Trochanter attachment device

A trochanter attachment device can include a plate for attachment to an inner portion of a greater trochanter of a femur, a collar for attaching the plate to a hip implant, and a fastener for securing the collar to a hip implant. The trochanter attachment device can include a groove or other feature for receiving a reinforcing material, such as a wire or a cable, such as to reinforce an attachment of the device to the greater trochanter and/or the hip implant. The trochanter attachment device can include an insert attachable to the plate and configured to attach the plate to the greater trochanter. All or a portion of the plate and/or the insert can include a porous material, such as to promote bone ingrowth of the greater trochanter.

TECHNICAL FIELD

The present patent application relates to orthopedic implants, and more particularly, to an apparatus and method for reattaching the greater trochanter to the femur during or following hip arthroplasty.

BACKGROUND

Orthopedic procedures may be used for the replacement of all, or a portion of, a patient's joint. Total hip arthroplasty may be used to restore function to a diseased or injured hip joint. The hip joint is a ball and socket joint that includes the acetabulum and the femoral head of the femur (or femoral bone). The femur also includes the greater trochanter.

As part of the original hip arthroplasty or a later hip revision surgery, all or a portion of the greater trochanter may become detached from the femur. Existing techniques for reattaching the greater trochanter to the femur can include attaching a metal plate to an outer portion (a lateral side) of the greater trochanter such that the metal plate extends lengthwise down the outer side of the femur. This type of plate may be used with wires or cables that wrap around the greater trochanter and the femur.

OVERVIEW

The present inventors have recognized, among other things, that there is an opportunity for a trochanter attachment device that can provide greater stability to the greater trochanter, such as relative to the femur and a femoral component of a hip implant. More particularly, the present inventors have recognized that a device can be secured to an inner portion (a medial side) of the greater trochanter, as well as to the hip implant, such as to help provide stability to the greater trochanter. The trochanter attachment device described herein can be used, for example, in cases where the greater trochanter is deficient (for example, having cracks and/or missing portions) and/or partially or wholly detached from the femur.

To better illustrate the trochanter attachment device and methods disclosed herein, a non-limiting list of examples is provided here:

In Example 1, a trochanter attachment device comprises a plate, a collar, and a fastener. The plate can have an inner surface and an outer surface configured to attach to an inner portion of a greater trochanter of a femur. The collar can be attached to the inner surface of the plate and configured to connect the plate to a hip implant. The fastener can be configured for securing the collar to the hip implant. A bottom end of the collar can be configured to contact a top surface of the hip implant. An upper portion of the plate can be configured to extend above the top surface of the hip implant when the collar is secured to the hip implant, and a lower portion of the plate can be configured to extend below the top surface of the hip implant when the collar is secured to the hip implant.

In Example 2, the trochanter attachment device of Example 1 is optionally configured such that the fastener includes a screw and a nut configured to engage with the screw and a stem of the hip implant.

In Example 3, the trochanter attachment device of Example 2 is optionally configured such that the nut includes a first end portion having a threaded portion configured to engage with the screw and a second end portion having a threaded portion configured to engage with the stem of the hip implant.

In Example 4, the trochanter attachment device of any one of Examples 2 or 3 is optionally configured such that the nut comprises a spline on an outer surface of the nut. The spline can be configured to engage with an inside surface of the collar.

In Example 5, the trochanter attachment device of Example 2 is optionally configured such that the nut includes a first end portion configured to engage with the screw and a second end portion configured to engage with the stem of the hip implant. The first end portion can include a cone-shaped portion configured to engage with an inside surface of the collar.

In Example 6, the trochanter attachment device of any one of Examples 1-5 optionally further includes an insert configured to be attachable to the outer surface of the plate and configured to attach the plate to the greater trochanter.

In Example 7, the trochanter attachment device of Example 6 is optionally configured such that the insert includes a porous portion.

In Example 8, the trochanter attachment device of Example 7 is optionally configured such that the porous portion includes tantalum.

In Example 9, the trochanter attachment device of any one of Examples 1-8 optionally further includes a ring including a groove extending at least partially circumferentially around an outer surface of the ring. The ring can be configured to be attachable to an outer surface of the collar.

In Example 10, the trochanter attachment device of any one of Examples 1-9 is optionally configured such that the collar includes a groove on an outer surface of the collar configured for receiving a reinforcing material.

In Example 11, the trochanter attachment device of any one of Examples 1-10 is optionally configured such that the fastener includes a screw. The screw can include a groove extending at least partially circumferentially around an outer surface of the screw.

In Example 12, the trochanter attachment device of any one of Examples 1-11 is optionally configured such that the plate and the collar include at least one of stainless steel, cobalt, cobalt-chromium, titanium, tantalum, or one or more alloys thereof.

In Example 13, the trochanter attachment device of any one of Examples 1-12 is optionally configured such that the plate and the collar include a porous tantalum region.

In Example 14, the trochanter attachment device of any one of Examples 1-14 is optionally configured such that the fastener secures the bottom end of the collar to a top surface of a femoral component of the hip implant.

In Example 15, a trochanter attachment device comprises a plate configured to attach to an inner portion of a greater trochanter of a femur, a collar attached to the plate and configured to contact an outer surface of a hip implant to secure the plate to the hip implant, a screw configured to extend through the collar for securing the collar to the hip implant, and a nut having a first end portion and a second end portion. The first end portion of the nut can be configured to engage with the collar and the screw. The second end portion of the nut can be configured to engage with a stem portion of the hip implant. The plate can include at least one aperture configured for receiving a fastener configured to secure the plate to the greater trochanter.

In Example 16, the trochanter attachment device of Example 15 optionally further includes an insert configured to be attachable to an outer surface of the plate and configured to attach the plate to the greater trochanter. The insert can include a porous material.

In Example 17, the trochanter attachment device of Example 16 is optionally configured such that the porous material includes tantalum.

In Example 18, the trochanter attachment device of any one of Examples 15-17 is optionally configured such that the plate and the collar include at least one of stainless steel, cobalt, cobalt-chromium, titanium, tantalum, one or more alloys thereof, or one or more combinations thereof.

In Example 19, the trochanter attachment device of any one of Examples 15-18 is optionally configured such that the outer surface of the plate is configured to attach to an inside portion of the greater trochanter.

In Example 20, a method of securing a greater trochanter to a femur using an attachment device comprising a plate and a collar includes attaching an outer surface of the plate to an inner portion of the greater trochanter. The method further includes attaching the collar to a top surface of a hip implant implantable into the femur and securing the attachment device to at least one of the greater trochanter and the hip implant. The attachment device can be configured such that, when the collar is attached to the top surface of the hip implant, an upper portion of the plate extends above the top surface of the hip implant and a lower portion of the plate extends below the top surface of the hip implant.

In Example 21, the method of Example 20 is optionally configured such that securing the attachment device to at least one of the greater trochanter and the hip implant includes using at least one reinforcing material.

In Example 22, the method of Example 21 is optionally configured such that the at least one reinforcing material includes at least one of a cable, a wire, a bolt, a suture, or one or more combinations thereof, and the attachment device includes at least one feature configured to receive the at least one reinforcing material.

In Example 23, the method of any one of Examples 20-22 is optionally configured such that attaching the outer surface of the plate to an inner portion of the greater trochanter includes placing an insert between the plate and the inner surface of the greater trochanter. The insert can include a porous material.

In Example 24, the device or method of any one or any combination of Examples 1-23 is optionally configured such that all elements or options recited are available to use or select from.

These and other examples and features of the present trochanter attachment devices and methods will be set forth in part in the following Detailed Description. This overview is intended to provide a summary of subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. The detailed description is included to provide further information about the present patent application.

DETAILED DESCRIPTION

The present application relates to devices and methods for attaching or reattaching a greater trochanter of the femur to the femur, such as during a hip arthroplasty and/or as part of a later hip revision surgery.FIG. 1shows a femur or femoral bone10and a pelvic bone12. As shown inFIG. 1, the femoral bone10has different bone regions, including a femoral head14and a greater trochanter16. In hip arthroplasty, at least part of the hip joint is replaced with an implant, such as a prosthesis50shown inFIG. 2. The hip prosthesis or implant50can include an acetabular shell52, a femoral head54, an implant body56, and a stem58. In some designs of the prosthesis or implant50, the implant body56can be attached to the stem58, such as using a nut and threads, taper or other means to engage and connect the implant body56to the stem58.

As part of the hip replacement surgery or arthroplasty, the femoral head14can be removed from the femoral bone10. An opening can be created through the diaphysis of the femoral bone10. Such an opening can follow the intramedullary canal of the femur and can be configured for receiving the stem58of the implant50. In some cases, the greater trochanter16remains intact on the femoral bone10; however, in some instances, the greater trochanter16can become deficient, or partially or completely detached from the femoral bone10. Even if the greater trochanter16remains intact following the original replacement surgery, if a revision has to be performed, the greater trochanter16may likely become further compromised or detached as a result of the revision surgery.

FIG. 3shows an example of a trochanter attachment device100that can include a plate102, a collar104, a screw106, and a nut108. Each of these components is also shown inFIG. 4, which is an exploded view of the trochanter attachment device100ofFIG. 3. The trochanter attachment device100can be used during a hip replacement surgery or during a revision surgery. The plate102is configured for attachment to an inner surface or inner portion of the greater trochanter16. In an example of the attachment device100shown inFIGS. 3 and 4, the plate102can include one or more apertures110, which can extend from an inner surface112of the plate102to an outer surface114of the plate102, and which can be configured to respectively receive a fastener, such as for securing the plate102to the greater trochanter16. Known types of fasteners or fixation devices, such as, for example, bone screws, can be used with the apertures110. The plate102can include more or less apertures110compared to the two apertures110shown inFIGS. 3 and 4.

The collar104can be attached to the plate102. The collar104can be configured to connect the plate102to a hip implant, such as shown inFIG. 5. The collar104can include an opening116, which can extend from a first end118to a second end120of the collar104. The opening116can be configured to engage with the screw106and the nut108. As shown inFIG. 4, the nut108can include one or preferably a plurality of splines126, such as near a first end122of the nut108. In an example, the first end118of the collar104can be configured to align with the first end122of the nut108, such as to permit the one or more splines126to contact an inner surface128of the collar104. In an example, the collar104, including the inner surface128, can include or can be formed of a porous structure, such as to permit the splines126to grip the porous material on the inner surface128. As an alternative to or in addition to the porous material, the inner surface128can include grooves that engage with the splines126.

As described further below, a second end124of the nut108can be configured to engage with a stem of a hip prosthesis or implant. In an example, the nut108can include at least one cut-out or recessed track feature129at or near the second end124, such as can be used to secure or lock the nut108on the stem of the prosthesis. In the example shown inFIGS. 3 and 4, the nut108includes three features129on the second end124. The features129can receive or otherwise interact with corresponding respective protruding features on the stem, such as to secure or lock the nut108on the stem of the prosthesis.

The screw106can be configured to secure the collar104to a proximal femoral component of a hip prosthesis, such as shown inFIG. 5, and can include external threads130that can engage with corresponding internal threads132on an inner surface134of the nut108. The screw106can have internal threading and the nut108can have external threading. The attachment device100can optionally include a ring136, such as having a groove137, which can be sized, shaped or otherwise configured to attach to the collar104, for example, by a snap-fit, bonding, or other attachment technique. The ring136can attach to the collar104such that the ring136can extend circumferentially around at least a portion of the collar104. As shown inFIGS. 3 and 4, the screw106can include a groove138, such as extending partly or completely around a circumference of the screw106. The grooves137and138can be used to receive a wire or cable, such as discussed below. In an example in which the trochanter attachment device does not include a ring, the collar can include an at least partially circumferential groove, and such groove can be used to receive a wire, cable, or other reinforcing material.

In an example of the attachment device100shown inFIGS. 3 and 4, the plate102and the collar104can together be a singular piece and formed of the same material. Otherwise, the plate102and the collar104can be separate pieces, such as can be bonded together, or attached by another technique; in that case, the plate102and the collar104can be formed from the same material or of different materials.

In an example, the plate102and/or the collar104can include or can be formed of a porous structure, such as to facilitate bone ingrowth or regrowth. A porous biomaterial can be useful as a bone substitute, and can have a porosity as low as 55%, 65%, or 75%, or as high as 80%, 85%, or 90%, or within any range defined by any of the foregoing values. In an example, the porous structure can include or can be formed of a material produced using Trabecular Metal™ technology, generally available from Zimmer, Inc. of Warsaw, Ind. Trabecular Metal™ is a trademark of Zimmer, Inc. Such a material can be formed using a foamed polymer (such as polyurethane, as one example) that can be reduced to a reticulated vitreous carbon foam substrate or skeleton. The carbon skeleton can be infiltrated and coated with a first layer of biocompatible metal, such as tantalum, to produce a low density material, and then plated with a second layer of tantalum to produce a high density material. The metal can be deposited on the carbon substrate by a chemical vapor deposition (CVD) process, such as in the manner disclosed in detail in U.S. Pat. No. 5,282,861, the disclosure of which is incorporated herein by reference. One or more other metals, e.g., in addition to tantalum, including alloys thereof, can be used, such as, for example, niobium.

Generally, the porous structure can include a large plurality of ligaments defining open spaces there between, with each ligament generally including a carbon core covered by a thin film of metal, such as tantalum, for example. The open spaces between the ligaments can form a matrix of continuous channels, such as having no dead ends, such as to permit uninhibited growth of cancellous bone through the porous tantalum structure. The porous structure can include up to 75%-85% or more void space therein. In an example, a porous tantalum structure can provide a lightweight, strong porous structure that can be substantially uniform and consistent in composition, and that can closely resemble the structure of natural cancellous bone, which can thereby provide a matrix into which cancellous bone can grow. The porous tantalum structure can be made in a density selected from a variety of densities, such as to selectively tailor the structure for a particular application. The porous tantalum can be fabricated to permit selecting virtually any desired porosity and pore size, and can thus be matched with the surrounding natural bone, such as to provide an improved matrix for bone ingrowth and mineralization.

The plate102or the collar104can be formed of other porous or non-porous materials. For example, the plate102or the collar104can be formed of stainless steel, cobalt, cobalt-chromium, titanium, tantalum, or one or more alloys thereof. As described above, the plate102or the collar104can be formed of the same or different materials. All or a portion of the outer surface114of the plate102can be a porous tantalum structure, since the outer surface114will contact the greater trochanter, and one or more other parts of the plate102can be a non-porous material. The plate102can be formed of a non-porous material and all or part of the outer surface114of the plate102can be coated with a porous structure, such as the porous tantalum structure described above. Use of a porous material on the outer surface114of the plate102can promote fixation of the plate102to the greater trochanter and/or can promote bone ingrowth.

The ring136can be made of a different material than the collar104. The ring136can be made of a harder or more resistant material than the collar104, such as to protect the collar104if a reinforcing material is used around the collar104. In an example, the ring136can be titanium or a titanium alloy.

The screw106or the nut108can be made of one or more materials such as can be used in fasteners for devices implanted inside a human or animal body. These materials can include stainless steel, titanium, cobalt, or one or more alloys thereof. In an example, the screw106can be made of titanium. In an example, the nut108can be made of stainless steel, titanium, cobalt, or one or more alloys thereof.

FIG. 5shows an example of the trochanter attachment device100ofFIGS. 3 and 4attached to a hip prosthesis or hip implant150, which can be similar to the prosthesis50shown inFIG. 2. As shown inFIG. 5, the trochanter attachment device100can attach to a femoral component of the prosthesis or implant150, which can include a body156and a stem158. The body156can include a neck portion160and an elongate portion162. The neck portion160can be sized shaped, or otherwise configured to attach to a femoral head that is part of the complete prosthesis implanted in a body.

As shown inFIG. 5, the trochanter attachment device100can attach to the neck portion160of the body156. The second end120of the collar104can contact an outer surface of a top portion164of the body156, which is a top surface of the femoral component of the hip implant150. The inner surface112of the plate102can contact an outer surface on a backside166of the body156. The inner surface112of the plate102may not be centered on the backside166of the body156; rather, the inner surface112can be located generally more on one side of the body156than the other side. After attachment of the device100to the body156, the plate102can have some movement or flexibility relative to the body156. As shown inFIG. 5, when the collar104is attached or secured to the top surface164of the hip implant150, an upper portion168of the plate102can extend above the top surface164and a lower portion170of the plate102can extend below the top surface164.

One or more like or different mechanisms can be employed to reinforce attachment of the greater trochanter16to the implant150and the femur10, such as once the implant150and the attachment device100are implanted at least partially into the femur. Examples of possible reinforcement mechanisms can include, but are not limited to, one or more of a cable, a wire, a tiedown, a bolt, a suture, another reinforcement mechanism, or one or more combinations thereof. In an example, the attachment device100can be sized, shaped, or otherwise configured for receiving one or more wires; for example, a wire(s) can be received in the groove137of the ring136and/or in the groove138on the screw106. Such wire(s) can be wrapped around the greater trochanter16and/or the femur10.

FIG. 6is a cross-section of a portion ofFIG. 5, showing an example of the attachment device100and the hip prosthesis150.FIG. 6shows the nut108extending through the neck portion160of the prosthesis150. In an example, the threads132on the inner surface134of the nut108can be configured to engage with corresponding threads157on an outer surface159of the stem158of the prosthesis150. The nut108can be secured on the stem158, such as using the one or more track features129, which can be used to lock the nut108on the stem158. The attachment device100can be attached to a greater trochanter16, such as using the one or more apertures110on the plate102, through which a fastener can be inserted, such as to extend through the greater trochanter16and the plate102, at a location on the trochanter16aligned with a particular one of the apertures110.

Some approaches to designs of a proximal femoral component of a hip prosthesis can include a nut that is used to attach a stem to a body portion of the prosthesis. Thus, the attachment device100can include or use a nut already used in the prosthesis. The nut from the hip prosthesis can optionally be modified for use in or with the attachment device100. In an example, such as shown inFIG. 6, a majority of a length of the inner surface134of the nut108can be threaded. The length of the nut108can include more or less threading, as compared to the example shown inFIG. 6, and the specific threading can depend on a design of the screw106and/or the stem158.

In contrast to the prosthesis design shown inFIGS. 5 and 6, hip implants can include a one-piece prosthesis that can include a neck and an elongate body portion. In those designs, an inner surface of the elongate portion162can include threads that can be configured to engage with corresponding threads on the nut108.

As shown inFIGS. 5 and 6, in an example, the outer surface114of the plate102can have a curved or non-linear shape, such as can be used to promote fitting or fixation of the plate102to the greater trochanter16. In an example, the outer surface114of the plate102can be generally straight or linear. As part of the preparation for attachment of the trochanter attachment device100to a greater trochanter16, a reamer or other surgical device can be used to shape an inner surface of the greater trochanter16, such as to accommodate the shape of the plate102, such as for improved or optimal fitting or fixation of the plate102to the greater trochanter16. In an example, a patient-specific trochanter attachment device100can be used, in which case, the outer surface114or other feature of a plate102of the trochanter attachment device100can be shaped to match a particular shape and/or dimension(s) of that particular patient's greater trochanter16.

Although a screw106is shown in the example of the trochanter attachment device100shown inFIGS. 3-6, one or more other types of fasteners can be used to secure the collar104of the device100to an outer surface of the neck portion160of the prosthesis150and to secure the device100to the stem158of the prosthesis150. In an example, the attachment device100ofFIGS. 3-6can use a combination of a screw106and a nut108; however, a screw can be used without a nut and the screw can thread directly onto or into a stem of the implant.

FIG. 7shows an example of a trochanter attachment device200, similar to the attachment device100, and which can include a plate202, a collar204, a screw206, and a nut208. Each of these components is also shown inFIG. 8, which is an exploded view of the trochanter attachment device200ofFIG. 7.

The attachment device200can also include an insert209, which can be sized, shaped, or otherwise configured to attach to an outer surface214of the plate202. The insert209can include one or more apertures211, such as extending from an inner surface213to an outer surface215of the insert209. The apertures211on the insert209can be arranged or otherwise configured to align with the apertures210on the plate202. As similarly described above for the attachment device100, the device200can be attached to a greater trochanter16, such as using one or more fasteners and the apertures210on the plate202and the apertures211on the insert209, an example of which is shown inFIG. 10. The insert209can be bonded or otherwise attached to the plate202, or the insert209can be separate from the attachment device200before attachment to a greater trochanter16. The plate202and the insert209can include more or less than the two apertures shown inFIG. 10on each of the plate202and the insert209.

The insert209can be used for fixation of the plate202to the greater trochanter16and/or to promote integration of the plate202with the bone making up the greater trochanter16. The insert209can include or can be made of a porous material, such as a porous tantalum structure, such as can be made using the Trabecular Metal™ technology described above. The use of a porous material for the insert209can help promote ingrowth of the cancellous bone with the insert209and/or the plate202. The insert209can be sized, shaped, or otherwise configured such that it matches with a shape of the greater trochanter16or a desired portion thereof. In an example, multiple inserts209, such as of various sizes and shapes, can be made available in a kit or otherwise for use with the trochanter attachment device200, and the user can select a particular insert209to be used, such as based on a particular size and shape of the greater trochanter16for a particular patient. In an example, a patient-specific insert209can be prepared for a specific patient, prior to surgery, such as based on a predetermined size and shape of the patient's greater trochanter16, such as can be ascertained using a medical imaging modality or other technique. As an alternative to or in addition to a patient-specific insert209, a patient-specific plate202can similarly be prepared for a patient.

As visible inFIG. 8, the collar204can include a groove205, such as can be sized, shaped, or otherwise configured for receiving a wire, cable, or other reinforcing material. The groove205can be larger or smaller than that shown inFIG. 8. The collar204can include an aperture207, such as for receiving a screw or other similar or suitable fastener, such as to prevent or limit movement of the screw206. A similar aperture can be included elsewhere, such as on the other side of the collar204, which is not visible inFIGS. 7 and 8.

As shown inFIG. 7, the plate202can include one or more apertures203, such as for use as suture wire holes. The apertures203can be used to help anchor the greater trochanter16to the implant or prosthesis. Similar apertures can be included on the plate102of the attachment device100. The trochanter attachment devices100and200can include any one or more of a variety of features, in addition to or as an alternative to those described herein, such as for receiving a cable, a wire, or another reinforcing mechanism, such as to reinforce attachment of the device100or200to the greater trochanter16and/or to femoral component of the hip implant.

Similar to a design of the nut108of the trochanter attachment device100, the nut208of the trochanter attachment device200can include splines226near a first end222of the nut208. The splines226can be well-suited if an inside portion of the collar204is formed of a porous material, such that the splines226can grip an inside of the collar204. In an example, the nut208can be configured without any splines. Other known features and methods can be used to attach or fit the nut208to the collar204.

FIG. 9shows an example of the trochanter attachment device200attached to a greater trochanter180, which can be similar to the greater trochanter16ofFIG. 1. As also shown inFIG. 9, the device200can also be implanted in a canal of the femur182and attached to a femoral component of a hip prosthesis250, which can be similar to prosthesis150ofFIGS. 5 and 6. Fasteners190and192can extend through the greater trochanter180, such as to attach the device200to the greater trochanter180, such as also shown inFIG. 10. As visible inFIG. 9, in an example, a second end220of the collar204can be curved or sloped downward from a front side219to a back side221of the collar204. As such, the collar204can be configured to engage with a prosthesis having a more angled neck portion compared to the prosthesis shown inFIG. 9. The collar204can have more or less of a sloped (or curved) design, if any, from the front219to back side221.

FIG. 10is a cross-sectional view of what is shown inFIG. 9. Fasteners190and192can extend through the plate202and the insert209, such as via apertures210and211, respectively, such as to attach the device200to the greater trochanter180. The fasteners190and192can be drilled or otherwise passed through an outer surface of the greater trochanter180. The apertures210and211of the plate202and the insert209can be preformed with the trochanter attachment device200. The fasteners190and192, as shown inFIGS. 9 and 10, can be oriented generally perpendicular to the plate202and the insert209; similarly, the apertures210and211can be oriented generally perpendicular relative to a length of the plate202and the insert209, respectively. In an example, the apertures210and211can be oriented at an angle relative to the length of the plate202and the insert209, in which case, the fasteners190and192can be inserted at a corresponding angle.

In an example, the apertures210and211can be formed as part of the procedure for using the trochanter attachment device200to secure the greater trochanter180to the femur182. The user can determine a particular placement and angle of the apertures210and211, which can depend, at least in part, on the particular patient's anatomy and the shape and condition of the patient's greater trochanter.

As shown inFIG. 10and similarly described above in reference toFIG. 6, the nut208of the attachment device200can be threaded, such as to engage with both the screw206and a stem258of the prosthesis250, each of which can have a threaded outer surface. As also described above in reference to device200, the nut208can include more or less threading. Before or during the procedure to attach the device200to the greater trochanter180, an inner surface of the greater trochanter180can be shaped, such as to better engage with the insert209and/or the plate202.

FIG. 11shows an example of a trochanter attachment device300similar to the trochanter attachment devices100and200. The trochanter attachment device300can include a plate302, a collar304, a screw306, and a nut308. The trochanter attachment device300can include an interference fit between the nut308and the collar304. Such interference fit can include, for example, a taper lock created by the nut308and the screw306. A taper lock can commonly be used for modular connections. The nut308can include a cone-shaped portion323at or near a first end322of the nut308and configured to engage with an inside surface of the collar304. The cone-shaped portion323can be shaped or otherwise configured such that the screw306can lock the nut308into place inside the collar304. A diameter of the nut308at a first end325of the cone-shaped portion323can be less than a diameter of the nut308at a second end327of the cone-shaped portion323. (The first end325of the cone-shaped portion323can generally coincide with the first end322of the nut308.)

As shown inFIG. 11, in an example, the trochanter attachment device300can be configured to not include a ring for attachment to the collar304and/or not include an insert for attachment to the plate302. In an example, the trochanter attachment device300can include a ring, like the ring136of the trochanter attachment device100, and/or an insert, like the insert209of the trochanter attachment device200.

The present disclosure includes a method of securing a greater trochanter to the femur, such as using a trochanter attachment device, such as described herein. The method can include attaching a plate of the trochanter attachment device to an inner surface of a greater trochanter, and attaching a collar of the trochanter attachment device to a hip implant implantable in the femur. More specifically, the trochanter attachment device can be attached to the proximal femoral component of a hip implant. The trochanter attachment device can be attached to the hip implant after the hip implant is installed in the diaphysis of the femoral bone. The trochanter attachment device can be attached to the greater trochanter before or after the trochanter attachment device is attached to the hip implant. The method of securing the greater trochanter to the femur can include using at least one reinforcing material or mechanism or device, such as described above, such as to secure the trochanter attachment device to the greater trochanter and the hip implant. Examples of such a reinforcing material, mechanism, or device can include a cable, a wire, a bolt, a suture, or one or more combinations thereof. As described above, the trochanter attachment device can include one or more features that can be sized, shaped, or otherwise configured for receiving or engaging with the reinforcing material, mechanism, or device.

Although specific configurations of a trochanter attachment device are shown inFIGS. 3-11and particularly described above, other designs of a trochanter attachment device can be used. The trochanter attachment device described herein can be easily configurable, such as for attachment to any of a variety of types of hip implants, including both modular designs, having a detachable stem, and one-piece designs. The trochanter attachment device can also be customized (e.g., provided with at least one patient specific component) such as through the use, for example, of a customizable insert piece, which can be sized, shaped, or otherwise configured to be placed between the plate and the greater trochanter.

In the examples shown inFIGS. 3-11, a screw and a nut can be included, such as for attaching the collar of the trochanter attachment device to the body of the implant, and/or for attaching the device to the stem of the implant. It is recognized that additional or alternative configurations can be used to secure the attachment device to the implant. For example, depending on a length of the screw, a screw of the attachment device can directly attach to the stem of the implant, and as such, a nut may optionally be omitted.

The trochanter attachment device is particularly described herein for use in reattaching the greater trochanter to the femur or reinforcing the existing attachment, or partial attachment, of the greater trochanter to the femur. The trochanter attachment device described herein can also be used in other situations, such as in which the greater trochanter is completely compromised and no longer available for attachment to the femur. In those cases, the plate of the attachment device can be attached to surrounding soft tissue, such as, for example, ligaments and muscles, including the abductor. Particularly if the plate is made of, or coated or otherwise provided with, a porous structure, the attachment device can facilitate soft tissue ingrowth and better stabilize the femoral component of the hip implant to which the attachment device is attached. An attachment device with the insert shown inFIGS. 7-10can be used to facilitate soft tissue ingrowth, particularly if the insert is made of, or coated or otherwise provided with, a porous structure. An insert made of a porous structure can be used as an alternative to, or in addition to, a plate made of a porous structure.