FR2715557A1 - Three part prosthetic ankle joint - Google Patents

Three part prosthetic ankle joint Download PDF

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Publication number
FR2715557A1
FR2715557A1 FR9401176A FR9401176A FR2715557A1 FR 2715557 A1 FR2715557 A1 FR 2715557A1 FR 9401176 A FR9401176 A FR 9401176A FR 9401176 A FR9401176 A FR 9401176A FR 2715557 A1 FR2715557 A1 FR 2715557A1
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France
Prior art keywords
tibial
talar
pins
bone
block
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Granted
Application number
FR9401176A
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French (fr)
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FR2715557B1 (en
Inventor
De Velde Van Denis
Letendart Joel
Pfaifer Patrick
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Groupe Lepine SAS
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Groupe Lepine SAS
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Priority to FR9401176A priority Critical patent/FR2715557B1/en
Publication of FR2715557A1 publication Critical patent/FR2715557A1/en
Application granted granted Critical
Publication of FR2715557B1 publication Critical patent/FR2715557B1/en
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4202—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for ankles
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30159—Concave polygonal shapes
    • A61F2002/30176—V-shaped
    • 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
    • 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • A61F2002/3039—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove with possibility of relative movement of the rib within the groove
    • A61F2002/30398—Sliding
    • 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
    • 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
    • A61F2002/30604—Special structural features of bone or joint prostheses not otherwise provided for modular
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30841—Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30891—Plurality of protrusions
    • A61F2002/30892—Plurality of protrusions parallel
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4202—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for ankles
    • A61F2002/4205—Tibial components
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4202—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for ankles
    • A61F2002/4207—Talar components
    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028—Shapes in the form of latin or greek characters
    • A61F2230/0054—V-shaped

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Surgery (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Dentistry (AREA)
  • Cardiology (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Prostheses (AREA)

Abstract

A prosthetic ankle joint includes tibia and astragalus elements, each held in place by pointed nail-like pins embedded in spongy bone. The prosthetic tibia element is fixed by two pins inclined laterally, and the astragalus element by two pins inclined front to back. An intermediate articulation element is situated between the two, comprising: (a) one flat face in contact with the tibia element, (b) one curved face in contact with the astragalus, and (c) a V shaped region in the transverse plan, giving a natural range of movement. Also claimed are the instruments used to position the prosthesis and the method for doing so.

Description

La présente invention concerne une prothèse de cheville et un ensemble d'instruments ancillaires permettant notamment la pose de cette prothèse. The present invention relates to an ankle prosthesis and a set of ancillary instruments allowing in particular the fitting of this prosthesis.

Les prothèses de cheville existantes comprennent un élément tibial et un élément astragalien ancrés dans l'os au moyen de plots. The existing ankle prostheses include a tibial element and a talar element anchored in the bone by means of studs.

Ces plots ne permettent pas un ancrage parfaitement satisfaisant puisque le taux de descellement de ces prothèses reste important. These studs do not allow a perfectly satisfactory anchoring since the loosening rate of these prostheses remains high.

La prothèse de cheville selon l'invention vise & remédier à cet inconvénient. The ankle prosthesis according to the invention aims to remedy this drawback.

En outre, les prothèses actuelles comprennent généralement deux éléments, c'est- & -dire l'élément tibial et l'élément astragalien précités, ces deux éléments étant en contact l'un avec l'autre par des surfaces congruantes appropriées, pouvant glisser; l'une contre l'autre pour permettre des mouvements en flexion-extension. In addition, current prostheses generally comprise two elements, that is to say the tibial element and the talar element mentioned above, these two elements being in contact with each other by suitable congruent surfaces, capable of sliding. ; one against the other to allow flexion-extension movements.

Pour l'obtention de possibilités de mouvements supérieures et plus proches de l'articulation naturelle, il a été réalisé des protheses en trois éléments comprenant un élément intermédiaire de glissement, interposé entre les éléments tibial et astragalien. To obtain possibilities of higher movements and closer to the natural joint, prostheses in three elements have been produced comprising an intermediate sliding element, interposed between the tibial and talar elements.

Dans ces prothèses, les faces de l'élément tibial et de l'élément intermédiaireiqui sont en contact l'une de l'autre sont planes tandis que les faces de l'élément intermédiaire et de l'élément astragalien qui sont en contact sont courbes dans uh plan antéro-postérieur et présentent une section en V évasé dans un plan transversal. Ainsi, l'élément intermédiaire présente un certain degré de mobilité antéro-postérieure et latérale par rapport â l'élément tibial, autorisant les possibilités de mouvements supérieures précitées. In these prostheses, the faces of the tibial element and of the intermediate element which are in contact with each other are flat while the faces of the intermediate element and of the talus element which are in contact are curved in an anteroposterior plane and have a V-shaped section flared in a transverse plane. Thus, the intermediate element has a certain degree of anteroposterior and lateral mobility with respect to the tibial element, allowing the above-mentioned possibilities of upper movements.

Ces prothèses & trois éléments, de plus en plus couramment employées, doivent être implantées avec une grande précision, compte tenu des contraintes que subit l'articulation.  These prostheses & three elements, more and more commonly used, must be implanted with great precision, taking into account the constraints which the joint undergoes.

Les instruments ancillaires actuels ne facilitent guère la pose d'une telle prothèse et ne permettent pas l'obtention de la précision requise dans le positionnement des éléments de la prothèse, de sorte qu'il existe un taux de descellement restant important. The current ancillary instruments hardly facilitate the installation of such a prosthesis and do not allow obtaining the required precision in the positioning of the elements of the prosthesis, so that there is a significant remaining loosening rate.

L'ensemble d'instruments ancillaires selon l'invention vise & remédier cet inconvénient. The set of ancillary instruments according to the invention aims to remedy this drawback.

Les éléments tibial et astragalien de la prothèse selon l'invention comprennent des plots dont les extrémités libres sont pointues, ces plots pouvant venir prendre appui dans l'os spongieux la manière de clous. The tibial and talar elements of the prosthesis according to the invention comprise studs whose free ends are pointed, these studs being able to come to bear in the cancellous bone in the manner of nails.

Un ancrage renforcé est ainsi rendu possible. En outre, l'insertion des plots dans l'os assure un pr*-positionnement des éléments prothétiques le temps que s'opère la repousse osseuse ou le durcissement complet du ciment de scellement. Reinforced anchoring is thus made possible. In addition, the insertion of the studs in the bone ensures a pre-positioning of the prosthetic elements while the bone regrowth takes place or the complete hardening of the sealing cement.

L'ensemble d'instruments ancillaires selon l'invention comprend
- un bloc de coupe astragalienne, venant prendre appui contre l'os au niveau: du col de l'astragale et pouvant être immobilisé par rapport à l'os au moyen de broches, la surface supérieure de ce bloc servant de surface de guidage & la scie de résection de l'astragale ;
- une tige de référence, venant prendre appui sur ledit bloc de coupe astragalienne et comprenant une portion élargie percée d'au mains deux trous pour la mise en place de broches dans le tibia, à des endroits déterminés, et
- un bloc de coupe tibiale, pouvant être engagé sur les deux broches précitées insérées dans le tibia après retrait de ladite tige de référence, ce bloc comprenant au moins une surface de guidage de la scie de résection tibiale et au moins deux séries de trous alignés se trouvant chacune en face de l'une des broches tibiales précitées. The set of ancillary instruments according to the invention comprises
- an astragalar cutting block, which comes to rest against the bone at the level of: the neck of the talus and can be immobilized relative to the bone by means of pins, the upper surface of this block serving as a guiding surface & the astragalus resection saw;
a reference rod coming to bear on said astragalar cutting block and comprising an enlarged portion pierced with two hands for the placement of pins in the tibia, at determined locations, and
a tibial cutting block, which can be engaged on the two aforementioned pins inserted into the tibia after removal of said reference rod, this block comprising at least one guide surface of the tibial resection saw and at least two series of aligned holes each located opposite one of the aforementioned tibial pins.

La tige de référence, en venant prendre appui sur le bloc de coupe astragalienne permet un positionnement rigoureux des broches tibiales, et donc un positionnement rigoureux du bloc de coupe tibia le par rapport au bloc de coupe astragalienne. La distance séparant les deux plans de coupe est ainsi parfaitement définie quel que soit le volume d'os & réséquer, de sorte qu'elle correspond aux différentes épaisseurs de prothèses susceptibles d'être implantées. The reference rod, coming to bear on the talar cutting block allows a rigorous positioning of the tibial pins, and therefore a rigorous positioning of the tibia cutting block relative to the talar cutting block. The distance separating the two cutting planes is thus perfectly defined whatever the volume of bone & resect, so that it corresponds to the different thicknesses of prostheses likely to be implanted.

Ces deux guides permettent en outre une découpe rapide et précise des deux os. These two guides also allow rapid and precise cutting of the two bones.

Selon diverses dispositions avantageuses
- le bloc de coupe astragalienne et la tige de référence comprennent des moyens de positionnement réciproques, par exemple du type a engagement ;
- le bloc de coupe tibiale comprend deux surfaces superposées de guidage de la scie, dont la distance de l'une par rapport & l'autre correspond sensiblement & la moitié de la distance séparant deux trous consécutifs des séries de trous précitées ;i le bloc de coupe tibiale permet ainsi une découpe de l'os selon une valeur d'incrément faible, l'une ou l'autre des deux surfaces de guidage pouvant être utiliséepour chaque position du bloc de coupe tibiale par rapport aux broches insérées dans l'os
- le bloc de coupe astragalienne et le bloc de coupe tibia le comprennent des pointes pouvant être insérées dans l'os, pour assurer leur positionnement par rapport & celui-ci.According to various advantageous provisions
- the talar cutting block and the reference rod comprise reciprocal positioning means, for example of the engagement type;
the tibial cutting block comprises two superimposed surfaces for guiding the saw, the distance of one of which relative to the other corresponds substantially to half the distance separating two consecutive holes from the above-mentioned series of holes; i the block of tibial cut thus allows a cutting of the bone according to a value of small increment, one or the other of the two guide surfaces being able to be used for each position of the block of tibial compared to the pins inserted in the bone
- the talar cutting block and the tibia cutting block include points which can be inserted into the bone, to ensure their positioning in relation to it.

Les instruments décrits ci-dessus sont complétés par divers autres instruments tels que des jauges de mesure de la distance entre les surfaces réséquées des os, des guides de perçage pour aménager les trous d'insertion des plots, des éléments d'essai, des impacteurs, etc.  The instruments described above are supplemented by various other instruments such as gauges for measuring the distance between the resected surfaces of the bones, drilling guides for arranging the insertion holes for the studs, test elements, impactors , etc.

Pour sa bonne compréhension, l'invention est & nouveau décrite ci-dessous, en référence au dessin schématique annexe représentant, & titre d'exemple non limitatif, une forme de égalisation préférée de la prothèse de cheville et des instruments ancillaires qu'elle concerne. For its proper understanding, the invention is & again described below, with reference to the accompanying diagrammatic drawing representing, & by way of nonlimiting example, a preferred form of equalization of the ankle prosthesis and the ancillary instruments which it relates .

La figure 1 est une vue en coupe et en élévation de la prothèse de cheville, une fois celle-ci posée ;
les figures 2 & 4 sont des vues en perspective de trois instruments ancillaires que comprend l'ensemble d'instruments permettant la pose de cette prothèse
la figure 5 est une vue de l'instrument représenté & la figure 4, sous un autre angle et
les figures 6 & 8 sont des vues de profil de ces trois instruments, au cours de trois phases opératoires successives.Figure 1 is a sectional view in elevation of the ankle prosthesis, once it is placed;
Figures 2 & 4 are perspective views of three ancillary instruments that includes the set of instruments allowing the fitting of this prosthesis
FIG. 5 is a view of the instrument shown & FIG. 4, from another angle and
Figures 6 & 8 are side views of these three instruments, during three successive operating phases.

La figure 1 représente une prothèse de cheville en trois éléments, comprenant un élément tibial 1, un élément astragalien 2 et un élément intermédiaire de glissement 3, interposé entre l'élément tibial 1 et l'élément astragalien 2. FIG. 1 represents an ankle prosthesis in three elements, comprising a tibial element 1, a talar element 2 and an intermediate sliding element 3, interposed between the tibial element 1 and the talar element 2.

Les faces de l'élément tibial 1 et de l'élément intermédiaire 3 qui sont en contact l'une de l'autre sont planes tandis que les faces de l'élément intermédiaire 3 et de l'élément astragalien qui sont en contact sont courbes dans le plan antéro-postérieur et présentent une section en V évasé dans un plan transversal. The faces of the tibial element 1 and of the intermediate element 3 which are in contact with one another are flat while the faces of the intermediate element 3 and of the talus element which are in contact are curved in the anteroposterior plane and have a V-shaped section flared in a transverse plane.

L'élément tibial 1 et l'élément astragalien 2 comprennent chacun une paire de plots d'ancrage 4 inclinés, ces plots étant alignés latéralement en ce qui concerne l'élément tibial 1 et alignés dans le plan antéro-postérieur en ce qui concerne l'élément astragalien 2. The tibial element 1 and the talar element 2 each comprise a pair of inclined anchoring studs 4, these studs being aligned laterally as regards the tibial element 1 and aligned in the anteroposterior plane as regards the astragalian element 2.

Comme le montrent les figures, les extrémités libres des plots 4 sont pointues, de sorte que ces plots 4 peuvent venir prendre appui dans l'os spongieux & la manière de clous.  As the figures show, the free ends of the studs 4 are pointed, so that these studs 4 can come to bear in the cancellous bone & like nails.

Dans une telle prothèse en trois éléments, l'élément intermédiaire 3 présente un certain degré de mobilité antEro-postErieure et latérale par rapport & l'élément tibial 1, autorisant des possibilités de mouvements de l'articulation supérieures à celles des prothèses en deux éléments, et plus proches de celles de l'articulation naturelle. In such a three-element prosthesis, the intermediate element 3 has a certain degree of anterior-posterior and lateral mobility relative to the tibial element 1, allowing possibilities of movement of the joint greater than those of two-element prostheses , and closer to those of the natural joint.

Grdce aux extrémitéstlibres pointues des plots 4, un ancrage renforcé des éléments tibial et astragalien 2 est rendu possible. En outre, l'insertion des plots 4 dans l'os assure un pré-positionnement des éléments prothétiques 1,2 le temps que s'opère la repousse osseuse ou le durcissement complet du ciment de scellement, assurant l'ancrage définitif. Thanks to the pointed free ends of the studs 4, a reinforced anchoring of the tibial and talar elements 2 is made possible. In addition, the insertion of the studs 4 in the bone ensures a pre-positioning of the prosthetic elements 1, 2 while the bone regrowth takes place or the complete hardening of the sealing cement, ensuring the final anchoring.

Les figures 2 à 8 représentent sous différents angles trois instruments ancillaires permettant notamment la pose de cette prothèse. Figures 2 to 8 show from different angles three ancillary instruments allowing in particular the installation of this prosthesis.

Les figures 2 et 6 montrent un bloc de coupe astragalienne 10, comprenant un trou d'axe vertical 11, deux trous horizontaux 12 qui le traversent de part en part et deux pointes inférieures 13, aptes à être insérées dans l'os par pression. Ce bloc 10 présente en outre une surface supérieure servant surface de guidage & la scie de résection de l'astragale. Figures 2 and 6 show an astragalian cut block 10, comprising a vertical axis hole 11, two horizontal holes 12 which pass right through and two lower points 13, adapted to be inserted into the bone by pressure. This block 10 also has an upper surface serving as a guiding surface & the resection saw of the talus.

Les figures 3 et 7 montrent une tige 15, dite "de référence", comprenant une partie effilée 16 et une portion élargie 17 percée de trous 18, d'axes horizontaux, la traversant de part en part, et de deux trous borgnes latéraux 19 pour la mise en place de tiges latérales de référence horizontales (non teprésentées). En outre, du côté oppose & la partie effilée, la tige 15 comprend un plot 20 en saillie, apte à être engagé sans jeu dans le trou 11 du bloc de coupe astragalienne 10. Figures 3 and 7 show a rod 15, called "reference", comprising a tapered portion 16 and an enlarged portion 17 pierced with holes 18, of horizontal axes, passing right through, and two side blind holes 19 for the installation of lateral horizontal reference rods (not shown). In addition, on the opposite side to the tapered part, the rod 15 comprises a protruding stud 20, capable of being engaged without play in the hole 11 of the talar cutting block 10.

Comme le montre la figure 3, quatre trous 18, répartis en deux paires, sont aménagés en partie supérieure de la portion ' élargie 17, tandis qu'un cinquième trou 18 est aménagé en partie inférieure de celle-ci, au niveau de son axe médian. As shown in Figure 3, four holes 18, distributed in two pairs, are arranged in the upper part of the enlarged portion 17, while a fifth hole 18 is arranged in the lower part thereof, at its axis median.

Les figures 4,5 et 8 montrent un bloc de coupe tibiale 25 comprenant, en partie supérieure, deux plots 26 d'appui contre l'os, deux pointes 27 pouvant etre insérées dans l'os par pression, en partie médiane, quatre séries de trous 28 alignés longitudinalement, qui traversent le bloc 25 de part en part et dont la répartition correspond & celle des quatre trous 18 précités aménagés en partie supérieure de la portion élargie 17 de la tige 15, et, en partie inférieure, deux fentes parallèles 29 aménagées l'une au-dessus de l'autre. Figures 4,5 and 8 show a tibial cut block 25 comprising, in the upper part, two studs 26 bearing against the bone, two points 27 which can be inserted into the bone by pressure, in the middle part, four series of holes 28 aligned longitudinally, which pass through the block 25 right through and whose distribution corresponds to that of the four aforementioned holes 18 arranged in the upper part of the enlarged portion 17 of the rod 15, and, in the lower part, two parallel slots 29 arranged one above the other.

La distance des deux fentes 29 correspond sensiblement & la moitié de la distance séparant deux trous 28 consécutifs des séries de trous précités. The distance from the two slots 29 corresponds substantially to half the distance separating two consecutive holes 28 from the above-mentioned series of holes.

Le bloc de coupe tibia le 25 comprend, en outre, quatre trous 30, qui le traversent de part en part. The tibia cutting block 25 further comprises four holes 30, which pass right through it.

En pratique, le bloc de coupe astragalienne 10 est emmanché sur l'extrémité d'ufl impacteur grâce à son trou 11 puis est mis en place aulmoyen de cet impacteur, par insertion des pointes 13 dans l'os, au niveau du col de l'astragale. In practice, the talar cutting block 10 is fitted onto the end of the impactor ufl thanks to its hole 11 and is then placed in the middle of this impactor, by insertion of the points 13 into the bone, at the neck of the astragalus.

Des broches 30 sont ensuite engagées au travers des trous 12 puis insérées dans l'astragale, pour une complète immobilisation du bloc 10. La surface supérieure de ce dernier se trouve aldrs & hauteur adéquate pour guider, par simple glissement, la scie de résection de la partie supérieure de l'astragale, comme le montre la figure 6. Pins 30 are then engaged through holes 12 and then inserted into the talus, for complete immobilization of the block 10. The upper surface of the latter is aldrs & adequate height to guide, by simple sliding, the resection saw of the upper part of the talus, as shown in Figure 6.

Après retrait de l'impacteur précité, le plot 20 de la tige 15 est engagé dans le trou 11 du bloc 10, et la tige 15 est positionnée parallèlement au tibia. En partie supérieure, elle est maintenue par rapport à l'os à l'aide de moyens appropriés (non représentés). After removal of the aforementioned impactor, the stud 20 of the rod 15 is engaged in the hole 11 of the block 10, and the rod 15 is positioned parallel to the tibia. In the upper part, it is held relative to the bone using appropriate means (not shown).

Trois broches 31 sont engagées au travers de deux des trous 18 supérieurs et du trou 18 inférieur et sont partiellement visées dans l'os. On utilise, selon les besoins, les trous supérieurs situés vers l'intérieur ou vers l'extérieur. Three pins 31 are engaged through two of the upper holes 18 and the lower hole 18 and are partially targeted in the bone. The upper holes located inward or outward are used, as required.

Les broches 31 sont ensuite retirées pour permettre le retrait de la tige 15, des broches 30 et du bloc 10. The pins 31 are then removed to allow the rod 15, the pins 30 and the block 10 to be removed.

Comme le montre la figure 8, les deux broches 31 supérieures sont ensuite remises en place dans leur position préalablement déterminée au moyen de la tige 15, et sont complètement vissées dans l'os, puis le bloc de coupe tibiale 25 est engagé sur elles. As shown in Figure 8, the two upper pins 31 are then replaced in their previously determined position by means of the rod 15, and are completely screwed into the bone, then the tibial cutting block 25 is engaged on them.

Ce bloc 25 peut être placé hauteur adéquate, en fonction de la découpe osseuse b réaliser, par engagement des broches 31 dans la paire de trous 28 appropriée. This block 25 can be placed at an appropriate height, depending on the bone cut to be made, by engagement of the pins 31 in the appropriate pair of holes 28.

Les pointes 27 permettent d'assurer un positionnement temporaire du bloc 25 par leur insertion dans l'os tandis que les trous 30 permettent la mise en place de broches supplémentaires, pour une totale immobilisation dudit bloc 25. The points 27 ensure temporary positioning of the block 25 by their insertion into the bone while the holes 30 allow the placement of additional pins, for total immobilization of said block 25.

Chaque fente 29 constitue une surface de guidage pour la scie de résection du tibia. Grâce à leur distance précitée l'une par rapport: & l'autre et grâce aux différentes possibilités de positionnement du bloc 25 au moyen des séries de trous 28, ?la découpe osseuse peut être réalisée selon une valeur d'incrément faible, l'une ou l'autre des deux surfaces de guidage définies par les fentes 29 pouvant être utilisée pour chaque position du bloc 25 par rapport aux broches 31. Each slot 29 constitutes a guide surface for the tibia resection saw. Thanks to their aforementioned distance from one another: & the other and thanks to the different possibilities of positioning the block 25 by means of the series of holes 28, the bone cutting can be carried out according to a small increment value, the either of the two guide surfaces defined by the slots 29 can be used for each position of the block 25 relative to the pins 31.

Les instruments décrits ci-dessus sont complétés par divers autres instruments tels que des jauges de mesure de la distance entre les surfaces réséquées des os, des guides de perçage pour aménager les trous d'insertion des plots 4, des éléments prothétiques d'essai, des impacteurs, etc.... The instruments described above are supplemented by various other instruments such as gauges for measuring the distance between the resected surfaces of the bones, drilling guides for arranging the insertion holes of the pads 4, trial prosthetic elements, impactors, etc.

Ces instruments facilitent la pose d'une prothèse de cheville en trois éléments, avec toute la précision requise dans le positionnement relatif des éléments constituant cette prothèse. These instruments facilitate the installation of an ankle prosthesis in three elements, with all the precision required in the relative positioning of the elements constituting this prosthesis.

En effet, la tige de référence 15, en venant prendre appui sur le bloc de coupe astragalienne 10, permet un positionnement rigoureux des broches tibiales 31, et donc un positionnement rigoureux du bloc de coupe tibiale 25 par rapport au bloc de coupe astragalienne 10. Indeed, the reference rod 15, coming to bear on the talar cutting block 10, allows rigorous positioning of the tibial pins 31, and therefore rigorous positioning of the tibial cutting block 25 relative to the talar cutting block 10.

La distance séparant les deux plans de coupe de l'os est ainsi parfaitement définie quel que soit le volume d'os & réséquer, de sorte que cette distance correspond parfaitement aux différentes épaisseurs de prothèses susceptibles d'être implantées. The distance separating the two cutting planes of the bone is thus perfectly defined whatever the volume of bone & resected, so that this distance corresponds perfectly to the different thicknesses of prostheses likely to be implanted.

Claims (3)

REVIRJDICCATrONS 1- Prothèse de cheville, du type comprenant un élément tibial (1) et un élément astragalien (2), caractérisée en ce que ces éléments comprennent des plots (4) dont les extrémités libres sont pointues, ces plots (4) pouvant venir prendre appui dans l'os spongieux & la manière de clous.REVIRJDICCATrONS 1- Ankle prosthesis, of the type comprising a tibial element (1) and an talar element (2), characterized in that these elements include studs (4) whose free ends are pointed, these studs (4) being able to come take support in the cancellous bone & the way of nails. 2 - Prothèse selon la revendication 1, caractérisée en ce que l'élément tibial (1) et l'élément astragalien (2) comprennent chacun une paire de plots d'ancrage (4) inclinés, ces plots étant alignés latéralement en ce qui concerne l'élément tibial (1) et alignés dans le plan antéro-postérieur en ce qui concerne l'élément astragalien (2). 2 - Prosthesis according to claim 1, characterized in that the tibial element (1) and the talar element (2) each comprise a pair of inclined anchoring studs (4), these studs being aligned laterally as regards the tibial element (1) and aligned in the anteroposterior plane with regard to the talar element (2). 5 - Prothèse selon la revendication 1 ou la revendication 2, caractérisée en ce qu'elle comprend un élément tibial (1), un élément astragalien (2) et un élément intermédiaire de glissement (3), interposé entre l'élément tibial (1) et l'élément astragalien (2), les faces de l'élément tibial (1) et de l'élément intermédiaire (3) qui sont en contact étant planes tandis que les faces de l'élément intermédiaire (3) et de l'élément astragalien (2) qui sont en contact sont courbes dans le plan antéro-postérieur et présentent une section en V évasé dans le plan transversal. 5 - Prosthesis according to claim 1 or claim 2, characterized in that it comprises a tibial element (1), a talar element (2) and an intermediate sliding element (3), interposed between the tibial element (1 ) and the talar element (2), the faces of the tibial element (1) and of the intermediate element (3) which are in contact being plane while the faces of the intermediate element (3) and of the the talar element (2) which are in contact are curved in the anteroposterior plane and have a V-shaped section flared in the transverse plane. 4 - Ensemble d'instruments ancillaires permettant notamment la pose de la prothèse selon l'une des revendications 1 & 3, caractérisé en ce qu'il comprend 4 - set of ancillary instruments allowing in particular the fitting of the prosthesis according to one of claims 1 & 3, characterized in that it comprises - un bloc de coupe astragalienne (10), venant prendre appui contre l'os au niveau du col de l'astragale et pouvant être immobilisé par rapport à l'os au moyen de broches (30), la surface supérieure de ce bloc (10) servant de surface de guidagè à la scie de résection de l'astragale ; - a block of astragalar cut (10), coming to bear against the bone at the level of the neck of the talus and being able to be immobilized with respect to the bone by means of pins (30), the upper surface of this block ( 10) serving as a guide surface for the astragalus resection saw; - une tige de référence (15), venant prendre appui sur ledit bloc de coupe astragalienne (10) et comprenant une portion élargie (17) percée d'au moins deux trous (18) pour la mise en place de broches (31) dans le tibia, a des endroits déterminés, et - A reference rod (15), coming to bear on said talar cutting block (10) and comprising an enlarged portion (17) pierced with at least two holes (18) for the positioning of pins (31) in the tibia, in specific places, and - un bloc de coupe tibiale (25), pouvant être engagé sur les deux broches (31) précitées insérées dans le tibia après retrait de ladite tige de référence (15), ce bloc (25) comprenant au moins une surface de guidage (29) de la scie de résection tibiale et au moins deux séries de trous alignés (28) se trouvant chacune en face de l'une des broches tibiales (31) précitées. - a tibial cutting block (25), which can be engaged on the two aforementioned pins (31) inserted into the tibia after removal of said reference rod (15), this block (25) comprising at least one guide surface (29 ) of the tibial resection saw and at least two series of aligned holes (28) each located opposite one of the aforementioned tibial pins (31). s - Ensemble d'instruments ancillaires selon la revendication 4, caractérisé en ce que le bloc de coupe astragalienne (10) et la tige de référence (15) comprennent des moyens (11,20) de positionnement réciproque, par exemple du type à engagement. s - set of ancillary instruments according to claim 4, characterized in that the talar cutting block (10) and the reference rod (15) comprise means (11,20) for reciprocal positioning, for example of the engagement type . - Ensemble d'instruments ancillaires selon la revendication 4 ou la revendication 5, caractérisé en ce que le bloc de coupe tibiale (25) comprend deux surfaces (29) superposées de guidage de la scie, dont la distance l'une par rapport & l'autre correspond sensiblement & la moitié de la distance séparant deux trous consécutifs (28) des séries de trous précitées. - Set of ancillary instruments according to claim 4 or claim 5, characterized in that the tibial cutting block (25) comprises two superimposed surfaces (29) for guiding the saw, the distance of which one relative to l the other corresponds substantially to half the distance separating two consecutive holes (28) from the above-mentioned series of holes. 7 - Ensemble d'instruments ancillaires selon l'une des revendications 4 à 6, caractérisé en ce que le bloc de coupe astragalienne (10) et le bloc de coupe tibiale (25) comprennent des pointes (13,27) pouvant être insérées dans l'os, pour assurer leur positionnement par rapport & celui-ci.  7 - set of ancillary instruments according to one of claims 4 to 6, characterized in that the talar cutting block (10) and the tibial cutting block (25) comprise points (13,27) which can be inserted into bone, to ensure their positioning in relation to it.
FR9401176A 1994-01-28 1994-01-28 Ankle prosthesis and set of ancillary instruments for fitting this prosthesis. Expired - Fee Related FR2715557B1 (en)

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FR2759900A1 (en) * 1997-02-26 1998-08-28 Sem Sa Ancillary instrument for fitting components of ankle joint prosthesis
FR2808994A1 (en) * 2000-05-22 2001-11-23 Transysteme Sarl Prosthesis for e.g. ankle is made of two parts with protruding elements forced within a hole in the bone and a smooth opposite face cooperating with an intermediate part
EP1393696A1 (en) * 2002-08-26 2004-03-03 DePuy Products, Inc. Ankle fusion guide and method
WO2013169475A1 (en) * 2012-05-08 2013-11-14 Neal David J Porous spacers, instruments, and methods for foot and ankle fusion
EP3064155A1 (en) * 2015-03-06 2016-09-07 Tornier, Inc. Surgical instrumentation assembly for positioning an ankle prosthesis
WO2016201078A2 (en) * 2015-06-09 2016-12-15 Mohamed Mahfouz Patient-specific instrumentation and methods for total ankle replacement

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FR2759900A1 (en) * 1997-02-26 1998-08-28 Sem Sa Ancillary instrument for fitting components of ankle joint prosthesis
FR2808994A1 (en) * 2000-05-22 2001-11-23 Transysteme Sarl Prosthesis for e.g. ankle is made of two parts with protruding elements forced within a hole in the bone and a smooth opposite face cooperating with an intermediate part
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EP1393696A1 (en) * 2002-08-26 2004-03-03 DePuy Products, Inc. Ankle fusion guide and method
AU2013260048B2 (en) * 2012-05-08 2017-07-06 Zimmer, Inc. Porous spacers, instruments, and methods for foot and ankle fusion
WO2013169475A1 (en) * 2012-05-08 2013-11-14 Neal David J Porous spacers, instruments, and methods for foot and ankle fusion
US9220518B2 (en) 2012-05-08 2015-12-29 Zimmer, Inc. Porous spacers, instruments, and methods for foot and ankle fusion
US9492178B2 (en) 2012-05-08 2016-11-15 Zimmer, Inc. Porous spacers, instruments, and methods for foot and ankle fusion
EP3064155A1 (en) * 2015-03-06 2016-09-07 Tornier, Inc. Surgical instrumentation assembly for positioning an ankle prosthesis
EP3437572A1 (en) 2015-03-06 2019-02-06 Tornier, Inc. Surgical instrumentation assembly for positioning an ankle prosthesis
US10517741B2 (en) 2015-03-06 2019-12-31 Tornier, Inc. Surgical method and instrumentation assembly for positioning an ankle prosthesis
US11324607B2 (en) 2015-03-06 2022-05-10 Howmedica Osteonics Corp. Surgical method and instrumentation assembly for positioning an ankle prosthesis
WO2016201078A3 (en) * 2015-06-09 2017-03-23 Mohamed Mahfouz Patient-specific instrumentation for total ankle replacement
WO2016201078A2 (en) * 2015-06-09 2016-12-15 Mohamed Mahfouz Patient-specific instrumentation and methods for total ankle replacement
US10881417B2 (en) 2015-06-09 2021-01-05 Zimmer, Inc. Patient-specific instrumentation and methods for total ankle replacement

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