U.S. patent number 3,918,102 [Application Number 05/454,680] was granted by the patent office on 1975-11-11 for artificial hip joint.
This patent grant is currently assigned to Sulzer Brothers Limited. Invention is credited to Joachim Eichler.
United States Patent |
3,918,102 |
Eichler |
November 11, 1975 |
Artificial hip joint
Abstract
An artificial hip joint consists of a femoral implant, a socket
member and a bearing support for the socket member. The femoral
implant is intended for implantation in a prepared cavity in the
femur of a patient and has a stem for insertion in the cavity, a
femoral neck attached to the stem and a condyl on the femoral neck.
The socket member is intended for location in the patient's hip
socket which has previously been surgically enlarged and receives
the femoral condyle. The bearing support is intended to be embedded
in the hip socket in the patient's pelvis and has an exterior
flange, which is arranged to bear against the bone surrounding the
hip socket, and a recess to accommodate the socket member. The
bearing support can be formed separately from or integrally with
the socket member.
Inventors: |
Eichler; Joachim (Wiesbaden,
DT) |
Assignee: |
Sulzer Brothers Limited
(Winterthur, CH)
|
Family
ID: |
5875770 |
Appl.
No.: |
05/454,680 |
Filed: |
March 25, 1974 |
Foreign Application Priority Data
|
|
|
|
|
Mar 24, 1973 [DT] |
|
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2314708 |
|
Current U.S.
Class: |
623/22.39 |
Current CPC
Class: |
A61F
2/34 (20130101); A61F 2230/0019 (20130101); A61F
2002/3487 (20130101); A61F 2002/30153 (20130101); A61F
2002/3631 (20130101); A61F 2002/4631 (20130101); A61F
2230/0004 (20130101); A61F 2/32 (20130101); A61F
2230/0023 (20130101); A61B 17/8066 (20130101); A61F
2002/30136 (20130101); A61F 2002/30787 (20130101); A61F
2230/0026 (20130101); A61F 2002/3611 (20130101); A61F
2002/30156 (20130101); A61F 2002/3479 (20130101); A61F
2220/0025 (20130101); A61F 2310/00011 (20130101); A61F
2002/30594 (20130101); A61F 2002/3429 (20130101); A61F
2002/3625 (20130101); A61F 2002/3401 (20130101); A61F
2002/30158 (20130101); A61F 2/36 (20130101); A61F
2002/30329 (20130101) |
Current International
Class: |
A61F
2/32 (20060101); A61F 2/34 (20060101); A61B
17/68 (20060101); A61B 17/80 (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
Foreign Patent Documents
|
|
|
|
|
|
|
1,215,737 |
|
Dec 1970 |
|
UK |
|
1,047,640 |
|
Jul 1953 |
|
FR |
|
Other References
McBride Acetabulum Cups (No. 6429), Vitallium Surgical Appliances
(Catalog), Austenal Co., New York, N.Y., 1964, page 30..
|
Primary Examiner: Frinks; Ronald L.
Attorney, Agent or Firm: Kenyon & Kenyon, Reilly, Carr
& Chapin
Claims
What I claim as my invention and desire to secure by Letters Patent
is:
1. A support bearing for embodiment in a prepared socket in a
pelvis comprising a generally cup-shaped element defining a
substantially part-spherical internal cavity for reception of a
socket for a femoral condyle and having an external flange adjacent
the mouth of said cavity, said cup-shaped element comprising a
plurality of fingers connected to the flange and formed integrally
therewith, the fingers defining at least in part the cavity and
having barbed tips, which, when viewed in a direction perpendicular
to the plane of the flange axially of the opening to the cavity,
resemble arrow heads.
2. A support bearing according to claim 1, in which the cup-shaped
element further comprises a plurality of webs connected at one end
to the flange and formed integrally therewith and mutually
connected at their other ends on the axis of the opening to the
cavity.
3. A support bearing according to claim 2, in which the free edges
of the webs are provided with corrugations.
4. A support bearing according to claim 2, in which the free edges
of the webs are provided with hooks.
5. A support bearing according to claim 1, in which there are eight
fingers whose tips lie a distance of from about 20 to about 25mm
from the flange.
6. A support bearing according to claim 2, in which there are three
webs and in which there are two fingers between each web, the
fingers and webs being symmetrically disposed with respect to the
axis of the opening to the cavity.
7. A support bearing according to claim 2, in which the cup-shaped
element further comprises a secondary web extending in an annular
fashion with respect to the axis of the opening to the cavity
between the flange and the meeting point of the first-mentioned
webs.
8. In or for an artificial hip joint comprising a femoral implant
for implantation in a femur, the femoral implant comprising a stem
for embedding in a prepared cavity in a femur of a patient, a
femoral neck attached to the stem and a femoral condyle on the
femoral neck, and a hemispherical socket member for reception of
the femoral condyle, said socket having uninterrupted internal and
external surfaces for adjustment of said socket, the improvement
comprising bearing support means for the socket member adapted for
embedding in a prepared cavity in the pelvis of the patient, the
bearing support means comprising a substantially part-spherical
element having a recess for reception of the socket member, an
external flange for bearing against the bone surrounding the
prepared cavity in the pelvis and at least one aperture affording
communication between the external surface of the bearing support
and the recess for the socket.
9. An artificial hip joint comprising a femoral implant for
implantation in a prepared cavity of a femur of a patient and a
socket device for insertion in a previously enlarged socket in the
pelvis of the patient, said socket device including a bearing
support having an external flange adapted to bear against the bone
surrounding the socket in the pelvis and a recess having at least
one aperture affording communication between the external surface
of the bearing support and said recess, said socket device further
including a hemispherical socket having a continuous external
surface for adjustment within said recess of said bearing support
and a smooth uninterrupted internal surface for receiving femoral
implant.
10. An artificial hip joint according to claim 9 wherein socket
socket device is made of a plastics material.
11. A support bearing for embedment in a prepared socket in a
pelvis comprising a generally cup-shaped element defining a
substantially part-spherical internal cavity for reception of a
socket for a femoral condyle and having an external flange adjacent
the mouth of said cavity and having a plurality of fingers
extending in cantilever fashion inwardly from said flange into said
cavity to define at least one aperture affording communication
between the external surface of the bearing support and the
socket.
12. A support bearing according to claim 11 in which the flange is
provided with a plurality of apertures.
13. A support bearing according to claim 11, in which at least one
external surface of the cup-shaped element is provided with a
bead.
14. A support bearing according to claim 13, in which the bead
extends in a generally radial direction with respect to the axis of
the opening to the cavity.
15. In combination, a femoral implant having a femoral condyle; a
socket member for receiving said femoral condyle; and a support
bearing having a part-spherical internal cavity for reception of
said socket, an external flange, and a plurality of fingers
extending from said flange and defining at least one aperture
within said cavity to permit passage of a bone cement for anchoring
of said socket in a pelvis cavity.
16. A support bearing for embedment in a prepared socket in a
pelvis comprising a generally cup-shaped element defining a
substantially part-spherical internal cavity for reception of a
socket for a femoral condyle and having an external flange adjacent
the mouth of said cavity, and having a plurality of spaced webs
defining a plurality of apertures therebetween and a skeletal
structure, each said aperture affording communication between the
external surface of the bearing support and the socket.
17. In combination, a femoral implant having a femoral condyle; a
socket member for receiving said femoral condyle; and a support
bearing having a part-spherical internal cavity for reception of
said socket, an external flange, and a plurality of webs defining
at least one aperture within said cavity to permit passage of a
bone cement for anchoring of said socket in a pelvic cavity.
Description
FIELD OF THE INVENTION
This invention relates to an artificial hip joint.
BACKGROUND OF THE INVENTION
In the treatment of degenerative diseases of the hip joint
accompanied by substantial destruction of the joint (coxarthrosis)
it has been a common practice since 1946 to replace the femoral
condyle by a prosthetic implant of metal comprising a femoral
condyle, a femoral neck and a metal stem.
A "total" artificial hip joint was developed in 1961. In this a
hemispherical socket of plastics is inserted into the previously
enlarged bone socket, which is provided with some grooves to
provide better keying of the bone cement, to cooperate with the
metallic femoral neck. The plastics socket is secured by means of
bone cement. This total artificial hip joint has since been
modified.
Some patients suffering from degenerative hip joint deformations
exhibit primary or secondary protrusio acetabuli. In this special
form of coxarthrosis the bone socket base gradually curves forward
into the minor pelvis in the course of years and is also gradually
reduced, i.e. at the end of the pathological process the base of
the bone socket is replaced exclusively by soft tissue which is
unable to perform any load-supporting function. The descent of the
femoral condyle into the minor pelvis also reduces the distance
between the minor and major rolling surface on the one hand and the
pelvic inlet plane on the other hand so that this feature is
additionally accompanied by a reduced or limited movability of the
hip joint.
The cause of primary protrusio acetabuli, which is usually
double-sided, is unknown. In recent times one-sided secondary cases
occurred frequently as the result of so-called "socket looseness"
after the insertion of an artificial hip joint. Bone resorption
occurs after the insertion of an artificial hip joint through
causes which are not accurately known but are generally the result
of slow infections. These pathological processes again result in
forward curving of the residual bone socket into the minor
pelvis.
Known artificial hip joints which are used for the operative
treatment of protrusio acetabuli and have hemispherical sockets may
lead to a central dislocation of the artificial joint into the
minor pelvis and result in reduced mobility because the inlet plane
of the plastics sockets is located deeply in the natural socket and
the resection face of the femoral neck on movement strikes against
the natural bony pelvic inlet.
DESCRIPTION OF THE PRIOR ART
It has been proposed to use a fine gauge wire mesh in the operative
treatment of protrusio acetabuli.
The main purpose of such a mesh was to prevent the bone cement
penetrating into the soft parts of the minor pelvis. Prior to
securing the artificial socket and prior to the introduction of
bone cement the procedure was to chase three grooves by means of a
chisel into the bony pelvis behind the socket inlet. The mesh was
intended mainly to prevent the ingress of bone cement via the
grooves into the minor pelvis. However, the biomechanics of the hip
socket are not likely to be improved by the presence of this
mesh.
An improved mesh of this kind constructed of physiologically
compatible metal in the form of a grid and in accordance with
another proposal also prevents the ingress of bone cement into the
minor pelvis and in addition improves anchoring of the socket but
without exerting any substantial effect on the biomechanics of the
artificial hip joint.
BRIEF DESCRIPTION OF THE INVENTION
I have now discovered, through observations made during operations
and by subsequent X-ray investigations as well as by
pathological-anatomical investigations, that protrusio acetabuli is
accompanied by increased bone stability at the hip socket inlet due
to an annular selerotic condition of the pelvis in this region. The
invention accordingly makes use of this knowledge and utilizes this
stability and mechanical strength of the existing bone tissue of
the pelvic bone at the inlet to the hip joint socket and
surrounding such inlet in order to support the plastics socket and
therefore the entire artificial hip joint.
It is accordingly a principal object of the invention to provide an
artificial hip joint which avoids the disadvantages of the above
mentioned prior art operation methods and implants.
It is also an object of the invention to provide an artificial hip
joint in which the distance between the hip inlet plane and the
resection face of the femoral neck is increased.
It is a further object of the invention to provide an artificial
hip joint in which the hip socket is mounted in a plane different
from that in which the plastics socket was hitherto secured to the
pelvis.
A still further object of the invention is to provide a support
bearing for the hip socket of an artificial hip joint in which the
bearing forces are taken up by the surface of the bony part of the
pelvis surrounding the previously enlarged hip socket in the
pelvis.
According to the invention an artificial hip joint, comprising the
femoral condyle, femoral neck and the stem which is to be inserted
into the femur on the one hand and the hemispherical socket which
is to be inserted into the hip joint socket on the pelvis on the
other hand is characterized by a support bearing for the
hemispherical socket in the form of a spherical section with a
surrounding flange. The internal diameter of the spherical section
is slightly larger, preferably about 1 to about 2 mm larger than
the external diameter of the hemispherical socket. The spherical
section is preferably approximately or equal to a hemisphere. The
flange is broad, preferably having a width of 8 - 12 mm. The
spherical section and/or the flange is provided with apertures. The
apertures of the spherical section may be constructed so that, when
seen in plain view, arrow-shaped claws or fingers extend from the
flange in the surface of the spherical section while leaving free a
central opening. The spherical section surface between the claws
can also be constructed in the form of narrow webs which converge
in the centre. The spherical section surface may also exclusively
comprise a plurality of narrow webs which converge in the centre.
The edges of the narrow webs may be provided with corrugations or
hooks.
The surface of the spherical section and/or the claws and/or the
narrow webs are preferably provided with beads that extend
radially. In one embodiment of the invention the flange is provided
with eight claws or fingers whose ends advantageously terminate at
a position about 20 to about 25 mm from the flange. In another
embodiment the flange is provided with three webs disposed at
identical distances in a star pattern, two claws being formed
between every two such webs.
An annular web can also be formed between the flange and the centre
in the surface of the spherical section to bridge the spaces
between the radial webs or the ends of the claws.
The support bearing according to the invention can be constructed
of a chemically stable and physiologically compatible strong metal
plate, preferably of the same material as that of which the femoral
condyle is constructed. The support bearing may however also be
constructed from a physiologically compatible plastics material and
can be joined to the hip joint socket, which is also constructed of
plastics, or it may be integrally constructed with the hip joint
socket.
BRIEF DESCRIPTION OF THE DRAWINGS
Further objects and advantages will become apparent from the
following detailed description taken in connection with the
accompanying drawings, in which:
FIG. 1 is a front view of the hip region of a human skeleton, the
right hip joint of which has been replaced by an artificial hip
joint according to the invention;
FIG. 2 is a perpsective view of the individual parts of the
artificial hip joint of FIG. 1;
FIG. 3 is a perpsective view of the hemispherical socket of the
artificial hip joint of FIG. 2 which is inserted into one form of a
support bearing according to the invention;
FIG. 4 is a side view, partially in section, of another form of
support bearing according to the invention;
FIG. 5 is a plan view of the support bearing of FIG. 4;
FIG. 6 is a side view of yet another form of support bearing
according to the invention;
FIG. 7 is a plan view of the support bearing of FIG. 6;
FIG. 8 is a side view of a further form of support bearing
according to the invention;
FIG. 9 is a plan view of the support bearing of FIG. 8; and
FIG. 10 is a plan view of part of a still further form of support
bearing according to the invention.
DETAILED DESCRIPTION OF THE INVENTION
Referring to the drawings, FIG. 1 is a front view of a pelvis of a
patient whose right hip joint has been replaced by an artificial
hip joint according to the invention (in the drawing the artificial
hip joint is disposed on the left hand side). The artificial hip
joint comprises a femoral part 1 which is inserted by means of a
pin into the femur 4 after removal of the upper part of this bone.
A support bearing 3 according to the invention is fixedly mounted
in the joint socket of the pelvis 5 and retains a hemispherical
socket 2 which forms the seat for the ball head (condyle) of the
femoral part 1.
The prosthetic implant or femoral part 1 which is inserted after
removal of the top part of the femur 4 comprises a metal stem 6, a
femoral neck 7 and a femoral condyle 8. This contiguous part is
generally constructed integrally from a physiologically compatible
metal. The femoral condyle 8 is shaped in the form of a sphere and
is inserted into a hemispherical socket 2 which is generally
constructed of a physiologically compatible plastics material and
whose external surface is provided with different indentations so
that it can be inserted with bone cement into a prepared bone
socket in the pelvis 5. As shown in FIGS. 1 and 2 a support bearing
3 is however previously inserted into the bone socket of the pelvis
5 and is secured with bone cement and the hemispherical socket 2 is
inserted thereafter into the support bearing 3.
The support bearing 3 according to the invention substantially
comprises a spherical section 10 of special shape which is
surrounded by a flange 11.
The spherical section 10, generally in the shape of a hemisphere or
approximately in the shape of a hemisphere is provided with
apertures and one embodiment is constructed as may be seen by
reference to FIGS. 2 and 3 so that arrow-shaped claws 13 extend
inwardly from the annular flange 11 in the surface of the spherical
section. The opening of the spherical section surface is complete
above the ends of the claws 13 and the individual aperture members
that extend between the claws 13 are broadened directly above the
flange 11. The length of the claws 13 from their base on the flange
11 to their end is 20 - 25mm in a preferred embodiment, given an
internal diameter of the spherical section of approximately 50 cm
and a flange width of 8 - 12 mm.
After preparing the bone socket in the pelvis 5 the support bearing
3 is inserted with bone cement into the socket so that the annular
flange 11 bears all round firmly against the bone tissue which
surrounds the socket inlet on the pelvis, where appropriate by the
interposition of bone cement. At least some parts of the spherical
section of the support bearing 3 bear against load bearing bone
fabric in the socket of the pelvis through the interposition of
bone cement. After the insertion of the aforementioned support
bearing the plastics shell i.e. socket 2 of the artificial hip
joint is inserted into the support bearing and can be adjusted
within the support bearing taking into account the angle of
inclination and the so-called antetorsion, i.e. the axis setting in
the saggital and frontal plane so that the femoral condyle 8 which
is inserted into the smooth uninterrupted internal surface of the
hemispherical socket 2 assumes approximately the same pivoting
centre as the natural femoral condyle. The hemispherical socket 2
is also secured in the support bearing by means of bone cement in
the upright position imparted to it.
As may be seen more particularly by reference to FIG. 1 a support
bearing 3 according to the invention prevents the femoral condyle
and hemispherical cup-shaped socket from gradually penetrating
either immediately or in the course of time into the pelvic bone.
Such penetration would result in a displacement of the pivoting
point of the hip joint. Furthermore the pressure conditions of
artificial hip joints are improved and at the same time the
artificial hip joint socket is firmly secured. The support bearing
3 additionally improves the movability of artificial hip joints.
The distance between the major and minor rolling surface on the one
hand and the pelvic inlet plane on the other hand is also prevented
from diminishing; no further reduction or limitation of the hip
joint movability therefore occurs. The support bearing according to
the invention necessarily increases the distance between the inlet
plane of the artificial hip socket and the resection face on the
femoral neck.
FIGS. 4 and 5 show a further and particularly advantageous form of
support bearing according to the invention. The flange 11 is
provided with apertures 14 in the form of drilled or punched holes.
The spherical section surface with apertures which surrounds the
flange 11 comprises claws 13 of the shape already described in
connection with the embodiment of FIGS. 1 to 3 and also includes
three webs 15 which extend radially and converge in the centre. Two
claws 13 are disposed between every two webs 15. The webs 15 are
provided with radially extending beads 16. The purpose of these
beads on the one hand is to stiffen the webs 15 and on the other
hand to provide additional retention for the hemispherical socket
9. They also provide additional and advantageous anchoring in the
surrounding bone cement.
In general it should be noted that the internal diameter of the
spherical section 10 of the support bearing 3 is advantageously
larger by 1 to 2 millimeters than the external diameter of the
hemispherical socket 9 so that sufficient space for the
introduction of bone cement remains between the spherical section
surface parts in the form of claws 13 or webs 15.
Another form of support bearing is illustrated in FIGS. 6 and 7 and
is provided with webs 15 which are radially disposed and converge
in a star pattern at the center to form a skeletal structure. These
webs can also be provided with radial beads 16. In the support
bearing of FIGS. 8 and 9 the webs 15 are provided at half their
height with an annular web 17 which has the same centre as the
centre of the support bearing. The annular web 17 can also be
provided with a bead. If desired, the internal parts of the radial
webs 15 which are disposed between the ring 17 and the centre of
the support bearing of FIGS. 8 and 9 can be omitted. As shown in
FIG. 10 the edges of the webs 15 can be provided with corrugations
or hooks 18 which additionally improve anchoring in the bone
cement.
Also, if desired, the support bearing 3 can be constructed of a
physiologically compatible plastics material and can be joined to
the hemispherical socket 2 or integrally constructed therewith so
that the view of FIG. 3 represents a single, contiguous part which
is constructed all of the same material.
* * * * *