WO1982003323A1 - Joint prothesis - Google Patents

Joint prothesis Download PDF

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Publication number
WO1982003323A1
WO1982003323A1 PCT/DE1982/000078 DE8200078W WO8203323A1 WO 1982003323 A1 WO1982003323 A1 WO 1982003323A1 DE 8200078 W DE8200078 W DE 8200078W WO 8203323 A1 WO8203323 A1 WO 8203323A1
Authority
WO
WIPO (PCT)
Prior art keywords
joint prosthesis
prosthesis according
joint
prepreg
adapter
Prior art date
Application number
PCT/DE1982/000078
Other languages
German (de)
French (fr)
Inventor
Medizinische Prod Gmbh Mecron
Original Assignee
Kranz Curt
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Kranz Curt filed Critical Kranz Curt
Priority to AT82900937T priority Critical patent/ATE15324T1/en
Priority to DE8282900937T priority patent/DE3265973D1/en
Publication of WO1982003323A1 publication Critical patent/WO1982003323A1/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8802—Equipment for handling bone cement or other fluid fillers
    • A61B17/8805—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
    • A61B17/8808—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it with sealing collar for bone cavity
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/3094—Designing or manufacturing processes
    • A61F2/30965—Reinforcing the prosthesis by embedding particles or fibres during moulding or dipping

Definitions

  • the invention relates to an endoprosthesis (joint prosthesis) frequently used in orthopedic surgery. It can be used for all types of endoprostheses, although the following description of an exemplary embodiment relates exclusively to a hip joint prosthesis. Various indications can make it seem appropriate to implant a joint replacement in a patient. However, conventional endoprostheses only have a lifespan of around five to eight years. The most common form of failure of these prostheses is loosening from the cement tube or, in the case of cementless prostheses, from the cortex of the femur.
  • the conventional cementless endoprosthesis has the disadvantage that the shaft protruding into the bone (for example, femur) due to the necessary assembly in a certain number of sizes and due to the lack of a further curvature out of the single plane of curvature (no distinction from the right and left) is insufficiently adapted to the shape of the medullary cavity.
  • the resulting punctiform supports lead to locally very high transverse loads and relieve the cortex in the longitudinal direction and thus to resorption in the upper area of the prosthesis attachment.
  • the cemented endoprosthesis is anchored in the cavity in a form-fitting manner by the cement, but the bond between the prosthesis socket and the cement holder is a component that is more rigid than the cortex of the bone by about a factor of ten. The result is a reorientation of the flow of force in the cortex with a large relief and local overloading across the fiber orientation.
  • the object of the invention is to create a joint prosthesis which can be individually adapted to the cortex of the bone in terms of shape and stiffness distribution without substantial compromises and which is capable of carrying out the general movement to bear the necessary forces both statically and dynamically and to introduce them into the cortex in a physiological manner, so that loosening can be expected to a lesser extent than in conventional prostheses.
  • prepreg is the usual name for fiber fabrics (glass, carbon, aramid or the like) which have already been wetted with a matrix plastic and which have not yet hardened, i.e. whose polymerization process must first be stimulated by external influences such as heat, ultraviolet light, light, ultrasound or the like.
  • the Matrix- Kunststoffst.off used is a plastic that is connected in liquid form to fibers or fabrics and, after curing, creates a bond between the individual fibers or fibers. These are stacked on top of one another or contained in the form of directed fabric with the aim of producing precisely defined, directed stiffnesses and strengths of the composite resulting in connection with suitable matrix plastics.
  • the prepreg part preferably consists of specially tailored strips fastened at the end, which take over the load-bearing and force-introducing function of the prosthesis and are only cured during the operation phase by the use of ultraviolet light or ultrasound and thus precisely to the Cortical be adjusted.
  • the transfer of force to a joint head, with for example, an aluminum oxide ceramic ball is made by a specially shaped adapter (adapter), which is preferably made of a body-compatible titanium alloy.
  • the longer service life due to the reduced risk of loosening and the associated risk of breakage in conventional prostheses is due to the joint prosthesis according to the invention of the better individual adaptability of the load-bearing and force-introducing structure of the implant (prepreg part) to the physical conditions ( Shape, roughness) of the medullary cavity during the insertion of the joint prosthesis in the course of an operation and the introduction of force into the cortical bone, which is better adapted to the physiological conditions (flexural rigidity), while largely avoiding non-physiological forces perpendicular to the fiber orientation of the cortical bone Joint prosthesis can be implanted without much more effort than conventional prostheses, and it is in case of a necessary reoperation - 5 -
  • FIG. 2 shows the main components of the same joint prosthesis, which is inserted into a cortex but is not yet attached there
  • Figure 3 shows the arrangement of Figure 2, but during curing
  • Figure 4 shows the fully inserted and completed joint prosthesis.
  • a two-part adapter 1 which forms a clamping connection with a prepreg part 2, is provided with a holding part la, on the threaded neck 1b of which a screw-over part 1c is screwed on.
  • the prepreg part 2 is clamped with its upper region between the parts la and lc.
  • An insertion aid 3 which extends through the threaded neck of the adapter part 1 and projects into the prepreg part, also represents the so-called insertion part, to which reference is made in various ways.
  • Pressure means 4 are provided in the interior of the prepreg part in the form of a foil bag and at the lower end of the insertion part 3 together with this inflatable tube which is closed.
  • a UV light or ultrasound emitter 5 that can be inserted into the insertion part is provided with transport means 6.
  • the mounting aid 10 consists of a screw-on adapter, which has the necessary connections for the passage of flow and curing agents.
  • the assembly aid makes handling of the prosthesis easier during implantation because of the increased accessible surface.
  • the prepreg part 2 consists of longitudinal strips and / or counter-rotating spiral strips which are interwoven in a suitable manner, which are clamped between the holding part 1 a and the screwed-on throwing part 1 c and in this way give the impression of a feathered bell which however - if the hardening does not take place here also in the operation phase - in an upper region where it is attached to the adapter 1, it is hardened, while in a lower region 2b it is still deformable and uncured.
  • the pressing means 4 which is largely impermeable to fluids, in particular airtight and inflatable, is clamped at its upper end facing the adapter 1.
  • this pressing means 4 for example a film or rubber bag, air can be passed through the fitting 10 a through the mounting aid 10.
  • the pipe 7, the insertion aid 3 and holes 3a provided therein are passed into the pressing means 4.
  • the seals 8 and 9 are provided.
  • a vent (not shown in more detail) is provided in the adapter 1, through which air can also be drawn off (in addition or instead of using compressed air through the nozzle 10a).
  • the air pressed into the pressing means 4 and / or sucked out of the cavity 11 is the flow means to be used in the present exemplary embodiment, through which the pressing means 4 can be inflated around the strips of the prepreg part 2 in the area 2b to press against the inner wall of the bone.
  • a curing agent is provided, namely the radiator 5.
  • the insertion part 3 is provided in the form of a tube made of polyethylene or the like, which also serves as an insertion aid for the still flexible parts 2 (in the area 2b) and 4.
  • An elongated, resilient element, by means of which energy is supplied to the radiator, is used as the transport means 6 for the radiator 5, either in the form of electrical energy or of ultraviolet light, if the transport means 6 is also designed as a light guide.
  • the emitter 5 is transported at a defined pull-out speed by drive means, not shown, which can be fastened to the assembly aid 10.
  • the prepreg strips in area 2b can be designed such that empty spaces remain between them when they are pressed against an inner wall of the bone. Bone tissue can then later grow into these interspaces.
  • the plastic material of the prepregs can e.g. a material can be used which is used in dental practice under the name "UVIOBOND".
  • FIG. 3 shows a later phase with pressed prepreg strips after air has been pressed into the connector 10a
  • the UV light or ultrasound emitter 5 has already passed halfway through the medullary cavity 13 and has caused part of the prepreg strips 2 to be cured by its radiation penetrating the parts 3 and 4. In contrast to the use of bone cement, there is no heat. The curing takes approximately 6 to 8 minutes when using ultraviolet light for curing.
  • the aids that are no longer required that is to say parts 3 to 10 are removed, for which purpose a channel (15 in FIG. 4) is provided in adapter part i with respect to parts 3 to 7. It is surrounded by the threaded neck 1b (FIG. 1), onto which the assembly aid 10 can be screwed in order to accomplish the processes of pressing the prepreg part 2 and curing it.
  • the assembly aid 10 is unscrewed and, after removing the remaining aids, an articulated head, e.g. an aluminum oxide ceramic ball is screwed on, as shown in FIG. 4 to show the final state.
  • the threaded neck 1b has a self-locking, conical thread.
  • the prosthesis While in the known hip joint prostheses, the force is introduced into the bones with the formation of transverse forces, which the bones generally cannot cope with the force is introduced in the joint prosthesis according to the invention in the physiologically correct direction, the prosthesis on the one hand having a large moment of inertia and on the other hand the introduction forces per unit area are low because of the large areas involved. Cross loads on the bone and a more or less punctiform transfer of force as in conventional prostheses are avoided, especially since the structure itself is elastic and can therefore follow the elastic deformations of the bone.
  • the prosthesis according to the invention can be repaired by replacing individual parts.
  • a new prosthesis can later be inserted easily due to the available cavity, which can be of a conventional type or can also correspond to the embodiment according to the invention. .

Abstract

The hinge prothesis comprises a part (2) of impregnated material presenting hardenable areas. This part has a shape corresponding to that of the bone cavity to which it is intended and, by means of a sealed and inflatable means (4), may be applied against the inner wall of the bone and fixed and hardened in that position.

Description

- 1 - - 1 -
GelenkprotheseJoint prosthesis
B e s c h r e i b u n qB e s c h r e i b u n q
Die Erfindung betrifft eine in der orthopädischen Chirur¬ gie häufig angewendete Endoprothese (Gelenkprothese). Sie ist für alle Arten von Endoprothesen anwendbar, obgleich sich die nachfolgende Beschreibung eines Ausführungsbei¬ spiels ausschließlich auf eine Hüftgelenkprothese bezieht. Die verschiedensten Indikationen können es angebracht erscheinen lassen, einem Patienten einen Gelenkersatz zu implantieren. Die herkömmlichen Endoprothesen haben aber nur eine Lebensdauer von etwa fünf bis acht Jahren. Die häufigste Versagensform dieser Prothesen ist die Lockerung aus dem Zementköcher bzw. bei zementlos eingesetzten Prothesen aus der Kortikalis des Femur. Die herkömmliche zementlos eingesetzte Endoprothese hat den Nachteil, daß der in den Knochen (z.B. Femur) hineinragende Schaft durch die notwendige Konfektionierung in einer bestimmten Anzahl von Größen und durch das Fehlen einer weiteren Krümmung aus der einzigen Krümmungsebene heraus (keine Unterschei¬ dung von rechts und links) ungenügend an die Form des Markhohlraums angepaßt ist. Die daraus resultierenden punktuellen Auflagen führen zu örtlich sehr hohen Quer- b'elastungen sowie Entlastungen der Kortikalis in Längs¬ richtung und damit zu Resorptionen im oberen Bereich des Prothesenansatzes. Die zementierte Endoprothese ist zwar durch den Zement formschlüssig in dem Hohlraum verankert, jedoch stellt der Verbund zwischen Prothesenschaft und Zementköcher ein um etwa eine Zehnerpotenz biegesteiferes Bauteil dar als die Kortikalisröhre des Knochens. Die Folge ist eine Umorientierung des Kraftflusses in der Kor¬ tikalis mit einer großflächigen Entlastung sowie örtlichen überbelastungen quer zur Faserorientierung.The invention relates to an endoprosthesis (joint prosthesis) frequently used in orthopedic surgery. It can be used for all types of endoprostheses, although the following description of an exemplary embodiment relates exclusively to a hip joint prosthesis. Various indications can make it seem appropriate to implant a joint replacement in a patient. However, conventional endoprostheses only have a lifespan of around five to eight years. The most common form of failure of these prostheses is loosening from the cement tube or, in the case of cementless prostheses, from the cortex of the femur. The conventional cementless endoprosthesis has the disadvantage that the shaft protruding into the bone (for example, femur) due to the necessary assembly in a certain number of sizes and due to the lack of a further curvature out of the single plane of curvature (no distinction from the right and left) is insufficiently adapted to the shape of the medullary cavity. The resulting punctiform supports lead to locally very high transverse loads and relieve the cortex in the longitudinal direction and thus to resorption in the upper area of the prosthesis attachment. The cemented endoprosthesis is anchored in the cavity in a form-fitting manner by the cement, but the bond between the prosthesis socket and the cement holder is a component that is more rigid than the cortex of the bone by about a factor of ten. The result is a reorientation of the flow of force in the cortex with a large relief and local overloading across the fiber orientation.
Dementsprechend liegt der Erfindung die Aufgabe zugrunde, eine Gelenkprothese zu schaffen, die in Form und Steifig- keitsverteilung ohne wesentliche Kompromisse an die Kor- tikalis des Knochens individuell angepaßt werden kann und in der Lage ist, die für den allgemeinen Bewegungsablauf erforderlichen Kräfte sowohl statisch als auch dynamisch zu ertragen und auf physiologische Weise in die Kortikalis einzuleiten, so daß Lockerungen in geringerem Maße zu er¬ warten sind als bei herkömmlichen Prothesen.Accordingly, the object of the invention is to create a joint prosthesis which can be individually adapted to the cortex of the bone in terms of shape and stiffness distribution without substantial compromises and which is capable of carrying out the general movement to bear the necessary forces both statically and dynamically and to introduce them into the cortex in a physiological manner, so that loosening can be expected to a lesser extent than in conventional prostheses.
Diese Aufgabe wird gelöst durch die Gelenkprothese mit den Merkmalen des Patentanspruches 1. Vorteilhafte Weiterbil¬ dungen sind in den Unteransprüchen angegeben. Der dabei verwendete Begriff "Prepreg" ist die übliche Bezeichnung für bereits mit einem Matrix-Kunststoff benetzte Faser-Ge¬ lege (Glas, Kohle, Aramid od. ähnliches), die noch nicht ausgehärtet sind, d.h. deren Polymerisationsprozeß erst durch äußere Einflüsse wie Wärme, ultraviolettes Licht, Licht, Ultraschall oder ähnliches angeregt werden muß. Der dabei verwendete Matrix-Kunstst.off ist ein Kunststoff, der in flüssiger Form mit Fasern oder Geweben in Verbindung gebracht wird und nach der Aushärtung einen Verbund zwischen den einzelnen Fibern bzw. Fasern herstellt. Diese sind in dem Gelege aufeinandergeschichtet oder in Gestalt gerichteter Gewebe mit dem Ziel enthalten, genau definier¬ te, gerichtete Steifigkeiten sowie Festigkeiten des in Verbindung mit geeigneten Matrix-Kunststoffen sich erge¬ benden Verbundes zu erzeugen.This object is achieved by the joint prosthesis with the features of claim 1. Advantageous further developments are specified in the subclaims. The term "prepreg" used here is the usual name for fiber fabrics (glass, carbon, aramid or the like) which have already been wetted with a matrix plastic and which have not yet hardened, i.e. whose polymerization process must first be stimulated by external influences such as heat, ultraviolet light, light, ultrasound or the like. The Matrix- Kunstst.off used is a plastic that is connected in liquid form to fibers or fabrics and, after curing, creates a bond between the individual fibers or fibers. These are stacked on top of one another or contained in the form of directed fabric with the aim of producing precisely defined, directed stiffnesses and strengths of the composite resulting in connection with suitable matrix plastics.
Bevorzugt besteht das Prepreg-Teil aus besonders zuge¬ schnittenen endseitig befestigten Streifen, welche die tragende und krafteinleitende Funktion der Prothese über¬ nehmen und erst während der Operationsphase durch die Ver¬ wendung von ultraviolettem Licht oder Ultraschall ausge- härtet werden und damit exakt an die Kortikalis angepaßt werden. Die Kraftüberleitung auf einen Gelenkkopf, bei- spielsweise eine Aluminiumoxid-Keramikkugel geschieht durch ein besonders geformtes $npaßteil (Adapter), das bevorzugt aus einer körperverträglichen Titanlegierung besteht. Durch die Anwendung eines bereits in der Zahn- medizin gebräuchlichen Kunststoffs, der durch ultraviolet¬ tes Licht aushärtet, zum Einbetten der Fasern der Prepreg- Streifen entstehen keine zusätzlichen Komplikationen im Zusammenhang mit der Körperverträglichkeit des gesamten Implantats. Vielmehr ist gleiche oder bessere Verträglich- keit mit dem menschlichen Körper zu erwarten als bei herkömmlichen Prothesen. Alle für die Implantation notwen¬ digen Hilfsstoffe und Vorrichtungen können aus gebräuch¬ lichen sterilisierbaren Stoffen gefertigt werden. Als Fa¬ serwerkstoff wird Glas, Aramid oder bei Aushärtung durch Ultraschall auch Carbon verwendet.The prepreg part preferably consists of specially tailored strips fastened at the end, which take over the load-bearing and force-introducing function of the prosthesis and are only cured during the operation phase by the use of ultraviolet light or ultrasound and thus precisely to the Cortical be adjusted. The transfer of force to a joint head, with for example, an aluminum oxide ceramic ball is made by a specially shaped adapter (adapter), which is preferably made of a body-compatible titanium alloy. By using a plastic that is already used in dentistry and hardens through ultraviolet light to embed the fibers of the prepreg strips, there are no additional complications in connection with the body tolerance of the entire implant. Rather, the same or better compatibility with the human body can be expected than with conventional prostheses. All of the auxiliary materials and devices required for the implantation can be produced from customary, sterilizable materials. Glass, aramid or, if hardened by ultrasound, carbon are used as fiber material.
Die größere Lebensdauer durch verminderte Gefahr der Lockerung und der damit verbundenen Bruchgefahr bei her¬ kömmlichen Prothesen verdankt die erfindungsgemäße Gelenk- prothese der besseren individuellen Anpaßbarkeit der tra¬ genden und krafteinleitenden Struktur des Implantats (Pre- preg-Teil) an die physiolo ischen Gegebenheiten (Form, Rauigkeit) des Markhohlraums während des Einsetzens der Gelenkprothese im Verlauf einer Operation sowie der an die physiologischen Bedingungen (Biegesteifigkeit} besser an¬ gepaßten Krafteinleitung in die Kortikalis des Knochens bei weitgehender Vermeidung von unphysiologischen Kräften senkrecht zur Faserorientierung der Kortikalis. Dabei ist die neue Gelenkprothese ohne wesentlich größeren Aufwand zu implantieren als die herkömmlichen Prothesen, und sie ist im Falle einer eventuellen notwendigen Reoperation - 5 -The longer service life due to the reduced risk of loosening and the associated risk of breakage in conventional prostheses is due to the joint prosthesis according to the invention of the better individual adaptability of the load-bearing and force-introducing structure of the implant (prepreg part) to the physical conditions ( Shape, roughness) of the medullary cavity during the insertion of the joint prosthesis in the course of an operation and the introduction of force into the cortical bone, which is better adapted to the physiological conditions (flexural rigidity), while largely avoiding non-physiological forces perpendicular to the fiber orientation of the cortical bone Joint prosthesis can be implanted without much more effort than conventional prostheses, and it is in case of a necessary reoperation - 5 -
ohne großen Aufwand zu entfernen. Sie ist in allen Fällen einsetzbar, in denen derzeit die konventionelle Form der Prothese benutzt wird, und im besonderen, wenn eine phy¬ siologische Abnormität die Einpassung einer konventionel¬ len Prothese erschwert oder unmöglich macht, weil diese nur in bestimmten Abmessungen konfektioniert auf dem Markt angeboten wird. Durch die hohe Anpassungsfähigkeit ist das Anwendungsspektrum bedeutend weiter als das der her¬ kömmlichen Prothesenform.easy to remove. It can be used in all cases in which the conventional form of the prosthesis is currently used, and in particular when a physiological abnormality makes it difficult or impossible to fit a conventional prosthesis because it is only available in certain dimensions on the market is offered. Due to the high adaptability, the range of applications is significantly wider than that of the conventional prosthesis shape.
Anhand der Zeichnungen wird ein bevorzugtes Ausführungs¬ beispiel der Erfindung beschrieben, bei welchem das Pre- preg-Teil und die Anpreßmittel durch voneinander getrennte Teile gebildet sind, während die Einführhilfe und das Ein- führungsteil für das Aushärtemi-ttel durch ein geraeinsames, beide Funktionen erfüllendes Teil gebildet sind, das hohl ist und durchlässig, sowohl für ein Strömungsmittel zum Aufblähen der Anpreßmittel als auch für Strahlung von ei¬ nem zum Aushärten des Prepreg-Teiles vorgesehenen Strah- 1er, der in dem hohlen Teil, das zugleich Einführhilfe und Einführungsteil ist, geführt ist. Es ist ersichtlich, daß die Art der Zuordnung verschiedener Funktionen zu unter¬ schiedlichen bzw. gemeinsamen Teilen, wie es im folgenden beschrieben und dargestellt ist, nur eine der möglichen Ausführungsformen wiedergibt. Es zeigen:A preferred exemplary embodiment of the invention is described with the aid of the drawings, in which the prepreg part and the pressing means are formed by separate parts, while the insertion aid and the insertion part for the curing agent are formed by a separate, both functions fulfilling part are formed, which is hollow and permeable, both for a fluid for inflating the pressing means and for radiation from a radiator provided for curing the prepreg part, which is in the hollow part, which is at the same time an insertion aid and an insertion part , is led. It can be seen that the type of assignment of different functions to different or common parts, as described and illustrated in the following, represents only one of the possible embodiments. Show it:
Figur 1 im Längsschnitt dargestellt eine Gelenkprothese als Ausführungsbeispiel der Erfindung,1 shows in longitudinal section a joint prosthesis as an embodiment of the invention,
Figur 2 die Hauptbestandteile derselben Gelenkprothese, die in eine Kortikalis eingesetzt, dort aber noch nicht befestigt ist, Figur 3 die Anordnung nach Figur 2, jedoch während des Aushärtens, undFIG. 2 shows the main components of the same joint prosthesis, which is inserted into a cortex but is not yet attached there, Figure 3 shows the arrangement of Figure 2, but during curing, and
Figur 4 die fertig eingesetzte und vervollständigte Ge- lenkprothese.Figure 4 shows the fully inserted and completed joint prosthesis.
In den untereinander mit identischen Bezugszeichen ver¬ sehenen Figuren ist übereinstimmend die folgende Anordnung vorhanden: -The following arrangement coincidentally exists in the figures provided with identical reference numerals:
Ein zweiteiliges Anpaßteil 1, welches eine Klemmverbindung mit einem Prepreg-Teil 2 bildet, ist mit einem Halteteil la versehen, auf dessen Gewindehals lb ein Überwurfteil lc aufgeschraubt ist. Das Prepreg-Teil 2 ist mit seinem oberen Bereich zwischen den Teilen la und lc eingespannt. Eine durch den Gewindehals des Anpaßteils 1 hindurchge¬ führte, in das Prepreg-Teil hineinragende, Einführhilfe 3 stellt zugleich das sogenannte Einführungsteil dar, auf das verschiedentlich getrennt Bezug genommen wird. Anpreß- mittel 4 sind im Innerern des Prepreg-Teils in Gestalt eines Folienbeutels und eines am unteren Ende des Einfüh¬ rungsteiles 3 zusammen mit diesem verschlossenen, aufbläh¬ baren Schlauches vorgesehen. Ein in das Einführungsteil hineinführbarer UV-Licht- oder Ultraschall-Strahler- 5 ist mit Transportmitteln 6 versehen. Weiterhin sind ein Rohr 7, Dichtungen 8 und 9 und eine Montagehilfe 10 mit einem Stutzen 10a vorgesehen. Die Montagehilfe 10 besteht aus einem aufschraubbaren Adapter, welcher die notwendigen Anschlüsse zum Durchlaß von Strömungs- und Aushärtemitteln aufweist. Durch die Montagehilfe ist wegen der vergrößer¬ ten zugänglichen Oberfläche die Handhabung der Prothese bei der Implantation erleichert. Das Prepreg-Teil 2 besteht aus Längsstreifen und/oder gegenläufigen spiraligen Streifen, die auf geeignete Weise verwoben sind, die zwischen dem Halteteil la und dem auf¬ geschraubten überwurfteil lc eingeklemmt sind und auf diese Weise den Eindruck einer gefiederten Glocke er¬ wecken, die jedoch - falls die Aushärtung nicht auch hier erst in der Operationsphase erfolgt - in einem oberen Bereich, wo sie am Anpaßteil 1 befestigt ist, ausgehärtet ist, während sie in einem unteren Bereich 2b noch verform- bar und unausgehärtet vorliegt.A two-part adapter 1, which forms a clamping connection with a prepreg part 2, is provided with a holding part la, on the threaded neck 1b of which a screw-over part 1c is screwed on. The prepreg part 2 is clamped with its upper region between the parts la and lc. An insertion aid 3, which extends through the threaded neck of the adapter part 1 and projects into the prepreg part, also represents the so-called insertion part, to which reference is made in various ways. Pressure means 4 are provided in the interior of the prepreg part in the form of a foil bag and at the lower end of the insertion part 3 together with this inflatable tube which is closed. A UV light or ultrasound emitter 5 that can be inserted into the insertion part is provided with transport means 6. Furthermore, a tube 7, seals 8 and 9 and an assembly aid 10 with a nozzle 10a are provided. The mounting aid 10 consists of a screw-on adapter, which has the necessary connections for the passage of flow and curing agents. The assembly aid makes handling of the prosthesis easier during implantation because of the increased accessible surface. The prepreg part 2 consists of longitudinal strips and / or counter-rotating spiral strips which are interwoven in a suitable manner, which are clamped between the holding part 1 a and the screwed-on throwing part 1 c and in this way give the impression of a feathered bell which however - if the hardening does not take place here also in the operation phase - in an upper region where it is attached to the adapter 1, it is hardened, while in a lower region 2b it is still deformable and uncured.
In dem Gewindehals lb steckt ein Rohr 7, in welches wie¬ derum die Einführhilfe 3 so eingesteckt ist, daß das weit¬ gehend für Strömungsmittel undurchlässige, insbesondere luftdichte und aufblähbare Anpreßmittel 4 an dessen Oberen, dem Anpaßteil 1 zugewandten Ende eingeklemmt ist. Zur Aufblähung dieses Anpreßmittels 4, z.B. Folien- oder Gummisackes, kann durch den Stutzen 10a Luft durch die Montagehilfe 10,. das Rohr 7, die Einführhilfe 3 und darin vorgesehene Löcher 3a in die Anpreßmittel 4 geleitet wer¬ den. Um das Entweichen dieser Luft an unerwünschten Stel¬ len zu verhindern, sind die Dichtungen 8 und 9 vorgesehen. Zum Gewährleisten des Entweichens der Luft aus dem Hohl¬ raum 11 ist eine nicht näher dargestellte Entlüftung in dem Anpaßteil 1 vorgesehen, durch welche auch Luft (zu¬ sätzlich oder anstelle der Druckluftanwendung über dein Stutzen 10a) abgesaugt werden kann. Die in die Anpreßmit¬ tel 4 gedrückte und/oder aus dem Hohlraum 11 yesaugte Luft ist das im vorliegenden Ausführungsbeispiel anzuwendende Stromungsraittel, durch welches die Anpreßmittel 4 aufbläh¬ bar sind, um die Streifen des Prepreg-Teiles 2 im Bereich 2b gegen die Knocheninnenwand zu pressen. Um diesen ange¬ paßten Zustand zu konservieren, ist ein Aushärtemittel vorgesehen, nämlich der Strahler 5.In the threaded neck 1b there is a tube 7, into which the insertion aid 3 is inserted in such a way that the pressing means 4, which is largely impermeable to fluids, in particular airtight and inflatable, is clamped at its upper end facing the adapter 1. To inflate this pressing means 4, for example a film or rubber bag, air can be passed through the fitting 10 a through the mounting aid 10. the pipe 7, the insertion aid 3 and holes 3a provided therein are passed into the pressing means 4. In order to prevent this air from escaping at undesired locations, the seals 8 and 9 are provided. To ensure that the air escapes from the cavity 11, a vent (not shown in more detail) is provided in the adapter 1, through which air can also be drawn off (in addition or instead of using compressed air through the nozzle 10a). The air pressed into the pressing means 4 and / or sucked out of the cavity 11 is the flow means to be used in the present exemplary embodiment, through which the pressing means 4 can be inflated around the strips of the prepreg part 2 in the area 2b to press against the inner wall of the bone. In order to preserve this adapted state, a curing agent is provided, namely the radiator 5.
Zum Einführen ist das Einführungsteil 3 in Gestalt eines Rohres aus Polyäthylen oder ähnlichem vorgesehen, das zugleich als Einführhilfe für die noch flexiblen Teile 2 (im Bereich 2b) und 4 dient.For insertion, the insertion part 3 is provided in the form of a tube made of polyethylene or the like, which also serves as an insertion aid for the still flexible parts 2 (in the area 2b) and 4.
Als Transportmittel 6 für den Strahler 5 dient ein läng¬ liches, federnd nachgiebiges Element, mittels dessen dem Strahler Energie zugeführt wird, entweder in Gestalt elek¬ trischer Energie oder von ultraviolettem Licht, wenn das Transportmittel 6 zugleich als Lichtleiter ausgebildet ist. Der Transport des Strahlers 5 erfolgt mit definierter Ausziehgeschwindigkeit durch nicht dargestellte Antriebs¬ mittel, die an der Montagehilfe 10 befestigt sein können. Die Prepreg-Streifen im Bereich 2b können so ausgebildet sein, daß dazwischen Leerräume verbleiben, wenn sie an eine Knocheninnenwand angedrückt sind. In diese Zwischen¬ räume kann dann später Knochengewebe einwachsen. Als Kunststoffmaterial der Prepregs kann z.B. ein Material verwendet werden, welches unter der Bezeichnung "UVIOBOND" in der zahnärztlichen Praxis Verwendung findet.An elongated, resilient element, by means of which energy is supplied to the radiator, is used as the transport means 6 for the radiator 5, either in the form of electrical energy or of ultraviolet light, if the transport means 6 is also designed as a light guide. The emitter 5 is transported at a defined pull-out speed by drive means, not shown, which can be fastened to the assembly aid 10. The prepreg strips in area 2b can be designed such that empty spaces remain between them when they are pressed against an inner wall of the bone. Bone tissue can then later grow into these interspaces. The plastic material of the prepregs can e.g. a material can be used which is used in dental practice under the name "UVIOBOND".
In Figur 2 ist gezeigt, wie die Gelenkprothese nach Figur 1 nach weitgehendem Ausräumen des • Spongiosa 12 aus einem Markhohlraum 13 einer Kortikalis 14 eingesetzt ist.In Figure 2 is shown how the joint prosthesis according to Figure 1 after substantial clearing of • cancellous bone 12 is inserted from a marrow cavity 13 of a cortical fourteenth
Figur 3 zeigt eine spätere Phase mit angepreßten Prepreg- Streifen nach dem Eindrücken von Luft in den Stutzen 10aFIG. 3 shows a later phase with pressed prepreg strips after air has been pressed into the connector 10a
H - 9 -H - 9 -
unter leichtem Überdruck von ungefähr 0,8 bar. Der UV- Licht- oder Ultraschall-Strahler 5 hat den Markhohlraum 13 schon zur Hälfte durchlaufen und durch seine die Teile 3 und 4 durchdringende Strahlung die Aushärtung eines Teils der Prepreg-Streifen 2 bewirkt. Dabei entsteht keine Wärme im Gegensatz zur Verwendung von Knochenzement. Die Aushär¬ tung dauert ungefähr 6 bis 8 Minuten bei Verwendung von ultraviolettem Licht zur Aushärtung.under a slight excess pressure of approximately 0.8 bar. The UV light or ultrasound emitter 5 has already passed halfway through the medullary cavity 13 and has caused part of the prepreg strips 2 to be cured by its radiation penetrating the parts 3 and 4. In contrast to the use of bone cement, there is no heat. The curing takes approximately 6 to 8 minutes when using ultraviolet light for curing.
Nach Beendigung der in Figur 3 gezeigten Phase werden die nicht mehr benötigten Hilfsmittel, also die Teile 3 bis 10 entfernt, wofür bezüglich der Teile 3 bis 7 ein Kanal (15 in Figur 4) im Anpaßteil i vorgesehen ist. Er ist von dem Gewindehals lb (Figur 1) umgeben, auf welchen die Montage- hilfe 10 aufschraubbar ist für die Bewerkstelligung uer Vorgänge des Anpressens des Prepreg-Teiles 2 und der Aus¬ härtung. Nach dem Aushärten wird die aMontagehilfe 10 abge¬ schraubt und nach dem Entfernen der restlichen Hilfsmittel stattdessen ein Gelenkkopf, z.B. eine Aluminiumoxid- Keramikkugel aufgeschraubt, wie es in Figur 4 zur Darstel¬ lung des Endzustandes gezeigt ist. Der Gewindehals lb weist zu diesem Zweck ein selbsthemmendes, konisches Ge¬ winde auf.After the phase shown in FIG. 3 has ended, the aids that are no longer required, that is to say parts 3 to 10, are removed, for which purpose a channel (15 in FIG. 4) is provided in adapter part i with respect to parts 3 to 7. It is surrounded by the threaded neck 1b (FIG. 1), onto which the assembly aid 10 can be screwed in order to accomplish the processes of pressing the prepreg part 2 and curing it. After curing, the assembly aid 10 is unscrewed and, after removing the remaining aids, an articulated head, e.g. an aluminum oxide ceramic ball is screwed on, as shown in FIG. 4 to show the final state. For this purpose, the threaded neck 1b has a self-locking, conical thread.
Der weitere Verlauf der Operation, einschließlich des Ein¬ setzens der Hüftpfanne, geschieht in der herkömmlichen Art und Weise.The further course of the operation, including the insertion of the acetabulum, takes place in the conventional manner.
Während bei den bekannten Hüftgelenkprothesen die Kraft- einleitung in den Knochen unter Ausbildung von Querkräften geschieht, denen der Knochen in der Regel nicht gewachsen ist, erfolgt die Krafteinleitung bei der Gelenkprothese nach der Erfindung in der physiologisch richtigen Richtung, wobei die Prothese einerseits ein großes Träg¬ heitsmoment aufweist und andererseits die Einleitungs- kräfte pro Flächeneinheit wegen der großen beteiligten Flächen gering sind. Querbelastungen des Knochens und eine mehr oder weniger punktförmige Kraftüσertragung wie bei herkömmlichen Prothesen werden vermieden, zumal die Struk¬ tur selbst elastisch ist und damit den elastischen Verfor- mungen des Knochens folgen kann.While in the known hip joint prostheses, the force is introduced into the bones with the formation of transverse forces, which the bones generally cannot cope with the force is introduced in the joint prosthesis according to the invention in the physiologically correct direction, the prosthesis on the one hand having a large moment of inertia and on the other hand the introduction forces per unit area are low because of the large areas involved. Cross loads on the bone and a more or less punctiform transfer of force as in conventional prostheses are avoided, especially since the structure itself is elastic and can therefore follow the elastic deformations of the bone.
Eine Reparatur der erfindungsgemäßen Prothese ist im Ge¬ gensatz zu den bekannten Prothesen durch Ersatz einzelner Teile möglich. Darüber hinaus kann später eine neue Prothese wegen des zur Verfügung stehenden Hohlraumes ohne weiteres eingebracht werden, wobei diese herkömmlicher Art sein oder auch der erfindungsgemäßen Ausführungsform ent- - sprechen kann. .In contrast to the known prostheses, the prosthesis according to the invention can be repaired by replacing individual parts. In addition, a new prosthesis can later be inserted easily due to the available cavity, which can be of a conventional type or can also correspond to the embodiment according to the invention. .
* * * * ** * * * *
OMPI OMPI

Claims

P a t e n t a n s p r ü c h e Patent claims
1. Gelenkprothese,1. joint prosthesis,
g e k e n n z e i c h n e t d u r c h folgende Bestand¬ teile:The following components are used:
a) wenigstens ein Anpaßteil (1),a) at least one adapter (1),
b) wenigstens ein mit dem Anpaßteil (1) verbundenes und in denjenigen Bereichen (2b) aushärtbares Prepreg-Teil (2), die dem Knochenhohlraum (13) anzupassen sind, in den die Gelenkprothese einzusetzen ist.b) at least one prepreg part (2) which is connected to the adapter part (1) and can be hardened in those areas (2b) which are to be adapted to the bone cavity (13) into which the joint prosthesis is to be inserted.
c) für ein Strömungsmittel weitgehend undurchlässige und durch dieses aufblähbare Anpreßmittel (4) zum Anpressen der noch unausgehärteten Bereiche (2b) des Prepreg-Teiles (2) mittels des . zuführ- und/oder absaugbaren Strömungs- mittels.c) for a fluid largely impermeable and by this inflatable pressure means (4) for pressing the still uncured areas (2b) of the prepreg part (2) by means of. fluid that can be supplied and / or extracted.
2. Gelenkprothese nach Anspruch 1, d a d u r c h g e ¬ k e n n z e i c h n e t , daß wenigstens eine Einführ- hilfe (3), welche in die weitgehend für Strömungsmittel undurchlässigen Anpreßmittel (4) einführbar oder in diese eingeführt und steifer ausgestaltet ist als die Anpre߬ mittel (4).2. Articulated prosthesis according to claim 1, so that at least one insertion aid (3), which can be inserted into or inserted into the largely fluid-impermeable pressing means (4) and made stiffer than the pressing means (4).
3. Gelenkprothese nach einem der vorangehenden An¬ sprüche, d a d u r c h g e k e n n z e i c h n e t , daß das Prepreg-Teil (2) mindestens in demjenigen Bereich3. Joint prosthesis according to one of the preceding claims, characterized in that the prepreg part (2) at least in that area
(2a), in dem es vom Anpaßteil (1) gehalten ist, schlauch- oder ring-, insbesondere glockenförmig ist und/oder bereits vorausgehärtet ist.(2a), in which it is held by the adapter (1), is tubular or ring-shaped, in particular bell-shaped, and / or has already been pre-hardened.
4. Gelenk-prothese nach einem der vorangehenden An¬ sprüche, d a d u r c h g e k e n n z e i c h n e t , daß das Prepreg-Teil (2) mindestens am noch unausgehärteten Ende streifenförmige und/oder in Form von wechselnd ge¬ genläufigen Spiralen, die miteinander verwoben sind, aus¬ gebildete Bereiche (2b) aufweist.4. Joint prosthesis according to one of the preceding claims, characterized in that the prepreg part (2) at least at the still unhardened end is strip-shaped and / or in the form of alternating opposed spirals which are interwoven with one another, formed areas (2b).
5. Gelenkprothese nach einem der voran enenden An¬ sprüche, d a d u r c h g e k e n n z e i c h n e t , daß ein Einführungsteil (3) für Aushärtemittel (5) für die un¬ ausgehärteten. Bereiche (2b) des Prepreg-Teiles (2) vorge¬ sehen ist.5. Articulated prosthesis according to one of the preceding claims, namely that an insertion part (3) for curing agent (5) for the uncured. Areas (2b) of the prepreg part (2) are provided.
6. Gelenkprothese nach Anspruch 5, d a d u r c h g e ¬ k e n n z e i c h n e t , daß das Einführungsteil zu¬ gleich als Einführhilfe (3) und/oder Einleitungste'il für das zuzuführende Strömungsmittel ausgebildet ist.6. Joint prosthesis according to claim 5, dadurchge ¬ indicates that the insertion part is at the same time as an insertion aid (3) and / or initiation part ' il is formed for the fluid to be supplied.
7. Gelenkprothese nach einem der vorangehenden An¬ sprüche, d a d u r c h g e k e n n z e i c h n e t , daß das Aushärtemittel (5) als UV-Licht- und/oder Ultraschall- Strahler ausgebildet ist und zwischen Strahler und Pre- preg-Teil (2) befindliche Teile (3, 4) für die Strahlung durchlässig sind.7. Joint prosthesis according to one of the preceding claims, characterized in that the curing agent (5) is designed as a UV light and / or ultrasound lamp and between the lamp and pre- preg part (2) located parts (3, 4) are transparent to the radiation.
8. Gelenkprothese nach einem der Ansprüche 6 oder 7, d a d u r c h g e k e n n z e i c h n e t , daß das Ein¬ führungsteil als Führungselement für den Strahler (5) aus¬ gebildet ist.8. Joint prosthesis according to one of claims 6 or 7, d a d u r c h g e k e n n z e i c h n e t that the insertion part is designed as a guide element for the radiator (5).
00
9. Gelenkprothese nach einem der vorangehenden Ansprü¬ che, d a d u r c h g e k e n n z e i c h n e t , daß das Einführungsteil (3) derart hohl geformt ist, daß das Aüshärtemittel (5) hindurchführbar ist. 59. Joint prosthesis according to one of the preceding claims, that a d u r c h g e k e n e z e i c h n e t that the insertion part (3) is shaped so hollow that the hardening agent (5) can be passed through. 5
10. Gelenkprothese nach einem der vorangehenden Ansprüche, d a d u r c h g e k e n n z e i c h n e t , daß die für Strömungsmittel weitgehend undurchlässigen 0 Anpreßmittel (4) im aufgeblähten, aber nicht merklich ge¬ dehnten Zustand erweitert ausgebildet sind im Vergleich zu dem bestimmungsgemäß zur Aufnahme von Gelenkprothesen¬ teilen vorgesehenen Knochenhohlraum (13) und/oder weniger weit ausgebildet sind als der bestimmungsgemäß zur Auf- 5 nähme von Gelenkprothesenteilen vorgesehene Knochenhohl¬ raum (13) und/oder beuteiförmig ausgebildet sind.10. Joint prosthesis according to one of the preceding claims, characterized in that the largely impermeable to fluid pressure means (4) are expanded in the inflated but not noticeably expanded state compared to the intended bone cavity for receiving joint prosthesis parts (13 ) and / or are formed less widely than the bone cavity (13) intended and intended for receiving prosthetic joint parts and / or are bag-shaped.
11. Gelenkprothese nach einem der vorangehenden Ansprü- u ehe, d a d u r c h g e k e n n z e i c h n e t , daß die weitgehend Strömungsmittel undurchlässigen Anpreßmittel (4) aus Folie bestehen. 11. A prosthetic joint according to one of the preceding claims and marriage, characterized in that the largely fluid-impermeable pressing means (4) consist of film.
12. Gelenkprothese nach einem der vorangehenden Ansprü¬ che, d a d u r c h g e k e n n z e i c h n e t , daß das Prepreg-Teil (2) zugleich als weitgehend für Strö¬ mungsmittel undurchlässiges Anpreßmittel (4) ausgebildet ist.12. Articulated prosthesis according to one of the preceding claims, that the prepreg part (2) is at the same time designed as a pressing means (4) largely impermeable to flow means.
13. Gelenkprothese nach einem der vorangehenden Ansprü¬ che, d a d u r c h g e k e n n z e i c h n e t , daß das Anpaßteil (1) einen Kanal (15) für die Einführhilfe (3) ringförmig umgibt und/oder ein Tragelement für Endo- prothesenteile (Gelenkkopf 16) bildet.13. Joint prosthesis according to one of the preceding claims, that the adapter part (1) surrounds a channel (15) for the insertion aid (3) in an annular manner and / or forms a support element for endoprosthesis parts (joint head 16).
14. Gelenkprothese nach Anspruch 13» d a d u r c h g e ¬ k e n n z e i c h n e t , daß durch den Kanal (.15) hin¬ durch mindestens eines der folgenden Bauteile entfernbar ist: die Einführhilfe (3), das Einführungsteil (3), die Aushärtemittel (5), die Transportmittel (6), die Anpreß- mittel (4).14. Joint prosthesis according to claim 13 »dadurchge ¬ indicates that through the channel ( . 15) hin¬ by at least one of the following components can be removed: the insertion aid (3), the insertion part (3), the curing agent (5), the means of transport (6), the pressure means (4).
15. Gelenkprothese nach einem der Ansprüche 13 oder 14, d a d u r c h g e k e n n z e i c h n e t , daß .der Ka- nal (15) innerhalb eines Stutzens (Gewindehals lb) des Anpaßteiles (1) angeordnet ist, der lösbar mit einer Mon¬ tagehilfe (10) verbindbar ist.15. A prosthetic joint according to one of claims 13 or 14, so that the channel (15) is arranged within a connecting piece (threaded neck lb) of the adapter (1) which can be detachably connected to a mounting aid (10).
* * * * * * * * * *
PCT/DE1982/000078 1981-04-01 1982-04-01 Joint prothesis WO1982003323A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
AT82900937T ATE15324T1 (en) 1981-04-01 1982-04-01 JOINT PROSTHESIS.
DE8282900937T DE3265973D1 (en) 1981-04-01 1982-04-01 Joint prosthesis

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
DE3113531 1981-04-01
DE3113531 1981-04-01
DE3142730811023 1981-10-23
DE19813142730 DE3142730A1 (en) 1981-04-01 1981-10-23 "JOINT PROSTHESIS"

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Publication Number Publication Date
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Application Number Title Priority Date Filing Date
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EP (2) EP0074981B1 (en)
DE (2) DE3142730A1 (en)
WO (1) WO1982003323A1 (en)

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EP0074981A1 (en) 1983-03-30
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DE3142730A1 (en) 1982-10-21
EP0074981B1 (en) 1985-09-04
EP0061993A1 (en) 1982-10-06

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