Patent Application
20150250615
The present invention relates to a device for inserting an insert element, made in particular of ceramic material, into a cup which is itself designed to be received in the cotyloidal cavity of a hip of a patient.
Insertion devices are already known that comprise a rod, an impaction head fixed to the end of the rod and designed to come into contact with the insert and gripping means designed for temporarily holding the insert to the insertion device when the impaction head is in contact with the insert, the latter being then adjusted by force to the cup by means of a shock or impaction applied to the rod by the surgeon to secure it in such a way that it is difficult, almost impossible, to remove.
Said devices of the prior art are complicated to use and do not guarantee a reliable impaction force in the right direction. It is often the case that either the insert is misaligned in relation to the cup prior to its impaction, or the axis in which the impaction is performed is not set accurately in a direction suitable for joining the insert and the cup perfectly. As a result the insert could be fitted badly in the cup, which over the long term may lead to breaking and associated complications for the patient (new operation for removing the defective cup, which is often shattered, and refitting a cup).
The present invention proposes overcoming the disadvantages of the prior art by proposing an insertion device which makes it possible to achieve the impaction of the insert into the cup with a very precise orientation relative to the insert and the cup, thus largely avoiding its deterioration over the long term, in particular avoiding cracks or breakages, and thus guaranteeing a long lifetime for the cup in the hip.
According to the invention, a device for inserting an insert, made in particular of ceramic material, by impaction into a cup designed to be received in the cotyl of a hip, comprising:
In this way an insertion device is obtained for insertion by impaction which makes it possible to perform said insertion in a particularly reliable and simple manner, by reducing to a very large degree the risk of “off-centre” insertion, which is a potential source of tearing or breaking of the cup once it has been placed into the cotyl. Whatever the angle of the force of impaction relative to the insert, i.e. the orientation of the rod relative to the insert, the latter, held by the insertion device with the possibility of pivoting, is always positioned perfectly relative to the cup, regardless of the orientation of the rod relative to the cup, such that the surgeon no longer needs, as in the prior art, to ensure that the rod is aligned perfectly perpendicularly to the plane of the base of the cup during the insertion.
Preferably, the pivot point of the assembly pivoting the gripping means relative to the rod-impaction head assembly is located substantially in the centre of the inner sphere of the insert.
According to a preferred embodiment of the invention, the gripping means of the insert are formed by a holding grip comprising at least two, preferably three, feet designed to fit around the insert in a releasable elastic manner.
Preferably, the holding grip comprises a base plate from the periphery of which the feet project.
In particular, the base plate is pierced by a hole, in particular substantially in the centre, the inner wall surface of which matches the form of a pivot pin formed on the rod so as to enable the relative pivoting of the rod and the base plate.
According to an advantageous embodiment, the distal end of the rod comprises a head projecting laterally from the rod and forming the impaction head, the head having a distal end surface, in particular in the form of a dome, designed to match in part the form of the base of the inner cavity of the insert.
Preferably, the outer surface of the impaction head 9 designed to be applied against the wall of the base of the cavity 4 is in the form of a sphere, the centre of which coincides with the pivot point.
In this way a free orientation of the insert is achieved.
According to one refinement also forming an invention in itself, independently of the invention described above, the device for inserting an insert, made in particular of ceramic material, into a cup designed to be received in the cotyl of a hip, comprising gripping means for the insert, in particular at an upper free edge of the insert, and a rod designed for the impaction of the insert when it is held by the gripping means opposite the hollow part of the cup, comprises means for imparting a downwards shock to the rod for the impaction of the insert into the cup, that is introduce it with an adjustment of force into the cup, said means for imparting a shock conveying a shock of predetermined power to the rod.
According to data and/or experience, it is also possible to adjust the power of the shock to optimise the blow given to the insert for the insertion thereof, thus avoiding variations in the power provided by the practitioner and/or his form on the day which are likely to involve either the cracking or breaking of the insert or the cup, or an incomplete insertion of the insert into the cup.
According to a preferred embodiment of the invention, the means for imparting a shock of predetermined power to the rod comprise a piston and a spring.
Preferably, means are provided for moving the piston against the compression of the spring so as to compress the spring.
According to a preferred embodiment, it is possible to provide means for locking the piston in a loaded position in which the spring is compressed and means, in particular in the form of a trigger, designed to release the piston, the release of the piston involving its instantaneous displacement by means of the decompression of the spring and its pulse action on the rod imparting to the latter a predetermined level of shock.
Preferably, the spring and the piston are received in a cavity proximal to the rod.
Preferably, the cavity receiving the piston and the spring is formed in a frame in one piece with the rod.
Preferably, a grip, in particular in the form of a pistol grip, projects laterally from the body.
The present invention also relates to an assembly comprising an insertion device according to the invention and at least one insert, made in particular of ceramic material, designed to be inserted into a cup of a cotyl, as well as to a unit comprising an assembly according to the invention and a cup designed to be received in a cotyl of a hip.
In the following, by way of example, embodiments of the invention are described with reference to the drawings, wherein:
The insertion device is formed by a circular cylindrical rod 6 to which an impaction end piece 5 has been adapted at its distal end. The end piece 5 comprises a tubular proximal section 7 which is tapped to receive the threaded end of the rod 6 therein, to thus join the latter by screw connection. It is possible instead to ensure that the end piece is held with the rod by means of another type of connection, for example a clipping system. It is also possible for the end piece to be in one piece with the rod.
The end piece 5 then comprises an intermediate section in the form of a spherical ball 8 and a distal section forming the impaction head 9. The impaction head 9 has a greater transverse dimension than the rest of the end piece 5, in particular than the proximal section 7, and its lower or distal surface is in the form of a dome being at least partly complementary to the inner surface of the cavity 4 of the insert 1, so as to be able to make surface contact with the latter. Conversely, it is also possible that the impaction head 9 has a smaller transverse dimension than the rest of the end piece 5, in particular than the proximal section 7.
The outer surface of the head 9 designed to be applied against the wall of the base of the cavity 4 is inscribed in a sphere, concentric to the sphere defining the ball 8. This facilitates the free orientation of the insert.
On the inside of the end piece 5, at the end of the proximal section 7 there is an abutment 10 against which the distal end of the rod 6 abuts, in order to block its screw connection with the internal tapping of section 7. Furthermore, a channel 11 opening to the lower surface in the form of a dome of section 9 by an opening facilitates the internal cleaning of the end piece.
A connecting element 13 which is also tubular terminates the connection between the end piece 5 and the rod 6. Said element 13 comprises a threaded end which screws into the part of the thread of the screw which does not cooperate with the tapping of the end piece 5. From the other proximal side the element 13 is welded at 14 to the rod.
An element forming a grip is mounted pivotably in relation to the ball 8. Said grip comprises a substantially planar plate 17, with a triangular form and with three tips from which three respective feet 20, 21 and 22 project. The feet are designed to fit around the insert on its upper or proximal edge. The feet and/or the plate are made from a material and/or have thickness such that they have a certain degree of elasticity which enables them to fit elastically around the upper edge of the insert 1 in an flexible manner and to release it when a deforming force is applied to the grip, for example by bearing on the plate 17. The plate 17 is pierced in its centre by a hole 18 with a shape complementary to the spherical ball 8 forming the pivot pin and comprises elements 23 in the form of teeth which have substantially a form complementary to that of the spherical ball 8 so as to match the form. The material and/or the thickness of the teeth is(are) selected so as to enable the elastic clipping of the plate onto the pivot pin. The inner edge of the hole 18 has an inner wall with a curved shape complementary to the form of the ball 8 forming the pivot pin. The assembly is such that the plate 17, once clipped by teeth 23 to the pivot pin 8, can pivot relative to the pivot pin 8, and therefore relative to the connected rod 6 particularly in rotation of the pivot pin 8.
In the embodiment shown three feet have been provided. However, it would also be possible to have more, in particular four or five for large inserts. It is also possible instead of feet to provide a disc that runs all around.
The dimension of the plate is such that when the head 9 is in contact with the surface of the internal wall of the insert made of ceramic material, the three feet 20, 21 and 22 fit around the free peripheral edge of the truncated cone part 3 of the insert 1 made of ceramic material, the three feet 20, 21 and 22 then extend towards the cup along the outer surface of the part 3 of the insert 1 made of ceramic material by fitting around the latter. The insert 1 made of ceramic material is thus held by the grip in an elastic manner.
Once the insert is held between the feet 20, 21, 22 (
To then insert the insert into the cup by force, the surgeon applies a shock to the rod, for example by striking the top of the rod downwards in the direction of extension of the rod. Taking into account the flexibility of the feet and/or the plate, this shock simultaneously presses the insert into its final position in the cup (position represented in
As the insert has been positioned by means of the device of the invention and centred perfectly relative to the cup in the position of
The relative locking of the insert in the cup is achieved by the slight difference in conicity of the inner walls 19 of the cup and 3 outer walls of the insert 1. However, it is also possible to achieve said adjustment of force in another way, for example by providing projections from the outer surface of the insert.
A first embodiment has been described above in which the surgeon applies the impaction shock by striking the rod.
It is possible, according to another advantageous embodiment, to provide at the proximal end of the rod 6 a part in the form of a pistol. Said part in the form of a pistol comprises a body 30 with a barrel 31 designed to be connected, in particular in a joined manner, to the rod 6. In the barrel 31 a cavity 32 is formed in which a plunger 33 is mounted to be movable in translation along the length of the axis of the barrel. A spring 34 is arranged at the rear of the plunger. A rod 36 joined to the plunger 33 passes through the spring and leaves the body 30 through a rear opening 50. The rod 36 enables the user, in particular by means of a ring 37 connected to the rod 36, to pull the plunger 33 to the rear thus compressing the spring 34 against a shoulder 51 of the plunger 33 until a transverse circular notch 38 is locked by clicking into an abutment 39. When the abutment 39 is locked into the notch 38, the plunger is displaced as far as possible to the rear and the spring 34 is compressed. The abutment 39 is mounted rotatably, such that a tail of a trigger 40, mounted rotatably, drives the rotation of the abutment 39 and therefore its exit from the notch 38 and lastly the release of the plunger 33. Under the effect of the charge of the precompressed spring, the plunger 33 is then displaced at high speed towards the left in
The rod is then subjected to a shock which impinges on the insert made of ceramic material to insert it into the cup.
The device also comprises a grip 41 in the form of a pistol handle.
Thus the impaction force applied to the rod 6 can be determined in advance by the choice of spring 34, its rigidity and displacement path towards the rear of the plunger 33. In this way a constant impulsion force is ensured on the rod and thus a force or impaction power of the insert into the cup which is constant or substantially constant, corresponding exactly to that which is necessary to ensure the correct insertion of the insert, without the latter cracking, as was the case in the prior art where it was difficult to control the effort of the hammer. The speed imparted to the rod by the release of the plunger can be determined in advance by the choice of geometry of the constituent elements of the insertion device, in particular the spring, the plunger, the length of the tube 6 and the like.
| Number | Date | Country | Kind |
|---|---|---|---|
| 14 00564 | Mar 2014 | FR | national |
