FR2871369A1 - Glenoidal component for shoulder prosthesis, has metallic unit defining convex articulation surface which has semi-sphere shape and centered on symmetry axis that is not perpendicular to rear side of component - Google Patents

Glenoidal component for shoulder prosthesis, has metallic unit defining convex articulation surface which has semi-sphere shape and centered on symmetry axis that is not perpendicular to rear side of component Download PDF

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Publication number
FR2871369A1
FR2871369A1 FR0406471A FR0406471A FR2871369A1 FR 2871369 A1 FR2871369 A1 FR 2871369A1 FR 0406471 A FR0406471 A FR 0406471A FR 0406471 A FR0406471 A FR 0406471A FR 2871369 A1 FR2871369 A1 FR 2871369A1
Authority
FR
France
Prior art keywords
component
base
axis
glenoid
centered
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.)
Granted
Application number
FR0406471A
Other languages
French (fr)
Other versions
FR2871369B1 (en
Inventor
Alain Tornier
Francois Sirveaux
Gilles Walsch
Daniel Mole
Christophe Levigne
Pascal Boileau
Luc Favard
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Tornier SAS
Original Assignee
Tornier SAS
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
Priority to FR0406471A priority Critical patent/FR2871369B1/en
Application filed by Tornier SAS filed Critical Tornier SAS
Priority to US11/147,177 priority patent/US8303665B2/en
Priority to EP05356103A priority patent/EP1607067B1/en
Priority to AT05356103T priority patent/ATE539706T1/en
Publication of FR2871369A1 publication Critical patent/FR2871369A1/en
Application granted granted Critical
Publication of FR2871369B1 publication Critical patent/FR2871369B1/en
Priority to US13/664,197 priority patent/US8852283B2/en
Priority to US14/504,327 priority patent/US9545312B2/en
Priority to US15/379,363 priority patent/US10610363B2/en
Priority to US16/806,311 priority patent/US11523907B2/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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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
    • A61F2/40—Joints for shoulders
    • A61F2/4081—Glenoid components, e.g. cups
    • 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
    • A61F2/30721—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
    • 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • 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
    • A61F2/40—Joints for shoulders
    • 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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    • A61F2/4059—Humeral shafts
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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
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30224—Three-dimensional shapes cylindrical
    • A61F2002/3023—Three-dimensional shapes cylindrical wedge-shaped cylinders
    • 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
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    • 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
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
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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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2002/30433—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
    • 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
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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
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    • 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
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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
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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
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    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
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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
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    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30795—Blind bores, e.g. of circular cross-section
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    • A61F2/4637—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for connecting or disconnecting two parts of a prosthesis
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    • 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
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
    • 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
    • A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
    • 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
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0069—Three-dimensional shapes cylindrical
    • 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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005—The prosthesis being constructed from a particular material
    • A61F2310/00011—Metals or alloys

Landscapes

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

Abstract

The component has a metallic unit (22) defining a convex articulation surface (S 2) which has a semi-sphere shape and centered on a symmetry axis (X 2 - X` 2). The symmetry axis is not perpendicular to rear side (26) of the component. The symmetry axis is directed towards base (21), when the rear side of the component is vertical. The component is configured such that the symmetry axis is horizontal when a patient stands. An independent claim is also included for an overall shoulder prosthesis including a glenoidal component.

Description

La présente invention a trait à un composant glénoïdien de prothèseThe present invention relates to a glenoid component of a prosthesis

d'épaule ainsi qu'à un jeu de tels composants pouvant être utilisés pour constituer une prothèse. L'invention a également trait à une prothèse  as well as a set of such components that can be used to form a prosthesis. The invention also relates to a prosthesis

d'épaule comprenant un tel composant ainsi qu'à une méthode de pose d'un tel composant.  shoulder comprising such a component as well as a method of laying such a component.

Dans le domaine des prothèses d'épaule, il est connu, par exemple de US-A3,978,528, de constituer une prothèse dite inversée dans laquelle une surface articulaire convexe solidaire de la glène et une surface articulaire concave solidaire de l'humérus coopèrent pour recréer une articulation au niveau de l'épaule. Dans ce genre de prothèses, le composant glénoïdien peut être formé, ainsi qu'il ressort de FR-A-2 835 425, d'une embase destinée à être immobilisée sur la glène et d'un élément destiné à être monté sur cette embase et définissant la surface d'articulation convexe.  In the field of shoulder prostheses, it is known, for example from US Pat. No. 3,978,528, to constitute an inverted prosthesis in which a convex articular surface integral with the glenoid and a concave articular surface integral with the humerus cooperate to recreate a joint at the shoulder. In this kind of prosthesis, the glenoid component can be formed, as is clear from FR-A-2,835,425, a base intended to be immobilized on the glenoid and an element intended to be mounted on this base and defining the convex hinge surface.

Il est par ailleurs connu de FR-A-2 836 039 de prévoir une possibilité de montage d'un élément formant une surface d'articulation convexe sur un socle correspondant dans différentes positions, ce qui permet un réglage de la surface articulaire en hauteur par rapport à la glène.  It is also known from FR-A-2 836 039 to provide a possibility of mounting a member forming a convex hinge surface on a corresponding base in different positions, which allows adjustment of the articular surface height by report to the glenoid.

L'embase ou le socle des composants glénoïdiens connus est pourvue d'une face dite face arrière destinée à venir en appui contre une surface réséquée de la glène qui est normalement sensiblement verticale lorsque le patient se tient debout. Or, il arrive que la partie supérieure de l'omoplate soit usée ou détruite, au point de modifier la cinématique de l'implant par le déplacement du centre de rotation d'origine, ce qui a pour conséquence de limiter les mouvements du bras du patient.  The base or the base of the known glenoid components is provided with a so-called rear face intended to bear against a resected surface of the glenoid which is normally substantially vertical when the patient is standing. However, it happens that the upper part of the scapula is worn or destroyed, to the point of modifying the kinematics of the implant by the displacement of the original center of rotation, which has the effect of limiting the movements of the arm of the patient.

C'est à ces inconvénients qu'entend plus particulièrement remédier l'invention en proposant un composant glénoïdien qui permet d'assurer un bon positionnement de la surface d'articulation convexe, y compris lorsque la glène est endommagée ou usée en partie supérieure, voire en partie inférieure.  It is these drawbacks that the invention intends to remedy more particularly by proposing a glenoid component which makes it possible to ensure a good positioning of the convex hinge surface, even when the glenoid is damaged or worn in the upper part, or even in the lower part.

Dans cet esprit, l'invention concerne un composant glénoïdien de prothèse d'épaule qui forme une surface d'articulation convexe centrée sur un axe de symétrie. Ce composant est caractérisé en ce que l'axe de symétrie de la surface d'articulation convexe est non perpendiculaire à une face arrière du composant qui est destinée à venir en appui contre la glène.  In this spirit, the invention relates to a glenoid component of a shoulder prosthesis which forms a convex hinge surface centered on an axis of symmetry. This component is characterized in that the axis of symmetry of the convex hinge surface is non-perpendicular to a rear face of the component which is intended to bear against the glenoid.

Grâce à l'invention, la surface d'articulation convexe peut être inclinée vers le bas ou déversée par rapport à la face arrière du composant, ce qui permet d'orienter de façon correcte cette surface articulaire, y compris lorsque la surface d'appui créée dans la glène par résection n'est pas parallèle à la direction de la colonne vertébrale du patient. L'invention permet donc de rattraper ou de compenser un défaut de parallélisme entre la surface réséquée de la glène et l'axe de la colonne vertébrale du patient.  Thanks to the invention, the convex hinge surface can be inclined downwards or poured relative to the rear face of the component, which allows to correctly orient this articular surface, including when the bearing surface created in the glenoid by resection is not parallel to the direction of the patient's spine. The invention therefore makes it possible to compensate for or compensate for a lack of parallelism between the resected surface of the glenoid and the axis of the patient's spine.

Selon des aspects avantageux mais non obligatoires, un composant glénoïdien peut incorporer une ou plusieurs des caractéristiques suivantes prises dans toute combinaison techniquement admissible: - En configuration assemblée du composant et lorsque la face arrière est verticale, l'axe de symétrie de la surface d'articulation convexe est dirigé vers le bas en s'éloignant de la face arrière.  According to advantageous but not mandatory aspects, a glenoid component may incorporate one or more of the following features taken in any technically permissible combination: - In the assembled configuration of the component and when the rear face is vertical, the axis of symmetry of the surface of the component convex hinge is directed downward away from the back face.

- Le composant comprend une embase apte à être immobilisée sur la glène d'une épaule et un élément prévu pour être monté sur cette embase et définissant la surface articulaire convexe, alors que l'embase est pourvue d'une face avant sensiblement plane dans laquelle est percé un logement de réception d'un doigt de centrage de l'élément formant la surface d'articulation convexe, ce logement étant centré sur un axe sensiblement perpendiculaire à cette face avant, cette face avant n'étant pas parallèle à la face arrière de l'embase. Dans ce cas, les faces avant et arrière de l'embase peuvent former entre elles un angle compris entre 2 et 18 . L'embase peut être pourvue d'une surface axisymétrique centrée sur un axe perpendiculaire à sa face avant, cette surface étant apte à coopérer avec une surface interne de l'élément précité pour son centrage et son immobilisation sur l'embase.  - The component comprises a base adapted to be immobilized on the glenoid of a shoulder and an element provided to be mounted on this base and defining the convex articular surface, while the base is provided with a substantially flat front face in which is drilled a housing for receiving a centering finger of the element forming the convex hinge surface, this housing being centered on an axis substantially perpendicular to the front face, this front face not being parallel to the rear face of the base. In this case, the front and rear faces of the base can form between them an angle of between 2 and 18. The base may be provided with an axisymmetric surface centered on an axis perpendicular to its front face, this surface being adapted to cooperate with an inner surface of the aforementioned element for its centering and its immobilization on the base.

- Le composant peut être pourvu d'une queue d'ancrage qui s'étend selon une direction qui n'est pas perpendiculaire à une partie au moins de sa face arrière.  - The component may be provided with an anchor tail which extends in a direction which is not perpendicular to at least part of its rear face.

- Le composant comprend une embase apte à être immobilisée sur la glène d'une épaule et un élément prévu pour être monté sur cette embase et définissant la surface articulaire convexe, alors que l'élément qui forme la surface d'articulation convexe est pourvu d'une jupe non symétrique par rapport à l'axe de la surface précitée, qui prolonge cette surface et dans laquelle est défini, au moins en partie, un logement de la réception d'une partie au moins de l'embase. Cette jupe peut être sensiblement en forme de tronçon de tore. L'élément qui définit la surface d'articulation convexe est avantageusement pourvu d'un perçage de passage d'un organe de manoeuvre d'un moyen de solidarisation de cet élément sur l'embase, ce passage s'étendant sensiblement selon une direction globalement perpendiculaire à cette surface mais non confondue avec son axe de symétrie.  - The component comprises a base adapted to be immobilized on the glenoid of a shoulder and a member adapted to be mounted on this base and defining the convex articular surface, while the element which forms the convex hinge surface is provided with a skirt not symmetrical with respect to the axis of the aforementioned surface, which extends this surface and in which is defined, at least in part, a receiving housing of at least a portion of the base. This skirt may be substantially in the form of a torus section. The element which defines the convex hinge surface is advantageously provided with a bore for the passage of an actuating member of a means for securing this element to the base, this passage extending substantially in a direction generally. perpendicular to this surface but not confused with its axis of symmetry.

L'invention concerne également un jeu de composants glénoïdiens pour prothèse d'épaule du type défini ci-dessus qui permet à un chirurgien de sélectionner un composant de géométrie adaptée en fonction de la configuration effective de la glène une fois celle-ci réséquée. Ce jeu de composants est caractérisé en ce que l'orientation de l'axe de symétrie de la surface d'articulation convexe, par rapport à une face arrière de chaque composant destinée à venir en appui contre la glène, est variable d'un composant à l'autre.  The invention also relates to a set of glenoid components for shoulder prosthesis of the type defined above which allows a surgeon to select a component of geometry adapted according to the effective configuration of the glenoid once it resected. This set of components is characterized in that the orientation of the axis of symmetry of the convex hinge surface, with respect to a rear face of each component intended to bear against the glenoid, is variable of a component to the other.

Selon une première variante de réalisation, les faces avant et arrière des embases des composants peuvent ne pas être parallèles entre elles, auquel cas l'angle entre ces faces avant et arrière est différent d'un composant à l'autre.  According to a first variant embodiment, the front and rear faces of the bases of the components may not be parallel to each other, in which case the angle between these front and rear faces is different from one component to the other.

Selon une autre variante, les éléments de ces composants qui forment une surface articulaire convexe peuvent être chacun pourvus d'une jupe, comme mentionné ci-dessus, les dimensions des jupes étant différentes d'un composant à l'autre.  According to another variant, the elements of these components which form a convex articular surface may each be provided with a skirt, as mentioned above, the dimensions of the skirts being different from one component to another.

L'invention concerne également une prothèse totale d'épaule qui comprend un composant glénoïdien tel que décrit ci-dessus ou sélectionné dans un jeu de composants tel que décrit ci-dessus.  The invention also relates to a total shoulder prosthesis which comprises a glenoid component as described above or selected from a set of components as described above.

L'invention concerne enfin une méthode de pose d'un composant glénoïdien de prothèse totale d'épaule, un tel composant définissant une surface articulaire convexe centrée sur un axe de symétrie, alors que cette méthode comprend des étapes consistant à : - fraiser la glène du patient pour créer une surface d'appui du composant; - sélectionner, parmi plusieurs composants glénoïdiens dont les axes de symétrie des surfaces articulaires convexes sont orientées différemment par rapport à leur face d'appui contre la surface réséquée de la glène, un composant qui peut être plaqué contre cette surface dans une position telle que l'axe de symétrie précité est globalement perpendiculaire à la direction de la colonne vertébrale du patient et - immobiliser le composant glénoïdien sélectionné sur la glène dans la position précitée.  The invention finally relates to a method for fitting a glenoid component of a total shoulder prosthesis, such a component defining a convex articular surface centered on an axis of symmetry, whereas this method comprises the steps of: - milling the glenoid the patient to create a support surface of the component; selecting, from among several glenoid components whose axes of symmetry of the convex articular surfaces are oriented differently with respect to their bearing surface against the resected surface of the glenoid, a component which can be pressed against this surface in a position such that the The aforementioned axis of symmetry is generally perpendicular to the direction of the patient's spine and immobilize the selected glenoid component on the glenoid in the aforementioned position.

L'invention sera mieux comprise et d'autres avantages de celle-ci apparaîtront plus clairement à la lumière de la description qui va suivre de cinq modes de réalisation d'un composant glénoïdien et de deux modes de réalisation d'un jeu de composants glénoïdiens conformes à son principe, donnée uniquement à titre d'exemple et faite en référence aux dessins annexés dans lesquels: - la figure 1 est une représentation schématique de principe d'une prothèse d'épaule conforme à l'invention implantée sur un patient dans une première configuration; - la figure 2 est une vue analogue à la figure 1 pour une prothèse également conforme à l'invention implantée dans une seconde configuration; - la figure 3 est une vue de côté éclatée du composant glénoïdien utilisé dans la prothèse de la figure 2; - la figure 4 est une vue en perspective d'une embase appartenant au composant représenté à la figure 3; - la figure 5 est une représentation schématique de principe d'un jeu de composants glénoïdiens incorporant celui représenté aux figures 3 et 4; - la figure 6 est une vue analogue à la figure 3 pour un composant conforme à un second mode de réalisation de l'invention; - la figure 7 est une vue analogue à la figure 3 pour 30 un composant conforme à un troisième mode de réalisation de l'invention; - la figure 8 représente un composant glénoïdien conforme à un quatrième mode de réalisation de l'invention dont l'embase est représentée en vue de côté et dont l'élément définissant la surface articulaire convexe est représenté en coupe transversale; - la figure 9 est une vue en perspective éclatée du composant de la figure 8; - la figure 10 est une vue analogue à la figure 8 pour un composant conforme à un cinquième mode de réalisation de l'invention; et - la figure il est une vue analogue à la figure 9 pour le composant de la figure 10.  The invention will be better understood and other advantages thereof will become more apparent in the light of the following description of five embodiments of a glenoid component and two embodiments of a set of glenoid components. in accordance with its principle, given solely by way of example and with reference to the accompanying drawings in which: - Figure 1 is a schematic representation of a shoulder prosthesis according to the invention implanted on a patient in a first configuration; - Figure 2 is a view similar to Figure 1 for a prosthesis also according to the invention implanted in a second configuration; FIG. 3 is an exploded side view of the glenoid component used in the prosthesis of FIG. 2; - Figure 4 is a perspective view of a base belonging to the component shown in Figure 3; FIG. 5 is a schematic representation of a set of glenoid components incorporating that represented in FIGS. 3 and 4; FIG. 6 is a view similar to FIG. 3 for a component according to a second embodiment of the invention; Figure 7 is a view similar to Figure 3 for a component according to a third embodiment of the invention; - Figure 8 shows a glenoid component according to a fourth embodiment of the invention, the base is shown in side view and whose element defining the convex articular surface is shown in cross section; FIG. 9 is an exploded perspective view of the component of FIG. 8; FIG. 10 is a view similar to FIG. 8 for a component according to a fifth embodiment of the invention; and FIG. 11 is a view similar to FIG. 9 for the component of FIG.

La prothèse P représentée à la figure 1 comprend un composant huméral 1 comportant une tige 11 destinée à être ancrée dans le canal médullaire de l'humérus H ainsi qu'une partie métaphysaire 12 dans laquelle est immobilisée une coupelle 13 en polyéthylène définissant une surface articulaire concave S1 sensiblement en forme de tronçon de sphère.  The prosthesis P shown in Figure 1 comprises a humeral component 1 comprising a rod 11 to be anchored in the medullary canal of the humerus H and a metaphyseal portion 12 in which is immobilized a polyethylene cup 13 defining a joint surface concave S1 substantially in the shape of a sphere section.

Selon une variante non représentée de l'invention, le composant 1 peut être dépourvu de coupelle 13, la surface S1 étant formée par la partie métaphysaire qui est métallique.  According to a variant not shown of the invention, the component 1 may be devoid of cup 13, the surface S1 being formed by the metaphyseal part which is metallic.

La prothèse P comprend également un composant glénoïdien 2 qui définit une surface articulaire convexe S2 sensiblement en forme de demi sphère.  The prosthesis P also comprises a glenoid component 2 which defines a convex articular surface S2 substantially in the shape of a half-sphere.

Pour la clarté du dessin, le composant 1 est représenté en coupe, alors que le composant 2 est 25 représenté en vue extérieure sur la figure 1.  For the sake of clarity, component 1 is shown in section, while component 2 is shown in an external view in FIG.

La surface S2 est sensiblement en forme de demi sphère et l'on note X2X'2 l'axe de symétrie sur lequel est centrée cette surface.  The surface S2 is substantially in the shape of a half-sphere and X2X'2 denotes the axis of symmetry on which this surface is centered.

On note par ailleurs Z-Z' un axe vertical passant par 30 le centre de la colonne vertébrale du patient qui se tient debout.  Z-Z 'is also noted as a vertical axis passing through the center of the vertebral column of the patient who is standing.

On note SG la surface fraisée de la glène G contre laquelle vient en appui le composant 2 lorsqu'il est monté sur la glène.  SG is noted the milled surface of the glenoid G against which bears the component 2 when mounted on the glenoid.

Normalement, la surface SG est sensiblement parallèle à l'axe Z-Z', de telle sorte qu'un axe XG-X'G normal à la surface SG et passant par son centre est sensiblement perpendiculaire à l'axe Z-Z', c'est-à-dire sensiblement horizontal lorsque le patient se tient debout. Dans la configuration de la figure 1 qui correspond à une configuration nominale d'implantation, les axes XG-X'G et X2-X'2 sont confondus et tous deux horizontaux.  Normally, the surface SG is substantially parallel to the axis Z-Z ', so that an axis XG-X'G normal to the surface SG and passing through its center is substantially perpendicular to the axis Z-Z' that is to say substantially horizontal when the patient is standing. In the configuration of FIG. 1, which corresponds to a nominal layout configuration, the XG-X'G and X2-X'2 axes coincide and both are horizontal.

Cependant, comme représenté à la figure 2, il arrive que la surface SG ne soit pas réellement parallèle à l'axe Z-Z', notamment du fait d'une usure de la glène G ou d'une destruction partielle de celle-ci en partie haute, voire en partie basse. Dans ce cas, la surface SG forme un angle a non nul par rapport à une droite Z1-Z'1 parallèle à l'axe Z- Z' et passant par le centre MG de la surface SG. Lorsque le patient se tient debout, l'axe XG-X'G forme, par rapport à l'horizontale, le même angle a.  However, as shown in FIG. 2, it happens that the surface SG is not really parallel to the axis Z-Z ', in particular because of a wear of the glenoid G or a partial destruction thereof in the upper part, even in the lower part. In this case, the surface SG forms a non-zero angle with respect to a straight line Z1-Z'1 parallel to the axis ZZ 'and passing through the center MG of the surface SG. When the patient is standing, the axis XG-X'G forms, relative to the horizontal, the same angle a.

Conformément à l'invention, le composant 2 est configuré pour que l'axe X2-X' 2 de la surface S2 soit sensiblement horizontal lorsque le patient se tient debout, malgré l'orientation non optimale de la surface SG.  According to the invention, the component 2 is configured so that the axis X2-X '2 of the surface S2 is substantially horizontal when the patient is standing, despite the non-optimal orientation of the surface SG.

Le composant 2 est représenté en vue de côté éclatée à la figure 3 et comprend une embase ou platine 21 destinée à être fixée sur la glène G, ainsi qu'un élément métallique 22, parfois dénommé tête , qui définit la surface S2 et qui est pourvu d'un doigt de centrage 23 destiné à pénétrer dans un logement 24 ménagé dans l'embase 21 et centré sur un axe X24-X'24 perpendiculaire à la face avant 25 de l'embase 21 qui est sensiblement plane et orientée à l'opposé de la glène lorsque l'embase est montée sur la glène.  The component 2 is shown in an exploded side view in FIG. 3 and comprises a base or plate 21 intended to be fixed on the glenoid G, as well as a metal element 22, sometimes referred to as a head, which defines the surface S2 and which is provided with a centering finger 23 intended to penetrate into a housing 24 formed in the base 21 and centered on an axis X24-X'24 perpendicular to the front face 25 of the base 21 which is substantially flat and oriented at the opposite of the glenoid when the base is mounted on the glenoid.

On note 26 la face arrière de l'embase 21 qui porte contre la surface SG en configuration montée de l'embase.  Note 26 the rear face of the base 21 which bears against the surface SG in mounted configuration of the base.

Une queue d'ancrage 27 s'étend à partir de la surface 26 selon une direction parallèle à un axe X27-X'27 perpendiculaire à la surface 26.  An anchor tail 27 extends from the surface 26 in a direction parallel to an axis X27-X'27 perpendicular to the surface 26.

L'embase 21 est également percée de quatre orifices 28 5 de passage de quatre vis 29 représentées uniquement par leurs traits d'axe à la figure 4.  The base 21 is also pierced with four orifices 28 for the passage of four screws 29 represented solely by their centerlines in FIG. 4.

La face avant 25 est en forme de disque centré sur l'axe X24-X'24 et bordée par une surface 30 tronconique, centrée sur l'axe X24-X'24 et convergente à l'opposé de la queue 27.  The front face 25 is disk-shaped centered on the X24-X'24 axis and bordered by a frustoconical surface 30, centered on the X24-X'24 axis and converging opposite the tail 27.

La surface 30 s'étend tout autour de la face avant 25 mais rejoint la face arrière 26 sur une partie seulement de la périphérie de l'embase 21.  The surface 30 extends all around the front face 25 but rejoins the rear face 26 on only a part of the periphery of the base 21.

La face 26 est sensiblement plane et les faces 25 et 15 26 ne sont pas parallèles entre elles. On note 0 l'angle non nul formé entre les faces 25 et 26.  The face 26 is substantially flat and the faces 25 and 26 are not parallel to each other. We note 0 the non-zero angle formed between the faces 25 and 26.

Le caractère incliné de la face avant 25 par rapport à la face arrière 26 de l'embase 21 permet de rattraper complètement ou partiellement le caractère incliné par rapport à la droite Z1-Z'1 de la surface SG, pour autant que la partie la moins épaisse de l'embase 21, qui est représentée sur la droite de la figure 3, est disposée au voisinage de la partie inférieure de la surface SG, c'est-à-dire de la partie située du côté des côtes du patient.  The inclined nature of the front face 25 relative to the rear face 26 of the base 21 makes it possible to make up completely or partially the inclined character with respect to the straight line Z1-Z'1 of the surface SG, provided that the part Less thick of the base 21, which is shown on the right of Figure 3, is disposed in the vicinity of the lower part of the surface SG, that is to say, the part located on the side of the patient's ribs.

Lorsque l'embase ou platine 21 a été ancrée sur la glène G comme indiqué ci-dessus grâce à la queue 27 et à la mise en place des quatre vis 29, l'élément 22 peut être mis en place en introduisant le doigt 23 dans le logement 24 et en faisant porter une surface interne 31 de l'élément 22 représenté en pointillés uniquement à la figure 3 contre la surface 30. Les géométries des surfaces 30 et 31 sont adaptées pour obtenir un verrouillage à la façon d'un cône Morse.  When the base or plate 21 has been anchored to the glenoid G as indicated above thanks to the shank 27 and to the introduction of the four screws 29, the element 22 can be put in place by introducing the finger 23 into the housing 24 and carrying an inner surface 31 of the element 22 shown in phantom only in Figure 3 against the surface 30. The geometries of the surfaces 30 and 31 are adapted to obtain a lock in the manner of a Morse taper .

Ainsi, l'orientation relative des faces 25 et 26 permet d'orienter l'axe X2-X'2 de la surface S2 vers le bas à la figure 2 par rapport à l'axe XGX'G dans sa partie qui dépasse de la glène, c'est-à-dire de ramener cet axe en configuration sensiblement horizontale, alors que la surface SG n'est pas parallèle à l'axe Z-Z'.  Thus, the relative orientation of the faces 25 and 26 makes it possible to orient the axis X 2 -X '2 of the surface S 2 downwards in FIG. 2 with respect to the axis XGX' G in its portion which exceeds the glene, that is to say to bring this axis in substantially horizontal configuration, while the SG surface is not parallel to the Z-Z 'axis.

Compte tenu de l'orientation relative des faces 25 et 26, la surface 30 ne borde la face 25 que sur une fraction de la hauteur de la partie de l'embase située entre les faces 25 et 26. On note 32 la portion de surface périphérique de l'embase 21 qui n'est pas formée par la partie 30. Cette surface est gauche.  Given the relative orientation of the faces 25 and 26, the surface 30 borders the face 25 only a fraction of the height of the portion of the base located between the faces 25 and 26. Note 32 the surface portion peripheral of the base 21 which is not formed by the portion 30. This surface is left.

Comme il ressort plus particulièrement de la figure 5, un jeu de composants glénoïdiens conforme à l'invention peut incorporer plusieurs composants glénoïdiens 2a, 2b, 2c et 2d dont les embases 21a, 21b, 21c et 21d ont des faces avant 25a, 25b, 25c et 25d qui font des angles,6a, Pb, $c, ,3d différents par rapport à leurs faces arrières respectives 26a, 26b, 26c et 26d. On note que les faces avant et arrière de l'embase 21d sont sensiblement parallèles, l'angle,6d entre celles-ci est alors nul.  As is more particularly apparent from FIG. 5, a set of glenoid components according to the invention can incorporate several glenoid components 2a, 2b, 2c and 2d whose bases 21a, 21b, 21c and 21d have front faces 25a, 25b, 25c and 25d which make angles, 6a, Pb, $ c,, 3d different from their respective rear faces 26a, 26b, 26c and 26d. Note that the front and rear faces of the base 21d are substantially parallel, the angle, 6d between them is then zero.

L'élément 22 associé à chaque embase 21a, 21b, 21c et 21d peut être le même ou être différent d'un composant à l'autre.  The element 22 associated with each base 21a, 21b, 21c and 21d may be the same or different from one component to another.

Ainsi, lorsqu'un chirurgien pose une prothèse d'épaule P, il peut, en fonction de l'orientation relative de la surface SG et de l'axe Z-Z', choisir un composant glénoïdien dont l'embase comporte des faces avant et arrière orientées d'une façon permettant de rattraper l'essentiel du défaut d'orientation de la surface SG.  Thus, when a surgeon places a shoulder prosthesis P, he can, depending on the relative orientation of the SG surface and the Z-Z 'axis, choose a glenoid component whose base comprises front faces and rear oriented in a way to make up most of the defect orientation SG surface.

Bien entendu, le nombre de composants glénoïdiens d'un jeu tel que celui représenté à la figure 5 n'est pas nécessairement de quatre. Il peut être choisi en fonction de la précision recherchée. En outre, il n'est pas obligatoire que, dans un tel jeu, une platine ait des surfaces parallèles entre elles, comme celle représentée sur la droite de la figure 5. On note cependant que le composant glénoïdien représenté sur la droite de la figure 5 peut être utilisé lorsque la prothèse P doit être implantée dans la configuration de la figure 1.  Of course, the number of glenoid components of a game such as that shown in Figure 5 is not necessarily four. It can be chosen according to the desired accuracy. In addition, it is not mandatory that, in such a game, a plate has surfaces parallel to each other, such as that shown on the right of Figure 5. Note however that the glenoid component shown on the right of the figure 5 can be used when the prosthesis P is to be implanted in the configuration of FIG.

La pose d'une prothèse totale d'épaule est facilitée par l'utilisation d'un tel jeu de composants dans la mesure où le chirurgien peut sélectionner un composant glénoïdien effectivement adapté à la morphologie du patient puis immobiliser ce composant dans une position telle que l'axe de symétrie de la surface articulaire convexe est sensiblement perpendiculaire à l'axe longitudinal de la colonne vertébrale du patient.  The installation of a total shoulder prosthesis is facilitated by the use of such a set of components insofar as the surgeon can select a glenoid component effectively adapted to the patient's morphology and then immobilize this component in a position such that the axis of symmetry of the convex articular surface is substantially perpendicular to the longitudinal axis of the patient's spine.

Dans le second mode de réalisation de l'invention représenté à la figure 6, les éléments analogues à ceux du premier mode de réalisation portent des références identiques augmentées de 100. Le composant glénoïdien 102 de ce mode de réalisation comprend un élément 122 qui porte une surface articulaire convexe sensiblement hémisphérique, cet élément étant identique à celui du premier mode de réalisation. L'embase 121 du composant 102 comprend également une queue d'ancrage 127. Cette queue d'ancrage est centrée sur un axe X27-X'27 perpendiculaire à la face avant 125 de l'embase 121 qui est plane et bordée par une surface tronconique 130. L'embase 121 est pourvue d'une logement 124 de réception d'un doigt 123 appartenant à l'élément 122, ce doigt étant centré sur l'axe X2-X'2 de symétrie de la surface S2. L'axe central X124-X'124 du logement 124 est confondu avec l'axe central X127-X' 127 de la queue 127.  In the second embodiment of the invention shown in FIG. 6, elements similar to those of the first embodiment carry identical references increased by 100. The glenoid component 102 of this embodiment comprises an element 122 which carries a substantially hemispherical convex articular surface, this element being identical to that of the first embodiment. The base 121 of the component 102 also comprises an anchoring stem 127. This anchoring tail is centered on an axis X 27 -X '27 perpendicular to the front face 125 of the base 121 which is flat and bordered by a surface frustoconical 130. The base 121 is provided with a housing 124 for receiving a finger 123 belonging to the element 122, the finger being centered on the axis X2-X'2 of symmetry of the surface S2. The central axis X124-X'124 of the housing 124 coincides with the central axis X127-X '127 of the shank 127.

Ce mode de réalisation diffère du précédent en ce que la face arrière 126 de l'embase 121 n'est pas perpendiculaire à l'axe X127-X'127, de telle sorte qu'un angle 0 non nul existe entre les faces 125 et 126.  This embodiment differs from the previous one in that the rear face 126 of the base 121 is not perpendicular to the axis X127-X'127, so that a non-zero angle θ exists between the faces 125 and 126.

Dans ce mode de réalisation, on peut considérer que la face arrière 126 est pourvue d'un talon ou coin 134 qui sert à compenser l'orientation non optimale de la surface SG.  In this embodiment, it can be considered that the rear face 126 is provided with a heel or wedge 134 which serves to compensate for the non-optimal orientation of the surface SG.

Dans le troisième mode de réalisation de l'invention représenté à la figure 7, les éléments analogues à ceux du premier mode de réalisation portent des références identiques augmentées de 200. Le composant glénoïdien 202 de ce mode de réalisation comprend une embase 221 ainsi qu'un élément 222 qui forme une surface articulaire S2 sensiblement hémisphérique et centrée sur un axe X2-X' 2 sur lequel est également centré un doigt de centrage 223.  In the third embodiment of the invention shown in FIG. 7, elements similar to those of the first embodiment carry identical references increased by 200. The glenoid component 202 of this embodiment comprises a base 221 as well as an element 222 which forms a substantially hemispherical articular surface S2 centered on an axis X2-X '2 on which is also centered a centering pin 223.

Les faces avant 225 et arrière 226 de l'embase 221 ne sont pas parallèles entre elles et définissent un angle i non nul. Ce mode de réalisation incorpore certains éléments des premier et second modes de réalisation à savoir que les surfaces 225 et 226 sont toutes deux inclinées, dans des sens différents, par rapport à un axe longitudinal X227-X'227 d'une queue d'ancrage 227 de l'embase 221 dans la glène.  The front 225 and rear 226 of the base 221 are not parallel to each other and define a non-zero angle. This embodiment incorporates certain elements of the first and second embodiments, namely that the surfaces 225 and 226 are both inclined, in different directions, relative to a longitudinal axis X227-X'227 of an anchor tail. 227 of the base 221 in the glenoid.

Dans le quatrième mode de réalisation de l'invention représenté aux figures 8 et 9, les éléments analogues à ceux du premier mode de réalisation portent des références identiques augmentées de 300. Le composant glénoïdien 302 de ce mode de réalisation comprend une embase 321 analogue à celle du composant représenté sur la droite de la figure 5, c'est-à-dire dont les faces avant 325 et arrière 326 sont sensiblement parallèles entre elles et perpendiculaires à un axe central X327-X'327 d'une queue d'ancrage 327.  In the fourth embodiment of the invention shown in FIGS. 8 and 9, elements similar to those of the first embodiment carry identical references increased by 300. The glenoid component 302 of this embodiment comprises a base 321 similar to that of the component shown on the right of Figure 5, that is to say whose front 325 and rear 326 are substantially parallel to each other and perpendicular to a central axis X327-X'327 of an anchor tail 327.

Un élément 322 destiné à être monté sur l'embase 321 définit une surface S2 sensiblement en forme de demi sphère et centrée sur un axe X2-X'2 qui n'est pas parallèle à l'axe X327-X' 327 en configuration montée de l'élément 322 sur l'embase 321. Pour ce faire, la portion 322a de l'élément 322 qui définit la surface S2 est prolongée par une jupe 322b en forme de tronçon de tore centré sur un axe Xc perpendiculaire à l'axe X2-X'2 et tangent à la surface articulaire convexe S2 au voisinage d'une zone d'intersection entre cette surface S2 et un plan H perpendiculaire à l'axe X2-X'2 et passant par le centre C2 de la surface S2. On note y l'amplitude angulaire de la jupe 322, c'est-à-dire l'angle entre le plan 7r et la face arrière 322c de l'élément 322 destinée à être tournée vers la surface réséquée de la glène en configuration montée du composant 302.  An element 322 intended to be mounted on the base 321 defines a surface S2 substantially in the shape of a half-sphere and centered on an axis X2-X'2 which is not parallel to the axis X327-X '327 in mounted configuration of element 322 on the base 321. To do this, the portion 322a of the element 322 which defines the surface S2 is extended by a skirt 322b in the form of a torus portion centered on an axis Xc perpendicular to the axis X2-X'2 and tangent to the convex articular surface S2 in the vicinity of an intersection zone between this surface S2 and a plane H perpendicular to the axis X2-X'2 and passing through the center C2 of the surface S2 . There is noted the angular amplitude of the skirt 322, that is to say the angle between the plane 7r and the rear face 322c of the element 322 intended to be turned towards the resected surface of the glenoid in mounted configuration component 302.

Un logement 332 est ménagé à l'intérieur de l'élément 322, à la fois dans la jupe 322b et dans la portion 322a. Ce logement est destiné à recevoir la partie de l'embase 321 définie entre les surfaces 325 et 326. Le logement 332 est bordé par une surface 331 tronconique et convergente en direction de la surface S21 alors qu'une surface 330 de même géométrie est prévue sur l'élément 321 entre les faces 325 et 326.  A housing 332 is formed inside the element 322, both in the skirt 322b and in the portion 322a. This housing is intended to receive the part of the base 321 defined between the surfaces 325 and 326. The housing 332 is bordered by a frustoconical surface 331 and convergent towards the surface S21 while a surface 330 of the same geometry is provided on the element 321 between the faces 325 and 326.

On note 333 l'ouverture d'entrée circulaire du logement 332.  Note 333 the circular inlet opening of the housing 332.

La surface S2 est percée d'un passage 334 permettant l'introduction d'un outil dans le sens de la flèche F3 jusqu'à l'intérieur de l'élément 322, ce qui permet de manoeuvrer une vis non représentée d'immobilisation de l'élément 322 sur l'embase 321. Une telle vis peut, notamment, commander le déplacement d'un doigt tel que le doigt 23 du premier mode de réalisation, qui est alors fileté, pour l'amener en prise avec une partie taraudée de l'embase 321, ceci conformément à l'enseignement technique de FR-A-2 835 425.  The surface S2 is pierced with a passage 334 allowing the insertion of a tool in the direction of the arrow F3 to the inside of the element 322, which makes it possible to maneuver a screw the element 322 on the base 321. Such a screw may, in particular, control the movement of a finger such as the finger 23 of the first embodiment, which is then threaded, to bring it into engagement with a threaded portion of the base 321, this in accordance with the technical teaching of FR-A-2,835,425.

On note X334-X'334 l'axe longitudinal du passage 334. Cet axe est perpendiculaire à la surface S2 et décalé de l'angle y par rapport à l'axe X2-X'2.  X334-X'334 is the longitudinal axis of the passage 334. This axis is perpendicular to the surface S2 and offset from the angle y with respect to the axis X2-X'2.

Dans le cinquiême mode de réalisation de l'invention représenté à la figure 10, les éléments analogues à ceux du premier mode de réalisation portent des références identiques augmentées de 400. Le composant glénoïdien 402 de ce mode de réalisation est réalisé selon le même principe que celui du quatrième mode de réalisation avec une embase 421 identique à l'embase 321 et un élément 422 qui définit une surface S2 centrée sur un axe X2-X' 2 incliné vers le bas à la figure 10. Ce mode de réalisation diffère du précédent en ce que l'amplitude angulaire y de la jupe 422b, qui prolonge la portion 422a de l'élément 422 définissant la surface S2, est plus important que dans le mode de réalisation des figures 8 et 9, ce qui permet d'augmenter l'effet de déversement de la surface S2 par rapport à la face arrière 426 de l'embase 421.  In the fifth embodiment of the invention shown in FIG. 10, elements similar to those of the first embodiment bear identical references increased by 400. The glenoid component 402 of this embodiment is produced according to the same principle as that of the fourth embodiment with a base 421 identical to the base 321 and an element 422 which defines a surface S2 centered on an axis X2-X '2 inclined downwards in Figure 10. This embodiment differs from the previous in that the angular amplitude y of the skirt 422b, which extends the portion 422a of the element 422 defining the surface S2, is greater than in the embodiment of FIGS. 8 and 9, which makes it possible to increase the spill effect of the surface S2 with respect to the rear face 426 of the base 421.

Les composants représentés aux figures 8 à 11 peuvent être considérés comme appartenant à un même jeu de composants glénoïdiens permettant au chirurgien de sélectionner le composant le plus adapté en fonction de la valeur de l'angle y et de l'orientation de la surface réséquée SG de la glène par rapport à l'axe longitudinal Z-25 Z' de la colonne vertébrale du patient.  The components shown in FIGS. 8 to 11 can be considered as belonging to the same set of glenoid components allowing the surgeon to select the most adapted component as a function of the value of the angle γ and the orientation of the resected surface SG of the glenoid with respect to the longitudinal axis Z-25 Z 'of the patient's spine.

Bien entendu, le nombre de composants d'un tel jeu n'est pas limité à deux.  Of course, the number of components of such a game is not limited to two.

Les caractéristiques des différents modes de réalisation représentés peuvent être combinées entre elles en ce sens qu'une embase ou platine à faces avant et arrière non parallèles pourrait être utilisée avec un élément pourvu d'une jupe prolongeant la portion de cet élément définissant une surface articulaire convexe axisymétrique.  The characteristics of the different embodiments shown can be combined with each other in that a base or plate with non-parallel front and rear faces could be used with an element provided with a skirt extending the portion of this element defining a joint surface. convex axisymmetric.

L'invention permet également une implantation correcte d'un composant glénoïdien lorsque la partie inférieure de l'omoplate est endommagée. Il suffit alors de retourner le composant par rapport à la configuration représentée à la figure 2.  The invention also allows for proper implantation of a glenoid component when the lower portion of the scapula is damaged. It is then sufficient to return the component with respect to the configuration shown in FIG.

L'invention a été représentée avec des composants glénoïdiens bi-partites. Elle s'applique cependant 10 également aux composants glénoïdiens monoblocs.  The invention has been shown with bi-partite glenoid components. It also applies, however, to monoblock glenoid components.

Claims (13)

REVENDICATIONS 1. Composant glénoïdien de prothèse d'épaule formant une surface d'articulation convexe centrée sur un axe de symétrie, caractérisé en ce que ledit axe de symétrie (X2-X' 2) est non perpendiculaire (0,r) à une face arrière (26 126; 226; 326; 426) dudit composant (2; 102; 202 302; 402) destinée à venir en appui contre la glène (G).  A glenoid component of a shoulder prosthesis forming a convex hinge surface centered on an axis of symmetry, characterized in that said axis of symmetry (X2-X '2) is non-perpendicular (0, r) to a rear face (26,126; 226; 326; 426) of said component (2; 102; 202,302; 402) intended to bear against the glenoid (G). 2. Composant selon la revendication 1, caractérisé en ce qu'en configuration montée dudit composant (2; 102; 202; 302; 402) et lorsque ladite face arrière (26; 126 226; 326; 426) est verticale, ledit axe (X2X'2) est dirigé vers le bas en s'éloignant de ladite face arrière.  2. Component according to claim 1, characterized in that in mounted configuration of said component (2; 102; 202; 302; 402) and when said rear face (26; 126,226; 326; 426) is vertical, said axis ( X2X'2) is directed downward away from said rear face. 3. Composant selon l'une des revendications précédentes, caractérisé en ce qu'il comprend une embase (21; 121; 221), apte à être immobilisée sur la glène d'une épaule, et un élément (22; 122; 222), prévu pour être monté sur ladite embase et définissant ladite surface (S2), et en ce que ladite embase est pourvue d'une face avant (25; 125; 225) sensiblement plane dans laquelle est percé un logement (24; 124) de réception d'un doigt (23 123; 223) de centrage dudit élément (22; 122; 222), ledit logement étant centré sur un axe (X24-X'24; X124-X'124) sensiblement perpendiculaire à ladite face avant, ladite face avant n'étant pas parallèle (0) à la face arrière (26; 126; 226) de ladite embase.  3. Component according to one of the preceding claims, characterized in that it comprises a base (21; 121; 221), adapted to be immobilized on the glenoid of a shoulder, and a member (22; 122; 222). , adapted to be mounted on said base and defining said surface (S2), and in that said base is provided with a substantially planar front face (25; 125; 225) in which a housing (24; receiving a finger (23 123; 223) for centering said element (22; 122; 222), said housing being centered on an axis (X24-X'24; X124-X'124) substantially perpendicular to said front face, said front face not being parallel (0) to the rear face (26; 126; 226) of said base. 4. Composant selon la revendication 3, caractérisé en ce que lesdites faces avant (25; 125; 225) et arrière (26; 126; 226) forment ensemble un angle (0) compris entre 2 et 18 .  4. Component according to claim 3, characterized in that said front (25; 125; 225) and rear (26; 126; 226) faces together form an angle (0) between 2 and 18. 5. Composant selon l'une des revendications 3 ou 4, caractérisé en ce que ladite embase (21; 121; 221) est pourvue d'une surface axisymétrique (30; 130) centrée sur un axe (X24-X'24; X124-X' 124) perpendiculaire à ladite face avant (25; 125; 225), ladite surface étant apte à coopérer avec une surface interne (31) dudit élément (22; 122; 222) pour le centrage et l'immobilisation dudit élément sur ladite embase.  5. Component according to one of claims 3 or 4, characterized in that said base (21; 121; 221) is provided with an axisymmetrical surface (30; 130) centered on an axis (X24-X'24; X124 -X '124) perpendicular to said front face (25; 125; 225), said surface being adapted to cooperate with an inner surface (31) of said member (22; 122; 222) for centering and immobilizing said element on said base. 6. Composant selon l'une des revendications précédentes, caractérisé en ce qu'il est pourvu d'une queue d'ancrage (127; 227) qui s'étend selon une direction qui n'est pas perpendiculaire à une partie au moins de ladite face arrière (126; 226).  6. Component according to one of the preceding claims, characterized in that it is provided with an anchor (127; 227) which extends in a direction which is not perpendicular to at least a part of said rear face (126; 226). 7. Composant selon l'une des revendications précédentes, caractérisé en ce qu'il comprend une embase (321; 421), apte à être immobilisée sur la glène d'une épaule, et un élément (322; 422) prévu pour être monté sur ladite embase définissant ladite surface (S2) et en ce que ledit élément est pourvu d'une jupe (322b; 422b) non symétrique (y) par rapport audit axe, qui prolonge ladite surface articulaire convexe (S2) et dans laquelle est défini, au moins en partie, un logement (332) de réception d'une partie au moins de ladite embase (321; 421).  7. Component according to one of the preceding claims, characterized in that it comprises a base (321; 421), adapted to be immobilized on the glenoid of a shoulder, and a member (322; 422) intended to be mounted. on said base defining said surface (S2) and in that said element is provided with a non-symmetrical skirt (322b; 422b) (y) with respect to said axis, which extends said convex articular surface (S2) and in which is defined at least in part, a housing (332) for receiving at least a portion of said base (321; 421). 8. Composant selon la revendication 7, caractérisé en ce que ladite jupe (322b; 422b) est sensiblement en forme de tronçon de tore.  8. Component according to claim 7, characterized in that said skirt (322b; 422b) is substantially in the form of a torus section. 9. Composant selon l'une des revendications 7 ou 8, caractérisé en ce que ledit élément (322; 422) est pourvu d'un perçage (334) de passage (F3) d'un organe de man uvre d'un moyen de solidarisation dudit élément sur ladite embase (321; 421), ledit perçage s'étendant sensiblement selon une direction (X334-X'334) globalement perpendiculaire à ladite surface (S2) et non confondue (y) avec ledit axe (X2-X' 2)  9. Component according to one of claims 7 or 8, characterized in that said element (322; 422) is provided with a piercing (334) passage (F3) of a body of maneuver means of securing said element to said base (321; 421), said piercing extending substantially in a direction (X334-X'334) generally perpendicular to said surface (S2) and not coincidental (y) with said axis (X2-X ' 2) 10. Jeu de composants glénoïdiens pour prothèse d'épaule dans lequel chaque composant forme une surface d'articulation convexe centrée sur un axe de symétrie, caractérisé en ce que l'orientation (0,y) dudit axe de symétrie (X2-X'2), par rapport à une face arrière (26; 126; 226; 326; 426) de chaque composant destinée à venir en appui contre la glène (G), est variable d'un composant à l'autre (2a-2d; 302, 402).10. Set of glenoid components for shoulder prosthesis in which each component forms a convex hinge surface centered on an axis of symmetry, characterized in that the orientation (0, y) of said axis of symmetry (X2-X ' 2), with respect to a rear face (26; 126; 226; 326; 426) of each component intended to bear against the glenoid (G), is variable from one component to another (2a-2d; 302, 402). 11. Jeu de composants selon la revendication 10, caractérisé en ce que les composants sont selon la revendication 3 et en ce que l'angle (a) entre les faces avant (25; 125; 225) et arrière (26; 126; 226) des embases (21; 121; 221) est différent d'un composant à l'autre (2a-2d).  11. Set of components according to claim 10, characterized in that the components are according to claim 3 and in that the angle (a) between the front (25; 125; 225) and rear (26; 126; 226) faces. ) bases (21; 121; 221) is different from one component to another (2a-2d). 12. Jeu de composants selon la revendication 10, caractérisé en ce que les composants sont selon la revendication 7 et en ce que les dimensions (y) des jupes (322b, 422b) sont différentes d'un composant à l'autre (302, 402).  12. Set of components according to claim 10, characterized in that the components are according to claim 7 and in that the dimensions (y) of the skirts (322b, 422b) are different from one component to another (302, 402). 13. Prothèse totale d'épaule, caractérisée en ce qu'elle comprend un composant glénoïdien (2; 102; 202; 302; 402) selon l'une des revendications 1 à 9 ou sélectionné dans un jeu de composants (2a-2d; 302, 402) selon l'une des revendications 10 à 12.  13. Total shoulder prosthesis, characterized in that it comprises a glenoid component (2; 102; 202; 302; 402) according to one of claims 1 to 9 or selected from a set of components (2a-2d; 302, 402) according to one of claims 10 to 12.
FR0406471A 2004-06-15 2004-06-15 GLENOIDAL COMPONENT, SET OF SUCH COMPONENTS AND SHOULDER PROSTHESIS INCORPORATING SUCH GLENOID COMPONENT Expired - Fee Related FR2871369B1 (en)

Priority Applications (8)

Application Number Priority Date Filing Date Title
FR0406471A FR2871369B1 (en) 2004-06-15 2004-06-15 GLENOIDAL COMPONENT, SET OF SUCH COMPONENTS AND SHOULDER PROSTHESIS INCORPORATING SUCH GLENOID COMPONENT
US11/147,177 US8303665B2 (en) 2004-06-15 2005-06-08 Glenoidal component, set of such components and shoulder prosthesis incorporating such a glenoidal component
EP05356103A EP1607067B1 (en) 2004-06-15 2005-06-14 Glenoid component, set of such elements and shoulder prosthesis comprising such a glenoid component
AT05356103T ATE539706T1 (en) 2004-06-15 2005-06-14 SHOULDER JOINT POCKET PART, SET OF SUCH PARTS AND SHOULDER PROSTHESIS HAVING SUCH A SHOULDER JOINT POCKET PART
US13/664,197 US8852283B2 (en) 2004-06-15 2012-10-30 Glenoidal component, set of such components and shoulder prosthesis incorporating such a glenoidal component
US14/504,327 US9545312B2 (en) 2004-06-15 2014-10-01 Glenoidal component, set of such components and shoulder prosthesis incorporating such a glenoidal component
US15/379,363 US10610363B2 (en) 2004-06-15 2016-12-14 Glenoidal component, set of such components and shoulder prosthesis incorporating such a glenoidal component
US16/806,311 US11523907B2 (en) 2004-06-15 2020-03-02 Glenoidal component, set of such components and shoulder prosthesis incorporating such a glenoidal component

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FR0406471A FR2871369B1 (en) 2004-06-15 2004-06-15 GLENOIDAL COMPONENT, SET OF SUCH COMPONENTS AND SHOULDER PROSTHESIS INCORPORATING SUCH GLENOID COMPONENT

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EP2001414A2 (en) * 2006-03-23 2008-12-17 Exactech, Inc. Reverse shoulder prosthesis
WO2013148438A1 (en) * 2012-03-27 2013-10-03 DePuy Synthes Products, LLC Reverse shoulder orthopaedic implant having an elliptical glenosphere component
EP2689750A1 (en) * 2012-07-23 2014-01-29 Tornier Orthopedics Ireland Ltd. Glenoidal implant for shoulder prosthesis, support plate and surgical kit
US9629724B2 (en) 2012-03-27 2017-04-25 DePuy Synthes Products, Inc. Method of implanting a reverse shoulder orthopaedic implant having a metaglene component with a screw locking cap

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FR2871369B1 (en) 2006-08-25

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