Abstract:
A method for producing a prosthetic acetabulum includes the following steps. First, one makes available a ceramic cup ( 1 ) that has a concave internal receiving face ( 3 ) and has an external annular receiving structure ( 6 ). Next, one makes available a placement and orientation insert ( 7 ) that has an annular peripheral fixing structure ( 10 ) designed to cooperate with the receiving face ( 9 ) of the external annular receiving structure ( 6 ) by engaging around the external annular receiving structure ( 6 ). Next, one heats the placement and orientation insert ( 7 ) in order to increase the dimensions of the insert. Next, one engages the annular peripheral fixing structure ( 10 ) around the receiving face ( 9 ) of the external annular receiving structure ( 6 ). Finally, one returns the placement and orientation insert ( 7 ) to ambient temperature in order to reduce the dimensions of the insert, in such a way as to obtain a radial clamping of the annular peripheral fixing structure ( 10 ) on the external annular receiving structure ( 6 ).

Description:
TECHNICAL FIELD OF THE INVENTION 
     The present invention relates to a method for producing a prosthetic acetabulum intended to replace the natural acetabulum of the hip. 
     A total hip prosthesis comprises two parts constituting a ball-and-socket joint, namely a female part intended to replace the natural acetabulum of the hip, and a male part intended to replace the head of the femur. The male part of the joint generally has a shaft which is intended to engage in the medullary canal of the femur and of which the proximal end is connected by a neck to a spherical prosthetic head intended to engage in the female part. The female part of the joint, which has to replace the natural acetabulum of the hip, usually comprises a cup with a convex outer anchoring face, which is accommodated in a prepared acetabular cavity in the pelvic bone. This cup has a concave receiving face intended to directly or indirectly receive the spherical prosthetic head. 
     When fitting the cup in the acetabular cavity, it must be possible to use an impactor for holding and manipulating the cup and for applying a force to drive the cup into the acetabular cavity of the bone with a good orientation and, in particular, for a long enough period to allow a cement to set between the outer surface of the insertion cup and the acetabular cavity of the bone. 
     When the cup is made of metal, such a material allows means to be easily provided for reliable fixing of an impactor. To this end, the document U.S. Pat. No. 5,486,181 describes fixing an impactor by means of fins, while the document U.S. Pat. No. 5,888,205 describes a threaded top hole formed in the concave receiving face. 
     In the particular case of a cup made entirely of ceramic, these solutions are not applicable. This is because ceramic is too fragile for the formation of fins or of a threaded hole. A threaded hole is also unacceptable since, in the case of a cup made of ceramic, the concave receiving face is intended to receive the spherical prosthetic head directly: the concave receiving face must therefore be perfectly smooth and cannot therefore have the slightest machining. 
     The documents EP 0 931 523 and FR 2 830 746 describe impactors intended to be fixed to a cup by way of pivoting fastening fingers. The document WO 2009/098491 describes an impactor intended to be fixed to a cup by way of rotary bayonets. All of these impactors are complex and cumbersome and do not provide particularly good retention of the cup. 
     The document FR 2 909 541 describes a cup with a convex and hemispherical outer anchoring face. To hold this cup during its impaction, an outer annular groove is provided near its free annular edge. This annular groove permits the fixation of an impactor comprising a main body with at least two hook-shaped elastic tabs. In this document, the force with which the cup is retained by the impactor is in correlation with and substantially equal to the force that has to be applied to spread apart the elastic tabs. This means that the better the hold of the cup by the impactor, the more difficult it is to spread the tabs apart, and this causes the user more effort to fix the impactor to the cup. This increases the risk of accidental damage to the cup, which is critical in the case of a cup made of ceramic, which is a fragile material. 
     There is a need to permit easy fixation of an impactor to a cup while providing a reliable hold of the cup. 
     SUMMARY OF THE INVENTION 
     A problem addressed by the invention is that of making available a method for producing a prosthetic hip acetabulum with a ceramic cup that can be fixed more reliably and more firmly to an impactor, while limiting the forces to be applied and avoiding any risk of contamination. 
     To achieve these objects, and others, the invention proposes a production method comprising the steps of: 
     a) providing a ceramic cup having a concave inner receiving face, and having an outer annular receiving structure, 
     b) providing an installation and orientation insert having a peripheral annular fixing structure designed to cooperate with the receiving face of the outer annular receiving structure by engaging around the outer annular receiving structure, 
     c) heating the installation and orientation insert in order to increase the dimensions thereof, 
     d) engaging the peripheral annular fixing structure around the receiving face of the outer annular receiving structure, 
     e) bringing the installation and orientation insert back to room temperature in order to reduce the dimensions thereof, so as to achieve a radial clamping of the peripheral annular fixing structure on the outer annular receiving structure. 
     Such a production method makes it possible to obtain satisfactory radial clamping of the installation and orientation insert on the ceramic cup, and effective retention of the installation insert on the ceramic cup. 
     The forced retention of the installation and orientation insert on the insertion cup by radial clamping ensures reliable and secure fixation, by means of which it is possible to withstand the forces applied during the impaction of the insertion cup. The radial clamping of the peripheral annular fixing structure on the outer annular receiving structure makes it possible to achieve this reliable fixation without over-complicating the shape of the outer annular receiving structure. 
     The retention of the installation and orientation insert on the insertion cup is very reliable, especially by virtue of the fact that the radial clamping takes place on an annular receiving structure which is external and which thus has a large contact surface with the installation and orientation insert. 
     Finally, the radial clamping of the peripheral annular fixing structure on the outer annular receiving structure induces a state of prestressing in the ceramic cup, and this prestressing limits the risks of breaking of the cup during its impaction in the acetabulum of the pelvis of a patient, but also during its transport and its handling when the method according to the invention is implemented in the factory. 
     When the installation and orientation insert is mounted on the cup in the factory, the surgeon then only has to fix the impactor on the installation and orientation insert in order to proceed with the impaction of the cup. There is no risk of the surgeon damaging the concave inner receiving face of the insertion cup, the latter being protected by the installation and orientation insert. 
     It must be emphasized that fixing the installation and orientation insert to the cup by means of expansion of the installation and orientation insert by heating (followed by a return to room temperature) is particularly advantageous compared to a first alternative solution that would involve cooling the cup rather than the installation and orientation insert in order to reduce the external dimensions thereof (followed by a return to room temperature) or compared to a second alternative solution that would involve engaging the installation and orientation insert inside the cup and cooling this installation and orientation insert in order to reduce the external dimensions thereof (followed by a return to room temperature). 
     Indeed, these alternative solutions necessitate a refrigerated enclosure in which a condensation phenomenon can take place, leading to the presence of condensate liquids on the cup or the installation and orientation insert, which liquids may be contaminated by bacteria or microbes. This is particularly critical when the installation and orientation insert is made of plastic: the plastics that can be used for the installation and orientation insert, for example polyethylene, have a tendency to absorb the liquids. This is also particularly critical when the cup is made of ceramic, for example like the cup from the document U.S. Pat. No. 6,682,567, which has layers of porous ceramic, the pores of which can absorb and retain liquids. There is therefore a risk that the installation and orientation inserts made of plastic and/or the cups made of ceramic absorb condensate liquids that are contaminated by bacteria or microbes, which then leads to the contamination of the prosthetic acetabulum. 
     Since the receiving structure is annular, it allows the cup to be oriented in any direction by the application of radial forces to the impactor in any possible direction. 
     Since the receiving structure is external, the concave inner receiving face can be perfectly smooth, in order to permit perfect sliding between the cup and the spherical prosthetic head. 
     Advantageously, the method can also have a step f) during which the unit thus formed and packed in a microbial protection envelope is sterilized. 
     Preferably, provision can be made that the step f) of sterilization is carried out by bombardment with gamma rays, preferably at a dose of between approximately 25 kGy and approximately 40 kGy. 
     In order to ensure perfect mobility of the prosthesis, it is important that the receiving structure does not limit the clearance of the prosthetic neck. 
     Moreover, the prosthetic neck supporting the spherical prosthetic head is generally made of a very strong material (for example metal), whereas the ceramic of the cup is a very hard but fragile material. As a result, any contact or shock between the prosthetic neck and the ceramic of the cup would damage the latter irremediably and must therefore be avoided. 
     To do this, provision can advantageously be made that:
         the concave inner receiving face is a sphere portion having an opening face contained in an opening plane,   the annular receiving structure is set back from the opening plane.       

     By virtue of the fact that the annular receiving structure for the fixation of the impactor is set back from the opening plane, i.e. offset in the direction of the summit of the convex outer anchoring face, this annular receiving structure does not limit the angular clearance of the prosthetic femoral shaft that will be fitted. At the same time, this limits the risk of contact between the prosthetic femoral shaft and the edge of the ceramic cup, which therefore reduces the risk of damage to or breakage of the cup. 
     Advantageously, provision can be made that:
         the outer annular receiving structure comprises a continuous or interrupted peripheral radial shoulder of the annular edge, with a receiving face directed toward the outside,   the installation and orientation insert has a continuous or interrupted peripheral annular fixing structure with a connecting face directed toward the inside and designed to cooperate with the receiving face of the outer annular receiving structure.       

     Such an outer annular receiving structure is relatively simple to produce. 
     According to a first variant, provision can be made that:
         the receiving face of the outer annular receiving structure has an interrupted peripheral locking groove,   the connecting face of the peripheral annular fixing structure of the installation and orientation insert has a plurality of locking ribs which are distributed peripherally and are designed so as to engage in the interrupted peripheral locking groove.       

     According to a second variant, provision can be made that:
         either the receiving face of the outer annular receiving structure or the connecting face of the peripheral annular fixing structure has a continuous peripheral annular locking groove,   the other of the connecting face of the peripheral annular fixing structure or the receiving face of the outer annular receiving structure has a continuous or interrupted peripheral annular locking rib designed so as to engage in the continuous peripheral annular locking groove.       

     The locking groove and the locking rib or ribs participate in retaining the installation and orientation insert on the cup. This also greatly increases the strength of the connection between the installation and orientation insert and the insertion cup, so as to withstand the orientation couples that are transmitted by the surgeon by means of the impactor. 
     Advantageously, provision can be made that:
         the peripheral radial shoulder of the annular edge has a thickness of greater than or equal to approximately 0.5 mm,   said interrupted peripheral locking groove or said continuous peripheral annular locking groove of the outer annular receiving structure has a radial thickness of between approximately 0.2 mm and approximately 0.6 mm.       

     Such dimensions are compatible with a ceramic cup having a small thickness near its upper annular edge, for example of approximately 3 mm. In other words, these dimensions are such that they do not weaken or do not greatly weaken the ceramic cup near its upper annular edge, while at the same time they permit a good hold of the installation and orientation insert. The use of a cup having a small thickness near its upper annular edge (for example a thickness of approximately 3 mm) makes it possible to increase the diameter of the spherical head of the male part of the joint and thus effectively limit the risk of dislocation. 
     Preferably, provision can be made that the peripheral radial shoulder of the annular edge has a height of between approximately 1 mm and approximately 4 mm. 
     Such a height of the peripheral radial shoulder provides a sufficient contact surface between the installation and orientation insert and the ceramic cup for the radial clamping, without thereby excessively diminishing the surface area of the convex outer anchoring face intended to come into contact with the bone. This is all the greater in view of the fact that the outer anchoring surface part situated substantially in the vicinity of the equatorial plane thereof is a part that participates substantially in the retention of the insertion cup in the acetabular cavity of the pelvis. 
     Advantageously, provision can be made that said interrupted peripheral locking groove or said continuous peripheral annular locking groove of the outer annular receiving structure has a height of between approximately 0.4 mm and approximately 3 mm. 
     Preferably, provision can be made that the installation and orientation insert and the outer annular receiving structure of the cup are designed in such a way that, when the installation and orientation insert is fixed on the outer annular receiving structure of the cup, the installation and orientation insert does not protrude outside a substantially hemispherical surface defined by the outer convex anchoring face of the cup. This therefore avoids any risk of conflict of the installation and orientation insert with the bone substance present near the prepared acetabular cavity of the pelvis of the patient. 
     Advantageously, the peripheral annular fixing structure of the installation and orientation insert can have a radial thickness substantially equal to or less than the thickness of the radial shoulder of the annular edge. 
     Preferably, the installation and orientation insert can be made of polyethylene. Polyethylene is commonly used in the medical field and is inexpensive and easy to machine. Moreover, polyethylene does not risk damaging the ceramic cup when the surgeon applies shocks to the impactor in order to insert the cup in the acetabular cavity of the patient. 
     Advantageously, the installation and orientation insert can have an assembly structure to which an impactor can be removably fixed. 
     Preferably, the assembly structure can comprise a fixation hole with internal thread made in the installation and orientation insert, permitting the screwing of a corresponding threaded portion of the impactor. 
     Advantageously, the fixation hole can be a through-hole able to cooperate with a disconnecting tool that has a threaded rod able to be screwed into the through-hole and which has a distal end designed to bear against the concave inner receiving face of the cup when the threaded rod is screwed into the through-hole. 
     Preferably, provision can be made that:
         the installation and orientation insert is designed in such a way that a free space remains between the installation and orientation insert and the bottom of the concave inner receiving face once the installation and orientation insert has been fixed to the outer annular receiving structure of the cup,   the installation and orientation insert bears in a sealed manner across its connecting face against the receiving face of the outer annular receiving structure,   the fixation hole is a through-hole via which the free space between the installation and orientation insert and the bottom of the concave inner receiving face is brought into communication with the outside and which is dimensioned for leaktight engagement of the end of a syringe.       

    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Other subjects, features and advantages of the present invention will become clear from the following description of particular variants, said description making reference to the attached figures, amongst which: 
         FIG. 4  is a perspective view of a ceramic cup of a prosthetic acetabulum according to a first variant of the invention; 
         FIG. 5  is a side view of the ceramic cup from  FIG. 4 ; 
         FIG. 6  is a perspective view of an installation and orientation insert intended to be joined to the ceramic cup from  FIGS. 4 and 5 ; 
         FIG. 7  is a sectional view of the installation and orientation insert from  FIG. 6 ; 
         FIG. 8  is a perspective view of an installation and orientation insert and of a ceramic cup of a prosthetic hip acetabulum according to a second variant of the invention; 
         FIG. 9  is a sectional view of the installation and orientation insert from  FIG. 8 ; 
         FIG. 10  is a partial sectional view of the ceramic cup from  FIG. 8 ; 
         FIG. 11  is a partial sectional view of the installation and orientation insert from  FIG. 9 ; 
         FIG. 12  is a partial sectional view of the ceramic cup and of the installation and orientation insert from  FIGS. 10 and 11 ; and 
         FIG. 13  is a sectional view of an insertion cup and of an installation and orientation insert once they have been assembled. 
       Some of the attached figures illustrate a subject matter that is not part of the present invention but that is described below and that may become the subject of an independent protection. These figures are the following: 
         FIG. 1 , which is a perspective view of a ceramic cup of a prosthetic acetabulum; 
         FIG. 2 , which is a perspective view of an installation and orientation insert intended to be joined to the cup from  FIG. 1 ; and 
         FIG. 3 , which is a sectional view of the installation and orientation insert from  FIG. 2 . 
     
    
    
     DESCRIPTION OF PREFERRED EMBODIMENTS 
     Each one of  FIGS. 1 ,  4 ,  5  and  8  shows a ceramic cup  1  of a prosthetic hip acetabulum. This ceramic cup  1  comprises:
         a convex outer anchoring face  2 , designed to be anchored in an acetabular cavity of the pelvis of a patient, and a concave inner receiving face  3  with an annular edge  4 ,   an annular receiving structure  6  designed in such a way that an impactor can be fixed to said annular receiving structure  6  for the impaction of the cup  1  in the acetabular cavity of the pelvis of a patient.       

     The receiving structure  6  is external, which means that the concave inner receiving face  3  can be perfectly smooth in order to permit perfect sliding between the cup and the spherical prosthetic head. 
     It can be seen more particularly that:
         the concave inner receiving face  3  is a sphere portion having an opening face  5  contained in an opening plane P,   the annular receiving structure  6  is set back from the opening plane P.       

     In other words, the annular receiving structure  6  is offset with respect to the opening plane P, in the direction of the summit S of the outer anchoring face  2 . 
     The annular receiving structure  6  is therefore not situated in the continuation of the inner receiving face  3  (which is at the most hemispherical) continuing the latter past the summit S. It is thus possible to avoid limiting the angular clearance of the prosthetic neck, and the risk of contact between the prosthetic neck stem and the annular edge  4  of the ceramic cup  1  is reduced. 
       FIGS. 2 ,  3 ,  6 ,  7  and  9  show an installation and orientation insert  7  intended to be joined to a cup  1 . The installation and orientation insert  7  of  FIGS. 2 and 3  is intended to be joined to the cup  1  from  FIG. 1 . The installation and orientation insert  7  of  FIGS. 6 and 7  is intended to be joined to the cup  1  from  FIGS. 4 and 5  or  FIG. 8 . The installation and orientation insert  7  of  FIG. 9  is intended to be joined to the cup  1  from  FIG. 8 . 
     Each installation and orientation insert  7  can be fixed removably to the outer annular receiving structure  6  of the cup  1  and has an assembly structure  8  on which an impactor can be removably fixed. 
     In  FIGS. 1 ,  5  and  8 , it can be seen that the outer annular receiving structure  6  comprises a continuous or interrupted peripheral radial shoulder d of the annular edge  4 , with a receiving face  9  directed toward the outside. It can be seen in  FIGS. 2 ,  3 ,  6 ,  7  and  9  that each installation and orientation insert  7  has a continuous or interrupted peripheral annular fixing structure  10  with a connecting face  11  directed toward the inside and designed to cooperate with the receiving face  9  of the outer annular receiving structure  6 . 
     In the subject matter of  FIGS. 1 to 3 , the receiving face  9  of the outer annular receiving structure  6  has an external thread  12 , while the connecting face  11  of the peripheral annular fixing structure  10  of the installation and orientation insert  7  has an internal thread  13  designed to cooperate with the external thread  12  by screwing. 
     The subject matter of the present invention is illustrated in  FIGS. 4 to 13 . On these figures, the outer annular receiving structure  6  and the peripheral annular fixing structure  10  are designed in such a way that the installation and orientation insert  7  is engaged with force around the outer annular receiving structure  6  and is retained forcibly by a radial clamping of the peripheral annular fixing structure  10  on the outer annular receiving structure  6 . 
     On account of the external nature of the annular receiving structure  6 , the contact surface between the installation and orientation insert  7  and the cup  1 , on which surface the clamping is exerted, is large. This results in excellent fixation of the installation and orientation insert  7  on the cup  1 . 
     In order to further improve the hold of the installation and orientation insert  7  on the cup  1 , a supplementary cooperation can be provided between the installation and orientation insert  7  and the cup  1  by means of one or more locking ribs that engage in a locking groove. 
     In a first variant, illustrated on  FIGS. 4 to 7 , provision is made that:
         the receiving face  9  of the outer annular receiving structure  6  has an interrupted peripheral locking groove  14 ,   the connecting face  11  of the peripheral annular fixing structure  10  of the installation and orientation insert  7  has a plurality of locking ribs  15   a  to  15   d  which are distributed about the periphery and are designed so as to engage in the interrupted peripheral locking groove  14 .       

     In a second variant, illustrated on  FIGS. 8 and 9 , the receiving face  9  of the outer annular receiving structure  6  has a continuous peripheral annular locking groove  16 , while the connecting face  11  of the peripheral annular fixing structure  10  has a continuous peripheral annular locking rib  17  designed so as to engage in the continuous peripheral annular locking groove  16 . 
     In this second variant, it is also possible that the connecting face  11  of the peripheral annular fixing structure  10  has an interrupted peripheral annular locking rib. The installation and orientation insert  7  can then be similar to that of the first variant, illustrated on  FIGS. 6 and 7 . 
       FIG. 10  is a partial sectional view of the annular edge  4  of the cup  1  from  FIG. 8 . It will be seen more particularly on  FIG. 10  that the outer annular receiving structure  6  comprises a peripheral radial shoulder d with a receiving face  9  directed toward the outside. The peripheral radial shoulder d has a thickness e 1  of greater than or equal to approximately 0.5 mm. 
     The receiving face  9  has the continuous peripheral annular locking groove  16 . The continuous peripheral annular locking groove  16  has a radial thickness e 2  of between approximately 0.2 mm and approximately 0.6 mm. 
     The ceramic cup  1  has a thickness e 4  near its annular edge  4 . The thickness e 4  can be between approximately 3 mm and approximately 7 mm. 
     The peripheral radial shoulder d of the annular edge  4  has a height h 1  of between approximately 1 mm and approximately 4 mm. 
     Finally, the continuous peripheral annular locking groove  16  has a height h 2  of between approximately 0.4 mm and 3 mm. 
     All the dimensions given above in connection with the second variant are valid for the first variant and also for the subject matter of  FIGS. 1 to 3 . 
     As can be seen on  FIG. 11 , the peripheral annular fixing structure  10  of the installation and orientation insert  7  has, with its connecting face  11  and its continuous peripheral annular locking rib  17 , a shape and dimensions matching the receiving face  9  and the continuous peripheral annular locking groove  16 . The installation and orientation insert  7  and the ceramic cup  1  can thus be joined very intimately, as is illustrated on  FIG. 12 . 
     In order to avoid any conflict of the installation and orientation insert  7  with the bone substance around the natural acetabular cavity of the pelvis of the patient, the installation and orientation insert  7  and the outer annular receiving structure  6  of the cup  1  are designed in such a way that, when the installation and orientation insert  7  is fixed to the outer annular receiving structure  6  of the cup  1 , the installation and orientation insert  7  does not protrude outside a substantially hemispherical surface S 1  (illustrated by broken lines on  FIG. 12 ) defined by the convex outer anchoring face  2  of the cup  1 . The outer anchoring face  2  is made substantially hemispherical in order to adapt to and fix reliably in the acetabular cavity of the patient. 
     To do this, the peripheral annular fixing structure  10  of the installation and orientation insert  7  has a radial thickness e 3  ( FIG. 11 ) substantially equal to or less than the thickness e 1  of the radial shoulder d of the annular edge  4  ( FIG. 10 ). 
     So as not to risk damaging the ceramic cup  1 , the installation and orientation insert  7  is advantageously made of plastic, preferably of polyethylene, which is an inexpensive material, is easy to machine and avoids damage to the ceramic of the cup  1  despite the application of shocks to the impactor during the insertion of the cup  1  into the acetabular cavity of the patient. 
     Within the context of the invention, the concave inner receiving face  3  can be a slide face  3   a  for receiving the prosthetic femoral head. The concave inner receiving face  3  can also be a slide face  3   a  for receiving a movable articular insert, the movable articular insert pivotably receiving the prosthetic femoral head, for example for an acetabulum with dual mobility. 
     It can be seen more particularly on  FIG. 13  that the assembly structure  8  of the installation and orientation insert  7  comprises a fixation hole  20  with internal thread  21 . The internal thread  21  permits the screwing of a corresponding threaded portion of the impactor (not shown). 
     After the impaction of the ceramic cup  1  in the acetabular cavity of the pelvis of the patient, it is necessary to withdraw the installation and orientation insert  7 . This withdrawal has to be performed without inducing appreciable stresses between the outer anchoring face  2  and the acetabular cavity of the pelvis of the patient, so as not to destroy the join made between them during the impaction. 
     A first solution to permit separation thus consists in the fixation hole  20  being a through-hole that is able to cooperate with a disconnecting tool having a threaded rod with a distal end designed to bear against the concave inner receiving face  3  of the cup  1  when the threaded rod is screwed into the through-hole. On  FIG. 13 , the fixation hole  20  has a first portion  20   a  of diameter D 1  and a second portion  20   b  of smaller diameter D 2 . The threaded rod of the disconnecting tool has an external diameter designed such that it can be screwed into the portion  20   b  of diameter D 2  of the fixation hole  20 . 
     Alternatively, the threaded rod of the disconnecting tool can be accommodated slidably inside the impactor (which is screwed into the portion  20   a ) and thus has a diameter smaller than the diameter D 2  of the portion  20   b , in order to bear against the inner receiving face  3  by passing through the portion  20   b.    
     A second solution permitting separation is one in which:
         the installation and orientation insert  7  is designed such that a free space E 1  remains between the installation and orientation insert  7  and the bottom of the concave inner receiving face  3  ( FIG. 13 ) once the installation and orientation insert  7  has been fixed to the outer annular receiving structure  6  of the insertion cup  1 ,   the installation and orientation insert  7  bears in a sealed manner across its connecting face  11  against the receiving face  9  of the outer annular receiving structure  6 ,   the fixation hole  20  is a through-hole via which the free space E 1  (provided between the installation and orientation insert  7  and the bottom of the concave inner receiving face  3 ) is brought into communication with the outside and which is dimensioned for leaktight engagement of the end of a syringe.       

     In the case of  FIG. 13 , the syringe end has an external diameter made for engaging in a leaktight manner in the portion of diameter D 2  of the fixation hole  20 . 
     By actuation of the syringe, a liquid such as water or physiological saline is thus injected at pressure into the free space E 1  in order to induce a force of separation between the cup  1  and the installation and orientation insert  7 . 
     In order to obtain a sealed contact between the installation and orientation insert  7  and the cup  1 , use will preferably be made of the insertion cup  1  and the installation and orientation insert  7  that are illustrated on  FIGS. 8 and 9 . 
     Within the context of the present invention, when assembling the unit comprising the cup  1  and an installation and orientation insert  7 , it is important not to damage the annular receiving structure  6  and the peripheral annular fixing structure  10 . Thus, in order to achieve a radial clamping of the peripheral annular fixing structure  10  on the outer annular receiving structure  6 , it is necessary that the peripheral annular fixing structure  10  has diameter dimensions equal to or less than those of the outer annular receiving structure  6 . 
     An assembly method involving expansion and subsequent shrinkage is therefore used, during which the installation and orientation insert  7  is heated so as to increase its dimensions, after which the peripheral annular fixing structure  10  is engaged around the receiving face  9  of the outer annular receiving structure  6 , and, finally, the installation and orientation insert  7  is brought back to room temperature in order to reduce its dimensions. 
     Such a method permits assembly without blunting or damaging the one or more locking ribs  15   a - 15   d  or  17 , which thus retain sharp edges for a stronger connection between the installation and orientation insert  7  and the ceramic cup  1 . 
     This method of production by heating does not involve any risk of contamination of the installation and orientation insert  7 , especially when the latter is made of polyethylene. 
     On its return to room temperature, a radial clamping of the peripheral annular fixing structure  10  on the outer annular receiving structure  6  is obtained. 
     It is then possible to proceed to a step of sterilization of the unit thus formed and packed in a microbial protection envelope. A satisfactory sterilization will be achieved by bombardment with gamma rays, preferably at a dose of between approximately 25 kGy and approximately 40 kGy. 
     It is expressly underlined that the method of production and assembly of the unit on  FIG. 13 , by heating the installation and orientation insert  7  and then returning it to room temperature, can be used with a ceramic cup  1  whose outer annular receiving structure  6  is not necessarily situated set back from the opening plane P. The method of production may thus be able to be implemented independently of the position of the outer annular receiving structure  6  with respect to the opening plane P of the insertion cup  1 . 
     The present invention is not limited to the embodiments that have been explicitly described, and instead it includes the variants and generalizations contained within the scope of the attached claims.