Elbow prosthesis

This application claims the benefit of U.S. provisional application No. 60/473,446 filed May 28, 2003.

The present invention relates to an elbow prosthesis comprising at least one humeral component and one ulnar component.

It concerns more particularly an elbow prosthesis of which the ulnar component is adapted to receive a locking element which forms an articulating surface extending that of the ulnar component, the articulating surfaces of the locking element and of the ulnar component being adapted to be arranged together around at least a part of another articulating surface belonging to a humeral component. A prosthesis of this type is known from EP-A-1 051 954.

In such a prosthesis, the locking element is maintained in position on the ulnar component thanks to a screw introduced in a through housing in this element and tightened in a tapping provided on the ulnar component. It has proved in practice that the positioning of the locking element on the ulnar component is not always optimum when such a screw is tightened, which may lead to a skewed positioning of the screw with respect to the tapping, to such a point that the thread of the screw or the tapping may be distorted, thus preventing the locking element from being mounted. In addition, the afore-mentioned screw serves both to bring the locking element into correct position with respect to the ulnar component and to ensure blocking of these two elements with respect to each other. As a result, such an ulnar component must most often be fitted while the articulation of the elbow is in maximum flexion, which renders the surgeon's work more complex. It even happens that such fitting in maximum flexion is not possible, particularly in the case of marked obesity of the patient.

It is a more particular object of the invention to overcome these drawbacks by proposing an elbow prosthesis whose fit is facilitated, when it comprises a locking element as mentioned hereinabove.

To that end, the present invention relates to an elbow prosthesis comprising a humeral component, forming a first articulating surface, and an ulnar component forming a second articulating face adapted to be disposed around a part of the first articulating surface and to pivot about a longitudinal axis of this surface, the ulnar component being provided with means for mounting a locking element which forms a third articulating surface extending the second articulating surface and adapted likewise to be disposed around a part of the first articulating surface. This prosthesis is characterized in that the afore-mentioned mounting means comprise guiding means adapted to cooperate with complementary means provided on the locking element in order to guide this element in translation with respect to the ulnar component, up to a position where blocking means provided respectively on the locking element and on the ulnar component may be employed to immobilize the locking element on the ulnar component, these blocking means being able to be employed only in this position.

Thanks to the invention, the guiding means ensure an adequate positioning of the locking element with respect to the ulnar component before the blocking means are employed to effect an efficient immobilization of the locking element with respect to the ulnar component. In other words, the blocking means do not serve to bring the locking element in a configuration allowing its blocking, this function being performed by the guiding means which may be positioned and configured to ensure this function best.

In addition, an elbow prosthesis may incorporate one or more of the following characteristics, taken in any technically admissible combination:

The blocking means comprise a screw and a complementary tapping provided respectively on the locking element and on the ulnar component, or vice versa, the direction of relative translation between the locking element and the ulnar component as imposed by the guiding means being non-parallel to the longitudinal axis of the tapping and/or of the afore-mentioned screw.

The guiding means comprise at least one element in relief projecting with respect to a principal part of the ulnar component, while the complementary means provided on the locking element are adapted to interact with this element in relief by cooperation of shapes. In that case, the aforementioned element in relief may be a nose, while the complementary means comprise a fork of which two branches define therebetween a volume for receiving and for slide of this nose.

The guiding means and the blocking means are arranged in the vicinity of two opposite edges of the second articulating surface of the ulnar component, while the complementary means and the blocking means provided on the locking element are arranged on two opposite edges of that element.

The blocking means comprise a screw and a tapping, which are complementary and respectively provided on the locking element and on the ulnar component, or vice versa, while means are provided for blocking this screw in rotation. The head of the screw may thus be of non-circular section, while the piece against which this head bears forms a space for receiving this head, with contact between the surface of this piece and the outer surface of the head. More particularly, the head of the screw may be provided with catch elements adapted to penetrate superficially in the surface of the afore-mentioned piece. In a variant, the piece against which the head of the screw bears may be provided with a tab foldable into configuration of blockage of this head. In that case, the head of the screw may be of polygonal profile, with faces whose width is greater than the width of the foldable tab.

The invention will be more readily understood and other advantages thereof will appear more clearly in the light of the following description of a form of embodiment of a prosthesis in accordance with its principle, given solely by way of example and made with reference to the accompanying drawings, in which:

FIG. 1 is an exploded view in perspective of an elbow prosthesis according to the invention.

FIG. 2 is a longitudinal section of the ulnar component and of the locking element in the course of assembly.

FIG. 3 is a section similar to FIG. 2 while the locking element is mounted on the ulnar component.

FIG. 4 is a view in perspective of the metal part of the ulnar component.

FIG. 5 is a section along line V-V of FIG. 3 and

FIG. 6 is a view in perspective of the ulnar component and of the locking element of the prosthesis, on a larger scale.

Referring now to the drawings, the prosthesis visible in FIGS. 1 to 3 comprises a humeral component 10 comprising a stem 11 intended to be driven in the medullary canal of a humerus H and extending in two branches 12 and 13 , each pierced with an orifice 12 a, 13 a for passage of a hollow screw 14 forming pin. The hollow nature of the screw 14 allows the passage of suture yarns. The orifice 12 a is tapped, allowing the screw 14 to be screwed. The stem 11 also extends in a third branch 15 intended to come into abutment against the cortex of the humerus.

An elongated piece 16 is provided with a central bore 16 a whose dimensions are such as to receive the screw 14 , this making it possible to mount the piece 16 between the branches 12 and 13 . The piece 16 is provided with two end surfaces 16 b and 16 c provided to come respectively into contact with the opposite surfaces of the branches 12 and 13 .

Between the surfaces 16 b and 16 c, the piece 16 is substantially cylindrical, with circular base, and forms a surface of articulation S 1 which is also substantially cylindrical, whose generatrix G 1 is curved and concave, in that the diameter of the surface S 1 is minimum in the central part of the piece 16 included between the surfaces 16 b and 16 c. X 1 denotes the axis of symmetry of the surface S 1 .

The piece 16 extends in an extension 16 d whose outer surface S 4 is convex and which covers the branch 12 when the piece 16 is mounted between the branches 12 and 13 .

The whole of the humeral component 10 is made of metal.

The ulnar component 20 comprises a metal stem 21 intended to be inserted in the medullary canal of the ulna C and which is in one piece with a branch 22 likewise made of metal, of concave shape and whose inner surface is covered with a lining 23 made of a material adapted to the friction with the metal piece 16 , for example polyethylene. The lining 23 is mounted on the branch 22 by cooperation of shapes. A pin 27 makes it possible to immobilize elements 22 and 23 with respect to each other.

The inner surface of the lining 23 forms a surface of articulation S 2 whose shape is complementary to that of surface S 1 . X 2 denotes the central axis of elements 22 and 23 .

The respective diameters of surfaces S 1 and S 2 , which diameters are variable along axes X 1 and X 2 , are chosen so that the surface S 2 may be disposed around the surface S 1 , with a slight clearance, this allowing a rotation of the components 10 and 20 with respect to each other about axes X 1 and X 2 which, in that case, merge.

Moreover, the profiles of the generatrices of surfaces S 1 and S 2 are chosen so as to allow a degree of mobility of the surface S 1 in surface S 2 , in the sense of varus-valgus, i.e. about an axis perpendicular to X 1 and X 2 .

A locking element 30 is intended to be mounted on the component 20 and comprises a metal casing 32 and a lining 33 immobilized with respect to each other by clipping. The lining 33 is advantageously made of the same material as the lining 23 and forms a concave articulating surface S 3 intended to extend the surface S 2 and, with it, surround the surface S 1 .

In order to facilitate assembly of the element 30 on the component 20 , this component is provided, in extension of the outer surface 24 of the branch 22 , with an element in relief 25 in the form of a nose or beak which projects beyond the part 22 a of the branch 22 covered by the lining 23 .

Furthermore, the casing 32 of the element 30 extends beyond its part 32 a covered by the lining 33 , in an extension in the form of a fork 35 of which the two branches 35 a and 35 b together define a volume 35 c for slide and reception of the nose 25 when the element 30 is mounted on the component 20 .

The nose 25 is disposed in a space 23 c defined by the lining 23 which extends beyond the part 22 a of the branch 22 that it covers. In its part 23 d which extends in overhang with respect to the part 22 a, the lining has a substantially U-shaped cross-section. The space 23 c is defined at the centre of this U.

The nose 25 has a width decreasing in the direction of the bottom of the U formed by the part 23 d. In this way, the sides 25 a and 25 b of the nose 25 diverge, moving away from this bottom and approaching the branches of the U formed by the part 23 d. The nose 25 has a section substantially in the form of a dove-tail.

In addition, grooves 25 c and 25 d are formed on either side of the nose 25 . These grooves have profiles allowing them to receive convex parts 35 d and 35 e of the branches 35 a and 35 b.

The branches 35 a and 35 b thus have a geometry compatible with their introduction in the space 23 c, on either side of the nose 25 . Their surfaces intended to face towards the nose 25 deviate from each other towards the outside of the element 30 , with the result that these surfaces are substantially parallel to sides 25 a and 25 b.

In this way, the direction of assembly of the element 30 on the component 20 is necessarily that indicated by arrow F 1 in FIG. 2 , this direction being imposed by the cooperation of shapes between the nose 25 and the fork 35 . In effect, as indicated hereinabove, the transverse sections of the nose 25 on the one hand and of the inner parts of the branches 35 are chosen to impose this direction of slide.

Furthermore, the component 20 is provided with a tapping 26 for receiving a screw 36 which traverses a through housing 37 provided to that end in the element 30 .

The tapping 26 and the housing 37 are configured so that they are aligned, in a direction Y 1 perpendicular to axis X 2 , at the end of the slide of the element 30 with respect to the component 20 . Such slide takes place until the linings 23 and 33 come into abutment against each other in the vicinity of the members 25 and 35 , as shown in FIG. 3 . It is then possible to screw the screw 36 in the tapping 26 , in the direction of arrow F 2 in FIGS. 2 and 3 . In the configuration of FIG. 3 , the central axes of the screw 36 and of the tapping 26 merge and are parallel to direction Y 1 .

The direction Y 1 is not parallel to the direction of displacement of the element 30 with respect to the component 20 during its assembly, i.e. to arrow F 1 , with the result that the screw 36 can be introduced in the tapping 26 only at the end of slide of the clement 30 on the component 20 in the direction of arrow F 1 .

In this way, the screw 36 serves solely for blocking the element 30 in position on the component 20 and can be tightened only once a correct position of the element 30 on the component 20 has been attained. The risks of the screw 36 being tightened askew in the tapping 26 are thus avoided.

In addition, the mechanical strength of the assembly formed by the elements 20 and 30 in the configuration of FIG. 3 is much greater than that able to be obtained with the prosthesis known from EP-A-1 051 954 as, once the screw 36 is tightened, the element 30 is immobilized with respect to the component 20 on its two sides.

In effect, the nose 25 is provided in the vicinity of a first edge 20 a of the component 20 and of the surface S 2 , while the tapping 26 is provided near the opposite edge 20 b of this component. In the same way, elements 35 and 37 are respectively provided in the vicinity of the two opposite edges 30 a and 30 b of the element 30 and of the surface S 3 .

In other words, the function of guiding of the element 30 with respect to the component 20 is obtained in the vicinity of the edges 20 a and 30 a of these members, while the function of blocking is obtained in the vicinity of the edges 20 b and 30 b.

The housing 37 is formed by a circular orifice 37 a made in the metal casing 32 for the passage of the shank of the screw 36 , as well as by a concave zone 37 b made in an end part of the lining 33 , in the vicinity of the edge 30 b.

The head 36 a of the screw 36 presents a non-circular external section as it is equipped with peripheral catching elements or teeth 36 b provided to engage superficially in the inner radial surface 37 c of the concave zone 37 b, this contributing to the immobilization of the screw 36 in rotation and thus ensures an efficient blocking of the element 30 on the component 20 .

In addition, a tab 38 extends the casing 32 in the vicinity of the housing 37 , this tab being able to be folded into abutment against the head 36 a of the screw 36 when the latter is tightened, in the direction of arrow F 3 in FIG. 3 , so that it performs a function of non-return for this screw, this also contributing to the efficient blocking of the element 30 on the component 20 .

According to a variant embodiment of the invention (not shown), the head 36 a may present a polygonal profile, for example hexagonal or octagonal, with planar faces. In that case, the width of the tab 38 is chosen to be less than the width of the lateral faces of this head, this allowing the screw 36 to be blocked in rotation by surface abutment of one of these faces against this tab.

When the element 30 is mounted on the component 20 , the assembly thus produced may pivot about axis X 1 and the joining of surfaces S 2 and S 3 surrounds the surface S 1 over 360°.

A radial component adapted to be mounted on the radius R is advantageously provided in the prosthesis according to the invention, this component 40 defining a surface intended to cooperate with the surface S 4 . However, this is not compulsory.

The invention is not limited to the sole form of embodiment represented. In particular, it may concern a prosthesis in which the projecting element, such as the nose 25 , is provided on the element 30 , while a structure of fork type is provided on the ulnar component. Similarly, the tapping for receiving the blocking screw may be provided on the locking element, the ulnar component in that case defining a housing for receiving the locking screw.

Any mechanical means for blocking the locking element on the ulnar component may be envisaged within the framework of the present invention.