WO1994022397A1 - Implantable prosthetic patellar components - Google Patents

Implantable prosthetic patellar components Download PDF

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Publication number
WO1994022397A1
WO1994022397A1 PCT/GB1994/000701 GB9400701W WO9422397A1 WO 1994022397 A1 WO1994022397 A1 WO 1994022397A1 GB 9400701 W GB9400701 W GB 9400701W WO 9422397 A1 WO9422397 A1 WO 9422397A1
Authority
WO
WIPO (PCT)
Prior art keywords
femoral
patellar
component according
patella
parts
Prior art date
Application number
PCT/GB1994/000701
Other languages
French (fr)
Inventor
Julian Richard Minns
Swee Chai Ang
Ian William Wallace
Original Assignee
British Technology Group Limited
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
Application filed by British Technology Group Limited filed Critical British Technology Group Limited
Priority to US08/530,153 priority Critical patent/US5723016A/en
Priority to DE69418864T priority patent/DE69418864T2/en
Priority to EP94911268A priority patent/EP0691831B1/en
Priority to JP6521850A priority patent/JPH08508190A/en
Publication of WO1994022397A1 publication Critical patent/WO1994022397A1/en

Links

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
    • A61F2/38—Joints for elbows or knees
    • A61F2/3877—Patellae or trochleae
    • 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
    • A61F2/38—Joints for elbows or knees
    • A61F2/3877—Patellae or trochleae
    • A61F2002/3881—Patellae or trochleae with moving parts

Definitions

  • This invention concerns prosthetic patellar components for implantation in the knee joint of a patient.
  • a number of different knee prostheses have been developed for surgical treatment of the disabling effects of knee joint deterioration, such as results from arthritis, injury or disease.
  • a fairly common operation nowadays is total knee replacement, where the femoral facets of the proximal tibia as well as the patellar and tibia! facets of the distal femur are replaced with prosthetic components. It is also recognised that replacing the articulating surface on the posterior aspect of the patella improves the result of such operations, and prosthetic patellar elements for such a purpose have been developed.
  • prosthetic patellar components are disclosed in DE-U-9116507.5, WO-93/00871 and US-4041550. None of these teachings provides a device which suitably accommodates the conditions referred to above.
  • the present invention provides a novel i plantable prosthetic patellar component, comprising ⁇ patellar part having one side adapted to be secured to the inner surface of a natural patella, and a femoral part having one side defining an articulation surface to replace the femora! facet of the patella, the opposite sides of said parts being mutually engageable to afford sliding movement therebetween in a medio-lateral direction.
  • the invention therefore provides an i plantable prosthetic patellar component of two-part form, these two parts of the component referred to herein as the patellar part and the femoral part.
  • the component according to the invention allows sliding movement between the two parts in the medio-lateral direction to accommodate naturally occurring relative movement in this direction.
  • Considerable variation in the quadriceps-patellar ligament angle from subject to subject produces variations in the magnitude of the medio-lateral force acting on the patella, and such variations are allowed for by the component of the present invention. This improves congruency throughout flexion and at various loading of the joint, which has the effect of considerably reducing wear and deformation by reducing contact stresses during movement of the joint.
  • the engagement between the two parts allows translational sliding movement only in a substantially medio-lateral direction. In this way, sliding displacement of the whole of one part relative to the other part is limited to that in a substantially medio-lateral direction.
  • either the patellar part or the femoral part has an elongated dovetail slot, the other part having a complementary projection, such as a dovetail rib or a flared stud, the slot and the projection being dimensioned for engagement to afford the sliding movement between the two parts.
  • a complementary projection such as a dovetail rib or a flared stud
  • Figures 2a to 2c illustrate a femoral part of such a component
  • Figure 3 represents in side elevation a total knee replacement incorporating the patellar component illustrated in Figures 1 and 2;
  • FIGs 4a and 4b illustrate an alternative form of a femoral part of the component.
  • the patellar part of the illustrated patellar component consists of a metal disc 1 with a planar fixation surface la for attachment to an inner surface of a natural patella, and an opposite parallel planar interface surface lb in which a dovetail slot 2 is machined.
  • Figure la shows a plan view of the part, whilst Figure lb shows a side elevation.
  • the femoral part of the patellar component is shown in
  • Figure 2b offers a front view
  • Figure 2c offers a top view
  • Figure 2d offers a cross section of the part across plane A-A of Figure 2b.
  • the femoral part consists of an articulation element 3 of suitable biocompatible material, such as ultrahigh molecular weight polyethylene, having a planar interface surface 3a, from which a dovetail rib 4 protrudes, this rib being complementary to the dovetail slot 2 in the patellar part so that when inter-engaged the two can slide smoothly relative to one another in a direction parallel to the slot.
  • suitable biocompatible material such as ultrahigh molecular weight polyethylene
  • the opposite side of the femoral part consists of a smooth articulation facet 5 which, as can be seen from Figures 2a and 2c, is concavely curved in one direction and convexly curved in a perpendicular direction giving the part a 'saddle-shaped' bearing surface.
  • the actual curvatures in both directions will depend on the shape of the corresponding surface of the femoral component against which the part is designed to articulate, this last shape - the patellar facet - commonly being that of a trough.
  • the side edges of the part are rounded as can be seen in Figure 2b. Example dimensions for the two parts of the component are given in the figures but clearly can be varied in practice to suit different requirements.
  • the inner surface of the patient's patella 10 is appropriately prepared by a surgeon for fixation to the planar fixation surface of the patellar part 1 and the two are connected together such that the dovetail slot 2 is arranged in the medio-lateral direction.
  • the fixation may be by means of bone cement and/or fixation pins, or alternatively a projecting stud
  • the fixation surface of the patellar part may be provided on the fixation surface of the patellar part to facilitate satisfactory fixation.
  • the femoral part 3 is then engaged with the patellar part by means of the dovetail slot 2 and complementary rib 4, and the articulation facet 5 is brought into contact with the patellar facet 6 of the femoral component 7.
  • the articulation facet 5 has a concave sagittal profile and a convex transverse profile (i.e. a convex profile when viewed in superior aspect).
  • the articulation facet 5 moves against the patellar facet of the femoral component 7, guided in this trough-shaped surface by virtue of the convex transverse profile of its bearing surface.
  • the lateral pull during flexion found in the knee joint and described above is accommodated by a sliding motion between the two parts of the component in the medio-lateral direction.
  • the polyethylene articulation element 3 tracks from side to side by means of the dovetail joint, the planar surfaces lb and 3a thus sliding smoothly over one another, and this tracking allows increased congruency throughout flexion and at different loads on the joint.
  • the patellar component has been implanted it can be difficult to ensure that the articulation facet at the back of the component will conform with the patellar facet of the femoral component, depending partly on the accuracy of the fixation of the component to the natural patella. For this reason it is beneficial to build into the design the ability to permit rotation in a coronal plane.
  • Figures 4a and 4b (which present similar views to those in Figures 2a and 2b) illustrate a femoral part which allows both rotation and sliding between the two parts of the component.
  • a central flared stud 20 projects from the planar interface surface.

Abstract

An implantable prosthetic patellar component comprises a patellar part (1) having one side (1a) adapted to be secured to the inner surface of a natural patella (10), and a femoral part (3) having one side (5) defining an articulation surface to replace the femoral facet of the patella, the opposite surfaces (1b and 3a) of said parts being mutually engageable to afford sliding movement therebetween in a medio-lateral direction. The implant is able to accommodate relative medio-lateral movement and thereby improve congruency. It may be used in combination with other prosthetic components in a knee joint.

Description

IMPLANTABLE PROSTHETIC PATELLAR COMPONENTS
This invention concerns prosthetic patellar components for implantation in the knee joint of a patient.
A number of different knee prostheses have been developed for surgical treatment of the disabling effects of knee joint deterioration, such as results from arthritis, injury or disease. A fairly common operation nowadays is total knee replacement, where the femoral facets of the proximal tibia as well as the patellar and tibia! facets of the distal femur are replaced with prosthetic components. It is also recognised that replacing the articulating surface on the posterior aspect of the patella improves the result of such operations, and prosthetic patellar elements for such a purpose have been developed.
More recently study has been carried out directed to investigation of contact stresses between the patella and the femoral components in three common designs of knee prostheses. At different angles of flexion under a load of 500 newtons contact stresses across the patello- femoral interface were monitored. It was determined from these tests that the contact stress areas move outwards towards the periphery of the interface and the contact stress values increase at increases in knee flexion, for all the designs tested. Patellar implants retrieved at revision of the designs tested confirmed wear and deformation in the areas of measured maximum contact stress. All the designs showed poor congruency at all angles of knee flexion.
Examples of prosthetic patellar components are disclosed in DE-U-9116507.5, WO-93/00871 and US-4041550. None of these teachings provides a device which suitably accommodates the conditions referred to above. To improve this situation the present invention provides a novel i plantable prosthetic patellar component, comprising ε patellar part having one side adapted to be secured to the inner surface of a natural patella, and a femoral part having one side defining an articulation surface to replace the femora! facet of the patella, the opposite sides of said parts being mutually engageable to afford sliding movement therebetween in a medio-lateral direction.
The invention therefore provides an i plantable prosthetic patellar component of two-part form, these two parts of the component referred to herein as the patellar part and the femoral part. When in place in a patient the component according to the invention allows sliding movement between the two parts in the medio-lateral direction to accommodate naturally occurring relative movement in this direction. Considerable variation in the quadriceps-patellar ligament angle from subject to subject produces variations in the magnitude of the medio-lateral force acting on the patella, and such variations are allowed for by the component of the present invention. This improves congruency throughout flexion and at various loading of the joint, which has the effect of considerably reducing wear and deformation by reducing contact stresses during movement of the joint.
In a preferred form, the engagement between the two parts allows translational sliding movement only in a substantially medio-lateral direction. In this way, sliding displacement of the whole of one part relative to the other part is limited to that in a substantially medio-lateral direction.
Preferably, either the patellar part or the femoral part has an elongated dovetail slot, the other part having a complementary projection, such as a dovetail rib or a flared stud, the slot and the projection being dimensioned for engagement to afford the sliding movement between the two parts. In this way, the mutually interfacing sides of the parts are held in contact and the risk of dislocation of one part from the other is reduced. The provision of a flared stud accomplishes this whilst at the same time allowing relative rotation about an axis in the anterio-posterior direction.
Certain embodiments of the invention will now be described by way of example with reference to the accompanying drawings, in which:- Figures la and lb illustrate a patellar part of a prosthetic patellar component according to the invention;
Figures 2a to 2c illustrate a femoral part of such a component; Figure 3 represents in side elevation a total knee replacement incorporating the patellar component illustrated in Figures 1 and 2; and
Figures 4a and 4b illustrate an alternative form of a femoral part of the component. The patellar part of the illustrated patellar component consists of a metal disc 1 with a planar fixation surface la for attachment to an inner surface of a natural patella, and an opposite parallel planar interface surface lb in which a dovetail slot 2 is machined. Figure la shows a plan view of the part, whilst Figure lb shows a side elevation.
The femoral part of the patellar component is shown in
Figure 2, where Figure 2a offers a side elevation of the part,
Figure 2b offers a front view, Figure 2c offers a top view, and
Figure 2d offers a cross section of the part across plane A-A of Figure 2b.
The femoral part consists of an articulation element 3 of suitable biocompatible material, such as ultrahigh molecular weight polyethylene, having a planar interface surface 3a, from which a dovetail rib 4 protrudes, this rib being complementary to the dovetail slot 2 in the patellar part so that when inter-engaged the two can slide smoothly relative to one another in a direction parallel to the slot.
The opposite side of the femoral part consists of a smooth articulation facet 5 which, as can be seen from Figures 2a and 2c, is concavely curved in one direction and convexly curved in a perpendicular direction giving the part a 'saddle-shaped' bearing surface. The actual curvatures in both directions will depend on the shape of the corresponding surface of the femoral component against which the part is designed to articulate, this last shape - the patellar facet - commonly being that of a trough. The side edges of the part are rounded as can be seen in Figure 2b. Example dimensions for the two parts of the component are given in the figures but clearly can be varied in practice to suit different requirements. The operation of the parts of the component when implanted in a patient's knee will now be described with reference to Figure 3. This shows the patellar component used in a total knee replacement, but it is to be understood that the component could be used as a sole implant, functioning in an otherwise natural joint.
The inner surface of the patient's patella 10 is appropriately prepared by a surgeon for fixation to the planar fixation surface of the patellar part 1 and the two are connected together such that the dovetail slot 2 is arranged in the medio-lateral direction. The fixation may be by means of bone cement and/or fixation pins, or alternatively a projecting stud
(not shown) may be provided on the fixation surface of the patellar part to facilitate satisfactory fixation. The femoral part 3 is then engaged with the patellar part by means of the dovetail slot 2 and complementary rib 4, and the articulation facet 5 is brought into contact with the patellar facet 6 of the femoral component 7. When in place, the articulation facet 5 has a concave sagittal profile and a convex transverse profile (i.e. a convex profile when viewed in superior aspect). In subsequent flexion of the joint, the articulation facet 5 moves against the patellar facet of the femoral component 7, guided in this trough-shaped surface by virtue of the convex transverse profile of its bearing surface. At the same time, the lateral pull during flexion found in the knee joint and described above is accommodated by a sliding motion between the two parts of the component in the medio-lateral direction. The polyethylene articulation element 3 tracks from side to side by means of the dovetail joint, the planar surfaces lb and 3a thus sliding smoothly over one another, and this tracking allows increased congruency throughout flexion and at different loads on the joint. When the patellar component has been implanted it can be difficult to ensure that the articulation facet at the back of the component will conform with the patellar facet of the femoral component, depending partly on the accuracy of the fixation of the component to the natural patella. For this reason it is beneficial to build into the design the ability to permit rotation in a coronal plane. Figures 4a and 4b (which present similar views to those in Figures 2a and 2b) illustrate a femoral part which allows both rotation and sliding between the two parts of the component. In place of the dovetail rib 4 a central flared stud 20 projects from the planar interface surface. When this stud is engaged in the dovetail slot 2 of the patellar part of the component the two parts can move relative to one another both by sliding in a direction parallel to the slot and by rotation about the stud, and when implanted this design provides, in certain situations, further improved congruency within the joint.
Whilst the invention has been described and illustrated in conjunction with specific embodiments thereof, it should be understood that this in no way limits the scope of the invention, which is intended to embrace all other embodiments that fall within the spirit and scope of the appended claims.

Claims

1. An implantable prosthetic patellar component comprising a patella part having one side adapted to be secured to the inner surface of a natural patella, and a femoral part having one side defining an articulation surface to replace the femoral facet of the patella, the opposite sides of said parts being mutually engageable to afford sliding movement therebetween in a medio-lateral direction.
2. A component according to Claim 1, wherein the two parts are engageable for translational sliding movement therebetween only in a substantially medio-lateral direction.
3. A component according to Claim 2, wherein either the patella part or the femoral part has a longitudinal dovetail slot, and the other part has a complementary projection, the slot and the projection being dimensioned for engagement to afford said sliding movement between the two parts.
4. A component according to Claim 3, wherein the projection is a dovetail rib.
5. A component according to Claim 3, wherein the projection is a flared stud.
6. A component according to any one of Claims 1 to 5, wherein the articulation surface of the femoral part has a concave sagittal profile.
7. A component according to any one of Claims 1 to 6, wherein the articulation surface of the femoral part has a convex transverse profile.
8. A component according to any one of Claims 1 to 7, wherein the mutually engageable surfaces of the two parts are substantially planar.
PCT/GB1994/000701 1993-04-01 1994-03-31 Implantable prosthetic patellar components WO1994022397A1 (en)

Priority Applications (4)

Application Number Priority Date Filing Date Title
US08/530,153 US5723016A (en) 1993-04-01 1994-03-31 Implantable prosthetic patellar components
DE69418864T DE69418864T2 (en) 1993-04-01 1994-03-31 IMPLANTABLE PROSTHETIC KNEE DISC COMPONENTS
EP94911268A EP0691831B1 (en) 1993-04-01 1994-03-31 Implantable prosthetic patellar components
JP6521850A JPH08508190A (en) 1993-04-01 1994-03-31 Implantable prosthetic patella element

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB9306898.9 1993-04-01
GB939306898A GB9306898D0 (en) 1993-04-01 1993-04-01 Implantable prosthetic patellar components

Publications (1)

Publication Number Publication Date
WO1994022397A1 true WO1994022397A1 (en) 1994-10-13

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PCT/GB1994/000701 WO1994022397A1 (en) 1993-04-01 1994-03-31 Implantable prosthetic patellar components

Country Status (6)

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US (1) US5723016A (en)
EP (1) EP0691831B1 (en)
JP (1) JPH08508190A (en)
DE (1) DE69418864T2 (en)
GB (1) GB9306898D0 (en)
WO (1) WO1994022397A1 (en)

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US5702467A (en) * 1996-06-12 1997-12-30 Johnson & Johnson Professional, Inc. Patellar resurfacing component
WO1998006343A1 (en) * 1994-04-19 1998-02-19 David Giorgio Mendes Patella implant for prosthetic knee joint
US8425617B2 (en) 2002-12-20 2013-04-23 Smith & Nephew, Inc. Knee prostheses with convex slope on portion of tibial articular surface
US8834574B2 (en) 2010-12-07 2014-09-16 Zimmer, Inc. Prosthetic patella
US8926709B2 (en) 2010-08-12 2015-01-06 Smith & Nephew, Inc. Structures for use in orthopaedic implant fixation and methods of installation onto a bone
US9066804B2 (en) 1994-09-02 2015-06-30 Puget Bioventures Llc Method and apparatus for femoral and tibial resection
US9192391B2 (en) 2001-03-05 2015-11-24 Puget Bioventures Llc Method for minimally invasive total knee arthroplasty
US9730799B2 (en) 2006-06-30 2017-08-15 Smith & Nephew, Inc. Anatomical motion hinged prosthesis
US9814539B2 (en) 2004-01-14 2017-11-14 Puget Bioventures Llc Methods and apparatus for conformable prosthetic implants

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US6146423A (en) * 1999-01-28 2000-11-14 Implex Corporation Patella replacement apparatus
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US6190391B1 (en) 1999-10-01 2001-02-20 Bristol-Myers Squibb Company Method of preparing a resected posterior surface of a patella to receive a prosthetic element
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US8506639B2 (en) * 2004-03-31 2013-08-13 DePuy Synthes Products, LLC Sliding patellar prosthesis
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US8092544B2 (en) 2008-06-30 2012-01-10 Depuy Products, Inc. Implantable patella component having a thickened superior edge
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Cited By (16)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1998006343A1 (en) * 1994-04-19 1998-02-19 David Giorgio Mendes Patella implant for prosthetic knee joint
US9066804B2 (en) 1994-09-02 2015-06-30 Puget Bioventures Llc Method and apparatus for femoral and tibial resection
US5702467A (en) * 1996-06-12 1997-12-30 Johnson & Johnson Professional, Inc. Patellar resurfacing component
US9192391B2 (en) 2001-03-05 2015-11-24 Puget Bioventures Llc Method for minimally invasive total knee arthroplasty
US9421022B2 (en) 2001-03-05 2016-08-23 Puget Bioventures Llc Method and apparatus for total knee arthroplasty
US8425617B2 (en) 2002-12-20 2013-04-23 Smith & Nephew, Inc. Knee prostheses with convex slope on portion of tibial articular surface
US11369477B2 (en) 2002-12-20 2022-06-28 Smith & Nephew, Inc. High performance knee prostheses
US10149768B2 (en) 2002-12-20 2018-12-11 Smith & Nephew, Inc. High performance knee prostheses
US9320605B2 (en) 2002-12-20 2016-04-26 Smith & Nephew, Inc. High performance knee prostheses
US9402729B2 (en) 2002-12-20 2016-08-02 Smith & Nephew, Inc. High performance knee prostheses
US9707087B2 (en) 2002-12-20 2017-07-18 Smith & Nephew, Inc. High performance knee prosthesis
US9814539B2 (en) 2004-01-14 2017-11-14 Puget Bioventures Llc Methods and apparatus for conformable prosthetic implants
US9730799B2 (en) 2006-06-30 2017-08-15 Smith & Nephew, Inc. Anatomical motion hinged prosthesis
US10779949B2 (en) 2006-06-30 2020-09-22 Smith & Nephew, Inc. Anatomical motion hinged prosthesis
US8926709B2 (en) 2010-08-12 2015-01-06 Smith & Nephew, Inc. Structures for use in orthopaedic implant fixation and methods of installation onto a bone
US8834574B2 (en) 2010-12-07 2014-09-16 Zimmer, Inc. Prosthetic patella

Also Published As

Publication number Publication date
US5723016A (en) 1998-03-03
DE69418864D1 (en) 1999-07-08
EP0691831A1 (en) 1996-01-17
EP0691831B1 (en) 1999-06-02
DE69418864T2 (en) 1999-10-07
GB9306898D0 (en) 1993-05-26
JPH08508190A (en) 1996-09-03

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