WO1998020818A1 - Complete prosthesis for the knee - Google Patents

Complete prosthesis for the knee Download PDF

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Publication number
WO1998020818A1
WO1998020818A1 PCT/FR1997/001999 FR9701999W WO9820818A1 WO 1998020818 A1 WO1998020818 A1 WO 1998020818A1 FR 9701999 W FR9701999 W FR 9701999W WO 9820818 A1 WO9820818 A1 WO 9820818A1
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WO
WIPO (PCT)
Prior art keywords
insert
femoral
tibial base
intended
knee prosthesis
Prior art date
Application number
PCT/FR1997/001999
Other languages
French (fr)
Inventor
Frank Banon
Hervé Olivier
Philippe Petchot
Roger Thomas
Jean-Charles Toesca
Thierry Bouchet
Guillaume Dufour
Arnaud Largier
Jérôme LePage
Eric Duvillier
Jean-Marie Gineston
Olivier De Roaldes
Original Assignee
Osbone Societe Civile
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 Osbone Societe Civile filed Critical Osbone Societe Civile
Publication of WO1998020818A1 publication Critical patent/WO1998020818A1/en

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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
    • A61F2/38—Joints for elbows or knees
    • A61F2/3886—Joints for elbows or knees for stabilising knees against anterior or lateral dislocations

Definitions

  • the present invention relates to total knee prostheses, comprising, in known manner, a femoral part partially in the form of a trochlee and a tibial base, an insert being disposed between these two parts.
  • the tibial base is intended to replace the damaged upper part of the tibia, and to receive the insert on which is likely to pivot the femoral part, itself fixed on the damaged lower part of the femur.
  • Such prostheses are already known, for example documents FR-A-2 615 386, FR-A-2 668 703 or FR-A-2 672 798. They have various drawbacks. For example, they induce high stresses in the femoral part and / or in the insert during their respective pivoting, which leads to frequent replacement of the prosthesis. In addition, they do not allow the interchangeability of the different components to adapt to particular configurations or morphologies. It is then necessary to have a large number of components in order to be able to meet all the needs, or to produce these components to measure, which, in any case, leads to prohibitive costs.
  • the present invention is placed in this context and aims to provide a total knee prosthesis in which the stresses generated by the pivoting of the femoral part on 1 insert are distributed over the largest possible area to reduce the intensity.
  • the present invention provides a knee prosthesis, comprising a tibial base comprising a plate and intended to be fixed to the upper end of the tibia by means of a substantially cylindrical anchoring keel, a femoral part partially in the form of a trochlee comprising an anterior veil and two posterior veils joined by a connecting veil, the external face of the femoral part comprising two asymmetrical lateral condyles, a notch being formed in the femoral part, the femoral part being intended to be fixed to the lower end of the femur, and an insert intended to be fixed on the tibial base and comprising two impressions intended to cooperate with the two condyles of the femoral part.
  • the anchoring keel is formed with two plane wings extending substantially in a direction tangent to the cylinder forming the anchoring keel, and the imprints of the insert and the condyles of the femoral component. constitute congruent surfaces.
  • the posterior veils of the femoral component are joined at their free end by a bar that is substantially straight
  • the insert comprises a central stud, having in section the shape of 'a D, the rounded part of which has substantially the same radius of curvature as the rounded bottom of the notch of the femoral part, and the flat part of which has substantially the same length as that of the free part of the bar of the part femoral.
  • the flat part of the central stud of the insert makes an acute angle with the perpendicular to the plane of the plate of the tibial base.
  • the flat part of the central stud of the insert makes an angle equal to about six degrees with the perpendicular to the plane of the plate of the tibial base.
  • the tibial base has grooves intended to cooperate with notches formed on the insert to ensure the attachment of the insert to the tibial base, for example by clipping.
  • FIG. 1 is an exploded perspective view of the three elements making up the knee prosthesis produced according to the present invention
  • FIG. 2 represents a perspective view of the tibial base of the prosthesis of FIG. 1, and
  • FIG. 3 shows a bottom view of the tibial base of Figure 2.
  • the total knee prosthesis essentially comprises a tibial base A, intended to be fixed on the upper end of a previously prepared tibia, a femoral part B, intended to be fixed on the lower end of the femur, also previously prepared, and an insert C, intended to be placed between the two parts A and B.
  • the tibial base A essentially comprises a flat plate constituting a plate 10, and in the posterior edge of which is formed a notch 12 allowing the passage of the posterior cruciate ligament, if any. Holes 14 are formed in this plate to allow the fixation of the tibial base on the tibia by means of screws (not shown).
  • the underside of the plate 10 comprises a substantially cylindrical stud 16, intended to become embedded in the medullary canal of the tibia.
  • Two substantially planar wings 18 extend symmetrically on either side of this stud 16, to ensure the anchoring of the plate 10 in the tibia.
  • These wings 18 are in the form of right triangles, and extend substantially in a direction tangent to the cylinder forming the stud 16.
  • Such an arrangement has the advantage that the anchoring of the wings 18 takes place in a denser part, therefore more resistant, tibia, unlike the radial wings known so far.
  • the upper face of the plate 10 is formed with a rim
  • the flange 20 has grooves 22, three in the example shown, to allow the fixing of the insert C on the plate 10. These grooves can, for example, be obtained using ribs 24 formed on the part of the rim 20 furthest from the plate 10.
  • the femoral part B has, in cross section, the general shape of a U with cut internal sides, as is known in the art, and comprises an anterior veil 30 and two posterior veils 32 joined by a connecting veil 34.
  • the two rear webs 32 are separated by a notch 36, substantially in the shape of an isosceles triangle, the rounded top of which is located in the vicinity of the connection between the front web 30 and the connecting web 34, and the base of which is located in the vicinity of the free end of the rear sails, so as to provide a bar 38 joining the free ends of the rear sails 32.
  • the internal faces of the anterior, connecting and posterior veils form, in known manner, five planes intended to cooperate with complementary flats produced on the epiphysis of the femur.
  • the internal face of the connecting veil 34 further comprises two studs 40 intended to cooperate with complementary orifices hollowed out in the femur, to ensure the fixing, the centering and the lateral locking of the femoral part B on the femur.
  • the external faces of the anterior, connecting and posterior webs comprise, in a manner known per se, two asymmetrical lateral condyles 40 and 42.
  • the condyles 40 and 42 are intended to cooperate with two impressions 44 and 46 respectively formed on V insert C.
  • the insert C comprises a base 48, of a shape complementary to that of the receptacle consisting of the plate 10 and the rim 20, notches 50 being provided in the base 48 to cooperate with the ribs 24 and fix the insert C on the plate 10 , for example by clipping.
  • the same tibial base can receive different inserts, all having the same base 48, but different imprints.
  • the condyles 40 and 42 and the impressions 44 and 46 form congruent surfaces, so that the contact between these surfaces occurs on a line segment, and no longer on a point as in the prior art . As a result, the stresses generated by the pivoting of the femoral part on the insert are better distributed, their intensity therefore being reduced.
  • the insert C comprises, between the cavities 44 and 46, a central stud 52, substantially perpendicular to the base 48, and intended to cooperate with the notch 26 of the femoral piece B.
  • the stud 52 has, in section, substantially the shape of a D, the rounded part of which has substantially the same radius of curvature as the rounded bottom of the notch 26, and the flat part of which has substantially the same length as that of the part free of the bar 38 between the two rear wings 40 and 42.
  • the femoral part B has been shown turned 180 degrees, around the main axis of the stud 52, relative to the position it normally occupies when the prosthesis is in place and operational.
  • the stud 52 ensures the relative positioning between the femoral part B and the insert C, itself integral with the tibial base A, while allowing a certain degree of rotation during flexion, and thus ensuring a more natural functioning and a peripheral ligament play closer to that of a healthy knee.
  • the relative rotation of the femoral part B on the insert C is effected by sliding of the condyles 40 and 42 in the impressions 44 and 46 respectively, and by free sliding of the stud 52 in 1 ' indentation 36.
  • the internal face of the bar 38 comes into contact with the flat part of the stud 52.
  • the latter then acts as a cam between the femoral part B and the base tibial A, integral with the insert C, and causes a postponement of the center of rotation of the knee so as to improve the flexion, while the contact between the stud 52 and the bar 38 prevents any anterior dislocation of the knee.
  • the bar 38 is caused to move on the flat part of the stud 52, so as to allow this bending while retaining a stop retaining the carry back of the center of rotation.
  • the Applicant has found that the best result is obtained when the planar face of the pad 52 makes an acute angle, equal to approximately 6 degrees, with the perpendicular to the plane of the plate 10.

Abstract

The invention concerns a prosthesis for the knee, comprising a tibial base (A) including a plate (10) and designed to be fixed at the top end of the tibia by means of an anchoring pin (16), a femoral piece (B) comprising a front web (30) and two rear webs (32) joined by a linking web (34), the external face of the femoral piece comprising two asymmetric side condyles (40, 42), a notch being formed in the femoral piece (B), the femoral piece being designed to be fixed at the lower end of the thigh bone, and an insert (C) designed to be fixed on the tibial base (A) and two impressions (44, 46) designed to co-operate with the two condyles (40, 42) of the femoral piece.

Description

PROTHESE TOTALE DU GENOU TOTAL KNEE PROSTHESIS
La présente invention concerne les prothèses totales du genou, comprenant, de manière connue, une pièce fémorale partiellement en forme de trochlee et une embase tibiale, un insert étant disposé entre ces deux pièces. L'embase tibiale est destinée à remplacer la partie supérieure endommagée du tibia, et à recevoir l' insert sur lequel est susceptible de pivoter la pièce fémorale, elle-même fixée sur la partie inférieure endommagée du fémur.The present invention relates to total knee prostheses, comprising, in known manner, a femoral part partially in the form of a trochlee and a tibial base, an insert being disposed between these two parts. The tibial base is intended to replace the damaged upper part of the tibia, and to receive the insert on which is likely to pivot the femoral part, itself fixed on the damaged lower part of the femur.
De telles prothèses sont déjà connues, par exemple des documents FR-A-2 615 386, FR-A-2 668 703 ou FR-A-2 672 798. Elles présentent divers inconvénients. Par exemple, elles induisent des contraintes élevées dans la pièce fémorale et/ou dans l' insert lors de leur pivotement respectif, ce qui entraîne le remplacement fréquent de la prothèse. En outre, elles ne permettent pas l'interchangeabilité des différents composants pour s'adapter à des configurations ou des morphologies particulières. Il faut alors disposer d'un grand nombre de composants pour pouvoir répondre à tous les besoins, ou réaliser ces composants sur mesure, ce qui, dans tous les cas, amène à des coûts prohibitifs.Such prostheses are already known, for example documents FR-A-2 615 386, FR-A-2 668 703 or FR-A-2 672 798. They have various drawbacks. For example, they induce high stresses in the femoral part and / or in the insert during their respective pivoting, which leads to frequent replacement of the prosthesis. In addition, they do not allow the interchangeability of the different components to adapt to particular configurations or morphologies. It is then necessary to have a large number of components in order to be able to meet all the needs, or to produce these components to measure, which, in any case, leads to prohibitive costs.
La présente invention se place dans ce contexte et a pour objet de proposer une prothèse totale du genou dans laquelle les contraintes engendrées par le pivotement de la pièce fémorale sur 1' insert soient réparties sur la plus grande surface possible pour en diminuer l'intensité.The present invention is placed in this context and aims to provide a total knee prosthesis in which the stresses generated by the pivoting of the femoral part on 1 insert are distributed over the largest possible area to reduce the intensity.
Dans ce but, la présente invention propose une prothèse du genou, comprenant une embase tibiale comportant un plateau et destinée à être fixée à l'extrémité supérieure du tibia par l'intermédiaire d'une quille d'ancrage sensiblement cylindrique, une pièce fémorale partiellement en forme de trochlee comportant un voile antérieur et deux voiles postérieurs réunis par un voile de liaison, la face externe de la pièce fémorale comportant deux condyles latéraux asymétriques, une échancrure étant formée dans la pièce fémorale, la pièce fémorale étant destinée à être fixée à l'extrémité inférieure du fémur, et un insert destiné à être fixé sur l'embase tibiale et comportant deux empreintes destinés à coopérer avec les deux condyles de la pièce fémorale.For this purpose, the present invention provides a knee prosthesis, comprising a tibial base comprising a plate and intended to be fixed to the upper end of the tibia by means of a substantially cylindrical anchoring keel, a femoral part partially in the form of a trochlee comprising an anterior veil and two posterior veils joined by a connecting veil, the external face of the femoral part comprising two asymmetrical lateral condyles, a notch being formed in the femoral part, the femoral part being intended to be fixed to the lower end of the femur, and an insert intended to be fixed on the tibial base and comprising two impressions intended to cooperate with the two condyles of the femoral part.
Selon l'invention, en combinaison, la quille d'ancrage est formée avec deux ailes planes s'étendant sensiblement suivant une direction tangente au cylindre formant la quille d'ancrage, et les empreintes de l' insert et les condyles de la pièce fémorale constituent des surfaces congruentes.According to the invention, in combination, the anchoring keel is formed with two plane wings extending substantially in a direction tangent to the cylinder forming the anchoring keel, and the imprints of the insert and the condyles of the femoral component. constitute congruent surfaces.
De préférence, lorsque le ligament croisé postérieur du patient n'existe plus, les voiles postérieurs de la pièce fémorale sont réunis à leur extrémité libre par une barrette sensiblement recti ligne, et l' insert comporte un plot central, présentant en section la forme d'un D, dont la partie arrondie a sensiblement le même rayon de courbure que le fond arrondi de 1 'échancrure de la pièce fémorale, et dont la partie plane a sensiblement la même longueur que celle de la partie libre de la barrette de la pièce fémorale. Selon une caractéristique de l'invention, la partie plane du plot central de l' insert fait un angle aigu avec la perpendiculaire au plan du plateau de l'embase tibiale.Preferably, when the patient's posterior cruciate ligament no longer exists, the posterior veils of the femoral component are joined at their free end by a bar that is substantially straight, and the insert comprises a central stud, having in section the shape of 'a D, the rounded part of which has substantially the same radius of curvature as the rounded bottom of the notch of the femoral part, and the flat part of which has substantially the same length as that of the free part of the bar of the part femoral. According to a characteristic of the invention, the flat part of the central stud of the insert makes an acute angle with the perpendicular to the plane of the plate of the tibial base.
De façon préférentielle, la partie plane du plot central de l' insert fait un angle égal à environ six degrés avec la perpendiculaire au plan du plateau de l'embase tibiale.Preferably, the flat part of the central stud of the insert makes an angle equal to about six degrees with the perpendicular to the plane of the plate of the tibial base.
Selon un mode de réalisation avantageux, l'embase tibiale comporte des rainures destinées à coopérer avec des encoches formées sur l' insert pour assurer la fixation de V insert sur l'embase tibiale, par exemple par enclipsage.According to an advantageous embodiment, the tibial base has grooves intended to cooperate with notches formed on the insert to ensure the attachment of the insert to the tibial base, for example by clipping.
D'autres buts, caractéristiques et avantages de la présente invention ressortiront plus clairement de la description qui suit d'un exemple de réalisation donné à titre illustratif, en référence aux dessins annexés sur lesquels:Other objects, characteristics and advantages of the present invention will emerge more clearly from the following description of an exemplary embodiment given by way of illustration, with reference to the appended drawings in which:
- La Figure 1 est une vue éclatée en perspective des trois éléments composant la prothèse de genou réalisée selon la présente invention,FIG. 1 is an exploded perspective view of the three elements making up the knee prosthesis produced according to the present invention,
- La Figure 2 représente une vue en perspective de l'embase tibiale de la prothèse de la Figure 1, etFIG. 2 represents a perspective view of the tibial base of the prosthesis of FIG. 1, and
- La Figure 3 représente une vue de dessous de l'embase tibiale de la Figure 2.- Figure 3 shows a bottom view of the tibial base of Figure 2.
En référence maintenant aux Figures, on a représenté une prothèse totale du genoux complète, c'est à dire prévue pour un patient n'ayant plus de ligament croisé postérieur. L'homme du métier adaptera cette prothèse sans effort pour le cas contraire.Referring now to the Figures, there is shown a complete knee prosthesis, that is to say intended for a patient no longer having a posterior cruciate ligament. Those skilled in the art will adapt this prosthesis effortlessly for the opposite case.
On voit que la prothèse totale du genou comporte essentiellement une embase tibiale A, destinée à être fixée sur l'extrémité supérieure d'un tibia préalablement préparé, un pièce fémorale B, destinée à être fixée sur l'extrémité inférieure du fémur elle aussi préalablement préparée, et un insert C, destiné à être placé entre les deux pièces A et B.We see that the total knee prosthesis essentially comprises a tibial base A, intended to be fixed on the upper end of a previously prepared tibia, a femoral part B, intended to be fixed on the lower end of the femur, also previously prepared, and an insert C, intended to be placed between the two parts A and B.
L'embase tibiale A comporte essentiellement une plaque plane constituant un plateau 10, et dans le bord postérieur de laquelle est formée une échancrure 12 permettant le passage du ligament croisé postérieur éventuel. Des trous 14 sont formés dans ce plateau pour permettre la fixation de l'embase tibiale sur le tibia au moyen de vis (non représentées).The tibial base A essentially comprises a flat plate constituting a plate 10, and in the posterior edge of which is formed a notch 12 allowing the passage of the posterior cruciate ligament, if any. Holes 14 are formed in this plate to allow the fixation of the tibial base on the tibia by means of screws (not shown).
Comme on le voit mieux sur les Figures 2 et 3, la face inférieure du plateau 10 comporte un plot 16 sensiblement cylindrique, destiné à venir s'incruster dans le canal médullaire du tibia. Deux ailes sensiblement planes 18 s'étendent symétriquement de part et d'autre de ce plot 16, pour assurer l'ancrage du plateau 10 dans le tibia. Ces ailes 18 sont en forme de triangles rectangles, et s'étendent sensiblement suivant une direction tangente au cylindre formant le plot 16. Une telle disposition présente comme avantage que l'ancrage des ailes 18 s'effectue dans une partie plus dense, donc plus résistante, du tibia, contrairement aux ailes radiales connues jusqu'à présent.As best seen in Figures 2 and 3, the underside of the plate 10 comprises a substantially cylindrical stud 16, intended to become embedded in the medullary canal of the tibia. Two substantially planar wings 18 extend symmetrically on either side of this stud 16, to ensure the anchoring of the plate 10 in the tibia. These wings 18 are in the form of right triangles, and extend substantially in a direction tangent to the cylinder forming the stud 16. Such an arrangement has the advantage that the anchoring of the wings 18 takes place in a denser part, therefore more resistant, tibia, unlike the radial wings known so far.
La face supérieure du plateau 10 est formée avec un rebordThe upper face of the plate 10 is formed with a rim
20, perpendiculaire au plan du plateau 10, et formant un réceptacle pour V insert C. Comme on le voit bien sur la Figure 2, le rebord 20 comporte des rainures 22, trois dans l'exemple représenté, pour permettre la fixation de l' insert C sur le plateau 10. Ces rainures peuvent, par exemple, être obtenues à l'aide de nervures 24 formées sur la partie du rebord 20 la plus éloignée du plateau 10. La pièce fémorale B présente, en section transversale, la forme générale d'un U à pans intérieurs coupés, comme il est connu dans l'art, et comporte un voile antérieur 30 et deux voiles postérieurs 32 réunis par un voile de liaison 34. Les deux voiles postérieurs 32 sont séparés par une échancrure 36, sensiblement en forme de triangle isocèle, dont le sommet arrondi est situé au voisinage du raccordement entre le voile antérieur 30 et le voile de liaison 34, et dont la base est située au voisinage de l'extrémité libre des voiles postérieurs, de façon à ménager une barrette 38 réunissant les extrémités libres des voiles postérieurs 32.20, perpendicular to the plane of the plate 10, and forming a receptacle for V insert C. As can be seen in FIG. 2, the flange 20 has grooves 22, three in the example shown, to allow the fixing of the insert C on the plate 10. These grooves can, for example, be obtained using ribs 24 formed on the part of the rim 20 furthest from the plate 10. The femoral part B has, in cross section, the general shape of a U with cut internal sides, as is known in the art, and comprises an anterior veil 30 and two posterior veils 32 joined by a connecting veil 34. The two rear webs 32 are separated by a notch 36, substantially in the shape of an isosceles triangle, the rounded top of which is located in the vicinity of the connection between the front web 30 and the connecting web 34, and the base of which is located in the vicinity of the free end of the rear sails, so as to provide a bar 38 joining the free ends of the rear sails 32.
Les faces internes des voiles antérieur, de liaison et postérieurs forment, de façon connue, cinq plans destinés à coopérer avec des méplats complémentaires réalisés sur l'épiphyse du fémur. La face interne du voile de liaison 34 comporte de plus deux plots 40 destinés à coopérer avec des orifices complémentaires creusés dans le fémur, pour assurer la fixation, le centrage et le verrouillage latéral de la pièce fémorale B sur le fémur.The internal faces of the anterior, connecting and posterior veils form, in known manner, five planes intended to cooperate with complementary flats produced on the epiphysis of the femur. The internal face of the connecting veil 34 further comprises two studs 40 intended to cooperate with complementary orifices hollowed out in the femur, to ensure the fixing, the centering and the lateral locking of the femoral part B on the femur.
Les faces externes des voiles antérieur, de liaison et postérieurs comportent de façon connue en soi deux condyles latéraux asymétriques 40 et 42. Les condyles 40 et 42 sont destinés à coopérer avec deux empreintes 44 et 46 respectivement formées sur V insert C.The external faces of the anterior, connecting and posterior webs comprise, in a manner known per se, two asymmetrical lateral condyles 40 and 42. The condyles 40 and 42 are intended to cooperate with two impressions 44 and 46 respectively formed on V insert C.
L' insert C comporte une base 48, de forme complémentaire à celle du réceptacle constitué du plateau 10 et du rebord 20, des encoches 50 étant prévues dans la base 48 pour coopérer avec les nervures 24 et fixer l' insert C sur le plateau 10, par exemple par enclipsage. De la sorte, une même embase tibiale pourra recevoir différents inserts, ayant tous la même base 48, mais des empreintes différentes. Conformément à la présente invention, les condyles 40 et 42 et les empreintes 44 et 46 forment des surfaces congruentes, de telle sorte que le contact entre ces surfaces intervient sur un segment de ligne, et non plus sur un point comme dans l'art antérieur. Il en résulte ainsi que les contraintes engendrées par le pivotement de la pièce fémorale sur l' insert sont mieux réparties, leur intensité étant donc réduite.The insert C comprises a base 48, of a shape complementary to that of the receptacle consisting of the plate 10 and the rim 20, notches 50 being provided in the base 48 to cooperate with the ribs 24 and fix the insert C on the plate 10 , for example by clipping. In this way, the same tibial base can receive different inserts, all having the same base 48, but different imprints. In accordance with the present invention, the condyles 40 and 42 and the impressions 44 and 46 form congruent surfaces, so that the contact between these surfaces occurs on a line segment, and no longer on a point as in the prior art . As a result, the stresses generated by the pivoting of the femoral part on the insert are better distributed, their intensity therefore being reduced.
Ces surfaces congruentes permettent de plus que, pour une même embase tibiale et V insert qui lui est associé, on pourra choisir différentes pièces fémorales, ou inversement que pour une même pièce fémorale, on pourra choisir différents inserts, associés chacun à une même embase tibiale ou à des plateaux différents. On pourra ainsi poser la prothèse de genou selon la présente invention à un grand nombre de patients ayant des morphologies et des pathologies très différentes.These congruent surfaces allow moreover that, for the same tibial base and V insert which is associated with it, one will be able to choose different femoral parts, or conversely that for the same femoral part, one will be able to choose different inserts, each associated with the same tibial base or different trays. It will thus be possible to place the knee prosthesis according to the present invention to a large number of patients having very different morphologies and pathologies.
De plus, l' insert C comporte, entre les empreintes 44 et 46, un plot central 52, sensiblement perpendiculaire à la base 48, et destiné à coopérer avec l 'échancrure 26 de la pièce fémorale B. De façon plus précise, le plot 52 affecte, en section, sensiblement la forme d'un D, dont la partie arrondie a sensiblement le même rayon de courbure que le fond arrondi de l 'échancrure 26, et dont la partie plane a sensiblement la même longueur que celle de la partie libre de la barrette 38 entre les deux ailes postérieures 40 et 42.In addition, the insert C comprises, between the cavities 44 and 46, a central stud 52, substantially perpendicular to the base 48, and intended to cooperate with the notch 26 of the femoral piece B. More precisely, the stud 52 has, in section, substantially the shape of a D, the rounded part of which has substantially the same radius of curvature as the rounded bottom of the notch 26, and the flat part of which has substantially the same length as that of the part free of the bar 38 between the two rear wings 40 and 42.
On pourra noter que, pour la clarté du dessin, la pièce fémorale B a été représentée tournée de 180 degrés, autour de l'axe principal du plot 52, par rapport à la position qu'elle occupe normalement quand la prothèse est en place et opérationnelle. Le plot 52 permet d'assurer le positionnement relatif entre la pièce fémorale B et l'insert C, lui-même solidaire de l'embase tibiale A, tout en permettant un certain degré de rotation au cours de la flexion, et en assurant ainsi un fonctionnement plus naturel et un jeu ligamentaire périphérique plus proche de celui d'un genou sain.It will be noted that, for the sake of clarity of the drawing, the femoral part B has been shown turned 180 degrees, around the main axis of the stud 52, relative to the position it normally occupies when the prosthesis is in place and operational. The stud 52 ensures the relative positioning between the femoral part B and the insert C, itself integral with the tibial base A, while allowing a certain degree of rotation during flexion, and thus ensuring a more natural functioning and a peripheral ligament play closer to that of a healthy knee.
Lors d'une flexion de faible amplitude, la rotation relative de la pièce fémorale B sur l'insert C s'effectue par glissement des condyles 40 et 42 dans les empreintes 44 et 46 respectivement, et par libre coulissement du plot 52 dans 1 'échancrure 36. Lors d'une flexion de plus grande amplitude, la face interne de la barrette 38 vient en contact de la partie plate du plot 52. Ce dernier joue alors le rôle d'une came entre la pièce fémorale B et l'embase tibiale A, solidaire de l'insert C, et provoque un report en arrière du centre de rotation du genou de façon à améliorer la flexion, tandis que le contact entre le plot 52 et la barrette 38 évite toute luxation antérieure du genou.During flexion of small amplitude, the relative rotation of the femoral part B on the insert C is effected by sliding of the condyles 40 and 42 in the impressions 44 and 46 respectively, and by free sliding of the stud 52 in 1 ' indentation 36. During a greater amplitude bending, the internal face of the bar 38 comes into contact with the flat part of the stud 52. The latter then acts as a cam between the femoral part B and the base tibial A, integral with the insert C, and causes a postponement of the center of rotation of the knee so as to improve the flexion, while the contact between the stud 52 and the bar 38 prevents any anterior dislocation of the knee.
Lors d'une flexion de très grande amplitude, la barrette 38 est amenée à se déplacer sur la partie plate du plot 52, de façon à permettre cette flexion tout en conservant une butée conservant le report en arrière du centre de rotation. La Demanderesse a trouvé que le meilleur résultat est obtenu lorsque la face plane du plot 52 fait un angle aigu, égal à environ 6 degrés, avec la perpendiculaire au plan du plateau 10.During a very large amplitude bending, the bar 38 is caused to move on the flat part of the stud 52, so as to allow this bending while retaining a stop retaining the carry back of the center of rotation. The Applicant has found that the best result is obtained when the planar face of the pad 52 makes an acute angle, equal to approximately 6 degrees, with the perpendicular to the plane of the plate 10.
On a donc bien réalisé une prothèse totale du genou, ne nécessitant qu'un nombre réduit de composants pour pouvoir répondre à tous les besoins, et dans laquelle les contraintes engendrées par le pivotement de la pièce fémorale sur l'insert sont réparties sur la plus grande surface possible pour en diminuer l'intensité. Cette prothèse permet, de plus, une très grand mobilité de l'articulation ainsi réparée.We therefore produced a total knee prosthesis, requiring only a reduced number of components to be able to meet all needs, and in which the stresses generated by the pivoting of the femoral part on the insert are distributed over the most large area possible to reduce the intensity. This prosthesis also allows very high mobility of the joint thus repaired.
Bien entendu, l'invention n'est pas limitée aux modes de réalisation qui ont été décrits, mais elle est susceptible au contraire de recevoir de nombreuses modifications qui apparaîtront à l'homme du métier. Of course, the invention is not limited to the embodiments which have been described, but it is on the contrary liable to receive numerous modifications which will appear to a person skilled in the art.

Claims

REVENDICATIONS
1 - Prothèse du genou comprenant une embase tibiale (A) comportant un plateau (10) et destinée à être fixée à l'extrémité supérieure du tibia par l'intermédiaire d'une quille d'ancrage (16) sensiblement cylindrique, une pièce fémorale (B) partiellement en forme de trochlee comportant un voile antérieur (30) et deux voiles postérieurs (32) réunis par un voile de liaison (34), la face externe de la pièce fémorale comportant deux condyles latéraux asymétriques (40, 42), une échancrure (26) étant formée dans la pièce fémorale (B), la pièce fémorale étant destinée à être fixée à l'extrémité inférieure du fémur, et un insert (C) destiné à être fixé sur l'embase tibiale (A) et comportant deux empreintes (44, 46) destinées à coopérer avec les deux condyles (40, 42) de la pièce fémorale, caractérisée en ce que, en combinaison,1 - Knee prosthesis comprising a tibial base (A) comprising a plate (10) and intended to be fixed to the upper end of the tibia by means of an anchoring keel (16) substantially cylindrical, a femoral piece (B) partially in the form of a trochlee comprising an anterior veil (30) and two posterior veils (32) joined by a connecting veil (34), the external face of the femoral part comprising two asymmetrical lateral condyles (40, 42), a notch (26) being formed in the femoral part (B), the femoral part being intended to be fixed to the lower end of the femur, and an insert (C) intended to be fixed to the tibial base (A) and comprising two imprints (44, 46) intended to cooperate with the two condyles (40, 42) of the femoral component, characterized in that, in combination,
- la quille d'ancrage (16) est formée avec deux ailes planes (18) s'étendant sensiblement suivant une direction tangente au cylindre formant la quille d'ancrage (16),the anchoring keel (16) is formed with two flat wings (18) extending substantially in a direction tangent to the cylinder forming the anchoring keel (16),
- les empreintes (44, 46) de l'insert (C) et les condyles (40, 42) de la pièce fémorale constituent des surfaces congruentes.- The imprints (44, 46) of the insert (C) and the condyles (40, 42) of the femoral part constitute congruent surfaces.
2 - Prothèse du genou selon la revendication 1, caractérisée en ce que :2 - Knee prosthesis according to claim 1, characterized in that:
- les voiles postérieurs (32) de la pièce fémorale (B) sont réunis à leur extrémité libre par une barrette (38) sensiblement recti ligne, et - l'insert (C) comporte un plot central (52), présentant en section sensiblement la forme d'un D, dont la partie arrondie a sensiblement le même rayon de courbure que le fond arrondi de 1 'échancrure (26) de la pièce fémorale (B), et dont la partie plane a sensiblement la même longueur que celle de la partie libre de la barrette (38) de la pièce fémorale (B).- the posterior veils (32) of the femoral part (B) are joined at their free end by a bar (38) substantially straight line, and - the insert (C) comprises a central stud (52), having in section substantially the shape of a D, the rounded part of which has substantially the same radius of curvature as the rounded bottom of 1 notch (26) of the femoral part (B), and whose flat part has substantially the same length as that of the free part of the bar (38) of the femoral part (B).
3 - Prothèse du genou selon la revendication 2, caractérisée en ce que la partie plane du plot central (52) de l'insert (C) fait un angle aigu avec la perpendiculaire au plan du plateau (10) de l'embase tibiale (A).3 - Knee prosthesis according to claim 2, characterized in that the flat part of the central stud (52) of the insert (C) makes an acute angle with the perpendicular to the plane of the plate (10) of the tibial base ( AT).
4 - Prothèse du genou selon la revendication 3, caractérisée en ce que la partie plane du plot central (52) de l'insert (C) fait un angle égal à environ six degrés avec la perpendiculaire au plan du plateau (10) de l'embase tibiale (A).4 - Knee prosthesis according to claim 3, characterized in that the flat part of the central stud (52) of the insert (C) makes an angle equal to about six degrees with the perpendicular to the plane of the plate (10) of the '' tibial base (A).
5 - Prothèse du genou selon l'une quelconque des revendications précédentes, caractérisée en ce que l'embase tibiale (A) comporte des rainures (22) destinées à coopérer avec des encoches (50) formées sur l'insert (C) pour assurer la fixation de l'insert (C) sur l'embase tibiale (A).5 - Knee prosthesis according to any one of the preceding claims, characterized in that the tibial base (A) has grooves (22) intended to cooperate with notches (50) formed on the insert (C) to ensure fixing the insert (C) on the tibial base (A).
6 - Prothèse du genou selon la revendication 5, caractérisée en ce que la fixation de l'insert (C) sur l'embase tibiale (A) est obtenue par enclipsage de l'insert sur l'embase tibiale (A). 6 - Knee prosthesis according to claim 5, characterized in that the fixing of the insert (C) on the tibial base (A) is obtained by clipping the insert on the tibial base (A).
PCT/FR1997/001999 1996-11-08 1997-11-07 Complete prosthesis for the knee WO1998020818A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR96/13673 1996-11-08
FR9613673A FR2755601B1 (en) 1996-11-08 1996-11-08 TOTAL KNEE PROSTHESIS

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WO1998020818A1 true WO1998020818A1 (en) 1998-05-22

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US7261740B2 (en) 2003-10-29 2007-08-28 Wright Medical Technology, Inc. Tibial knee prosthesis
US7896922B2 (en) 2001-06-14 2011-03-01 Alexandria Research Technologies, Llc Implants for partial knee arthroplasty
US8002840B2 (en) 2004-01-12 2011-08-23 Depuy Products, Inc. Systems and methods for compartmental replacement in a knee
US8048163B2 (en) 2002-02-20 2011-11-01 Zimmer, Inc. Knee arthroplasty prosthesis
US8298288B2 (en) * 2008-06-24 2012-10-30 New York University Recess-ramp knee joint prosthesis
US8460391B2 (en) 2002-05-24 2013-06-11 Zimmer, Inc. Modular femoral components for knee arthroplasty
US8535383B2 (en) 2004-01-12 2013-09-17 DePuy Synthes Products, LLC Systems and methods for compartmental replacement in a knee
US8852195B2 (en) 2004-07-09 2014-10-07 Zimmer, Inc. Guide templates for surgical implants and related methods
US9675463B2 (en) 2004-01-12 2017-06-13 Paul A. Lotke Patello-femoral prosthesis

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US7896922B2 (en) 2001-06-14 2011-03-01 Alexandria Research Technologies, Llc Implants for partial knee arthroplasty
US8048163B2 (en) 2002-02-20 2011-11-01 Zimmer, Inc. Knee arthroplasty prosthesis
US8092546B2 (en) 2002-02-20 2012-01-10 Zimmer, Inc. Knee arthroplasty prosthesis
US8092545B2 (en) 2002-02-20 2012-01-10 Zimmer, Inc. Knee arthroplasty prosthesis method
US9072605B2 (en) 2002-02-20 2015-07-07 Zimmer, Inc. Knee arthroplasty prosthesis
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US8002840B2 (en) 2004-01-12 2011-08-23 Depuy Products, Inc. Systems and methods for compartmental replacement in a knee
US8535383B2 (en) 2004-01-12 2013-09-17 DePuy Synthes Products, LLC Systems and methods for compartmental replacement in a knee
US9675463B2 (en) 2004-01-12 2017-06-13 Paul A. Lotke Patello-femoral prosthesis
US8852195B2 (en) 2004-07-09 2014-10-07 Zimmer, Inc. Guide templates for surgical implants and related methods
US8298288B2 (en) * 2008-06-24 2012-10-30 New York University Recess-ramp knee joint prosthesis

Also Published As

Publication number Publication date
FR2755601A1 (en) 1998-05-15
FR2755601B1 (en) 1998-12-18

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