US3543749A - Mechanical pseudarthrosis of the femur - Google Patents

Description

United States Patent in] 3,543,749

[72] Inventor Ned M. Grove FOREIGN PATENTS 654N-ElCamiM, San Mateo, Califurnia 1,122,634 5/1956 France 12s/92c 332 1,448,955 7/1966 France l28/92Cl [2!] Appl. No 221 Filed Feb. 19, 1968 OTHER RE Q [45] patented Dec 1 1970 Replacement of Arthrltic Hips By the McKee-Farrar Prosthesis" by G. K. McKee et aL, JOURNAL OF BONE AND JOINT SURGERY, Vol. 48 B, No. 2, pages 245- 259. [54] MECHANICAL PSEUDARTHROSIS OF THE 1 28/92C FEMUB Primary Examiner-Richard A. Gaudet 10 Clams 5 Drawmg Figs Assistant ExaminerRonald L. Frinks [52] US. Cl 128/92, 3/ l A rn y-T wnsend and Townsend [SI] Int. Cl A6lf5/04, A6lf 5/01 [50] FieldofSearch 128/92,

9B92B3, 92C, 92C 1 92F, 926; 3/1

[56] References Cited ABSTRACT: A prosthetic device for insertion between the UNITED STATES PATENTS ends of a living bone to provide, in combination with distally 2,668,531 2/1954 Haboush 128/92Cl transferred muscles, relative movement between the ends of 2,696,817 12/ 1954 ,Prevo l28/92C the bone, and a method of inserting a prosthetic device.

Patented Dec 1, 1970 FIG 2- FIG 3 r-.'|ca...1.

INVENTOR. NED M. GROVE FIG. 4

ATTORNEYS sis-43749 l MscnAnicAL rsnunAn'rnnosrs or run rsrviun ThisQinvention relates to bone prosthesis and more particuw:

search-for new and better methods of repairing the ravages of disease, injury and aging in the joints of the human body, and has beenmade possible-by the availability of new metallic alloys, as well as othermaterials that have been found to be relatively iner-twhen disposed in live body tissue.

An operation't whic'h .typifies v conventional prosthetic procedures. femoral head replacement arthroplasty, frequently used to relieve unbearable pain caused, for example, by an'farthritic condition in the hip. In this operation, the top of the femur (upper leg or thigh bone), comprising the ball of the ball-andso cket construction of the hip joint, is trimmed or cut off entirely, arid af spherical'prosthesis device is then attached either by inserting a shaft or stem of the device into the end of the remaining portion-of the femur itself (intramedullar'y) or across the upper end of the femur. The sphericallyshapedbody of the device replaces the missing head of the femur and restores'the desired movement while rendering the ,hip joint relatively painless and usable again. This type of Th'j 'is accomplished by-performing an osteotorny i.e., surgi cally severing or breaking the femur below the femoral neck and above the top ,of the shaft where the cross section of the femur is defined by a large projecting segment of bone called prosthesis is especially valuable when the femoral head has beensubjected to either avascular necrosis or irreparable fractur'e such as ,where the opposing ends of the fractured bone becorr'ie relatively smooth, hardened," and well defined, but not joined (nonunion;

I-lowevenwhen the hip joint has been subjected to a disease such as ankylosing spondylitis, i.e., an inflammation and ossification of the membrane lining of the hip joint that causes abnormal stiffness or rigidity of the joint and produces restricted motion, such orthopedic devices are of limited usefulness. When such diseases are present, the replacement of the femoral head with a prosthesis only temporarily alleviates the immobility resulting from the continuing disease process. The

- same becomes better understood from reference'to the followreason for this is that the involved synovium, joint capsule, tissues (ligaments and muscles) caused by such conditions as an-. kylosing spondylitis and rheumatoid. arthritis are retained and the processof the disease continues. As a result, after a short period of time, the stiffness or immobility and discomfort at the joint returns. In these conditions, replacement of the head of the femur with a prosthesis is difficult and often unsatisfactory. Other methods used in this condition such as vitallium mold arthroplasty of the hip joint have proved unsatisfactory for the same reasons.

Therefore, it is a principal object of this invention to provide a pseudarthrosis at an intermediate location in an elongated skeletal member.

It is another object of this invention to provide a pseudarthrosis that is formed in the femur below the natural balland-socket of the hip joint. r r

It is a further object of this invention to utilize a portion of the femur that contains a large crosssection of bone, e'.g., the intertrochanteric region, as a location fora mechanical pseudarthrosis totreplace the natural hip joint when deterioration has occurred that produces loss of normal ambulation.

it is another object of this invention to provide an artificial hip joint that is spaced from any inflamed tissue resulting from diseases such as ankylosing spondylitis.

Still another object of this invention is to provide a method for inserting a prosthetic device in the femur at a location spaced from the femoral head.

It is a further object of this invention to provide a prosthetic device for immobilizing the natural ball-snd-socket of the hip while creating relative motion at about the intertrochantcric region of the femur.

Broadly stated, the present invention is directed to providing an arthrosis at an intermediate location in a skeletal member such as at the intertrochanteric region of the femur.

the greater trochanter. A recess or cavity is then provided that extends intothe' intertrochanteric region of the femur from the broken surface thereof. The cavity is preferably of sufficient size to receive the entire artificial cup-shaped socket while providing circumferential support therefor. Thereafter, a spherical prosthesis corresponding in external configuration I to the internal configuration of the aforementioned recessed socket is positioned with an intramedullary stem extending through the'other broken surface in the femur and into the in termedullary area of the shaft of the severed femur.

.It is preferable that the recess be formed in a segment of the severed femur that includes the greater trochanter. In this manner, the larger cross section of the femur in that area'will provide'addition'al support for the cup-shaped prosthesis membeL'With the proper irnplacernent of the prosthesis, the need for movement of the normal hip joint is eliminated. The muscles that control flexion, extension, adduction, external rotation and internal rotation will subtend the false joint and therefore-will not be altered. By distal transfer of the insertion of the various muscles that control abduction, normal muscle power can be provided to produce ambulatory motion. in this manner, the natural motion of the hip joint is replaced by a similar capacity for movement at about the pseudarthrosis. Furthermore, movement of the natural hip joint can be permanently eliminated by intentional ankylosis (fusion) by providing the socket arthroplasty device with a stem of sufficient length to extend through the head of the femur and the acetabulum into the innominate bone.

While 'this invention as'described herein is directed to a mechanical pseuda rthrosis for the hip, it will be apparent to those skilled in, this art that the teachings of the invention are applicable to any human balland-socket joint as well as in the practice of veterinary medicine.

Other objects and many of the attendantfca'tures and advantages of this invention will be more readily apparent as the ing detailed description, especially when considered in connectionwith the accompanying drawing:

FIG. 1 is an elevation of a portion of the ilium and an exploded view of the upper end of a human femur that has. been severed in the intertrochanteric region for insertion of an 'osteal appliance in accordance with this invention. (Relevant musculature is omitted for purposes of clarity.)

FIG. 2 is an exploded fragmentary elevation, partially cutaway, corresponding to FIG. I and illustrating the femur modified for receiving an osteal socket member;

FIG. 3 is an exploded elevation, partially cutaway, of the femunwith both portions of a hip prosthesis device inserted as intended;

FIG. 4 is an elevation depicting the hip prosthesis device of FIG. 3 positioned as intended in the modified femur; and

FIG. Sis an elevation in partial cross section illustrating one embodiment for the socket portion of the prosthesis.

- Referring now to the drawing wherein similar characters of reference represent corresponding parts in each of the several views, there is shown an innominate bone 10 and femur II. in-

nominate bone 10 includes acetabulum 12 while femur 11 includes femoral head 14, femoral neck 15, greater trochanter 16, femoral shaft 18 and lesser trochanter 19. Femur ll has been surgically severed in the intertrochanteric region 20 to provide a pair of femoral segments 22 and 24 suitable for the receive socket member 27 and can be of any shape cor-- responding to the outer configuration of member 27. How ever, preferably, recess 26 corresponds in shape to a spherical defines a sphericalse'gment of one base so that a portion of hemispherically-shaped ball member 31 can be disposed for slidable engagement within socket member 27 (as shown in 1 16.4). 4

Socket member 27 can be force-fitted into recess 26, retained in recess 26 with a fast-setting plastic, attached to a shank for rigid engagement within femur 11 or maintained within recess 26 in any way known to those skilled'in this art.

Furthermore, socket member 27 can also bemounted at the severed end of segment 22 without providing recess 26. When such a procedure is utilized, a section of femur l1 correspondl. A process for forming a mechanical pseudarthrosis in a femur at a location below thefemorai head thereof, comprising the steps of: surgically dividing the femur at about the intertrochanteric region to provide an upper portion including means to the lower portion of said femur; and inserting said ing to the height of member 27 should be removed to retain I the overall length of femur 1 1. However, it is preferable to i provide socket member 27 with shank 30 for attachment to member 27. ln'this manner, member 27 is not only supported by the wall of recess 26, but by internal contact of shank 30 with femur 11 along neck '15 and head 14 thereof. Shank 30 can also be of sufficient length to actually extend through acetabulum 12 and into innominate bone 10. The angle formed by shank 30 toia plane through the circumferential surface of socket member 27 is dependent upon the configuration of femur 11. In this manner, femoral head 14 can be fused into acetabulum 12 and-thereby prevent further painful movement at the diseased hip joint.

As shown in FIG. 5, shank 30 can also be of tapered, threaded configuration. in addition, for ease of implacement, socket member 27 can be fabricated from a separate socket and shank. Thus shank 30 may be surgically implanted as in tended. Thereafter, socket member 27 can be inserted into recess 26 and rigidly secured to shank- 30 with threaded member 36, preferably countersunk into socket member 27.

vl-iemispherically-shaped ball member 31 is'preferably of a diameter corresponding to the diameter of aperture 28 so that member 31 canbe disposed in slidable engagement within socket 27. Although hemispherically-shaped bone member 31 can be mounted at the severed end of segment 24 of femoral shaft 18 in any manner known to one skilled in this art, it is preferable that hemispherical member 31 include an intramedullary shank 3.4 for rigid engagement along the intramedullary region of femoral shaft 18. When prosthetic devices 27'and 31 are appropriately arranged on respective femoral segments 22 and 24,'the severed segments can be returned to normal anatomical alignment by disposing member 31 within aperture 28 and providing the necessary distal transfer of muscles. Although it will usuallyonly be necessary to transfer the abductor muscle attachments at greater trochanter 16, other muscle groups such as the iliopsoas, the rectus femoris, the glutei,.the tensor fascia femoris and the small external rotator muscles can also be distally transferred when necessary.

it will be apparent to one'skiliedin this art that many of the presently available osteal appliances having both a ball and socket may be modified as necessary to provide the desired anticular replacements needed for the surgical insertion required for this invention. Furthermore, the ostealappliances can be fabricated of any suitable material that is chemically inert, exhibits minimal foreign body reaction in a living tissue and is nonelectrolytic. Examples of specific materials that heretofore have been found to be suitable include stainless steel alloys, Vitallium, and various plastics such as the polymethacrylates.

While one embodiment of the invention has been shown and'described, it will be apparent that other adaptations and modifications can be made.

ball means into said socket means to permit relative motion between the upper portion and the lower portion of said femur.

2. The process of claim 1 and further characterized by providingthe upper portion of said femur with a cavity of a size sufficient to receive said socket means.

3. The process of claim 1 and further characterized by the distal transfer of at least the abductor muscles surrounding said femur so that said relative motion can be accomplished.

4. The process of claim 1 and further characterized by providing said socket means with a stem of sufficient length to extend through the neck and head of said femur and into the acetabulum; and insertingsaid stem along said femoral neck and head and into said acetabulum to eliminate pivotal movement between the head of said femur and said acetabulum.

. 5. The process of claim 4 wherein said stem is inserted in such a manner as to prevent rotational movement of said femoral head with respect to said acetabulum.

6. The process of claim 1 and further characterized by providing said ball means with a stemsuitable for rigid insertion into the intramedullary area of the lower portion of said femur; and inserting said stem into said lower portion to provide the desired -rigid attachment between said ball means and the lower portion of said femur.

7. A process for forming a mechanical pseudarthrosis at an intermediate location in an elongated bone having a ball and skeletal portions; mounting said ball means to the other said skeletal portion; and inserting said ball means into said socket means to permit relative motion between the first skeletal portion and the second skeletal portion of said elongated bone.

8. A -mechanicalclevice for insertion in a living femur at the adjacent ends created by surgical severing at about the inter 'trochanteric region thereof to form a lower femur segment and an upper femur segment including the femur head, comprising: first and second prosthetic means, said first means adapted to be mounted to said upper femur segment and including a cup-shaped member having a stem attached thereto of a length sufficient to extend through the neck and head of said femur and into the acetabulum to provide substantially total immobility for said hip joint; said second means including a hemispherically-shaped member adapted to be mounted to said 'lower femur segment, said hemisphericallyshaped

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