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    公开号:BE1019759A3
    申请号:E2010/0636
    申请日:2010-10-27
    公开日:2012-12-04
    发明作者:Benjamin Geebelen
    申请人:Materialise Nv；
    IPC主号:
    专利说明:

    CONDUCTORS AND IMPACTORS FOR AN ACETABULAR CUP
    IMPLANT, COMBINATIONS THEREOF, METHODS FOR MANUFACTURE
    FIELD OF THE INVENTION
    The present invention relates to guides for guiding an acetabular cup implant, as well as impactors for pressure fitting an acetabular cup implant, both of which are used during reconstructive joint surgery, more particularly during reconstructive hip joint surgery. The present invention also relates to combined guide and fitting elements for an acetabular cup implant, comprising a guide instrument and an impactor.
    BACKGROUND
    In most procedures for joint arthroplasty, surgical replacement and / or reconstruction, and in particular in hip joint surgery, the joint is replaced with a prosthetic implant. The main purpose of such interventions is to relieve (arthritic) pain and / or to repair serious physical joint damage. When a prosthesis breaks, a revision surgery is performed. However, this procedure is technically more difficult and time-consuming than the primary intervention and the result is often less satisfactory, both because there is less bone stock to work with and because the removal of suture cement or prosthetic components can result in fracture or perforation of the bone. Furthermore, with each successive joint review, the risk of infection and the symptomatic loosening of the prosthesis can increase significantly. Accordingly, one of the most important aspects of joint surgery procedures is the correct, accurate and stable placement of the primary implant.
    The majority of the acetabular implants used in hip surgery are currently being deployed using the pressure-fit technique. In this technique, the patient's acetabulum is first bored with a succession of hemisphere-shaped reappers with increasing diameters, such that a hemisphere-shaped cavity is created where the implant should be placed. However, the last largest reamer typically has a diameter smaller than that of the implant. In a further step, the implant is attached to an impactor and placed on the patient's pelvis such that the implant rests on the edge of the drilled out cavity and the orientation of the implant is anatomically appropriate. Finally, a hammer is hit on the impactor until the implant is inside the drilled cavity. The implant is then detached from the impactor.
    Although the general consensus in the art is that the correct and accurate orientation of the acetabular implant determines the success of the surgery and the lifespan of the implant (Hayakawa, Keiko, et al. Archives of orthopedic and trauma surgery 129.9 (2009): 1151 -6), the procedure described above shows several shortcomings in this regard. Namely, the only anatomical visual reference during the final placement is the orientation of the transverse ligament (Pearse, CJ., Et al. Hip international 18.1 (2008): 7-10), to which the upper surface of the implant should be oriented in parallel. Accordingly, the rotation about the axis of the transverse ligament remains a variable parameter. In addition, the transverse ligament is generally not visible to the surgeon, which further impedes the orientation process. Furthermore, the impactor and the hammer are both rather large, which makes it difficult to keep the impactor in a stable orientation.
    Few solutions to these problems have been proposed in the past.
    US Patent Application 2009/0163922 A1 (Meridew, Metzger) describes a patient-specific conductor that can be placed on the acetabular edge and optionally secured, which is designed to cooperate with the impactor to achieve correct orientation force. However, such a device does not have the rigidity and the strength to withstand the momentum applied during the stroke.
    Japanese patent application 2007-056337 (Hananouchi) describes a patient-specific guide for inserting a pen into the acetabular edge, which can then be used by the surgeon as a visual reference to which the impactor is held in a parallel position. However, such a system provides only visual but not mechanical guidance.
    Accordingly, there is a need for alternative and improved surgical devices, and in particular the surgical guides, that offer the ability to correctly and accurately insert, position and orient an implant into the joint of a patient. More specifically, there is a need for alternative and improved surgical guides to correctly and accurately implant an acetabular cup implant into a patient's aceta bulum during hip joint surgery.
    SUMMARY OF THE INVENTION
    The present invention provides surgical devices for joint implants that ensure correct, accurate and stable placement and orientation of an implant within the joint. More specifically, the present invention provides both conductors and impactors and combinations thereof that allow accurate and stable insertion of an acetabular cup implant into a patient's acetabulum during hip joint surgery procedures.
    In a first aspect, the present invention provides conductors for an acetabular cup implant comprising (i) a support structure that closely connects to an acetabular cup implant and (ii) one or more contact elements that closely connect to areas of the bone containing the acetabular cup implant-zohe in at least three contact points. More specifically, the contact elements of the conductors of the present invention are designed such that the angle between the plane through the central axis of the implant and one contact point and the plane through the central axis and the adjacent contact point is never greater than 180 °. In addition, the contact elements of the conductors of the present invention are designed such that, after contacting the corresponding areas of the bone surrounding the acetabulum, they ensure a close connection of the conductor to the bone.
    In special embodiments, the conductors according to the invention comprise at least three contact elements which are designed such that the angle between the plane through the central axis of the implant and one contact element and the plane through the central axis and the adjacent contact element is never greater than 180 °.
    In particular embodiments, the conductors according to the invention, and more particularly the contact elements thereof, are designed such that, after placement of the conductor in the acetabular implant zone, the conductor and the acetabular cup implant are either forced to rotate or can rotate around the center of the implant until the implant has the desired orientation with respect to the pelvis.
    In certain embodiments, the guides according to the invention further comprise a positioning element, such as a hole or a groove, which allows the passage of a positioning device placed in the bone surrounding the acetabulum. In these specific embodiments, the positioning device may be, for example, a pin that is placed in the bone surrounding the acetabulum.
    In further particular embodiments of the present invention, the contact elements included in the conductors of the invention form larger contact surfaces comprising two or more contact points.
    The conductors of the present invention can be medical image-based patient-specific conductors or they can be modular devices comprising elements that can be adapted to the shape of the bone, or combinations thereof.
    A further aspect of the present invention provides combinations of an acetabular cup implant and a conductor according to the present invention, wherein the conductor comprises (i) a support structure that closely connects to an acetabular cup implant and (ii) one or more contact elements that closely connect to areas of the bone that surrounds the acetabular cup implant zone in at least three contact points. More specifically, the contact elements of the conductors of the present invention are designed such that the angle between the plane through the central axis of the implant and one contact point and the plane through the central axis the adjacent contact point is never greater than 180 ° . In addition, the contact elements of the conductors of the combinations according to the present invention are designed such that, after contacting the corresponding regions of the bone surrounding the acetabulum, they ensure a close connection of the conductor to the bone.
    In a still further aspect, the present invention provides impactors for fitting an acetabular cup implant, which comprises (i) a shank comprising a drive member, a hinge element and an impact element and (ii) a fastening element that can be locked onto an implant and / or on a guide for an implant. In the impactors according to the present invention, the hinge element of the shank forms a ball joint, the fastening element allowing movement of the orientation of the shank relative to the fastening element. The mounting of the ball joint in the mounting element forms a hinge that provides the impactor with a large rotation capacity and a high degree of angular freedom.
    In certain specific embodiments, the impactors of the present invention may further comprise a locking element which can restrict or completely block the movement of the stem relative to the fixing element and / or a mechanism for easily releasing the conductor and / or the implant.
    The present invention further provides combinations of an acetabular cup implant and an impactor and optionally a conductor, the impactor comprising (i) a shank comprising a drive member, a hinge element and an impact element and (ii) a fastening element that is locked onto the implant and / or on the guide for the implant. In particular embodiments, the impactor is characterized by the fact that the hinge element of the shank forms a ball joint with the fastening element allowing movement of the orientation of the shank relative to the fastening element.
    In yet a further aspect, the present invention provides a combined guide and fitting element for an acetabular cup implant, which comprises a conductor and an impactor according to the present invention. Accordingly, the guide of the combined guide and fitting element comprises (i) a support structure that closely fits the acetabular cup implant and (ii) one or more contact elements that connect to areas of the bone that the acetabular cup implant has in at least three surrounds contact points, the contact elements being designed such that the angle between the plane through the central axis of the implant and one contact point and the plane through the central axis and the adjacent contact point is never greater than 180 ° and that, after contacting the corresponding areas of the bone surrounding the aceta bulum, the contact elements ensure a close connection of the conductor to the bone. In addition, the impactor of the combined guide and fitting element according to this aspect of the invention comprises (i) a stem comprising a drive member, a hinge element and an impact element and (ii) a fixing element that is mounted on the implant and / or on the conductor for the implant, wherein the hinge element of the stem forms a ball joint with the mounting element allowing movement of the orientation of the stem relative to the mounting element and wherein the mounting element of the impactor can be connected to the conductor.
    In certain specific embodiments of the combined guide and fitting element according to the present invention, the contact elements of the conductor are designed such that, after placement of the conductor, the conductor and the acetabular cup implant are forced to rotate or around the center of the be able to rotate the implant until the implant has the desired orientation relative to the acetabulum of the pelvis.
    In further embodiments of the combined guide and fitting element according to the present invention, the guide may comprise a positioning element, such as a hole or groove, thereby allowing the passage of a positioning device to be placed in the bone surrounding the acetabulum. In these specific embodiments, the positioning device may be, for example, a pin that is placed in the bone surrounding the acetabulum.
    In further particular embodiments of the combined guide and fitting element according to the present invention, one or more contact elements included in the conductor can form larger contact surfaces comprising two or more contact points.
    The conductors included in the combined guide and fitting elements of the present invention can be medical image-based patient-specific conductors, but can also be modular instruments comprising one or more standard parts that can be adjusted to the shape of the bone .
    In yet a further aspect of the present invention, combinations of an acetabular cup implant and a combined guide and fitting element for an acetabular cup implant according to the invention are provided. More specifically, in these combinations, the guide and fitting element (a) comprises a guide for the acetabular cup implant comprising (i) a support structure that closely connects to an acetabular cup implant and (ii) one or more contact elements that connect on areas of the bone surrounding the acetabular cup implant zone in at least three contact points, the contact elements being designed such that the angle between the plane through the central axis of the implant and one contact point and the plane through the central axis and the adjacent contact point is never greater than 180 ° and that, after contacting the corresponding areas of the bone surrounding the acetabulum, the contact elements ensure a close connection of the conductors to the bone, and (b) an impactor comprising (i) a stem comprising a drive member, a hinge element and an impact element and (ii) a mounting element that can be connected to the implant and / or with a conductor for the implant, wherein the hinge element of the stem forms a ball joint with the mounting element allowing movement of the orientation of the stem relative to the mounting element and wherein the mounting element of the impactor is connected to said conductor.
    According to particular aspects of the present invention, a conductor, an impactor, and an implant are interconnected prior to placement of the implant in the acetabular cup-implant zone of the pelvic bone. The guide, present on the implant after its placement in the acetabulum, ensures correct placement of the implant.
    In order to further ensure a correct and stable orientation of the implant in the joint, the guides according to special embodiments of the invention are designed such that, after insertion of the implant, the implant is forced to rotate around its center in the desired and correct orientation. This is achieved in particular embodiments by adjusting, contacting or coinciding at least three contact elements of the conductors with at least three surfaces present on the bone of the pelvis surrounding the patient's acetabulum.
    The surgical devices for placing joint implants, ie conductors, impactors and combinations thereof, according to the present invention allow a more accurate and stable orientation of an acetabular cup implant in the acetabulum of a patient compared to the known surgical devices currently used are in hip joint surgery.
    BRIEF DESCRIPTION OF THE DRAWINGS
    The following description of the figures of specific embodiments of the invention is intended as an example only and is not intended to limit the current teaching, application or use thereof. In the drawings, corresponding reference numbers indicate identical or corresponding parts and elements.
    Figure 1 Guidance instrument for an acetabular cup implant according to a particular embodiment of the invention (viewed from below), comprising a support structure (2) comprising a guide cup and ring structure (7) and further comprising contact elements (3). The support structure further comprises a guide opening (4), positioning elements (5) and locking elements (6).
    Figure 2 The conductor (1) and implant (8) according to a particular embodiment of the invention shown after insertion into the pelvis. On the conductor (1), the support structure (2) comprising a ring structure (7) which interconnects the contact elements (3). One of the contact elements comprises a positioning element (5) and the ring structure of the support structure comprises locking elements (6).
    Figure 3 The implant (8) according to special embodiments of the invention comprising an edge (9) with locking elements (10). The central axis of the implant is indicated by X.
    Figure 4 A face of an implant (8) inserted into the pelvic bone (11) according to a particular embodiment of the invention. The locking elements (10) present on the edge of the implant are visible.
    Figure 5 Sectional view (left) and side view (right) of an impactor (13) according to special embodiments of the invention comprising a handle (14) and a fixing element (15). The handle comprises a drive member (16), an impact element (17) and a hinge element (20) that forms a ball joint with the fixing element (15). The opening (18) of the fastening element allows passage of the stem and its movement relative to the fastening element. The mounting element further comprises locking elements (19) for mounting on a conductor and / or acetabular cup implant.
    Figure 6 Sectional view (left) and side view (right) of a guide (1) and an impactor (13) assembly, wherein the fixing element (15) of the impactor comprises locking elements (19) that can be locked with the guide (1).
    Figure 7 Sectional view (left) and side view (right) of a combined guiding and fitting instrument and acetabular cup implant (8) according to special embodiments of the invention, wherein the combined guiding and fitting instrument comprises a conductor (1) and an impactor (13) includes. The outer surface of the impactor mounting element (15) corresponds to the shape of the support structure of the conductor (1), which itself corresponds to the inner shape of the implant (8). Locking elements (19) on the mounting element (15) of the impactor connect to the conductor (1) and the implant (8), which ensures a rigid assembly of impactor, conductor and implant.
    Figure 8 Combined conductor (1) and implant (8) connected to the fastening element of an impactor (13) according to a particular embodiment of the invention. The guide (1) comprises a stem (14) and a fixing element (15) which are connected to each other by a ball joint.
    Figure 9 A face of a combined guidance and fitting instrument and an acetabular cup implant (8) inserted into the pelvic bone (11) according to a particular embodiment of the invention. The combined guide and fitting instrument comprises a guide (1) and an impactor assembly (13), the latter comprising a stem (14) and a fastening element (15).
    Figure 10 Sectional view (left) and side view (right) of an impactor (13) according to special embodiments of the invention comprising a handle (14) and a fixing element (15). The handle comprises a drive member (16), an impact element (17) and a hinge element (20) that forms a ball joint with the fixing element (15). The opening (18) of the fastening element allows passage of the stem and its movement relative to the fastening element. The impactor further comprises a locking element (21) for locking the shank in a certain position in the fixing element.
    Figure 11 Sectional view (left) and side view (right) of a combined guide and fitting instrument according to particular embodiments of the invention, wherein the combined guide and fitting instrument comprises a guide (1) and an impactor assembly (13). Locking elements (19) on the mounting element (15) of the impactor connect to the conductor (1), which ensures a rigid assembly of impactor (13) and conductor (1).
    Figure 12 Sectional view (left) and side view (right) of a combined impactor (13) and implant (8) according to special embodiments of the invention. The impactor comprises a handle (14) and a fixing element (15). Locking elements (19) on the mounting element (15) of the impactor connect to the implant (8), which ensures a rigid assembly of impactor (13) and implant (8).
    List of reference numbers used in the Figures (1) guide (2) support structure (3) contact element (4) opening in the guide (5) positioning element (6) locking element (7) ring structure (part of the support structure) (8) acetabular cup implant (9) edge of the acetabular cup implant (10) locking element (11) pelvic bone (12) outer surface of the implant (13) impactor (14) stem (15) mounting element (16) drive member (17) impact element (18) ) opening of the fixing element (19) locking element (20) hinge element (21) locking element
    DETAILED DESCRIPTION
    The present invention will be described with respect to particular embodiments, but the invention is not limited thereto but only by the claims. Any reference sign in the claims will not be understood as limiting the scope thereof.
    Where the term "comprising" is used in the present description and claims, it does not exclude other elements or steps. Where an indefinite or definite article is used when referring to a single noun eg "one" or "the", this includes a plural of that noun unless specifically meant otherwise.
    Furthermore, the terms first, second, third and the like in the description and in the claims are used to distinguish between similar elements and not necessarily for describing a sequential or chronological order unless otherwise specified. It is to be understood that the terms so used are interchangeable under appropriate circumstances and that the embodiments of the invention described herein are suitable for carrying them out in sequences other than those described or shown herein.
    The terms or definitions used herein are provided only as an aid in understanding the invention.
    The present invention provides surgical devices for weight implants, which facilitates correct, accurate and stable placement and orientation of an implant within the joint. More specifically, the present invention provides conductors as well as impactors and combinations thereof, thereby providing the ability to accurately and stably insert an acetabular cup implant into an acetabulum of a patient during hip joint surgery methods.
    In a first aspect, the present invention provides surgical guides for guiding an acetabular cup implant, which allows both correct and accurate orientation, as well as stable placement of the implant in the patient's acetabulum.
    More specifically, the present invention provides surgical guides that fit on an acetabular cup implant and that are attached to an acetabular implant prior to its placement in the acetabulum (more particularly, the cavity provided at the implant site should be placed). This is ensured by a combination of a support structure and one or more contact elements which ensure an accurate connection of the conductor to the implant and a specific connection of the conductor to the acetabulum.
    The conductors according to the present invention thus comprise a support structure that accurately connects to an acetabular cup implant. The support structure serves to allow stable guidance and optimum orientation of the implant. Further, since the guide elements of the present invention are intended in particular embodiments for use as an interface between the implant and an impactor, the guide element ensures complete transfer of the impact force applied by an impactor to an implant after insertion of the implant into the implant. joint.
    In particular embodiments, the outer surface (ie, the surface facing the implant) of the support structure of the guide elements of the invention comprises a portion designed to correspond as closely as possible to the hemisphere inner surface of the acetabular implant (i.e., the surface that replaces the patient's acetabular cup, which is the surface of the implant opposite the surface that makes contact with the acetabular bone). This part of the support structure is also referred to as a guide cup. In special embodiments it is provided that the conductor cup corresponds to a single hemisphere-shaped structure. However, the conductor cup can also comprise a third of a hemisphere surface, a quarter of an atmospheric surface or any other portion of a hemisphere surface. In addition or alternatively, the guide cup may comprise multiple elements that, as a whole, provide rigid support to the acetabular cup implant. In further particular embodiments, the outer surface of the guide cup is completely complementary to the surface of the implant cup. In more particular embodiments, this complementarity implies a play between the guide cup and the implant.
    In specific embodiments, full three-dimensional coverage of the contact area between the support structure of the conductors of the invention and the acetabular implant ensures the stability of the conductors placed on the implant by preventing translation and (optionally) rotation along and / or around a certain axis.
    In particular embodiments, the conductor cup of the support structure of the conductor is a hollow structure, whereby the inner surface of the cup is designed to fit on the outer surface of (an attachment element of) an impactor. In further special embodiments, this outer surface is a hemisphere-shaped outer surface. In further particular embodiments, the conductor cup is designed to fit on an impactor according to the present invention as described herein below.
    In addition to the conductor cup, the support structure of the conductors of the present invention typically includes a structure that fits on the edge of the acetabular cup implant and serves as a connecting structure that interconnects at least three contact elements of the conductor (described in detail below) connects. This part of the support structure is typically circular, as an extension of the mounting of the guide cup on the edge of the acetabular cup implant and also referred to herein as a ring structure. However, the "ring structure" can also be an interrupted structure.
    The support structure of the conductors according to the invention, more particularly the conductor cup, can contain one or more conductor holes, i.e. openings or bores. The conductor hole may serve to allow a direct transfer of the impact force from the impactor to the implant. Regardless of this, one or more conductor holes may also serve as a mounting element, which helps to ensure a tight coupling between the conductor and an impactor and / or implant.
    In particular embodiments, the support structure of the conductors according to the invention can in fact comprise one or more locking elements, which allows a coupling to an impactor. In special embodiments where the impactor comprises a fastening element as described herein, the support structure of the conductors comprises one or more locking elements that allow a coupling with locking elements of the fastening element. Such locking elements include, but are not limited to, grooves, recesses, etc. In particular embodiments, the conductor hole also serves as a locking element that can be connected to a locking element of the fastening element.
    In further particular embodiments, the one or more locking elements are designed to allow easy release of the implant from the impactor or its mounting element by a mechanism provided as part of the locking elements and / or the impactor. Non-limiting embodiments of suitable systems to detach an acetabular cup implant from an impactor are described, for example, in US 2004/0153063 and US 2007/0173856.
    In special embodiments, the support structure of the conductors according to the invention can comprise one or more locking elements which ensure a coupling with an acetabular cup implant. These can be separate from or can be combined with the locking elements which ensure a coupling with the impactor described above. Such locking elements may be located on the ring structure protruding over the edge of the acetabular cup implant, thus ensuring a specific coupling with the edge of the implant. The one or more locking elements can be three-dimensional elements that are specifically designed on the conductor / implant combination, but can also be locking elements that allow coupling of a patient-specific or a standard conductor to a patient-specific or standard implant.
    The support structure of the conductors of the present invention may further comprise one or more elements for visual reference to further reduce any remaining orientation problems. In particular embodiments, these visual references are located on the ring portion of the support structure that is designed to fit on the acetabular edge of the implant.
    The conductors according to the present invention further comprise one or more contact elements which fit at least three contact points thereon, connect thereto or coincide with three or more regions of the pelvic bone that surrounds the acetabular cup implant zone. In this way, the surgical guides according to the present invention allow an accurate and stable orientation and a connection of the acetabular cup implant into the patient's acetabulum.
    In special embodiments, the contact elements of the conductors according to the invention are designed such that, after insertion of the implant, the conductor forces the implant to rotate in the desired orientation in the acetabulum relative to the pelvic bone. In particular embodiments, this is achieved by the fact that the one or more contact elements fit, make contact, or coincide with surfaces on the bone surrounding the acetabulum. In further specific embodiments, the three-dimensional connection between the contact elements of the conductors and the specific regions of the pelvic bone of the patient ensures that the acetabular cup-implant zone surrounds the stability of the conductor through both translation and rotation (either uni- or bi-directional) -directional) along and / or around a certain axis.
    To ensure conductor stability, the contact points of the one or more contact elements are located such that the angle between the plane through the central axis of the implant and one contact point and the plane through the central axis and the adjacent contact point is less than or equal to 180 °. In special embodiments, this is ensured by the presence of at least three contact elements, wherein the angle between the plane through the central axis of the implant and one contact element and the plane through the central axis and the adjacent contact element is less than or equal to 180 ° . More specifically, it is contemplated that the conductors comprise three contact elements that include contact points separated by an angle of about 120 °. The contact elements typically span larger surfaces such that the distance between each of the different contact elements is less than 120 °. In particular embodiments, contact elements are provided such that one contact element comprises a surface that spans more than one of these contact points. Accordingly, in specific embodiments, the conductors of the present invention effectively comprise one or more larger contact surfaces that span a surface corresponding to more than 120 ° of the bone around the central axis of the implant.
    In particular embodiments, the conductors of the present invention are modular instruments that include contact elements that can be adapted to closely fit the pelvic bone that surrounds the acetabular cup zone. For example, in particular embodiments, the contact elements include individually controllable elements that are fitted to the pelvic bone prior to or during attachment to ensure a tight fit to the acetabulum. More specifically, the contact elements are elements movably connected to a central support structure and which can be adjusted in height and / or rotate about the central axis of the implant to ensure the most accurate connection with the given parts of the pelvic bone .
    In particular embodiments, one or more contact elements of the conductors of the present invention are attached and positioned to ensure correct connection with a corresponding pelvic bone structure.
    In particular embodiments, at least one of the contact elements of the conductors of the present invention includes, at the contact point, a patient-specific surface on the side facing the pelvic bone that is precisely and completely complementary, ie specifically fits on a specific anatomical region of the pelvic bone that surrounds the acetabular cup implant zone of the patient. This can be ensured by a pre-operative planning based on images of the (drilled out) acetabular head zone. In further special embodiments, this specific connection may imply a clearance between the surface of the contact elements and the bone, such as, for example, a clearance between the surface of the contact elements and the bone of between 0.1 - 1.0 mm. When the patient-specific surfaces of the contact elements are contacted or placed against their corresponding complementary surfaces of the pelvic bone of the patient, they fit, fit and / or make contact with the surfaces, thereby fixing the conductor, and thus also the implant connected or attached to it in the correct and desired position.
    Typically, a patient-specific surface of a contact element is selected based on anatomical elements present on the pelvic bone that surrounds the implant zone. In particular embodiments, a patient-specific surface is selected based on anatomical elements present on one or more of the ilium part, the pubic part and the ischemic part of the pelvic bone. However, it is also provided in particular embodiments that elements are introduced on the patient's bone to allow the generation of patient-specific surfaces on the contact elements based thereon.
    In particular embodiments as explained in detail above, the one or more contact elements of the conductors according to the invention are designed such that, after placement of the conductor, the conductor and the acetabular cup implant (which are interconnected or interconnected) can be manipulated to rotate around the center of the implant or central axis until the implant has the desired orientation relative to the pelvis. According to these specific embodiments, a rotation around the center of the implant or the central axis ensures that the one or more contact elements take their correct position, ie that a connection or mutual connection is ensured between the (patient-specific) areas of the one or more multiple contact elements of the conductors and the corresponding anatomical regions of the patient's pelvic bone that surrounds the acetabular cup-implant zone. In these embodiments, the stability of the conductor is ensured by preventing both translation and rotation (either unidirectional or bi-directional) along and / or around the central axis of the implant.
    Apart from the condition that they must ensure a close connection to the pelvic bone, the size and shape of the contact elements of the conductors according to the present invention are not critical to the invention. Typically, the size and shape of the contact elements of the conductors of the present invention is determined by the three-dimensional surface of the pelvic bone that surrounds the acetabular cup implant zone, more particularly the pelvic bone that the acetabular cup implant zone of the patient for which it is designed, surrounds. In particular embodiments, the contact elements correspond to flanges, i.e., longitudinal structures extending from the support structure of the conductors of the invention in different directions and allowing stable mounting of the conductors on the pelvic bone. In further special embodiments, the flanges extend in the direction of the ilium, ischium and pubic, respectively. According to these embodiments, conductors with at least three, more particularly conductors with three flanges are considered. As explained in detail above, the flanges are typically connected (at least) by the support structure of the conductors of the present invention.
    In certain embodiments, the conductors according to the invention may further comprise one or more positioning elements that allow the passage of or the connection to a positioning device. Typically, such a positioning device is introduced into the bone surrounding the acetabulum in a planned position prior to insertion of the implant, and insertion of or connection to the positioning device facilitates placement of the guide. Optionally, the positioning device is introduced into the bone by placing the guide of the invention on the pelvis bone prior to placement of the implant, the one or more positioning elements allowing the positioning of the positioning device into the bone. In particular embodiments, the positioning element is a hole, a cannula, a channel or a groove that allows the passage of a positioning device such as a guide pin. In special embodiments, the element comprises at least one cylindrical hole. In addition or alternatively, the positioning device comprises a handle or other mounting element that allows a connection to a positioning device, such as a guide pin.
    More specifically, the nature of the one or more positioning elements of the conductors (i.e., actual height or distance with respect to the surface of the bone) is determined to ensure adequate conduction of the conductor by the positioning device or vice versa.
    As explained in detail above, in particular embodiments, the positioning element in the guide is also designed for use in the placement of the positioning device in the bone prior to the placement of the implant in the bone. In these embodiments, the one or more positioning elements may include a safety stop to prevent a positioning device from going beyond a planned depth in the bone.
    The location of a positioning element included in the guides according to the present invention is determined based on anatomical characteristics of the bone, the desired position of the guide on the pelvic bone and the structure of the guide. The one or more positioning elements can be provided either on the support structure or on one of the contact elements of the conductor (or on both). In a particular embodiment, the positioning element is a groove provided on one of the contact elements. The positioning element (s) is (are) located on the conductor such that the conductor is in the desired position when the positioning device is locked in the one or more positioning elements.
    The invention further provides methods for manufacturing the conductors described herein.
    As explained in detail above, in particular embodiments, the conductors include contact elements designed to ensure a tight connection of the conductor to the bone surrounding the acetabulum. In particular embodiments, this is ensured by designing the conductor or at least the contact elements based on pre-operative images of the bone that surrounds the acetabular implant zone and implant to be inserted therein. Accordingly, methods for manufacturing the (patient-specific) conductors of the invention typically include the step of (a) obtaining volume information of the pelvic bone and the acetabular implant to be placed therein, (b) identifying and selecting of parts of the bone surrounding the implant zone suitable for use as a base for the contact elements of the conductor, and (c) producing a conductor based on the information obtained in steps (a) and (b). In particular embodiments, step (b) comprises identifying and selecting parts of the bone surrounding the implant zone that contain sufficient characteristics such that the connection of the contact elements with the bone is patient-specific.
    Typically, the step of identifying and selecting parts of the bone that surrounds the implant zone and that are suitable for use as a base for the contact elements includes selecting a portion of the ilium, ischium and pubic bone of the pelvis suitable for use as a basis for a contact element.
    The method for manufacturing conductors according to the invention can include the step of identifying and selecting a suitable position for the placement of a positioning device and the corresponding positioning element in the conductor.
    The step of obtaining volume information from the pelvic bone and the acetabular implant to be implanted typically involves obtaining digital patient-specific image information, which can be performed by any suitable means known in the art, such as, for example, a computer tomography (CT) scanner , a magnetic resonance imaging (MRI) scanner, an ultrasonic scanner, or a combination of X-rays. A summary of medical imaging is described in "Fundamentals of Medical Imaging", by P. Suetens, Cambridge University Press, 2002.
    In a particular embodiment, Additive Manufacturing (AM) techniques are used to manufacture the conductor according to the invention. Additive Manufacturing (AM) can be defined as a group of techniques used to produce a tangible model of an object, typically using three-dimensional data for (3-D) computer assisted design (CAD) of the object. A large amount of additive manufacturing techniques are currently available, including stereolithography, selective laser sintering, fused deposition modeling, foil-based techniques, etc.
    Selective laser sintering uses a high-power laser or other concentrated heat source to sinter or weld small particles of plastic, metal, or ceramic powder into a mass representing the 3-dimensional object to be formed.
    Fused Déposition Modeling and related techniques use a temporary transition from a solid material to a liquid state, usually as a result of heating. The material is pressed through an extrusion nozzle in a controlled manner and deposited at the required location as described, inter alia, in U.S. Patent No. 5,141,680.
    Foil-based techniques attach layers to each other by gluing or photopolymerization or other techniques and cut the article from these layers or polymerize the article. Such a technique is described in US Patent No. 5,192,539.
    Typical AM techniques start from a digital representation of the 3-D object to be formed. In general, the digital representation is cut out as a series of cross-sectional layers that can be superimposed to form the object as a whole. The AM device uses this data to build the object on a layer-by-layer basis. The cross-sectional data representing the layer data of the 3-D object can be produced using a computer system and computer-assisted design and production software (CAD / CAM).
    The conductors according to the present invention can be made from different materials. Typically, only materials are considered that are biocompatible (eg USP class VI compatible) with the human body. Preferably, the surgical mold is formed from a material that can tolerate heat allowing it to tolerate high temperature sterilization. In the case that Selective Laser Sintering is used as an AM technique, the surgical mold can be made from a polyamide such as PA 2200, as can be manufactured by EOS, Munich, Germany or another material known to those skilled in the art can also be used to become.
    According to the present invention, conductors are provided for use with an acetabular cup implant, whereby the conductor and implant are typically interconnected prior to placement of the implant. Accordingly, the present invention also provides combinations of an acetabular cup implant and a conductor according to the present invention. Accordingly, the present invention provides a combination of an acetabular cup implant and a conductor, the conductor comprising (i) a support structure that closely fits the acetabular cup implant and (ii) one or more contact elements designed to connect to close to specific areas of the bone surrounding the acetabular cup implant zone, the contact elements being designed to contact the bone in at least three contact points, the angle between the plane passing through the central axis of the implant and one contact point and the plane through the central axis and the adjacent contact point is never greater than 180 ° and wherein, after contacting the bone surrounding the acetabulum, the one or more contact elements ensure a tight connection of the conductors to the bone.
    The acetabular cup implants for use in the context of the present invention may be standard implants or may be patient-specific, i.e. designed based on specific characteristics of the pelvic area of a patient and / or the damage to it. In particular embodiments, the acetabular cup implants for use in the context of the present invention are pressure-fit implants. Acetabular cup implants are known to those skilled in the art and most types of known pressure-fit acetabular cup implants are suitable for use in the context of the present invention.
    In particular embodiments, the acetabular cup implant is a patient-specific implant that is designed based on specific characteristics of the patient, obtained by medical images of the acetabular implant zone of the patient. As described above, methods of obtaining medical images useful for designing an implant are known to those skilled in the art and include, but are not limited to, a computed tomography (CT) scanner, a magnetic resonance imaging (MRI) scanner ), an ultrasonic scanner, or a combination of X-rays. Again reference can be made to the publication by P. Suetens (2002), referred to above.
    Regardless of the locking elements described herein, the outer surface of the acetabular cup implant may include a rough texture that makes mechanical contact with the bone and ensures a connection between the implant and the acetabulum. Such a rough texture can, for example, be irregular or comprise a homogeneous granular structure or a pattern of ribs and grooves.
    The connection of the conductor to the implant in the combinations of an acetabular cup implant and a conductor according to the present invention can be achieved in any suitable manner, such as, for example, by one or more locking elements or elements. The one or more locking elements or elements may, for example, be present on the guide, such as on the support structure of the guide. In these special embodiments, the conductors according to the invention comprise one or more locking elements which ensure a coupling with the acetabular cup implant. When the support structure of the conductors of the present invention (which are designed to fit into an acetabular cup implant) include a ring structure that is designed to fit on the edge of the implant, such locking elements may be located on the ring structure around a ensure specific coupling with the acetabular edge of the implant. The one or more locking elements may be three-dimensional elements specifically designed for each individual conductor / implant combination, or may be standard elements such that a modular conductor can fit on a standard implant or on different patient-specific implants.
    In addition or alternatively, the one or more locking elements interconnecting the conductor and the implant are provided on the acetabular cup implant prior to placement of the implant. Such locking elements are typically located on the edge of the acetabular cup implant but can also be provided on the inner surface (ie, the surface that does not contact the pelvic bone) of the hemisphere of the implant to ensure specific coupling to the conductor of the invention .
    In addition or alternatively, one or more locking elements interconnecting the conductor and the implant may be present prior to placement of the implant or may be designed to interact with locking elements of another element or device. For example, where conductive elements are contemplated for use with an impactor such as the impactors of the present invention, one or more locking elements may be present on or designed to interact with locking elements of the impactor. In this way the conductor, the acetabular cup implant and the impactor can be connected to each other such that these three form a rigid assembly.
    Suitable examples of locking elements that interact with each other include, but are not limited to, grooves and riders or hooks. Optionally, the locking elements include a mechanism through which the interconnected parts can be easily disassembled. In particular embodiments, where the locking elements ensure a rigid coupling between the conductor, implant and impactor prior to placement, an optional mechanism is provided whereby the implant is easily detached from the conductor and / or the impactor after placement. Non-limiting embodiments of suitable systems to detach acetabular cup implants from an impactor are described, for example, in US 2004/0153063 and US 2007/0173856.
    In a further aspect, the present invention provides surgical impactors for joint implants that permit correct, accurate, and stable placement and orientation of the implant within the joint. More specifically, the present invention provides impactors that provide for easy manipulation in a limited action window that facilitates accurate and stable insertion of a pressure-fit acetabular cup implant into a patient's acetabulum during hip joint surgery procedures.
    The impactors according to the present invention for pressure-fitting an acetabular cup implant comprise (i) a stem comprising a drive member, a hinge element and an impact element and (ii) a fixing element that can be locked on an implant and / or on an implant conductor for the implant. The different elements of the stem can be provided as separate interconnected parts but can also correspond to different areas of a device comprising one or more parts.
    In the impactors according to the present invention, the hinge element of the handle forms a ball joint with the attachment element that allows movement of the orientation of the handle relative to the attachment element. Namely, the impactors of the present invention are designed such that the stem can rotate freely around the center of the implant relative to the attachment element. This allows the surgeon to orient the shank of the impactor in different directions relative to the acetabular cup implant and / or a guide for the acetabular cup implant.
    The various components of the impactors according to the present invention are described in more detail below.
    As described above, the impactors of the present invention comprise a stem and a mounting element. The handle of the impactors according to the invention comprises a drive member, a hinge element and an impact element. The impact element of the stem receives the strokes that are given with the aid of an impact device.
    The drive member typically has a longitudinal shape (such as a shaft), which allows the surgeon to have a good grip on the impactor before placing it in the direction / orientation in which the stroke will be given. According to specific embodiments, the drive member of the shank is a roughly cylindrical longitudinal element.
    The shank of the impactors according to the invention further comprises a hinge element, which is a spherical element attached to the end of the drive member. The hinge element of the shank of the impactors of the present invention is locked in the impactor mounting element (described below) by forming a ball joint. This ball joint serves to transfer the strokes (which are given on the drive member of the stem) in the same way to the impactor mounting element and from there to the acetabular cup implant and / or the conductor connected thereto (as below) described in detail).
    The impactors according to the present invention also comprise a fastening element. This mounting element is designed a) to secure a ball joint with the impactor hinge element and b) to fit on an acetabular cup implant and / or guide for an acetabular cup implant. Accordingly, the impactors according to the invention further typically not only contain a general shape that is complementary to the shape of an acetabular cup implant and / or conductor of an acetabular cup implant but additionally one or more locking elements that allow close coupling to a conductor for an acetabular implant and / or with an aceta-bulaire cup implant.
    The part of the fixing element that forms the ball joint with the hinge element of the shank generally has a substantially spherical shape adapted to closely couple with the ball shape of the hinge element, thereby providing at least one opening for passage and movement of the drive member to admit. In particular embodiments, the aperture allows the movement of the drive member in any direction. In alternative embodiments, the opening in the mounting element limits the movement of the handle to specific orientations. In a particular embodiment the opening is provided such that the stem and / or the fixing element can rotate freely (relative to each other) around the center of the implant.
    In particular embodiments of the impactors of the present invention, the handle and / or the mounting element further comprises a locking element which can restrict or completely block the movement of the handle relative to the mounting element. Such a locking element allows the surgeon to have a predetermined desired orientation and / or position of the stalk of the impactor relative to the fastening element (and correspondingly relative to the implant and / or the guide for the implant attached or interconnected thereto ) easy to fix. Suitable examples of locking elements include, but are not limited to, a grip extending from the mounting element or a groove in the mounting element, which can be used to fix the position of the shank. In a particular embodiment, a locking element is provided on the drive member of the impactor, said locking element being movable along the drive member until it makes contact with the fixing element, thereby locking the position of the shank within the fixing element. When locked, the position of the handle relative to the mounting element can be provided at any angle ranging from 0 ° (the handle is locked in the mounting element in an upright position) to 90 ° (the orientation of the handle forms a straight angle with the x-axis of the mounting element). In further special embodiments, the drive member of the shank is provided with a screw thread, and the locking element is placed on this thread and can thus be rotated towards the opening of the fastening element to block the movement of the shank.
    As explained in detail above, the impactors of the present invention, and more particularly the fastening elements thereof, are designed to fit tightly either directly on an acetabular cup implant or on a guide for an acetabular cup implant (optionally in combination with the acetabular cup implant). Where the impactor is designed to fit directly on an acetabular cup implant, the outer shape of the ball joint structure of the fastener is typically hemisphere-shaped to match the shape of the implant. Where the impactor is designed to fit on a guide for an acetabular cup implant, the outer shape of the ball joint structure of the fastener is determined by the shape of the guide. Typically, where the shape of the conductor follows that of the implant (corresponding to a hollow hemisphere), the shape of the attachment element is also hemisphere-shaped. The corresponding concentric shapes of the fastening element and conductor allow a uniform transfer of a stroke that is given on the shank of the impactor to the whole of the implant.
    The impactors according to the invention typically further comprise one or more locking elements which themselves allow locking of the impactor on an acetabular cup implant and / or a guide for an acetabular cup implant, or they can cooperate with locking elements present on an acetabular cup implant and / or a guide for an acetabular cup implant to ensure a rigid assembly. The one or more locking elements may be three-dimensional elements that are specifically designed for an impactor / implant and / or a conductor combination. In addition or alternatively, the locking elements may permit the coupling of a standard impactor with a patient-specific conductor and / or patient-specific implant, with a modified conductor and / or a patient-specific implant, or with standard conductors and implants.
    The impactors of the present invention may further comprise a mechanism for easily detaching the implant and / or the implant conductor after the implant has been correctly placed in the patient's acetabulum (as described above).
    The impactors according to the invention can be manufactured from different materials using methods known to those skilled in the art. Typically, at least the stems and mounting elements of the impactors are produced from a rigid material, such as metal, to withstand the impact of a hammer or the like.
    The present invention further provides combinations of an acetabular cup implant and an impactor as described herein, wherein the impactor comprises (i) a shank comprising a drive member, a hinge element and an impact element and (ii) a mounting element that can be mounted on an implant and / or on a guide for an implant, wherein the hinge element of the stem forms a ball joint with the mounting element allowing movement of the orientation of the stem relative to the mounting element and wherein said mounting element of said impactor is locked on said implant. Namely, according to special embodiments, impactors are provided that are designed to fit directly on an acetabular cup implant. The implant is locked on the impactor prior to placement of the implant and released from it after the implant has been placed.
    In these embodiments, the impactor and / or the acetabular cup implant contain one or more elements which, either alone or together, permit close coupling of the impactor and the implant that form a rigid assembly. In special embodiments, the fastening element of the impactor comprises one or more hooks that fit into corresponding grooves present on the implant. Optionally, a mechanism is provided through which the implant can be easily detached from the impactor after placement.
    The present invention further provides a combined guide and fitting element for an acetabular cup implant. More in particular, the combined guide and fitting element for an acetabular cup implant comprises a conductor and an impactor. In special embodiments, the combined guide and fitting element according to the invention comprises a conductor, ie a conductor for an acetabular cup implant comprising (i) a support structure that closely connects to the acetabular cup implant and (ii) one or more contact elements that connect on areas of the bone that surrounds the acetabular cup implant zone in at least three contact points. The contact elements are designed such that the angle between the plane through the central axis of the implant and one contact point and the plane through the central axis and the adjacent contact point is never greater than 180 °. In addition, the one or more contact elements are designed such that, after contacting, they can ensure a tight connection of the conductors to the bone. The combined guide and fitting element further comprises an impactor. In further particular embodiments, the combined guide and fitting element according to the invention comprises an impactor as described herein, ie an impactor comprising (i) a shank comprising a drive member, a hinge element and an impact element and (ii) a fixing element that is locked on the implant and / or on the guide for the implant, wherein the hinge element of the stem forms a ball joint with the mounting element that allows movement of the orientation of the stem relative to the mounting element and wherein the mounting element of the impactor is mutually connected to said guide. The combined guide and fitting element further comprises a conductor. In the most special embodiments, the combined guide and fitting element according to the invention comprises both a guide for an acetabular cup implant and an impactor as described herein, wherein the guide and the impactor can be connected to each other to form a rigid assembly. This is achieved (a) by the fact that the outer shape of the fastening element is adapted to fit on the shape of the conductor, more particularly on the support structure of the conductor and (b) by one or more locking elements present on the impactor and / or conductor who can ensure a close coupling of these two elements. In special embodiments, the fastening element of the impactor comprises one or more hooks that fit into corresponding grooves present on the conductor. Optionally, a mechanism is provided through which the conductor can be easily detached from the impactor.
    The present invention further provides combinations of an acetabular cup implant and a combined guide and fitting element for an acetabular cup implant. In the most special embodiments of this combination, the guide and fitting element (a) comprises a guide for the acetabular cup implant and an impactor that can form a rigid assembly with the implant prior to its placement. More specifically, the conductor is a conductor as described herein, comprising (i) a support structure that closely connects to an acetabular cup implant and (ii) one or more contact elements that closely connect to areas of the bone that enclose the acetabular cup implant zone in at least three contact points, the contact elements being designed such that the angle between the plane through the central axis of the implant and one contact point and the plane through the central axis and the adjacent contact point is never greater than 180 °. More particularly, the conductor comprises three or more contact elements that are designed such that the angle between the plane through the central axis of the implant and one contact element and the plane through the central axis and the adjacent contact element is never greater than 180 °. Furthermore, the contact elements are designed such that after contacting the specific areas of the bone that surrounds the acetabulum, they can ensure a tight connection of the conductors to the bone. The impactor contemplated in this combination is an impactor which comprises (i) a stem comprising a drive member, a hinge element and an impact element and (ii) a mounting element that connects to the implant and / or to a conductor for the implant, wherein the hinge element of the shank forms a ball joint with the fastening element that allows movement of the orientation of the shank relative to the fastening element and wherein the fastening element of the impactor is mutually connected to the conductor. The acetabular cup implant for use in the combinations according to the invention is an acetabular cup implant as is known to those skilled in the art. In particular embodiments, the acetabular cup implant comprises one or more locking elements that can cause the conductor, impactor and implant to form a rigid assembly.
    A further aspect of the present invention provides methods to ensure accurate placement of an acetabular cup implant, which involves the use of the conductors, impactors, and combinations thereof according to the invention. In particular embodiments, a combination of an acetabular cup implant, a guide for the acetabular cup implant and an impactor is used, which is designed so that the elements can be locked together and form a rigid structure. Prior to placement of an implant, the implant and conductor are attached to the impactor mounting element. The implant is manually guided to the acetabular implant zone by the surgeon. The mounting element of the impactor (which is interconnected with the conductor and the implant) can rotate freely with respect to the stem, making it possible to place the conductor and the implant in the desired orientation, regardless of the available surgical window.
    Optionally, the conductor is placed with the help of a positioning instrument that mates with or fits onto a positioning element on the conductor. More specifically, a conductive pin is inserted into a corresponding groove on the conductor, which helps to place the implant and the conductor. In addition or alternatively, in particular embodiments, the conductor, and more particularly its contact surfaces, are designed such that, after insertion of the implant, the implant is forced to rotate about its center in the desired orientation so that the contact -ments would fit on corresponding structures of the surrounding bone.
    The impactor, more particularly the shank of the impactor, is struck with the help of a hammer to fit the implant into the (drilled out) aceta-bulaar implant zone. Optionally, the movement of the shank of the impactor is blocked by a locking element, prior to applying the strokes to the impactor.
    After inserting the implant in the desired position, both the impactor and the conductor are detached from the implant.
    The present invention further provides methods for ensuring accurate placement of an acetabular cup implant, which involves the use of the conductors and / or impactors of the invention, which are designed to lock into a rigid assembly with the implant.
    Typically, the conductors of the present invention are made based on a three-dimensional image of the acetabular implant zone of a patient's pelvis such that they accurately fit the pelvic bone in the desired position in a unique manner. In particular embodiments, the contact elements are designed such that, after placing the conductor in the acetabular implant zone, the conductor and the acetabular cup implant are either forced to rotate or can rotate around the center of the implant until the implant has the desired orientation relative to the pelvis. Accordingly, particular embodiments of the methods for ensuring accurate placement of the acetabular cup implant according to the invention include inserting the conductors with the implant connected thereto into the acetabular implant zone of the patient and pressing the conductor with a rotating movement to bring the conductor and the implant into position where the contact elements fit in a unique way with the corresponding bone structure.
    In special embodiments, the conductors according to the invention comprise a positioning element. In further special embodiments, the guide is used for the placement of a positioning device. In these embodiments, the guide is provided with a positioning element corresponding to a location that is suitable for the positioning of the positioning device based on the bone structure and the operation window. Accordingly, in these embodiments, the conductor is brought into its unique position in the pelvic bone of the patient. Thereafter, a positioning device, such as a positioning pin, is inserted into the positioning element of the guide and inserted into the bone. Optionally, the guide is then removed from the pelvis bone and the positioning device remains in place. This positioning device is used by the surgeon for the orientation of the impactor when force is applied to it.
    In alternative embodiments, the positioning device is placed in the pelvis bone prior to the placement of the guide and can be used to place the guide in the desired position.
    By using the impactors according to the invention, the rotation of the stem of the impactor relative to the fastening element (and the implant connected thereto) facilitates the accurate placement of the implant regardless of the available surgical window. More specifically, in certain embodiments, to facilitate placement of the acetabular cup implant in the limited surgical window, the orientation of the stem is moved such that it no longer corresponds to the x-axis of the implant. Optionally, a locking element present on the impactor permits locking of the stem to ensure that, after exerting force, the implant is fitted in the correct position.
    The impactor, more particularly the impact element of the stem, is struck with a hammer to fit the implant into the (drilled out) acetabular implant zone. After inserting the implant into the desired position, the impactor is detached from the implant (and where applicable, from the guide), typically by a mechanism that provides control over the locking elements present on the impactor and / or the implant (and the conductor).
    The various aspects of the invention are represented herein by the following non-limiting embodiments.
    According to special embodiments, a conductor (1) is provided, as shown in Figure 1, comprising a support structure (2) that closely connects to an acetabular cup implant and three contact elements (3), each comprising a contact point that connects to an area of the bone that surrounds the acetabular cup implant zone. The contact elements are designed such that the angle between the plane through the central axis of the implant (X, see Figure 3) and one contact point and the plane through the central axis (X) and the adjacent contact point is never greater than 180 °. Moreover, the contact elements (3) ensure a tight connection of the conductor to the said bone.
    In special embodiments, the conductor comprises one or more guide holes (4), i.e. openings which serve as a locking element that fits into a locking element of the impactor and which ensure a direct transfer of the impact to the implant.
    In particular embodiments, the conductor includes one or more positioning elements (5), e.g., holes or grooves that allow passage of a positioning device in the bone surrounding the acetabulum. In special embodiments, the positioning element (5) has a groove present in one of the contact elements (3) of the conductor (1).
    In particular embodiments, the conductor comprises one or more locking elements (6) that allow coupling of the conductor to an implant and / or an impactor, as further described herein. In particular embodiments, the locking elements are located on a ring structure (7) of the support structure that fits on the edge of acetabular implant.
    In further particular embodiments, the invention provides combinations of acetabular cup implants (8) and conductors for acetabular cup implants (1). A pelvic bone (11) in which an assembly of an acetabular cup implant (8) and a conductor instrument (1) is placed is shown in Figure 2.
    The acetabular cup implants for use in these embodiments may be standard or patient-specific. An acetabular cup implant is shown schematically in Figure 3. Typically, such an implant includes a surface texture on the outer surface (12) to ensure coupling to the bone. Optionally, the acetabular cup implant contains one or more locking elements (10) that allow its coupling to a conductor and / or an impactor according to the invention. Typically, these locking elements (10) are located on the edge (9) of the acetabular cup implant. The acetabular cup implants fit snugly on the pelvic bone in the bored acetabulum (as shown in Figure 4).
    The invention further provides impactors (13), as shown in Figure 5, comprising a stem (14) and a mounting element (15). The stem (14) comprises a drive member (16), a hinge element (20) and an impact element (17). The hinge element (20) of the handle forms a ball joint with the fastening element (15) that allows movement of the orientation of said handle relative to the fastening element. The mounting element (15) comprises an opening (18) that allows the passage and movement of the shank of the impactor. In particular embodiments, such as shown in Figure 10, the invention provides impactors (13) comprising a locking element (21) located on the drive member (16) of the shank (14) that can be used to control the movement of the shank block with respect to the fastening element,
    The mounting element (15) further comprises an outer shape corresponding to the shape of a conductor and / or an acetabular cup implant.
    The fastening element can comprise one or more locking elements (19) that can be connected to a guide for an acetabular cup implant and / or acetabular cup implant.
    The invention further provides combinations of a guide for an acetabular cup implant (1) and an impactor (13) according to the invention. An assembly of an acetabular cup implant connected to an impactor is shown in Figure 6. There is a close connection between the cup of the implant guide (1) and the fastening element (15) of the impactor. A close coupling is further ensured by locking elements (19) on the fixing element (15) which optionally lock together with corresponding elements on the guide. In a particular embodiment, as shown in Figure 11, the invention provides combinations of a guide for an acetabular cup implant (1) and an impactor (13) wherein the impactors (13) comprise a locking element (21) located on the drive member (16) of the shank (14) and can be used to block the movement of the shank relative to the fastening element.
    In particular embodiments of the invention, impactors (13) are provided which can form a rigid assembly with a guide for an acetabular cup implant (1) and a corresponding acetabular cup implant (8), as shown in Figures 7 and 8. The The outer shape of the fastening element (15) and the cup of the guide (1) are hemisphere-shaped to match the shape of the implant (8).
    Figure 9 illustrates an assembly of an implant (8), implant guide (1) and impactor (13) (comprising a stem (14) and a mounting element (15)) according to the invention, placed in a pelvic bone (11).
    The invention further provides combinations of an implant (8) and an impactor (13) designed to fit on the implant, as shown in Figure 12. The impactors include a stem (14) and a mounting element (15). The mounting element (15) contains locking elements (19) that lock with corresponding elements on the implant.
    权利要求:
    Claims (22)
    [1]
    A guide for an acetabular cup implant comprising: - a support structure that closely connects to an acetabular cup implant, and - one or more contact elements that connect to areas of the bone surrounding the acetabular cup implant zone in at least three contact points wherein - the one or more contact elements are designed such that the angle between the plane through the central axis of the implant and one contact point and the plane through the central axis and the adjacent contact point is never greater than 180 °; and the one or more contact elements, after contacting said specific areas of the bone surrounding the acetabulum, ensure a close connection of said conductor to said bone.
    [2]
    The conductor according to claim 1, comprising at least three contact elements which are designed such that the angle between the plane through the central axis of the implant (8) and one contact element and the plane through the central axis (8) and the adjacent contact element never exceeds 180 °.
    [3]
    The conductor according to claim 1 or 2, wherein said contact elements are designed such that, after placement of the conductor on the bone, said conductor and said acetabular cup implant are forced to rotate around the center of the implant until the implant has desired orientation relative to the pelvis.
    [4]
    The conductor according to any of claims 1 to 3, wherein said conductor further comprises a positioning element that allows passage of a positioning device that is placed in the bone surrounding the acetabum.
    [5]
    The conductor of claim 4, wherein said positioning device is a pin that is placed in the bone that surrounds the acetabulum.
    [6]
    The conductor according to any of claims 1 to 5, wherein two or more of said contact elements form larger contact surfaces.
    [7]
    The conductor according to any of claims 1 to 6, wherein the conductor is a medical image-based patient-specific instrument.
    [8]
    The conductor according to any of claims 1 to 6, wherein the conductor is a modular device comprising elements with a standard shape that can be adapted to the shape of the bone.
    [9]
    A combination of an acetabular cup implant and a conductor according to any of claims 1 to 8.
    [10]
    An impactor for pressure-fitting an acetabular cup implant comprising i) a shank comprising a drive member, a hinge element and an impact element; and ii) a mounting element that can be locked on said implant and / or on a guide for said implant, said hinge element forming a ball joint with said mounting element allowing movement of the orientation of said stem relative to said mounting element.
    [11]
    The impactor of claim 10, further comprising a locking element that can restrict or completely block the movement of the shank relative to the fastening element.
    [12]
    The impactor according to any of claims 10 or 11, further comprising a mechanism for easily releasing the conductor and / or implant.
    [13]
    A combination of an acetabular cup implant and an impactor according to any of claims 10 to 12, wherein said mounting element of said impactor is locked on said implant.
    [14]
    14. A combined guide and fitting element for an acetabular cup implant that comprises i) a guide for said acetabular cup implant that comprises: - a support structure that closely connects to an acetabular cup implant, and - one or more contact elements that connect on areas of the bone surrounding the acetabular cup implant zone in at least three contact points, wherein - the contact elements are designed such that the angle between the plane through the central axis of the implant and one contact point and the plane through the central axis (8 ) and the adjacent contact point is never greater than 180 °; and - the contact elements, after contacting said specific areas of the bone surrounding the acetabulum, ensure a close connection of said conductor to said bone, and ii) an impactor according to any of claims 10 to 12, wherein said attachment element of said bone impactor can be connected to said conductor.
    [15]
    The combined guide and fitting element according to claim 14, wherein said contact elements are designed such that, after placement of the conductor, said conductor and said acetabular cup implant are forced to rotate around the center of the implant until the implant has the desired orientation with respect to the acetabulum of the pelvis.
    [16]
    The combined guide and fitting element as claimed in claims 14 or 15, wherein said guide further comprises a positioning element that allows the passage of a positioning device that is placed in the bone surrounding the acetabulum.
    [17]
    The combined guide and fitting element according to claim 16, wherein said guide is a pin that is placed in the bone surrounding the acetabulum.
    [18]
    The combined guide and fitting element according to any of claims 14 to 17, wherein two or more of said contact elements are connected to form larger contact surfaces.
    [19]
    The combined guide and fitting element according to any of claims 14 to 18, wherein the conductor is a medical image-based patient-specific instrument.
    [20]
    The combined guide and fitting element according to any of claims 14 to 18, wherein the guide is a modular device comprising standard elements with a shape that can be adapted to the shape of the bone.
    [21]
    A combination of an acetabular cup implant and a combined guide and fitting element according to any of claims 14 to 20.
    [22]
    A method for manufacturing conductors according to any of claims 1 to 8, the method comprising: (a) obtaining volume information of the pelvic bone and the acetabular implant to be placed therein, (b) identifying and selecting parts of the bone surrounding the implant zone suitable for use as a base for the conductor, and (c) designing and producing a conductor based on the information obtained in steps (a) and B).
    类似技术:
    公开号 | 公开日 | 专利标题
    BE1019759A3|2012-12-04|CONDUCTORS AND IMPACTORS FOR AN ACETABULAR CUP IMPLANT, COMBINATIONS THEREOF, METHODS FOR MANUFACTURING THEM.
    BE1020070A5|2013-04-02|SURGICAL INSTRUMENT FOR POSITIONING AN ALIGNMENT ELEMENT.
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    同族专利:
    公开号 | 公开日
    US9198760B2|2015-12-01|
    GB201001985D0|2010-03-24|
    WO2011095575A3|2011-10-06|
    EP2531146B1|2016-04-06|
    EP2531146A2|2012-12-12|
    US20120303035A1|2012-11-29|
    WO2011095575A2|2011-08-11|
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    法律状态:
    2020-08-13| MM| Lapsed because of non-payment of the annual fee|Effective date: 20191031 |
    优先权:
    申请号 | 申请日 | 专利标题
    GB201001985|2010-02-05|
    GBGB1001985.9A|GB201001985D0|2010-02-05|2010-02-05|Guiding instruments and impactors for an acetabular cup implant, combinations therof, methods for manufacturing and uses thereof|
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