US20050090902A1 - Shoulder prosthesis with anatomic reattachment features - Google Patents
Shoulder prosthesis with anatomic reattachment features Download PDFInfo
- Publication number
- US20050090902A1 US20050090902A1 US10/987,348 US98734804A US2005090902A1 US 20050090902 A1 US20050090902 A1 US 20050090902A1 US 98734804 A US98734804 A US 98734804A US 2005090902 A1 US2005090902 A1 US 2005090902A1
- Authority
- US
- United States
- Prior art keywords
- bone
- tendon
- attachment points
- reattachment
- attachment
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
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- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06166—Sutures
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- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/40—Joints for shoulders
- A61F2/4014—Humeral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic humeral shafts
- A61F2002/4051—Connections of heads directly to shafts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/40—Joints for shoulders
- A61F2/4059—Humeral shafts
- A61F2002/4062—Proximal or metaphyseal parts of shafts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/40—Joints for shoulders
- A61F2/4059—Humeral shafts
- A61F2002/4077—Distal or diaphyseal parts of shafts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0004—Rounded shapes, e.g. with rounded corners
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0004—Rounded shapes, e.g. with rounded corners
- A61F2230/0013—Horseshoe-shaped, e.g. crescent-shaped, C-shaped, U-shaped
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0028—Shapes in the form of latin or greek characters
- A61F2230/0043—L-shaped
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0028—Shapes in the form of latin or greek characters
- A61F2230/0052—T-shaped
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00389—The prosthesis being coated or covered with a particular material
- A61F2310/00592—Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
- A61F2310/00796—Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite
Definitions
- This invention relates generally to orthopedic surgery and, in particular, to improved shoulder prostheses featuring more anatomic rotator cuff attachment geometries facilitating enhanced fixation of tendon and/or bone.
- a typical proximal humeral prosthesis is depicted generally at 100 in FIG. 1 , this particular drawing being taken in part from U.S. Pat. No. 5,282,865.
- the device includes a modular head attachment 106 , though variations of such devices exist, including those without modularity, and designs incorporating different modular arrangements.
- a tab 102 is provided on the lateral side of the prosthesis, as shown.
- the tab 104 is provided with two or more holes 106 disposed parallel to the length of the prosthesis; that is, parallel to the axis 108 of the stem 110 .
- the stated purpose of the apertured tab 102 is to assist with installation of the device and to minimize rotation once installed, it is common practice in repairing a fracture to bring previously detached tendons together and suture them to this vertical tab on the lateral side of the prosthesis.
- the tendons which are detached during the procedure may include the subscapularis tendon, the supraspinatus tendon, the infraspinatus tendon, and the teres minor tendon, the anatomy of each being well known, particularly to orthopedic surgeons. Since, in the case of a natural humerus, these tendons attach at different points of the bone to perform specific functions, vertically oriented tabs such as tab 102 in FIG. 1 does not adequately accommodate human anatomy.
- the subject invention resides in a humeral prosthesis with improved anatomic attachment areas for tendon or bone.
- the invention includes an elongated body having a proximal end and a distal end terminating in a stem with an axis configured for placement within an intramedullary canal of a humerus.
- at least one set of tendon/bone attachment points are provided along a line, at least a portion of which is divergent with respect to the axis of the stem.
- One or more sets of attachment points may further be provided along a line which is substantially parallel to the axis of the stem, resulting in a “T.” “U” or “L” configuration, including inverted versions thereof.
- attachment points having a changing degree of diversion with respect to the axis of the stem may be provided along a common, curved line.
- the attachment points may simply be apertures formed through the body of the implant though, in the preferred embodiment, the apertures are provided on raised tabs.
- An area of bone-ingrowth material may be provided adjacent to or at the attachment site, and may include a separate fastening mechanism such as a threaded hole to receive a screw, or any other alternative means operative to rigidly attach the tendon or bone to the prosthesis.
- a groove may also be provided in any embodiment to receive the biceps tendon.
- a recess may be provided to accept a tendon-bone unit such as the greater or lesser tuberosities with their respective tendons attached.
- a tendon-bone unit such as the greater or lesser tuberosities with their respective tendons attached.
- FIG. 1A is a drawing of a prior-art humeral prosthesis
- FIG. 1B is a drawing of proximal humerus and anatomic tendon attachments
- FIG. 1C is a drawing of a four-part fracture to which the subject invention is applicable.
- FIG. 2A is a lateral view of a humeral prosthesis according to the invention having an inverted-U bone/tendon attachment configuration
- FIG. 2B is a lateral view of a humeral prosthesis according to the invention having a non-inverted-U bone/tendon attachment configuration
- FIG. 2C is a lateral view of a humeral prosthesis according to the invention having an inverted L-shaped bone/tendon attachment configuration
- FIG. 2D is a lateral view of a humeral prosthesis according to the invention having a T-shaped bone/tendon attachment configuration
- FIG. 3 is an alternative embodiment of the invention, wherein a plurality of attachment points are arranged along a common curved line;
- FIG. 4 illustrates how bone-ingrowth sections are provided as localized sites along with fastening means to hold bone/tendon pieces in place
- FIG. 5 is a drawing which shows a bone-ingrowth areas provided for greater and lesser tuberosities in conjunction with separate sets of suture points.
- this invention is directed to humeral prostheses providing more anatomical attachment configurations for bone and/or tendons, with the goal being a greater range of post-operative motion and/or strength.
- FIG. 1B is a drawing of a human proximal humerus showing the natural anatomic tendon attachment areas.
- the humerus, 120 includes a proximal portion having a head 122 with an articulating surface adapted to co-act with the glenoid bone 126 in the shoulder joint.
- the supraspinatus tendon 130 lies flat on the proximal humerus, and attaches at a section of bone called the greater tuberosity 132 .
- the subscapularis tendon 140 extends across the side of the joint and attaches at the lesser tuberosity 142 .
- a groove 144 receives the biceps tendon (not shown).
- FIG. 1C is a drawing which illustrates what typically occurs during a multi-part fracture of the proximal humerus, in the case a so-called four-part fracture to which the subject invention is applicable.
- the bone shatters, leaving a separate head and shaft portion 150 and 152 .
- the greater tuberosity 160 breaks off with the supraspinatus tendon attached thereto.
- the lesser tuberosity 162 also forms a separate piece with the subscapularis tendon attached to that piece, as shown.
- the infraspinatus and teres minor tendons may be attached to the greater tuberosity as well or to separate fragments.
- FIG. 2A is a lateral view of a humeral prosthesis according to the invention.
- an anterior-to-posterior feature such as tab 202 is provided for attachment of the supraspinatus.
- tab 202 is shown generally transverse to the axis of the implant, the invention anticipates other orientations, described herein, with the basic premise being that one or more sets of divergent attachment points are provided for a more anatomical compliance with the rotator cuff.
- connection points tend away from a line strictly parallel to the axis of the implant which, of course, would include one or more connectors which are transverse or perpendicular to the axis of the implant, regardless of the muscular attachments.
- FIG. 2A An inverted-U is not the only tab configuration providing a more anatomic bone/tendon attachment arrangement according to the invention.
- a non-inverted-U bone/tendon attachment configuration may alternatively be provided, or an inverted L-shaped bone/tendon attachment configuration ( FIG. 2C ).
- both anterior and posterior tendons may be attached to a single substantially vertical feature, with the result being a “T” shape, as shown in FIG. 2D .
- Other geometries are also possible, including non-inverted and rotated L and T shapes, as long as separate and distinct regions are provided for reattachment of the greater and lesser tuberosities.
- one or more curved features may be provided, preferably with tangents 304 and 306 substantially along the axis of the implant and transverse thereto, as shown in FIG. 3 .
- one or more of the tabs or other features may be coated with a bone-ingrowth material or bone-ongrowth material. Biologic enhancements such as hydroxyapatite may also be provided.
- bone-ingrowth sections may be provided as localized areas 405 , along with fasteners such as screws 410 to hold the bone/tendon pieces in place.
- a groove 412 may be provided in the head and/or side portions of the prosthesis to receive the biceps tendon.
- the areas of bone-ingrowth material may be provided along with, or apart from, the tabs or other reattachment facilities discussed elsewhere herein.
- a bone-ingrowth area 502 for lesser tuberosity may be provided in conjunction with suture holes 504
- ingrowth area 512 may be provided for greater tuberosity in conjunction with suture holes 514 .
- the suture holes need not be provided on a raised tab, but may be located along a ridge or depression, as convenient to the embodiment.
- the invention is compatible with modular head/neck attachments as discussed in the Background of the Invention.
- FIG. 5 shows a post 530 associated with a modular head attachment.
- the groove 520 is optionally be provided to receive the biceps tendon, as discussed above.
Abstract
A humeral prosthesis features improved anatomic attachment areas for tendon or bone. In the preferred embodiment, in contrast to existing devices, at least one set of tendon/bone attachment points are provided along a line, at least a portion of which is divergent with respect to the axis of the stem. One or more sets of attachment points may be further be provided along a line which is substantially parallel to the axis of the stem, resulting in a “T” “L” or “U” shape. Alternatively, attachment points having a changing degree of diversion with respect to the axis of the stem may be provided along a common, curved line. The attachment points may simply be apertures formed through the body of the implant though, in the preferred embodiment, the apertures are provided on raised tabs. An area of bone-ingrowth material may be provided adjacent the attachment points, and may include a separate fastening mechanism such as a threaded hole to receive a screw. A groove may also be provided in any embodiment to receive the biceps tendon. Particularly with respect to fractures, including multi- and ‘four-part’ fractures, means specifically intended for the rigid reattachment of the greater or lesser tuberosities may be provided separately or in conjunction with other sets of reattachment configurations.
Description
- This invention relates generally to orthopedic surgery and, in particular, to improved shoulder prostheses featuring more anatomic rotator cuff attachment geometries facilitating enhanced fixation of tendon and/or bone.
- A typical proximal humeral prosthesis is depicted generally at 100 in
FIG. 1 , this particular drawing being taken in part from U.S. Pat. No. 5,282,865. The device includes amodular head attachment 106, though variations of such devices exist, including those without modularity, and designs incorporating different modular arrangements. - A
tab 102 is provided on the lateral side of the prosthesis, as shown. Thetab 104 is provided with two ormore holes 106 disposed parallel to the length of the prosthesis; that is, parallel to theaxis 108 of thestem 110. Although the stated purpose of the aperturedtab 102 is to assist with installation of the device and to minimize rotation once installed, it is common practice in repairing a fracture to bring previously detached tendons together and suture them to this vertical tab on the lateral side of the prosthesis. - The tendons which are detached during the procedure may include the subscapularis tendon, the supraspinatus tendon, the infraspinatus tendon, and the teres minor tendon, the anatomy of each being well known, particularly to orthopedic surgeons. Since, in the case of a natural humerus, these tendons attach at different points of the bone to perform specific functions, vertically oriented tabs such as
tab 102 inFIG. 1 does not adequately accommodate human anatomy. - More particularly, existing configurations are acceptable only with respect to the attachment of the posterior and anterior tendons. Since the supraspinatus tendon naturally lies flat along the top surface of the bone, the use of a vertical tab leads to an orientation which is perpendicular to the desired attachment configuration. This result, being anatomically incorrect, typically results in a reduced range of motion and strength following the procedure, particularly in initiating abduction; that is, in raising that arm. This is especially true in proximal humerus fractures known as ‘four-part’ fractures involving the head, shaft, greater tuberosity, and lesser tuberosity. Re-attachment to a vertical fin with sutures results in poor fixation in a non-anatomic arrangement.
- The subject invention resides in a humeral prosthesis with improved anatomic attachment areas for tendon or bone. As in prior-art devices, the invention includes an elongated body having a proximal end and a distal end terminating in a stem with an axis configured for placement within an intramedullary canal of a humerus. In the preferred embodiment of the invention, however, and in contrast to existing devices, at least one set of tendon/bone attachment points are provided along a line, at least a portion of which is divergent with respect to the axis of the stem.
- One or more sets of attachment points may further be provided along a line which is substantially parallel to the axis of the stem, resulting in a “T.” “U” or “L” configuration, including inverted versions thereof. Alternatively, attachment points having a changing degree of diversion with respect to the axis of the stem may be provided along a common, curved line. The attachment points may simply be apertures formed through the body of the implant though, in the preferred embodiment, the apertures are provided on raised tabs. An area of bone-ingrowth material may be provided adjacent to or at the attachment site, and may include a separate fastening mechanism such as a threaded hole to receive a screw, or any other alternative means operative to rigidly attach the tendon or bone to the prosthesis. A groove may also be provided in any embodiment to receive the biceps tendon. In addition, a recess may be provided to accept a tendon-bone unit such as the greater or lesser tuberosities with their respective tendons attached. Particularly with respect to fractures, including multi- and ‘four-part’ fractures, means specifically intended for the rigid reattachment of the greater or lesser tuberosities may be provided separately or in conjunction with other sets of reattachment configurations.
-
FIG. 1A is a drawing of a prior-art humeral prosthesis; -
FIG. 1B is a drawing of proximal humerus and anatomic tendon attachments; -
FIG. 1C is a drawing of a four-part fracture to which the subject invention is applicable; -
FIG. 2A is a lateral view of a humeral prosthesis according to the invention having an inverted-U bone/tendon attachment configuration; -
FIG. 2B is a lateral view of a humeral prosthesis according to the invention having a non-inverted-U bone/tendon attachment configuration; -
FIG. 2C is a lateral view of a humeral prosthesis according to the invention having an inverted L-shaped bone/tendon attachment configuration; -
FIG. 2D is a lateral view of a humeral prosthesis according to the invention having a T-shaped bone/tendon attachment configuration; -
FIG. 3 is an alternative embodiment of the invention, wherein a plurality of attachment points are arranged along a common curved line; -
FIG. 4 illustrates how bone-ingrowth sections are provided as localized sites along with fastening means to hold bone/tendon pieces in place; and -
FIG. 5 is a drawing which shows a bone-ingrowth areas provided for greater and lesser tuberosities in conjunction with separate sets of suture points. - As discussed above, this invention is directed to humeral prostheses providing more anatomical attachment configurations for bone and/or tendons, with the goal being a greater range of post-operative motion and/or strength. Before discussing the various embodiments of the invention in detail, it will be helpful to introduce aspects of the anatomy associated with procedures contemplated herein.
-
FIG. 1B is a drawing of a human proximal humerus showing the natural anatomic tendon attachment areas. The humerus, 120, includes a proximal portion having ahead 122 with an articulating surface adapted to co-act with theglenoid bone 126 in the shoulder joint. Thesupraspinatus tendon 130 lies flat on the proximal humerus, and attaches at a section of bone called thegreater tuberosity 132. Thesubscapularis tendon 140 extends across the side of the joint and attaches at thelesser tuberosity 142. Agroove 144 receives the biceps tendon (not shown). -
FIG. 1C is a drawing which illustrates what typically occurs during a multi-part fracture of the proximal humerus, in the case a so-called four-part fracture to which the subject invention is applicable. In particular, the bone shatters, leaving a separate head andshaft portion greater tuberosity 160 breaks off with the supraspinatus tendon attached thereto. Thelesser tuberosity 162 also forms a separate piece with the subscapularis tendon attached to that piece, as shown. The infraspinatus and teres minor tendons may be attached to the greater tuberosity as well or to separate fragments. - Reference is now made to
FIG. 2A , which is a lateral view of a humeral prosthesis according to the invention. Broadly, an anterior-to-posterior feature such astab 202 is provided for attachment of the supraspinatus. Althoughtab 202 is shown generally transverse to the axis of the implant, the invention anticipates other orientations, described herein, with the basic premise being that one or more sets of divergent attachment points are provided for a more anatomical compliance with the rotator cuff. By ‘divergent,’ it is meant that the set of connection points tend away from a line strictly parallel to the axis of the implant which, of course, would include one or more connectors which are transverse or perpendicular to the axis of the implant, regardless of the muscular attachments. - Having provided this facility, other tabs or attachment mechanisms be added for the anterior and/or posterior tendons, resulting in the preferred inverted “U” shape of
FIG. 2A . An inverted-U is not the only tab configuration providing a more anatomic bone/tendon attachment arrangement according to the invention. As shown inFIG. 2B , a non-inverted-U bone/tendon attachment configuration may alternatively be provided, or an inverted L-shaped bone/tendon attachment configuration (FIG. 2C ). As a further alternative, both anterior and posterior tendons may be attached to a single substantially vertical feature, with the result being a “T” shape, as shown inFIG. 2D . Other geometries are also possible, including non-inverted and rotated L and T shapes, as long as separate and distinct regions are provided for reattachment of the greater and lesser tuberosities. - Note also that separate tab segments need not be used, in that one or more curved features may be provided, preferably with
tangents FIG. 3 . To enhance reattachment, one or more of the tabs or other features may be coated with a bone-ingrowth material or bone-ongrowth material. Biologic enhancements such as hydroxyapatite may also be provided. As a further alternative, as shown inFIG. 4 , bone-ingrowth sections may be provided aslocalized areas 405, along with fasteners such asscrews 410 to hold the bone/tendon pieces in place. In this and each of the embodiments described herein, agroove 412 may be provided in the head and/or side portions of the prosthesis to receive the biceps tendon. - The areas of bone-ingrowth material may be provided along with, or apart from, the tabs or other reattachment facilities discussed elsewhere herein. For example, as shown in
FIG. 5 , a bone-ingrowth area 502 for lesser tuberosity may be provided in conjunction withsuture holes 504, and/oringrowth area 512 may be provided for greater tuberosity in conjunction with suture holes 514. Note that the suture holes need not be provided on a raised tab, but may be located along a ridge or depression, as convenient to the embodiment. In all embodiments, the invention is compatible with modular head/neck attachments as discussed in the Background of the Invention.FIG. 5 , for example, shows apost 530 associated with a modular head attachment. Thegroove 520 is optionally be provided to receive the biceps tendon, as discussed above.
Claims (5)
1-23. (canceled)
24. A humeral prosthesis with anatomic reattachment features, comprising:
an elongated body having a proximal end with a convex surface adapted to articulate with a glenoid bone; and
a plurality of raised fins on the body, each with a plurality of suture-receiving apertures for use in attaching one or more bone fragments and tendon to the prosthesis.
25. The humeral prosthesis of claim x, including three raised fins, each with a plurality of suture-receiving apertures.
26. The humeral prosthesis of claim y, wherein at least two of the fins are parallel along the body.
27. The humeral prosthesis of claim x, wherein the convex surface forms parts of a modularly attached component.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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US10/987,348 US20050090902A1 (en) | 2000-02-10 | 2004-11-12 | Shoulder prosthesis with anatomic reattachment features |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
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US09/500,827 US6398812B1 (en) | 2000-02-10 | 2000-02-10 | Shoulder prosthesis with anatomic reattachment features |
US10/164,223 US20020151982A1 (en) | 2000-02-10 | 2002-06-04 | Shoulder prosthesis with anatomic reattachment features |
US10/987,348 US20050090902A1 (en) | 2000-02-10 | 2004-11-12 | Shoulder prosthesis with anatomic reattachment features |
Related Parent Applications (1)
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US10/164,223 Continuation US20020151982A1 (en) | 2000-02-10 | 2002-06-04 | Shoulder prosthesis with anatomic reattachment features |
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US20050090902A1 true US20050090902A1 (en) | 2005-04-28 |
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US09/500,827 Expired - Lifetime US6398812B1 (en) | 2000-02-10 | 2000-02-10 | Shoulder prosthesis with anatomic reattachment features |
US10/164,223 Abandoned US20020151982A1 (en) | 2000-02-10 | 2002-06-04 | Shoulder prosthesis with anatomic reattachment features |
US10/987,348 Abandoned US20050090902A1 (en) | 2000-02-10 | 2004-11-12 | Shoulder prosthesis with anatomic reattachment features |
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US09/500,827 Expired - Lifetime US6398812B1 (en) | 2000-02-10 | 2000-02-10 | Shoulder prosthesis with anatomic reattachment features |
US10/164,223 Abandoned US20020151982A1 (en) | 2000-02-10 | 2002-06-04 | Shoulder prosthesis with anatomic reattachment features |
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Cited By (29)
Publication number | Priority date | Publication date | Assignee | Title |
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