FR2927529A1 - Joint e.g. inter-phalangeal joint, prosthesis, for patient, has blade forming central part projecting in transverse direction, where central part is directed from side of treated joint whose flexion movement is realized on central part - Google Patents
Joint e.g. inter-phalangeal joint, prosthesis, for patient, has blade forming central part projecting in transverse direction, where central part is directed from side of treated joint whose flexion movement is realized on central part Download PDFInfo
- Publication number
- FR2927529A1 FR2927529A1 FR0800808A FR0800808A FR2927529A1 FR 2927529 A1 FR2927529 A1 FR 2927529A1 FR 0800808 A FR0800808 A FR 0800808A FR 0800808 A FR0800808 A FR 0800808A FR 2927529 A1 FR2927529 A1 FR 2927529A1
- Authority
- FR
- France
- Prior art keywords
- prosthesis
- joint
- central part
- bone
- anchoring
- 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
Links
Classifications
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- 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
- A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4225—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for feet, e.g. toes
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
- A61F2002/3006—Properties of materials and coating materials
- A61F2002/30092—Properties of materials and coating materials using shape memory or superelastic materials, e.g. nitinol
-
- 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
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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
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- A61F2002/3011—Cross-sections or two-dimensional shapes
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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
- 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
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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- A61F2002/30182—Other shapes
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- 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
- A61F2002/30565—Special structural features of bone or joint prostheses not otherwise provided for having spring elements
- A61F2002/30571—Leaf springs
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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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
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30574—Special structural features of bone or joint prostheses not otherwise provided for with an integral complete or partial collar or flange
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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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- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
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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
- 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
-
- 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
- A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys
-
- 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
- A61F2310/00035—Other metals or alloys
- A61F2310/00071—Nickel or Ni-based alloys
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- 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
Description
1 La présente invention concerne une prothèse d'articulation pour articulation inter-phalangienne ou phalango-métacarpienne ou phalangométatarsienne. Pour traiter une affection au niveau d'une articulation inter-phalangienne, une technique connue consiste à immobiliser l'articulation en position d'alignement des phalanges au moyen d'une broche. Une telle arthrodèse a pour inconvénient majeur d'être invalidante, le patient ne pouvant plus saisir un objet de dimensions réduites tel qu'une aiguille posée sur une surface. Une autre technique consiste à implanter aux extrémités des deux os concernés des inserts de resurfaçage en matériau métallique. Cette technique n'est pas satisfaisante, compte tenu de l'absence de contrôle, ou du contrôle réduit, des mouvements de l'articulation en extension et dans la direction médio-latérale, et compte tenu de la diffusion de particules métalliques dans l'organisme du patient que génère le contact des implants métal sur métal. The present invention relates to a joint prosthesis for inter-phalangeal or phalango-metacarpal or phalangometatarsal articulation. In order to treat a condition at an inter-phalangeal joint, a known technique is to immobilize the joint in alignment position of the phalanges by means of a pin. Such arthrodesis has the major disadvantage of being disabling, the patient can no longer grasp an object of reduced dimensions such as a needle placed on a surface. Another technique is to implant at the ends of the two bones concerned resurfacing inserts made of metallic material. This technique is not satisfactory, given the absence of control, or reduced control, of the movements of the joint in extension and in the mediolateral direction, and taking into account the diffusion of metal particles in the organism of the patient that generates the contact of implants metal on metal.
Une autre technique encore consiste à implanter une prothèse articulaire en matériau souple et élastique, notamment en silicone, comprenant deux tiges médullaires et une partie centrale élargie, les deux tiges médullaires étant destinées à être insérées dans les canaux médullaires des deux os concernés, et la partie centrale étant destinée à occuper l'espace articulaire. Another technique consists in implanting a joint prosthesis of flexible and elastic material, in particular silicone, comprising two medullary rods and an enlarged central part, the two medullary rods being intended to be inserted into the medullary ducts of the two bones concerned, and the central part being intended to occupy the articular space.
La déformabilité de cette partie centrale permet le mouvement des deux tiges médullaires l'une par rapport à l'autre et donc le mouvement des deux os concernés l'un par rapport à l'autre. Une telle prothèse a également pour inconvénient important de ne pas permettre un bon contrôle du mouvement des phalanges dans le sens de l'extension et dans la direction médio-latérale. De plus, les tiges médullaires ont une certaine possibilité de jeu axial par rapport aux os, qui est génératrice de frottements répétés et donc de diffusion dans l'organisme du patient de particules de silicone. Cette diffusion conduit à l'affection connue sous le nom de "siliconite". The deformability of this central part allows the movement of the two medullary rods relative to each other and therefore the movement of the two bones concerned with respect to each other. Such a prosthesis also has the important disadvantage of not allowing good control of the movement of the phalanges in the direction of extension and in the mediolateral direction. In addition, the medullary stems have a certain possibility of axial play with respect to the bones, which is generating repeated friction and therefore diffusion into the body of the patient of silicone particles. This diffusion leads to the condition known as "siliconite".
La présente invention vise à remédier à l'ensemble des inconvénients précités des prothèses selon la technique antérieure. Son objectif principal est donc de fournir une prothèse d'articulation pour articulation inter-phalangienne ou phalango-métacarpienne ou phalangométatarsienne, permettant un mouvement contrôlé et limité d'un os par rapport 2 à l'autre, particulièrement dans le sens du mouvement d'extension de l'articulation et dans la direction médio-latérale. Un autre objectif de l'invention est de fournir une prothèse n'ayant pas d'effets néfastes sur l'organisme du patient, en particulier ne générant pas de 5 diffusion de particules du matériau constituant la prothèse. Un objectif supplémentaire de l'invention est de fournir une prothèse restant relativement facile à fabriquer. La prothèse concernée comprend, de manière connue en soi, deux parties latérales d'ancrage osseux et une partie centrale déformable destinée 10 à occuper l'espace articulaire. Selon l'invention, - ladite partie centrale déformable comprend au moins une lame en matériau élastique, dont l'épaisseur est orientée dans une direction parallèle au plan de la mobilité articulaire d'un os par rapport à l'autre, et 15 - ladite lame forme une partie médiane saillante dans le sens transversal, dirigée, après implantation, du côté de l'articulation traitée sur lequel se réalise le mouvement de flexion de cette articulation. Par le terme "épaisseur" ci-dessus, il faut entendre la dimension de la lame selon une direction perpendiculaire au plan de la mobilité articulaire d'un 20 os par rapport à l'autre. Cette structure en au moins une lame élastique à partie médiane saillante sur le côté de l'articulation traitée sur lequel se réalise le mouvement de flexion de cette articulation, c'est-à-dire du côté palmaire dans le cas du traitement d'une articulation inter-phalangienne ou phalango- métacarpienne 25 ou phalango-métatarsienne, permet d'obtenir une capacité appropriée de déformation de la partie centrale de la prothèse dans le sens de la flexion, c'est-à-dire dans le sens du pivotement d'un os (phalange) dans la direction palmaire par rapport à l'autre os (phalange ou métacarpe ou métatarse) tout en ayant une capacité appropriée de rappel élastique en position neutre. La 30 déformation en flexion de cette partie centrale de la prothèse est réalisée par le tendon fléchisseur, qui subsiste après implantation, et le retour en position neutre d'alignement des deux os concernés est réalisé par le rappel élastique de ladite lame, en suppléance du tendon extenseur, généralement sacrifié lors de l'implantation de la prothèse ou en mauvais état chez de nombreux 35 patients. 3 La prothèse selon l'invention reproduit ainsi le mouvement de flexion-extension d'une articulation inter-phalangienne ou phalango-métacarpienne ou phalango-métatarsienne dans les meilleures conditions. La structure en lame et la disposition précitée de cette lame par rapport au plan de mobilité d'un os par rapport à l'autre fait que la largeur de la lame est orientée perpendiculairement à ce plan, conférant à la prothèse une rigidité importante dans la direction transversale à ce plan, c'est-à-dire dans la direction médio-latérale de l'articulation traitée. Cette rigidité assure un parfait contrôle du mouvement de l'articulation dans cette direction. Il en est de même du contrôle du mouvement d'un os en rotation longitudinale par rapport à l'autre os. Ladite lame pourrait présenter une forme en "U" ou en "V". De préférence, toutefois, cette lame présente une forme ondulée, c'est-à-dire comprend deux portions arrondies latérales reliées chacune à l'une des parties d'ancrage et une portion arrondie centrale formant ladite partie médiane saillante. Cette structure ondulée s'avère reproduire le mouvement naturel de l'articulation dans les meilleures conditions. En particulier, les déformations conjointes des parties arrondies latérales et centrale permettent d'obtenir une amplitude de flexion importante, et une force de rappel élastique appropriée. Avantageusement, chaque portion arrondie latérale s'étend sur un arc de l'ordre de 90 à 100 degrés et se raccorde à une portion rectiligne elle-même raccordée, par son autre extrémité, à ladite portion arrondie centrale. Cette portion arrondie centrale s'étend de préférence sur un arc de l'ordre de 180 degrés. De préférence, lesdites portions rectilignes divergent dans la direction dudit côté de l'articulation sur lequel se réalise le mouvement de flexion de cette articulation, c'est-à-dire généralement du côté palmaire. En cas de mouvement d'extension extrême de l'articulation, les zones de ces portions rectilignes raccordées auxdites portions arrondies latérales sont susceptibles de venir au contact l'une avec l'autre, limitant ainsi la déformation de la partie centrale de la prothèse dans le sens de cette extension. L'angle formé par lesdites portions rectilignes peut notamment être de l'ordre de 30 degrés. 4 De préférence, lesdites parties d'ancrage sont constituées par des tiges médullaires destinées à être engagées étroitement dans le canal médullaire des os traités. Ces tiges médullaires, de par leur forme et leur rigidité, présentent de 5 faibles risques de jeu par rapport aux os, limitant ainsi le risque de frottements générateurs de particules métalliques. Avantageusement, au moins une de ces tiges médullaires comprend un aspect de surface ou un revêtement propre à assurer son immobilisation par rapport à l'os dans lequel elle est implantée, par croissance des cellules 10 osseuses le long de cette tige médullaire. Notamment, cette tige médullaire peut présenter une surface rugueuse, obtenue par exemple par grenaillage de la surface brute de cette tige, ou un revêtement poreux, notamment un revêtement ostéo-inducteur. Ladite partie centrale de la prothèse présente avantageusement une 15 largeur supérieure à celle des parties d'ancrage. Par ce terme "largeur", il faut entendre la dimension de la lame selon une direction perpendiculaire au plan de la mobilité articulaire d'un os par rapport à l'autre. Cette largeur supérieure augmente la rigidité de la prothèse dans la 20 direction médio-latérale. Avantageusement, au moins une partie d'ancrage présente un rebord ou une collerette destiné à prendre appui contre l'os dans lequel cette partie d'ancrage est destinée à être implantée. Ce rebord ou cette collerette augmente la surface d'appui de la partie 25 d'ancrage contre l'os et réduit les forces exercées sur les zones d'ancrage osseux de cette partie d'ancrage. La venue en butée de ce rebord ou de cette collerette contre l'os détermine en outre une position précise de la partie d'ancrage par rapport à l'os, et donc un positionnement précis de la prothèse par rapport à l'os. 30 De préférence, la prothèse est réalisée en un matériau métallique, notamment en l'alliage de nickel et de titane connu sous la dénomination "NITINOL". L'invention sera bien comprise, et d'autres caractéristiques et avantages de celle-ci apparaîtront, en référence au dessin schématique annexé, représentant, à titre d'exemple non limitatif, une forme de réalisation préférée de la prothèse qu'elle concerne. La figure 1 en est une vue en perspective ; ia figure 2 en est une vue de côté ; 5 la figure 3 en est une vue de dessus ; la figure 4 en est une vue similaire à la figure 2, après implantation dans deux phalanges ; et la figure 5 en est une vue similaire à la figure 2, selon une variante de réalisation. The present invention aims to remedy all of the aforementioned disadvantages of prostheses according to the prior art. Its main objective is therefore to provide a joint prosthesis for inter-phalangeal or phalango-metacarpal or phalangometatarsal articulation, allowing controlled and limited movement of one bone relative to the other, particularly in the direction of movement of the bone. extension of the joint and in the mediolateral direction. Another object of the invention is to provide a prosthesis having no adverse effects on the body of the patient, in particular not generating diffusion of particles of the material constituting the prosthesis. A further object of the invention is to provide a prosthesis remaining relatively easy to manufacture. The prosthesis concerned comprises, in a manner known per se, two lateral portions of bone anchoring and a deformable central part intended to occupy the articular space. According to the invention, - said deformable central portion comprises at least one blade of elastic material whose thickness is oriented in a direction parallel to the plane of the articular mobility of one bone relative to the other, and 15 - said lamina forms a median protruding part in the transverse direction, directed, after implantation, the side of the treated joint on which is performed the bending movement of this joint. By the term "thickness" above is meant the dimension of the blade in a direction perpendicular to the plane of articular mobility of one bone relative to the other. This structure has at least one elastic blade with a median part projecting on the side of the treated articulation on which the flexion movement of this articulation, that is to say on the palmar side, is performed in the case of the treatment of a inter-phalangeal or phalangometacarpal or phalango-metatarsal articulation, makes it possible to obtain an appropriate capacity for deformation of the central part of the prosthesis in the direction of flexion, that is to say in the direction of pivoting of the prosthesis. a bone (phalanx) in the palmar direction relative to the other bone (phalanx or metacarpus or metatarsus) while having a suitable elastic return capability in the neutral position. The flexural deformation of this central portion of the prosthesis is performed by the flexor tendon, which remains after implantation, and the return to neutral position of alignment of the two bones concerned is achieved by the elastic return of said blade, in substitution of the extensor tendon, usually sacrificed when implanting the prosthesis or in poor condition in many patients. The prosthesis according to the invention thus reproduces the flexion-extension movement of an inter-phalangeal or phalango-metacarpal or phalango-metatarsal articulation under the best conditions. The blade structure and the aforementioned disposition of this blade with respect to the plane of mobility of one bone relative to the other makes the width of the blade oriented perpendicular to this plane, giving the prosthesis considerable rigidity in the direction transverse to this plane, that is to say in the mediolateral direction of the treated joint. This rigidity ensures perfect control of the movement of the joint in this direction. It is the same for controlling the movement of a bone in longitudinal rotation relative to the other bone. Said blade could have a shape "U" or "V". Preferably, however, this blade has an undulating shape, that is to say comprises two lateral rounded portions each connected to one of the anchoring portions and a central rounded portion forming said projecting central portion. This corrugated structure proves to reproduce the natural movement of the joint in the best conditions. In particular, the joint deformations of the lateral and central rounded parts make it possible to obtain a large amplitude of flexion, and an appropriate elastic return force. Advantageously, each lateral rounded portion extends over an arc of the order of 90 to 100 degrees and is connected to a rectilinear portion itself connected at its other end to said central rounded portion. This central rounded portion preferably extends over an arc of the order of 180 degrees. Preferably, said rectilinear portions diverge in the direction of said side of the joint on which the bending movement of this joint is effected, that is to say generally on the palmar side. In case of extreme extension movement of the joint, the areas of these rectilinear portions connected to said lateral rounded portions are capable of coming into contact with one another, thus limiting the deformation of the central part of the prosthesis in the meaning of this extension. The angle formed by said rectilinear portions may in particular be of the order of 30 degrees. Preferably, said anchoring portions are constituted by medullary rods intended to be tightly engaged in the medullary canal of the treated bones. These medullary rods, by their shape and rigidity, have low risk of play relative to the bones, thus limiting the risk of friction generating metal particles. Advantageously, at least one of these medullary stems comprises a surface appearance or a coating adapted to ensure its immobilization with respect to the bone in which it is implanted, by growth of the bone cells along this medullary stem. In particular, this medullary stem may have a rough surface, obtained for example by shot blasting the rough surface of this rod, or a porous coating, in particular an osteoinductive coating. Said central portion of the prosthesis advantageously has a width greater than that of the anchoring portions. By this term "width" is meant the dimension of the blade in a direction perpendicular to the plane of the articular mobility of one bone relative to the other. This greater width increases the rigidity of the prosthesis in the mediolateral direction. Advantageously, at least one anchoring portion has a flange or collar intended to bear against the bone in which this anchoring portion is intended to be implanted. This flange or flange increases the bearing surface of the anchoring portion against the bone and reduces the forces exerted on the bone anchoring areas of this anchoring portion. The abutment of this flange or flange against the bone further determines a precise position of the anchoring portion relative to the bone, and thus a precise positioning of the prosthesis relative to the bone. Preferably, the prosthesis is made of a metallic material, in particular of the nickel-titanium alloy known under the name "NITINOL". The invention will be better understood, and other features and advantages thereof will appear, with reference to the accompanying drawing, showing, by way of non-limiting example, a preferred embodiment of the prosthesis it relates. Figure 1 is a perspective view; Figure 2 is a side view; Figure 3 is a view from above; Figure 4 is a view similar to Figure 2 after implantation in two phalanges; and FIG. 5 is a view similar to FIG. 2, according to an alternative embodiment.
Les figures 1 à 4 représentent une prothèse d'articulation 1 pour articulation inter-phalangienne ou phalango-métacarpienne ou phalangométatartienne, qui comprend deux tiges médullaires 2 d'ancrage osseux et une partie centrale déformable 3 destinée à occuper l'espace articulaire. Cette prothèse 1 est constituée en une seule pièce de matériau métallique élastiquement déformable, notamment en l'alliage de nickel et de titane connu sous la dénomination "NITINOL". Les tiges médullaires 2 présentent, du côté opposé à la partie centrale 3, des parties médullaires 2a et, du côté de cette partie centrale 3, un rebord d'appui 2b. Figures 1 to 4 show a joint prosthesis 1 for inter-phalangeal joint or phalango-metacarpal or phalangometatta, which comprises two bone anchoring medullary rods 2 and a deformable central portion 3 intended to occupy the articular space. This prosthesis 1 consists of a single piece of elastically deformable metal material, in particular the nickel-titanium alloy known under the name "NITINOL". The medullary rods 2 have, on the opposite side to the central portion 3, medullary portions 2a and, on the side of this central portion 3, a support flange 2b.
Chaque partie 2a a une section transversale substantiellement carrée et est légèrement effilée en direction de son extrémité opposée à la partie centrale 3, cette forme permettant à chaque tige 2 de pouvoir être engagée étroitement dans le canal médullaire de l'un des os de l'articulation traitée, avec calage en pivotement selon l'axe longitudinal de l'os. Chaque partie 2a présente par ailleurs un aspect de surface rugueux, obtenu par exemple par grenaillage de sa surface, cet aspect de surface rugueux permettant d'assurer l'immobilisation de la tige 2 par rapport à l'os dans lequel elle est implantée par croissance des cellules osseuses le long de la partie 2a. Chaque rebord 2b fait saillie de la tige 2 sur trois côtés de celle-ci, c'est- à-dire latéralement de part et d'autre de la tige 2, et en direction du côté de l'articulation traitée sur lequel se réalise le mouvement de flexion de cette articulation, c'est-à-dire généralement du côté palmaire s'agissant d'une articulation inter-phalangienne ou phalango-métacarpienne ou phalangométatarsienne.Each portion 2a has a substantially square cross section and is slightly tapered toward its end opposite the central portion 3, this shape allowing each rod 2 to be engaged tightly in the medullary canal of one of the bones of the treated joint, with pivotal wedging along the longitudinal axis of the bone. Each portion 2a also has a rough surface appearance, obtained for example by shot blasting of its surface, this rough surface appearance to ensure the immobilization of the rod 2 relative to the bone in which it is implanted by growth bone cells along part 2a. Each rim 2b protrudes from the stem 2 on three sides thereof, that is to say laterally on either side of the rod 2, and towards the side of the treated joint on which is realized the flexion movement of this joint, that is to say, generally on the palmar side with respect to an inter-phalangeal joint or phalango-metacarpal or phalangometatarsal.
6 La partie centrale 3 est constituée par une lame 5 présentant .une forme ondulée. La lame 5 a une largeur orientée perpendiculairement au plan dans lequel se réalise la mobilité articulaire d'un os par rapport à l'autre et une épaisseur orientée parallèlement à ce plan, ladite largeur étant nettement supérieure à ladite épaisseur, d'un rapport compris entre environ 10 à 1 ou 15 à 1 ainsi que cela apparaît par comparaison des figures 2 et 3. Elle comprend deux portions arrondies latérales 5a reliées chacune à l'une des tiges 2, une portion arrondie centrale 5b et deux portions rectilignes 5c reliant chaque portion latérale 5a à la portion centrale 5b. Chaque portion latérale 5a s'étend sur un arc de l'ordre de 90 à 100 degrés ; la portion centrale 5b s'étend sur un arc de l'ordre de 180 degrés ; les portions rectilignes 5c divergent l'une de l'autre dans la direction du côté de l'articulation sur lequel se réalise le mouvement de flexion de cette articulation, c'est-à-dire généralement du côté palmaire, formant entre elles un angle de 30 degrés. Comme cela est particulièrement visible sur les figures 2 et 4, lesdites portions rectilignes 5c et la portion arrondie centrale 5b forment une partie médiane 5d de la lame 5 faisant saille dans le sens transversal de la prothèse 1, c'est-à-dire perpendiculairement à la direction longitudinale de cette prothèse. Cette partie médiane 5d est dirigée, après implantation, du côté de l'articulation traitée sur lequel se réalise le mouvement de flexion de cette articulation, c'est-à-dire généralement du côté palmaire (cf. figure 4). La lame 5, de par sa structure, permet d'obtenir une capacité appropriée de déformation de la partie centrale 3 de la prothèse 1 dans le sens de la flexion, c'est-à-dire dans le sens du pivotement d'un os (phalange) dans la direction palmaire par rapport à l'autre os (phalange ou métacarpe ou métatarse) tout en ayant une capacité appropriée de rappel élastique en position neutre. La déformation en flexion de cette partie centrale 3 est réalisée par le tendon fléchisseur de l'articulation, qui subsiste après implantation, et le retour en position neutre d'alignement des deux os concernés est réalisé par le rappel élastique de la lame 5, en suppléance du tendon extenseur, généralement sacrifié lors de l'implantation de la prothèse 1 ou en mauvais état chez de nombreux patients. La partie médiane saillante 5d de la lame 5 permet, par les déformations conjointes des parties arrondies 5a 7 et 5b d'obtenir une amplitude de flexion importante ainsi qu'une force de rappel élastique appropriée. En cas de mouvement d'extension extrême de l'articulation, les zones des portions rectilignes 5c raccordées auxdites portions arrondies latérales 5a 5 sont susceptibles de venir au contact l'une avec l'autre, limitant ainsi la déformation de la partie centrale 3 de la prothèse dans ce sens. La lame 5 a par ailleurs sa largeur orientée perpendiculairement audit plan dans lequel se réalise le mouvement de flexion, conférant à la prothèse une rigidité importante dans la direction transversale à ce plan, c'est-à-dire 10 dans la direction médio-latérale de l'articulation traitée. Cette rigidité assure un parfait contrôle du mouvement de l'articulation dans cette direction. Il en est de même du contrôle du mouvement d'un os en rotation longitudinale par rapport à l'autre os. La prothèse 1 reproduit ainsi le mouvement de flexion-extension d'une 15 articulation inter-phalangienne ou phalango-métacarpienne ou phalango- métatarsienne dans les meilleures conditions. À titre purement indicatif, les dimensions suivantes peuvent être données pour la prothèse 1 selon invention : - longueur totale de la prothèse : 24 mm ; 20 - largeur des parties 2a des tiges médullaires 2 au niveau des rebords 2b : 2 à 2,5 mm ; - rayon de génération des portions arrondies 5a et 5b, au niveau des faces concaves de ces portions : 0,625 mm ; - largeur de la lame 5 : 3,5 mm ; 25 - épaisseur de la lame 5 : 0,25 mm ; - dimension, dans le sens transversal de la prothèse 1, de ladite partie médiane saillante 5d, depuis les faces convexes des portions arrondies 5a jusqu'à la face convexe de la portion arrondie 5b : 5 mm. La figure 5 montre une variante de réalisation possible de la prothèse 1, 30 dans laquelle la lame 5 présente une épaisseur moindre, de l'ordre de 0,125 mm et dans laquelle l'une des tiges médullaires 2 s'étend selon une direction longitudinale non sensiblement parallèle à celle de l'autre tige médullaire 2, l'angle formé par les deux directions longitudinales de ces deux tiges médullaires étant de l'ordre de deux 170 degrés.The central portion 3 is constituted by a blade 5 having a corrugated shape. The blade 5 has a width oriented perpendicularly to the plane in which the articular mobility of one bone is made with respect to the other and a thickness oriented parallel to this plane, said width being substantially greater than said thickness, of an included ratio. between about 10 to 1 or 15 to 1 as it appears by comparison of Figures 2 and 3. It comprises two lateral rounded portions 5a each connected to one of the rods 2, a central rounded portion 5b and two rectilinear portions 5c connecting each lateral portion 5a at the central portion 5b. Each lateral portion 5a extends over an arc of the order of 90 to 100 degrees; the central portion 5b extends over an arc of the order of 180 degrees; the rectilinear portions 5c diverge from each other in the direction of the side of the joint on which the bending movement of this articulation is effected, that is to say generally on the palmar side, forming between them an angle 30 degrees. As is particularly visible in Figures 2 and 4, said rectilinear portions 5c and the central rounded portion 5b form a median portion 5d of the blade 5 projecting in the transverse direction of the prosthesis 1, that is to say perpendicularly to the longitudinal direction of this prosthesis. This median portion 5d is directed, after implantation, on the side of the treated joint on which the bending movement of this articulation is effected, that is to say generally on the palmar side (see FIG. 4). The blade 5, by its structure, provides an appropriate capacity for deformation of the central portion 3 of the prosthesis 1 in the direction of bending, that is to say in the direction of pivoting of a bone (Phalanx) in the palmar direction relative to the other bone (phalanx or metacarpus or metatarsal) while having an appropriate elastic return capability in the neutral position. The deformation in flexion of this central portion 3 is performed by the flexor tendon of the joint, which remains after implantation, and the return to neutral position of alignment of the two bones concerned is achieved by the elastic return of the blade 5, in extensor tendon replacement, usually sacrificed during implantation of prosthesis 1 or in poor condition in many patients. The median projecting portion 5d of the blade 5 allows, by the joint deformations of the rounded portions 5a 7 and 5b to obtain a large bending amplitude and an appropriate elastic return force. In case of extreme extension of the articulation, the areas of the rectilinear portions 5c connected to said lateral rounded portions 5a 5 are capable of coming into contact with each other, thus limiting the deformation of the central portion 3 of the prosthesis in this sense. The blade 5 also has its width oriented perpendicularly to said plane in which the bending movement is carried out, giving the prosthesis considerable rigidity in the direction transverse to this plane, that is to say in the mediolateral direction. of the treated joint. This rigidity ensures perfect control of the movement of the joint in this direction. It is the same for controlling the movement of a bone in longitudinal rotation relative to the other bone. The prosthesis 1 thus reproduces the flexion-extension movement of an inter-phalangeal or phalango-metacarpal or phalangometatarsal joint under the best conditions. For information only, the following dimensions can be given for the prosthesis 1 according to the invention: total length of the prosthesis: 24 mm; 20 - width of the parts 2a of the medullary rods 2 at the edges 2b: 2 to 2.5 mm; radius of generation of the rounded portions 5a and 5b, at the concave faces of these portions: 0.625 mm; - width of the blade 5: 3.5 mm; 25 - thickness of the blade 5: 0.25 mm; dimension, in the transverse direction of the prosthesis 1, of said projecting medial part 5d, from the convex faces of the rounded portions 5a to the convex face of the rounded portion 5b: 5mm. FIG. 5 shows a possible variant embodiment of the prosthesis 1, 30 in which the blade 5 has a smaller thickness, of the order of 0.125 mm, and in which one of the medullary rods 2 extends in a longitudinal direction not substantially parallel to that of the other medullary rod 2, the angle formed by the two longitudinal directions of these two medullary rods being of the order of two 170 degrees.
8 Comme cela apparaît de ce qui précède, l'invention fournit une prothèse d'articulation pour articulation inter-phalangienne ou phalango-métacarpienne ou phalango-métatarsienne présentant de nombreux avantages par rapport aux prothèses homologues de la technique antérieure, en particulier ceux de : - permettre un mouvement contrôlé et limité d'un os par rapport à l'autre, particulièrement dans le sens du mouvement d'extension de l'articulation et dans la direction médio-latérale, - de ne pas générer de diffusion de particules du matériau constituant la prothèse, et - de rester relativement facile à fabriquer. L'invention a été décrite ci-dessus en référence à une forme de réalisation donnée à titre de pur d'exemple. Il va de soi qu'elle n'est pas limitée à cette forme de réalisation mais qu'elle s'étend à toutes les formes de réalisations couvertes par les revendications ci-annexées. Ainsi, ladite partie centrale déformable 3 de la prothèse pourrait présenter une forme en "U" ou en "V" en lieu et place d'une forme ondulée. As is apparent from the foregoing, the invention provides a joint prosthesis for inter-phalangeal or phalango-metacarpal or phalango-metatarsal articulation with many advantages over homologous prostheses of the prior art, in particular those of: allow a controlled and limited movement of one bone relative to the other, particularly in the direction of the extension movement of the joint and in the mediolateral direction, not to generate diffusion of particles of the material constituting the prosthesis, and - to remain relatively easy to manufacture. The invention has been described above with reference to an embodiment exemplified as pure. It goes without saying that it is not limited to this embodiment but that it extends to all the embodiments covered by the appended claims. Thus, said deformable central portion 3 of the prosthesis could have a shape of "U" or "V" instead of a wavy shape.
Claims (3)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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FR0800808A FR2927529B1 (en) | 2008-02-14 | 2008-02-14 | JOINT PROSTHESIS FOR INTER-PHALANGEAL OR PHALANGO-METACARPIAN OR PHALANGO-METATARSIAN JOINTS |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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FR0800808A FR2927529B1 (en) | 2008-02-14 | 2008-02-14 | JOINT PROSTHESIS FOR INTER-PHALANGEAL OR PHALANGO-METACARPIAN OR PHALANGO-METATARSIAN JOINTS |
Publications (2)
Publication Number | Publication Date |
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FR2927529A1 true FR2927529A1 (en) | 2009-08-21 |
FR2927529B1 FR2927529B1 (en) | 2011-02-11 |
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Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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FR0800808A Expired - Fee Related FR2927529B1 (en) | 2008-02-14 | 2008-02-14 | JOINT PROSTHESIS FOR INTER-PHALANGEAL OR PHALANGO-METACARPIAN OR PHALANGO-METATARSIAN JOINTS |
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JP2016516530A (en) * | 2014-03-28 | 2016-06-09 | ライト メディカル テクノロジー インコーポレイテッドWright Medical Technology, Inc. | Hammer to implant |
US9474561B2 (en) | 2013-11-19 | 2016-10-25 | Wright Medical Technology, Inc. | Two-wire technique for installing hammertoe implant |
US9498273B2 (en) | 2010-06-02 | 2016-11-22 | Wright Medical Technology, Inc. | Orthopedic implant kit |
US9498266B2 (en) | 2014-02-12 | 2016-11-22 | Wright Medical Technology, Inc. | Intramedullary implant, system, and method for inserting an implant into a bone |
US9504582B2 (en) | 2012-12-31 | 2016-11-29 | Wright Medical Technology, Inc. | Ball and socket implants for correction of hammer toes and claw toes |
US9603643B2 (en) | 2010-06-02 | 2017-03-28 | Wright Medical Technology, Inc. | Hammer toe implant with expansion portion for retrograde approach |
US9724140B2 (en) | 2010-06-02 | 2017-08-08 | Wright Medical Technology, Inc. | Tapered, cylindrical cruciform hammer toe implant and method |
US9808296B2 (en) | 2014-09-18 | 2017-11-07 | Wright Medical Technology, Inc. | Hammertoe implant and instrument |
US10080597B2 (en) | 2014-12-19 | 2018-09-25 | Wright Medical Technology, Inc. | Intramedullary anchor for interphalangeal arthrodesis |
US10383671B2 (en) | 2008-09-09 | 2019-08-20 | Stryker European Holdings I, Llc | Resorptive intramedullary implant between two bones or two bone fragments |
US10470807B2 (en) | 2016-06-03 | 2019-11-12 | Stryker European Holdings I, Llc | Intramedullary implant and method of use |
US10582957B2 (en) | 2014-09-19 | 2020-03-10 | Crossroads Extremity Systems, Llc | Bone fixation implant and means of fixation |
US11478285B2 (en) | 2005-04-14 | 2022-10-25 | Stryker European Operations Holdings Llc | Device for osteosyntheses or arthrodesis of two-bone parts, in particular of the hand and/or foot |
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US9545274B2 (en) | 2014-02-12 | 2017-01-17 | Wright Medical Technology, Inc. | Intramedullary implant, system, and method for inserting an implant into a bone |
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US9724140B2 (en) | 2010-06-02 | 2017-08-08 | Wright Medical Technology, Inc. | Tapered, cylindrical cruciform hammer toe implant and method |
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JP2016516530A (en) * | 2014-03-28 | 2016-06-09 | ライト メディカル テクノロジー インコーポレイテッドWright Medical Technology, Inc. | Hammer to implant |
US9808296B2 (en) | 2014-09-18 | 2017-11-07 | Wright Medical Technology, Inc. | Hammertoe implant and instrument |
US10299840B2 (en) | 2014-09-18 | 2019-05-28 | Wright Medical Technology, Inc. | Hammertoe implant and instrument |
US10582957B2 (en) | 2014-09-19 | 2020-03-10 | Crossroads Extremity Systems, Llc | Bone fixation implant and means of fixation |
US10080597B2 (en) | 2014-12-19 | 2018-09-25 | Wright Medical Technology, Inc. | Intramedullary anchor for interphalangeal arthrodesis |
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