the two components of the
prosthesis, and
FIG. 5 is a bottom view of the talar prosthesis.
DESCRIPTION OF THE INVENTION
In FIGS. 1 and 2 of the drawings the principal parts of the human
leg and foot adjacent and forming the ankle are shown and labeled,
and as these are well known to those skilled in the medical and
other arts to which this invention relates they will not be further
described here. This figure also shows the two components of the
prosthesis provided by this invention, in operative association
with the illustrated parts of the body. These components are a
tibial component which is constructed and intended to be attached
distally to the tibia, and a talar component which is constructed
and intended to be attached proximally to the talus.
The distal tibial component is designated generally by the letter
A, is formed of metal such as stainless steel, and comprises a
lower or base part 2 which is preferably circular in shape and
disposed substantially horizontally when implanted, and an upper
part 4 which extends upwardly from the base part and is constructed
and adapted to be driven into the distal tibial shaft from anterior
to posterior, as shown in FIG. 1 in order to attach the component
to the tibia.
The base part 2 of the tibial component has a lower surface 6 the
central part of which is formed as a concave, downwardly-facing
surface 8 of part-spherical shape. This surface, which engages the
similarly-shaped upper surface of the talar component, is polished
to a mirror finish, while the other parts of the component may have
a dull finish. The upper part 4 of this component is a saggital fin
having upwardly extending side walls 10, 12 which are spaced
laterally of the anterior-posterior axis of the ankle joint and
which at their upper ends join a flat upper surface 14. The lower
parts of the side walls are curved to join the base part 2, as
shown at 16, 18, and the upper parts are parallel. Upwardly and
outwardly extending saw-toothed ridges and grooves 20 are formed in
the upper parts of the side walls of the fin and extend in the
anterior-posterior direction. The fin has a notch 22 at the distal
posterior part of its base, adjacent the upper surface of the base
part 2 of the implant, which co-operates with the osteotomy slot
prepared in the distal posterior area of the tibia during the
implantation procedure for the purpose of locking the component in
place in the osteotomized area of the tibia.
Surrounding the central, concave, downwardly facing surface 8 is an
annular surface 24 the outer and inner peripheral edges of which
are convexly rounded to provide smooth contact with the talar
prosthesis, which is most important in the event of an unavoidable
"rocking" motion occurring between the two components which would
otherwise result in gouging or "digging in" of the plastic talar
component by the metal tibal component.
The talar component of the prosthesis is designated generally by
the letter B, is formed of a synthetic plastic material, is
preferably circular in shape and substantially horizontal when
implanted, and which may be somewhat larger in diameter than the
circular base 2 of the tibial component as shown in FIG. 3. This
base part 30 has a generally flat lower surface which engages and
rests on the upper plateau surface C of the talus after suitable
preparation thereof. The upper surface of the component rises above
the base 30 to provide an upwardly convex dome 32 which is
part-spherical in shape and has the same radius of curvature as the
downwardly facing concave lower surface 8 of the tibial component
so that the two surfaces will exactly mate.
Means are provided on the lower surface of the base part 30 of the
talar component for securely and permanently connecting the
component to the prepared plateau surface of the talus, and in its
preferred form, which is shown in FIG. 5, this means takes the form
of two groups 40, 42 of curved ridges 44 each of which is shaped as
a triangle in cross section and has a sharp lower edge, and which
by its configuration interlocks with the cement on the talar
surface, the ridges of each group being concentric and the centers
of the two groups being diametrically opposite each other as shown
in FIG. 5. A plurality of holes or recesses 46 extend upwardly from
the lower surface of the component and into the body thereof in a
direction perpendicular to a tangent of the dome 32, and the cement
which is used to connect the component to the talal plateau extends
into these holes and provides an additional locking action.
The talar component of the prosthesis is preferably made of
ultra-high molecular weight polyethylene or other material suitable
for human implant purposes. In accordance with known procedure, a
wire may be positioned in a groove formed in an outer surface of
one or both components which serves as an X-ray locator and a
reference line to permit wear of the prosthesis to be measured
while in use, as X-rays taken at one year or at some other interval
will indicate any variation in distance between the bottom edge of
the tibial component and the wire.
The two prosthetic components are designed to work together as a
unit in such a fashion as to emulate the normal motions
characteristic of a healthy human ankle. The positions of the
bearing surfaces permit flexion of the talus with respect to the
tibia with approximately 20.degree. dorsiflexion to approximately
40.degree. plantarflexion, thus substantially reproducing the range
of flexional movement of the human ankle. The part-spherical shape
of the dome of the talar component permits the bearing surface of
the tibial component to ride level on the talar dome during
rotational movements of the ankle without riding up on the sides of
the dome, which would produce binding between the tibial and talar
components. The two components are designed so that in use the
theoretical limits of motion are from 20.degree. dorsi-flexion to
40.degree. plantar-flexion, and 5.degree. to 10.degree. of rotation
and inversion/eversion. The prosthesis has great utility in
replacing the rheumatoid, the osteoarthritic, the traumatic
arthritic, and the post-failed arthrodesis ankle. Its use produces
many good results, among them being improved and more efficient
gait, conservation of energy (a study reveals a 6 percent above
average energy expediture with one ankle immobilized, nine percent
with two immobilized), less stress and subsequent wear at the knee
above and at the forefoot below the prosthesis with better weight
distribution on the foot during ambulation, especially over rough
ground, improved transfer capability from the seated to the
standing posture, especially if the knees are also diseased,
ability to wear regular shoes when equinas capability is retained,
with women being able to vary heel heights to meet fashion demands,
and easier post-operative recovery as the patient merely awaits
soft tissue healing, avoiding the 15 to 20 percent reported
incidents of failed bony fusion.
* * * * *