DE19613200C2 - Periprosthetic mounting systems for femoral head endoprostheses - Google Patents
Periprosthetic mounting systems for femoral head endoprosthesesInfo
- Publication number
- DE19613200C2 DE19613200C2 DE1996113200 DE19613200A DE19613200C2 DE 19613200 C2 DE19613200 C2 DE 19613200C2 DE 1996113200 DE1996113200 DE 1996113200 DE 19613200 A DE19613200 A DE 19613200A DE 19613200 C2 DE19613200 C2 DE 19613200C2
- Authority
- DE
- Germany
- Prior art keywords
- sleeve
- bone cement
- bone
- cement
- shaft
- Prior art date
- Legal status (The legal status 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 status listed.)
- Expired - Fee Related
Links
Classifications
-
- 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
-
- A—HUMAN NECESSITIES
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- 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
- A61F2/30721—Accessories
- A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
-
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- 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
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
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-
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- A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
- A61L24/02—Surgical adhesives or cements; Adhesives for colostomy devices containing inorganic materials
-
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- A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
- A61L24/04—Surgical adhesives or cements; Adhesives for colostomy devices containing macromolecular materials
-
- A—HUMAN NECESSITIES
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- 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
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- A—HUMAN NECESSITIES
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- 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
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- A61F2/30723—Plugs or restrictors for sealing a cement-receiving space
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- 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
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-
- A—HUMAN NECESSITIES
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- 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
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- 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
- A61F2/3662—Femoral shafts
-
- A—HUMAN NECESSITIES
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- 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
- A61F2/3662—Femoral shafts
- A61F2/367—Proximal or metaphyseal parts of shafts
-
- A—HUMAN NECESSITIES
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- 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
- A61F2/3662—Femoral shafts
- A61F2/3676—Distal or diaphyseal parts of shafts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
- A61F2002/3006—Properties of materials and coating materials
- A61F2002/3008—Properties of materials and coating materials radio-opaque, e.g. radio-opaque markers
-
- A—HUMAN NECESSITIES
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- 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
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30579—Special structural features of bone or joint prostheses not otherwise provided for with mechanically expandable devices, e.g. fixation devices
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30667—Features concerning an interaction with the environment or a particular use of the prosthesis
- A61F2002/30677—Means for introducing or releasing pharmaceutical products, e.g. antibiotics, into the body
-
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- A61F2/30—Joints
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- A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
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- A61F2310/00389—The prosthesis being coated or covered with a particular material
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- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00389—The prosthesis being coated or covered with a particular material
- A61F2310/00952—Coating, pre-coating or prosthesis-covering structure made of bone cement, e.g. pre-applied PMMA cement mantle
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Description
Der Erfindungenkomplex ist ein gattungsbegrifflich neues homogenes Zementschicht system um eine zu fixierende Femurkopfprothese.The complex of inventions is a generic, new homogeneous cement layer system around a femoral head prosthesis to be fixed.
Der Knochenzement, insbesondere Polymethylmetacrylat, in den der Schaft einer Fe murkopfprothese üblicherweise eingebettet wird, muß etwa 3 mm lückenlos dick sein. Schon bei mittleren Wanddicken besteht aber die Gefahr von Knochennekrosen durch die exotherme Polymerisationswärme. Außerdem ist es für den Operateur schwierig, während des etwa zwölfminütigen Aushärtens des noch viskosen Zementes die Prothe se manuell in der operativ gebotenen Längs- und Querachse fixiert zu halten.The bone cement, in particular polymethyl methacrylate, into which the shaft of an Fe Mur head prosthesis is usually embedded, must be about 3 mm thick without gaps. Even with medium wall thicknesses there is a risk of bone necrosis the exothermic heat of polymerization. It is also difficult for the surgeon to the prothe while the still viscous cement was hardening for about 12 minutes to keep it fixed manually in the operative longitudinal and transverse axis.
Das Zentrieren einer Geradschaftprothese mit einer zentralen Längsbohrung wird freilich folgendermaßen erleichtert (EP 03 31 623 A1): Über einen - als Hilfsmittel vorläufig angeordneten - "Zentrierstab", der mit einer üblichen Markraumsperre (Ze mentstopper) lösbar verbunden ist, wird die Geradschaft-Lochprothese in den noch viskosen Zement, der zuvor in das ausgearbeitete Implantatlager eingefüllt worden war, eingepresst. Dadurch wird der Schaft zwar gut distal zentriert; proximal, im Bereich der Trochanter, kann der Schaft aber nicht unbedingt wackelfrei im Zement fixiert werden, wenn der Zentrierstab nur manuell gehalten wird.Centering a straight stem prosthesis with a central longitudinal bore relieved, of course, as follows (EP 03 31 623 A1): About one - as an aid provisionally arranged - "centering rod", which with a usual medullary block (Ze mentstopper) is detachably connected, the straight stem prosthesis in the still viscous cement that has previously been poured into the prepared implant site was pressed. As a result, the shaft is centered well distally; proximal, in Area of the trochanter, but the shaft may not necessarily be wobble-free in the cement be fixed if the centering rod is only held manually.
Ebenfalls eine distal gute, aber proximal nicht hinreichend wackelfreie Fixierung zei tigt folgende Anordnung (DE 41 36 317 A1): Ein Drainagerohr, das durch die Längs bohrung einer Geradschaftprothese geschoben wird, ist mit einer Markraumsperre, die zur Drainage auch noch mit einer Drainagemembrane ausgestattet ist, lösbar verbun den. Dieses entfernbare Drainagerohr übernimmt somit auch die Funktion jenes Zentierstabes.Also a distally good, but not sufficiently wobble-free fixation proximally The following arrangement (DE 41 36 317 A1): A drainage pipe that runs through the longitudinal bore of a straight stem prosthesis is with a medullary block, the for drainage is also equipped with a drainage membrane, detachably connected the. This removable drainage pipe thus also takes on the function of that Centering rod.
Nun sind zwar auch schon allerlei Halterungssysteme bekannt, bei denen Hülsen die
Endoprothesenschäfte lückenlos von proximal bis distal umgeben. Diese sind aber
stofflich inhomogen und also dem Erfindungenkomplex nicht gattungsgleich und be
treffen ihn überhaupt nicht unmittelbar. (Die eingangs diskutierte, intraoperativ
auspolymerisierte Zementschicht stellt allein noch kein "System" dar.) Im einzelnen:
So wurde schon vorgeschlagen, den Prothesenstiel schon praeoperativ mit einer
Knochenzementschicht zu ummanteln (Willert und Buchhorn: Knochenzement. Verlag
Huber, Bern, Stuttgart, Toronto; 1987, Seite 126). Diese Prothesenart konnte jedoch
keinen wesentlichen Fortschritt auslösen, u. a. weil sie keine wackelfreie Positionie
rung ermöglicht, weil kein Knochenzement eingespart wird oder weil staatliche Arznei
mittel-Zulassungsvorschriften sie behinderten.
Now, all sorts of mounting systems are already known, in which sleeves surround the endoprosthesis shafts without gaps from proximal to distal. However, these are materially inhomogeneous and therefore not of the same type as the invention complex and do not directly affect it at all. (The intraoperatively polymerized cement layer discussed above does not in itself constitute a "system".) In detail:
It has already been proposed to coat the prosthetic stem with a layer of bone cement pre-operatively (Willert and Buchhorn: Bone Cement. Publisher Huber, Bern, Stuttgart, Toronto; 1987, page 126). However, this type of prosthesis could not trigger any significant progress, among other things because it does not enable a wobble-free positioning, because no bone cement is saved, or because state drug approval regulations hampered it.
Die EP 04 57 464 A1 betrifft ein periprothetisches Halterungssystem, das - zum Verhindern eines Bruches der adhäsiven Verbindung des (metallischen) Hüftendopro theseschaftes mit dem intraoperativ ausgehärteten Knochenzement - durch eine vorge fertigte Hülse gekennzeichnet ist, die sich inhomogen aus einem dem Knochenzement ähnlichen Material (etwa Polymethylmethacrylat) und einem Weichmacher zusammen setzt; sie ist dadurch flexibel, ist immer nur der Schaftoberfläche angepasst, ist daher außen auch nicht nach anatomischen Besonderheiten geformt und hat daher überall eine gleiche Wanddicke. Zum intraoperativen Zentrieren dieser Hülse können aus ihrer Außenseite vier Noppen ragen. Zum leichteren Überstülpen der Hülse befindet sich zwischen ihr und dem Schaft ein Schmiermittel. Dieses Halterungssystem ist also kein homogener Knochenzementverbund. Es ist insgesamt inhomogen - und gehört sonach zu einer anderen technischen Gattung -, weil es zusammengesetzt ist aus einem Schmiermittelfilm, einer vorgefertigten, flexiblen Hülse von selbst wieder inhomogener Struktur und einer intraoperativ ausgehärteten Knochenzementschicht.EP 04 57 464 A1 relates to a periprosthetic mounting system which - for Prevent breaking of the adhesive connection of the (metallic) hip endopro theseschaftes with the intraoperatively hardened bone cement - by a pre Finished sleeve is marked, which is inhomogeneous from a bone cement similar material (such as polymethyl methacrylate) and a plasticizer puts; it is therefore flexible, is only ever adapted to the shaft surface, and is therefore not shaped outside according to anatomical peculiarities and therefore has everywhere an equal wall thickness. For the intraoperative centering of this sleeve can from her Four knobs protrude on the outside. For easier putting on the sleeve is located a lubricant between it and the shaft. So this bracket system is not homogeneous bone cement composite. Overall, it is inhomogeneous - and therefore belongs to another technical genre - because it is composed of one Lubricant film, a prefabricated, flexible sleeve of itself inhomogeneous Structure and an intraoperatively hardened bone cement layer.
Auch die DE 695 12 304 T2 betrifft kein periprothetisches Halterungssystem für Femurkopf-Endoprothesen. Ihr Gegenstand gehört folglich auch zu einer ganz anderen technischen Gattung. Er ist eine Acetabulum-Pfanne für den Kugelkopf einer Hüft endoprothese, die vollständig ein ultrahochmolekularer Kunststoff-Festkörper ist. Sie besteht aus zwei oder drei formgepressten Schichten: (1) aus Polyethylen, (2) aus einem Gemisch aus Polyethylen und Polymethylmethacrylat und ggfs. (3) aus Co- Polymethylmethacrylat.DE 695 12 304 T2 also does not relate to a periprosthetic mounting system for Femoral head endoprostheses. Your object therefore belongs to a completely different one technical type. It is an acetabular cup for the ball head of a hip endoprosthesis, which is completely an ultra-high molecular plastic solid. she consists of two or three compression-molded layers: (1) made of polyethylene, (2) made of a mixture of polyethylene and polymethyl methacrylate and if necessary (3) from Co Polymethyl methacrylate.
Die DE 30 05 264 C2 - oder die US 3 789 029 - betrifft ebenfalls kein Halterungs system für Femurkopf-Endoprothesen, sondern Herstellungsverfahren für die prae operative Beschichtung von Femurprothesen mit einem inhomogenen Lack aus Poly methylmethacrylat plus Vernetzungsmittel, Katalysatoren, Aktivierungsmittel, Pla stifizierungsmittel, Inhibitoren und plastifizierenden Copolymere. Sein Zweck ("Auf gabe") ist die Erhöhung der Festigkeit der Grenzschicht von Prothese und intra operativem Knochenzement. Diese Prothese wird im Implantatlager, wie operativ üblich, von Knochenzement gehalten.DE 30 05 264 C2 - or US Pat. No. 3,789,029 - also does not concern a bracket system for femoral head endoprostheses, but manufacturing process for the prae operative coating of femoral prostheses with an inhomogeneous lacquer made of poly methyl methacrylate plus crosslinking agents, catalysts, activating agents, pla agents, inhibitors and plasticizing copolymers. Its purpose ("On gabe ") is the increase in the strength of the boundary layer of the prosthesis and intra surgical bone cement. This prosthesis is in the implant site, as is operational usual, held by bone cement.
Die DE 693 23 503 T2 behandelt auch kein periprothetisches Halterungssystem, son dern eine Hüftendoprothese zum zementfreien Implantieren. Ihr Schaft steckt, zum besseren Einwachsen in das Implantatlager, kraftschlüssig in einer Hülse, die zusam mengesetzt ist aus Knochenzement und aus bioaktiven Materialien und/oder aus Kno chenfragmenten, die außen mit dem übrigen Knochenzement eine Einheit bilden. Die Hülse ist also auch von inhomogener Struktur. Dieses Implantat wird im Implantat lager von eingestampften Knochenfragmenten umgeben. Es gehört auch zu einer anderen technischen Gattung als das Erfindungsprinzip.DE 693 23 503 T2 also does not deal with a periprosthetic mounting system, son a hip endoprosthesis for cementless implantation. Your shaft is stuck to better ingrowth in the implant site, non-positively in a sleeve that together is made of bone cement and bioactive materials and / or bone fragments that form a unit on the outside with the rest of the bone cement. The So sleeve is also of inhomogeneous structure. This implant is in the implant camp surrounded by stamped bone fragments. It also belongs to one different technical genre than the principle of invention.
Die DE 28 42 847 A1 beschreibt zwar ein periprothetisches Halterungssystem; dieses ist jedoch inhomogen, denn die den Hüftprotheseschaft umgebende Hülle ist vorwiegend metallisch, jedenfalls nicht aus festem Knochenzement. Sie dient nur der Stabilität des intraoperativ aushärtenden Knochenzements.DE 28 42 847 A1 describes a periprosthetic mounting system; however, this is inhomogeneous because the sheath surrounding the hip prosthesis shaft is predominantly metallic, at least not from solid bone cement. It only serves the stability of the intraoperative bone cement.
Schließlich geht es in der DE 44 24 883 A1 ebenfalls nur um ein inhomo genes Halterungssystem für den Schaft einer Femurprothese: Der Schaft ist mit einer hüllenförmigen, distal abgeschlossenen, elastischen, biokompatiblen Folie umgeben, die nach ihrer Natur nicht aus Knochenzement sein kann. Damit der zu polymerisierende Zement durch die Längsbohrung des Schaftes von etwa 2 mm gepresst werden kann, muss er sehr niederviskos sein, was neue Probleme aufwirft. Jedenfalls soll er die Folie füllen und bündig gegen das Implantatlager pressen.Finally, DE 44 24 883 A1 is also only about an inhomo Genes holder system for the shaft of a femoral prosthesis: The shaft is with a envelope-shaped, distally closed, elastic, biocompatible film surround the by their nature cannot be made of bone cement. So that the one to be polymerized Cement can be pressed through the longitudinal bore of the shaft of about 2 mm, it has to be very low viscous, which creates new problems. In any case, he should Fill the film and press it flush against the implant site.
Aufgabe der Erfindung ist es, die Nachteile der bekannten Halterungssysteme zu beheben.The object of the invention is to overcome the disadvantages of the known mounting systems to fix.
Das Erfindungsprinzip und dessen Ausgestaltungen, in den Patentansprüchen definiert, sind stofflich homogene Halterungssysteme aus praeoperativ polymerisiertem und intraoperativ noch auszupolymerisierendem Knochenzement.The principle of the invention and its configurations, defined in the patent claims, are material-homogeneous mounting systems made of pre-operative polymerized and Bone cement to be polymerized intraoperatively.
Dieser Erfindungenkomplex erfüllt neuartig und entwicklungsraffend insbesondere folgende fünf chirurgischen Zwecke: (1) den einer Halterung, (2) den einer Vermin derung des intraoperativ nötigen Knochenzementes und der anderenfalls höheren Poly merisationwärme, (3) den der Fixierung der Längsachse und (4) den der Fixiereung der Querachsen des Schaftes - beide schon während des Aushärtens des Knochen zementes (Zentrieren, kein varisches/valgisches Kippen, kein Verdrehen) - und (5) den des optimalen Verdichtens und optimal in die Spongiosa Eindrückens des noch visko sen Zementes, wenn die - nur den proximalen Teil des Schaftes umschließende Hülse - eingepresst wird, denn dann weicht das überschüssige Quantum von Zement nach proximal aus.This complex of inventions fulfills new and development-demanding in particular following five surgical purposes: (1) that of a holder, (2) that of a min change in the intraoperative bone cement and the otherwise higher poly heat of heat, (3) the fixation of the longitudinal axis and (4) that of the fixation the transverse axes of the shaft - both already during the hardening of the bone cement (centering, no varicose / valgian tipping, no twisting) - and (5) den of optimal compression and optimal impression of the cancellous bone that is still viscous sen cement if the sleeve - only enclosing the proximal part of the shaft - is pressed in, because then the excess quantum of cement softens proximally.
So entstehen zwei dünne Zementschichten und so entsteht auch vorübergehend die ses System: Schaft → Zementschicht → Innenwand der Hülse → Hülse → Außenwand der Hülse → Zementschicht → Knochen.This creates two thin layers of cement and temporarily creates that ses system: shaft → cement layer → inner wall of the sleeve → sleeve → outer wall of the Sleeve → cement layer → bone.
Nach ihrer Polymerisation bilden die vorgefertigte Hülse, die zwei sie einschließen den Filmschichten sowie die übrige distale Zementfüllung einen homogenen (in sich molekular-kohäsiv gebundenen) Block aus Zement.After their polymerization, the prefabricated sleeve, the two enclosing them, form the film layers as well as the remaining distal cement filling a homogeneous (in itself molecular-cohesively bonded) block of cement.
Der erfindungsgemäße Knochenzementverbund mit der vorgefertigten Hülse ersetzt weitgehend die sonst nicht immer homogen und mit optimaler Qualität intraoperativ herstellbare Knochenzementfüllung; er hält so auch die sonst auftretende Polymerisa tionswärme niedriger.The bone cement composite according to the invention replaced with the prefabricated sleeve largely the otherwise not always homogeneous and with optimal quality intraoperatively producible bone cement filling; it also holds the otherwise occurring polymerisa low heat.
Die erfindungsgemäße Hülse erstreckt sich vom resezierten Schenkelhals an nur über einen proximalen Teilbereich des Endoprothesenschaftes; sie umschließt ihn also nur teilweise. Die Hülse wird mit serienmäßiger Qualiltätssicherung vorgefertigt und außen anatomisch vorgeformt; sie ist für Geradschaftprothesen (mit oder ohne zentrale Drai nagebohrung) und für Bogenschaftprothesen geeignet. Die Innenwand der Hülse ist der Außenwand des Prothesenschaftes angepasst; die anatomisch vorgeformte Außenwand bestimmt, wie das Implantatlager zu ihr passend intraoperativ auszuarbeiten ist. Diese "passgerechten" Eigenschaften bewirken, dass die Längs- und die Querachsen des Schaftes, der Hülse und des Implantatlagers gekoppelt sind, so dass sie von vornher ein gegen ein Kippen oder Verdrehen fixiert sind, wenngleich sich zwischen der Pro these und der Hülse sowie zwischen der Hülse und dem Knochen zunächst noch je ein viskoser Film gleichartigen Knochenzementes befindet.The sleeve according to the invention only extends from the resected femoral neck a proximal portion of the endoprosthesis shaft; it only surrounds him partially. The sleeve is prefabricated with standard quality assurance and on the outside anatomically preformed; it is for straight stem prostheses (with or without a central drai nail hole) and suitable for arch stem prostheses. The inner wall of the sleeve is the Adjusted outer wall of the prosthesis socket; the anatomically preformed outer wall determines how the implant site should be worked out intraoperatively. This "Fit" properties cause the longitudinal and transverse axes of the Shank, the sleeve and the implant bearing are coupled so that they are from the start are fixed against tipping or twisting, although there is a difference between the Pro thesis and the sleeve as well as between the sleeve and the bone viscous film of similar bone cement.
Die vorgefertigte Knochenzementhülse kann mäßig gelöchert oder gitterartig sein. Sie kann einen Wulst oder Rand zum vorübergehenden Aufsetzen eines Adapters für das Einfüllen des viskosen Zementes aufweisen. Ferner können sich Löcher in der Hülse mit darin beweglichen Zapfen befinden. Diese sind zunächst mit der knochen seitigen Außenwand bündig; beim Einführen des Prothesenschaftes drücken sie sich in den Knochen.The prefabricated bone cement sleeve can be moderately perforated or lattice-like. It can have a bead or rim for temporary attachment of an adapter for have the filling of the viscous cement. Holes in the Sleeve with pins movable therein. These are first with the bones side outer wall flush; when the prosthetic socket is inserted, they press into the bone.
Das Bild zeigt die nur einen proximalen Teilbereich des Endoprothesenschaftes umschließende Hülse 1; sie ist eingesetzt in das Implantatlager, das passend auf ihre knochenseitige Außenwand operativ geformt worden war. Diese Hülse 1 umschließt, ebenfalls passend, den proximalen Teil der Femurprothese 2, nach deren Ausmaßen sie schon vorgefertigt ist. (Rechts daneben ist ihre Vorderansicht gezeichnet.)The picture shows the sleeve 1 , which only surrounds a proximal portion of the endoprosthesis shaft; it is inserted into the implant site, which was surgically shaped to match its outer wall on the bone side. This sleeve 1 also fits, appropriately, the proximal part of the femoral prosthesis 2 , the dimensions of which it has already been prefabricated. (Her front view is drawn to the right.)
Die Prothese 2 hat in dieser beispielsweisen Ausführungsform eine zentrale Boh rung 3 für die Drainage. Der Zementstopper 4 ist mit einer Drainage-Kanüle ver sehen.The prosthesis 2 has in this exemplary embodiment a central drilling 3 for drainage. The cement stopper 4 is seen with a drainage cannula.
Die zunächst noch viskose Zementfüllung 5 unterhalb der Hülse 1 ist quer schraffiert gezeichnet. Beim Einpressen der Hülse und des Prothesenschaftes weicht das überschüssige Quantum des noch viskosen Materials 5 proximal aus; es bilden sich zwei viskose Zementschichten: eine zwischen dem Prothesenschaft und der Hülsen-Innenwand und eine zwischen der Hülsen-Außenwand und der Spongiosa. (Im Bild nicht zu erkennen.)The initially viscous cement filling 5 below the sleeve 1 is shown cross-hatched. When the sleeve and the prosthesis shaft are pressed in, the excess quantity of the still viscous material 5 yields proximally; two viscous layers of cement form: one between the prosthesis socket and the inner wall of the sleeve and one between the outer wall of the sleeve and the cancellous bone. (Not recognizable in the picture.)
Claims (6)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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DE1996113200 DE19613200C2 (en) | 1996-04-02 | 1996-04-02 | Periprosthetic mounting systems for femoral head endoprostheses |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE1996113200 DE19613200C2 (en) | 1996-04-02 | 1996-04-02 | Periprosthetic mounting systems for femoral head endoprostheses |
Publications (2)
Publication Number | Publication Date |
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DE19613200A1 DE19613200A1 (en) | 1997-10-09 |
DE19613200C2 true DE19613200C2 (en) | 2001-12-20 |
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DE1996113200 Expired - Fee Related DE19613200C2 (en) | 1996-04-02 | 1996-04-02 | Periprosthetic mounting systems for femoral head endoprostheses |
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DE (1) | DE19613200C2 (en) |
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EP1799157A1 (en) * | 2004-09-21 | 2007-06-27 | Tigran Technologies AB | Method and device for improving the fixing of a prosthesis |
Citations (9)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3789029A (en) * | 1970-07-06 | 1974-01-29 | Research Corp | Plastic bone composition and method of making same |
DE2842847A1 (en) * | 1978-10-02 | 1980-04-17 | Adolf Dr Med Voorhoeve | Hip joint prosthesis anchor - comprises steel wire between shank and wall of cavity formed in bone |
EP0331623A1 (en) * | 1988-02-29 | 1989-09-06 | GebràDer Sulzer Aktiengesellschaft | Anchoring rod for a femural head prosthesis |
DE3005264C2 (en) * | 1979-02-15 | 1989-10-05 | Simon Montreal Quebec Ca Raab | |
EP0457464A1 (en) * | 1990-05-17 | 1991-11-21 | Howmedica International Inc. | Prosthetic intramedullary femoral prosthesis with preformed sheath |
DE4136317A1 (en) * | 1991-11-04 | 1993-05-06 | Merck Patent Gmbh, 6100 Darmstadt, De | Hip prosthesis with a marrow drainage system for an optimized cementing and implantation technique |
DE4424883A1 (en) * | 1994-07-14 | 1996-01-18 | Merck Patent Gmbh | Femoral prosthesis |
DE69323503T2 (en) * | 1992-02-03 | 1999-06-17 | Howmedica | Denture for cementless attachment |
DE69512304T2 (en) * | 1994-04-11 | 2000-03-23 | Bristol Myers Squibb Co | Composite polymer implant and method of making the same |
-
1996
- 1996-04-02 DE DE1996113200 patent/DE19613200C2/en not_active Expired - Fee Related
Patent Citations (9)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3789029A (en) * | 1970-07-06 | 1974-01-29 | Research Corp | Plastic bone composition and method of making same |
DE2842847A1 (en) * | 1978-10-02 | 1980-04-17 | Adolf Dr Med Voorhoeve | Hip joint prosthesis anchor - comprises steel wire between shank and wall of cavity formed in bone |
DE3005264C2 (en) * | 1979-02-15 | 1989-10-05 | Simon Montreal Quebec Ca Raab | |
EP0331623A1 (en) * | 1988-02-29 | 1989-09-06 | GebràDer Sulzer Aktiengesellschaft | Anchoring rod for a femural head prosthesis |
EP0457464A1 (en) * | 1990-05-17 | 1991-11-21 | Howmedica International Inc. | Prosthetic intramedullary femoral prosthesis with preformed sheath |
DE4136317A1 (en) * | 1991-11-04 | 1993-05-06 | Merck Patent Gmbh, 6100 Darmstadt, De | Hip prosthesis with a marrow drainage system for an optimized cementing and implantation technique |
DE69323503T2 (en) * | 1992-02-03 | 1999-06-17 | Howmedica | Denture for cementless attachment |
DE69512304T2 (en) * | 1994-04-11 | 2000-03-23 | Bristol Myers Squibb Co | Composite polymer implant and method of making the same |
DE4424883A1 (en) * | 1994-07-14 | 1996-01-18 | Merck Patent Gmbh | Femoral prosthesis |
Non-Patent Citations (1)
Title |
---|
Willert,Hans-Georg, "Knochenzement" Hrsg., Verlag Huber, Bern, u.a. 1987, S.126 * |
Also Published As
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DE19613200A1 (en) | 1997-10-09 |
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