Patent Application
20120209397
This invention relates to a prosthetic hip implant system which comprises a part-spherical cup adapted for location in an acetabulum and having a part-spherical inner bearing surface to receive a part-spherical ball head which can be attached to a prosthetic stem for location in a femur and in which the inner bearing surface of the cup extends around an angle of more than 180°. Cups of this type are known which comprise a single bearing element made, for example, of a synthetic plastic material such as ultra high molecular weight polyethylene or metal. The inner bearing surface can also be formed on an insert which again can be of a synthetic plastic material, a ceramic, or a metal and which is carried in an outer housing, the outer housing engages the acetabulum with which it is to be used and being held in place by, for example, cement or by mechanical means, for example nails or screws. The cup is used in connection with Total Hip Arthroplasty which includes implanting a femoral component in the femur which component normally includes a stem, a neck and ball head.
In other known constructions of the cup the inner bearing surface can be provided on an inner liner or insert made from a different material from an outer backing which engages the acetabulum. Dual mobility cups or bipolar cups generally comprise an inner bearing which receives the part-spherical ball head and which inner bearing itself is freely rotatably mounted in a part-spherical housing which has an outer surface for engaging an acetabulum and an inner bearing surface. The bearing outer surface engages the inner bearing surface of the outer housing which engages the acetabulum. This type of cup allows greater mobility of angular movement. Such cups are shown in U.S. Pat. No. 4,798,610 and U.S. Publication 2004/0143341.
In all these constructions, and, more especially, dual mobility cups, it is advantageous to have a means for retaining the ball head against the inner bearing surface. There are several ways of retaining the ball head inside the inner bearing surface. For example, U.S. Pat. No. 4,798,610 uses a ring seated on a conically tapered surface in the inner bearing. The second arrangement can consist of having two flats on the head and turning the head at 90° prior to inserting it into the cup and then again turning the head back through 90°. A disadvantage with this type of construction is that specific heads are required and there is the risk of wear due to the truncating of the head. A system of this type is shown in FR 2 785 525 and U.S. Patent Publication No. 20030171817.
Another way for retaining the ball in a part-spherical cup adapted for location in an acetabulum having a part-spherical inner bearing surface to receive the part-spherical ball head which can be attached to a stem for location in a femur is by using flat surfaces on the cup and ball. The part-spherical inner bearing surface of the cup extends around an angle of more than 180°, and a portion thereof adjacent an entry mouth is formed with a substantially flat face which is at a radius from the center of the part-spherical inner bearing surface. This radius is less than the radius of the remainder of the cup, and the ball head has a co-operating substantially flat face on its part-spherical surface on which is provided a structure to receive and retain the stem with which it is to be used, and which prior to attachment to the stem allows it to be located in the cup and rotated so that it is retained thereon. The dimensions and configuration of the part-spherical inner bearing surface and the part-spherical bearing surface on the ball head being arranged to cause a movement of translation of the head during rotation to displace the head so that there is a crescent shaped retention area on each opposed side.
Such a construction is shown in U.S. Pat. No. 7,520,902. An advantage of this construction is that standard sized ball heads can be used. The entry into the cup can be closely controlled by the dimensions of the flat on the inner bearing surface so that the operation of the ball head against the bearing surface is accurate.
In a preferred construction the transverse axis of the mouth of the cup which is substantially parallel with the flat face of the ball head when being inserted is offset from the transverse axis of the inner bearing surface of the cup. The offset can be less than 10 mm, for example up to 5 mm.
The invention can be applied to cups and balls of any suitable material, for example synthetic plastics material, metals or ceramics. An amount, for example, 1 mm of free subluxation can be incorporated if necessary.
The present invention can be applied to cups in which the inner bearing surface is provided on an inner bearing element or to dual mobility or bi-polar cups in which the inner bearing element is formed as an insert which can move within another bearing surface within a backing and to cemented or non-cemented cups. The prosthetic hip implant system of the present invention comprises a prosthetic femoral component having a stem portion, a neck portion coupled to the stem portion and a part-spherical head coupled to the neck portion. An acetabular component is provided which has a housing, the housing having a part-spherical inner bearing surface having an open end with a circumferential rim portion, the rim portion has a circumferential radially inwardly extending flange. The bearing element is received within the housing and has a part-spherical first outer surface bearing region engaging the part-spherical inner bearing surface of the housing. The bearing element has a part-spherical inner bearing surface region having an open end for receiving the head mounted on the neck of the femoral component. The part-spherical first outer surface region of the bearing element extends about central axis of the inner surface open end. The central axis intersects a pole of and a center of rotation of the part-spherical first outer surface bearing region of the bearing element. The bearing element has a second part-spherical outer surface region extending from adjacent the open end towards the pole. The first outer surface region extending radially further from a center of the part-spherical inner surface of the bearing element than the second part-spherical surface region. The bearing element center point may be the center of rotation of the first and second part-spherical outer surface regions as well as the part-spherical inner surface region. This center point lies along the polar axis.
The bearing element part-spherical first outer surface region extends from the pole towards the open end to define a circumferentially extending contact surface extending in a generally radial direction between the part-spherical first surface and the second outer surface. The circumferential contact surface preferably extends 360 degrees around the part-spherical first outer surface and the second part-spherical outer surface. The circumferential contact surface could be broken into two or more segments separated by gaps. The circumferential contact surface is located on the bearing element intermediate the pole and an equator which extends through the center of rotation of the part-spherical first outer surface perpendicular to the polar axis. The contact surface could be at an angle to or could be perpendicular to the polar axis of the inner bearing surface and perpendicular to the central axis of the first part-spherical outer surface. The circumferential contact surface is located at the position intermediate the pole and the equator such that upon rotation of the bearing element with respect to the housing the neck of the femoral component contacts the bearing element open end prior to the inwardly extending circumferential rim portion of the housing. The inwardly extending circumferential flange of the rim has an inner diameter less than an outer diameter of the first part-spherical outer surface portion of the bearing element and less than an outer diameter of the bearing element at an equator of the second part-spherical outer surface portion to produce a slight interference upon insertion of the bearing element into the housing. A surface of the rim facing the polar area of the housing has a surface matching the contact surface on the bearing element. The outer diameter of the first part-spherical outer surface portions at the circumferential contact surface is inwardly deformable upon contact with the rim to a diameter less than the inner diameter of the inwardly extending flange portion of the housing or shell. The circumferential contact surface may extend around a latitude of about 40° to 45° from the equator. The housing and/or shell may be mounted within a shell contacting an acetabulum. The housing may be metal and cemented into the acetabulum or attached thereto by screws.
a is a bottom view of the housing of
a shows an exploded view of an alternate embodiment with a two-piece backing comprising an outer shell and an inner housing fixed to the shell for receiving the bearing element;
b is an assembled view of a three part cup having the shell, the housing and the bearing element of
c is a cross-sectional view of the assembled alternate three piece assembly of
Referring to
Referring to
Bearing element 14 further includes a second part-spherical surface region 32 which extends from part-spherical bearing region 30 but has a smaller diameter and is spaced radially inwardly from surface 20. Thus there is no contact between surface 32 and surface 20. In a preferred embodiment the part-spherical bearing surfaces 30 and 32 are concentric and having the same center, for example center 35, thus forming a step or contact surface 34 therebetween extending 360° around the outer surface of bearing element 14. It may also be possible to form the first part-spherical bearing surface 30 in two or more segments separated by, for example, narrow grooves thus interrupting the otherwise continuous contact surface 30.
Bearing element 14 includes an inner bearing surface 36 designed to receive an outer bearing surface 37 of a head 38 of a femoral component 31. Part-spherical bearing surface 36 has an open end 39 through which head 38 is inserted when the total joint is assembled. Femoral component head 38 is coupled to a neck 42 either as a one-piece construction or via a tapered male and female interconnection which is integrally formed with, or connected by a second male and female tapered interconnection, to an intramedullary stem 44. Such modular femoral component designs are well known. Stem 44 is intended to be received within a medullary canal of the femur although in certain oncological applications may form the entire proximal femur. In addition, femoral component 31 may be a trial femoral component and cup 10 could be a trial acetabular cup. As is typical, head 38 engages and may rotate in any direction on part-spherical bearing surface 36 within bearing element 14.
Referring to
The advantage of acetabular cup 200 is that heads of the screws through holes 216 of shell 210 have their heads covered by outer surface 226 of housing 212. Once assembled shell 210 and housing 212 cannot rotate with respect to one another and thus have their polar axis coaxial. As indicated above, screw holes 209, 215 are centered around the polar axis.
As shown in
Part-spherical bearing element surface portion 30 also has a polar axis 81 which is perpendicular to an equatorial plane 83 through center 35 of the bearing element 14 outer surfaces 30 and 32. The equatorial plane may be parallel to the plane 86 of open end 39 of bearing insert 14. Again, in the preferred embodiment, the polar axis 81 is also perpendicular to the plane of opening 39 when axis 80, 81 are aligned as shown in
As shown in
Referring to
As shown in U.S. Pat. No. 4,798,610, the disclosure of which is incorporated herein by reference, a split ring 60, preferably constructed of ultra high molecular weight polyethylene similar to that used to construct the bearing element 14 has a split portion 62, rendering the ring 60 radially expandable and contractable. Ring 60 includes an upper end wall 64, a downwardly and inwardly sloping outer wall 66 of the same slope as outer wall 56 of recess 52 for mating engagement therewith. At assembly, head 38 is inserted axially into opening 39 in bearing element 14, past wall 59a and through ring 60, so that ring 60 will be raised axially upwardly to an upper position within recess 52 expanding ring 60. Once the equator or largest diameter of head 38 presses through ring 60 into engagement with part-spherical bearing surface 36 of bearing element 14, ring 60 contracts. When the ball contacts part-spherical inner surface 36, ring 60 contracts and slides downwardly along sloping walls 56, 66 capturing the head 38 in bearing element 14. Other methods of retaining the ball within the bearing element may be used such as that shown in U.S. Pat. No. 7,455,694 the disclosure of which is incorporated herein by reference.
Referring to
In a preferred embodiment the first part-spherical surface region 30, the second part-spherical surface region of 32 and the part-spherical inner surface 36 are all concentric and thus have the same center 35 but different radii. Thus, axis 80, 81 through the center 35 perpendicular to the equator plane 83 of the bearing intersects the inner part-spherical surface 36 and the first part-spherical surface 30 at a pole of the spherical surfaces as described above.
In one embodiment of the present invention the first part-spherical surface extends to a latitude of about 40 to 45 degrees with respect to polar axis 81 with contact surface 34 extending at a similar angle between surfaces 30 and 32.
During use, bearing element 14 rotates within housing 12 on surface 30 and head and neck 38, 42 rotates within the bearing element 14 on surface 36. When neck 42 makes contact with bearing element 14 it engages a beveled circumferential surface 90 which extends around opening 39 of bearing element 14. When the neck 42 engages surface 90 the bearing element 14 is rotated within housing 12, which rotation is limited by the engagement of contact surface 34 and upper surface 27 of flange 24. At this point no relative rotation between the neck 42 of femoral component 40 is possible in this direction of rotation. Contact surface 34 is located at a latitude with respect to the pole 80 of housing 12 such that the rotation of femoral component 40 is stopped at a point which spaces the surface of neck 42 away from the tip 25 of flange 24. Thus, neck 42 always engages the ultra high molecular weight polyethylene bearing element 14 rather than the metal of housing 12. Preferably the contact surface 34 extends circumferentially around a latitude of 45° from the polar axis 81 of bearing element 14. The contact surface may extend at any angle between surfaces 30 and 32 but preferably at an angle which intersects the center 83 of the bearing element.
Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims.
