Hip prosthesis

Disclosed is a prosthetic hip joint defined by a femoral component and a cooperating acetabular component. The femoral component includes an intertrochanteric body which is press-fit into a correspondingly shaped intertrochanteric cavity at the top end of the patient's femur. Load transferring surfaces between the femoral implant and the femur are located within the intertrochanteric cavity and at the upper end of the femur. The load transferring surface are shaped to generate compressive stresses only. The femoral implant includes an attachable guide stem which can be resorbable and extends into the medullary cavity but which is not secured thereto to eliminate undesirable transference of stresses from the implant to the bone. The acetabular component is defined by an acetabular cup that is pressfit into a pre-reamed acetabular cavity in the patient's pelvis. An anchor bolt, which can be resorbable, is threaded into the pelvis, extends through a corresponding hole in the cup and is secured to the cup. A low friction insert, immovably attached to the interior of the cup, defines an acetabular socket which receives a cooperating ball on the femoral implant. The ball is secured to the femoral implant with a morse taper fit. Also disclosed is a procedure for implanting both components of the prothesis.

BACKGROUND OF THE INVENTION 
The prosthetic replacement of hip joints, either the acetabular component 
implanted in the patient's pelvis or the femoral component implanted in 
the femur, or both, is now widely practiced to replace degenerated natural 
hip joints. Prosthetic hip joints have evolved over the years from early, 
relatively crude models to current prostheses which closely duplicate the 
functions and motions of a natural joint. As a result, prosthetic hips 
have provided patients with increasing comfort, freedom of motion and an 
ability to lead nearly normal lives. 
Although there have been problems with excessive wear between components of 
prosthetic devices which move with respect to each other, by and large the 
fixation of the prosthetic components to the patient's bone structure did 
and continues to represent the greatest difficulty. Early attempts to 
incorporate large fenestrations or openings in the implant components, 
which were thought to mechanically lock the implants to the bone by 
promoting the growth of bone through such openings, were soon discarded 
because they proved unsuccessful. With the event of tissue compatible 
acrylic cement, implants were increasingly cemented to the bone and this 
practice continues to be widely followed because, at least in the short 
term, it has proved to be highly successful. 
However, the longevity of cemented implants suffers primarily as a result 
of the differences in the moduli of elasticity at bone/cement and the 
cement/implant interfaces. For certain patients a loosening of the implant 
takes place after a number of years of other wise successful use. This can 
be painful and frequently requires the replacement of the implant which is 
burdensome, expensive and can incapacitate the patient for significant 
periods of time. 
In the recent past, attempts have again been made to enhance the longevity 
of prosthetic implants by supplementing the cement bond with at least a 
degree of direct bone-implant interlocking. This has been accomplished by 
providing porous implant surfaces which contact the bone tissue so that, 
after a typical ingrow period of several weeks, bone tissue grows into the 
pores and thereby forms a firm, mechanical connection. To achieve such 
bony ingrowth, it is necessary that any relative movements between the 
bone and the porous implant surfaces are prevented. Currently, cement 
continues to provide the necessary fixation of the implant. 
In spite of the improvements and advances that have taken place, the 
fixation of the implant to the surrounding bone structure remains the 
source of most implant failures. It is believed that this results from 
both failures of the implant-bone bond and the stresses generated between 
the implant, the bone and/or the cement. 
For example, femoral components of hip implants typically include elongated 
stems which extend into the medullary cavity of the femur and, depending 
on the particular technique employed, are bonded to the surrounding bone 
structure and/or a bone ingrowth into porous implant surfaces is 
attempted. The transfer of forces from the implant to the bone generates 
shear stresses which are not readily transferred, which tend to weaken the 
interface and, over time, are likely to destroy the connection. 
In addition, the load carrying structure of the femur is unnaturally 
stressed because the transfer of forces takes place over the entire length 
of the implant stem extending deep into the medullary cavity. In contrast, 
the normal load transfer to the femur is from the top. As a consequence, 
the absence of proper stressing of the femur from the top when 
conventional femoral implants are utilized leads to stress shielding at 
the top and a resultant bone resorption in this upper region which, in 
time, can lead to implant and/or bone failures. 
The acetabular components of prior art prosthetic hips are similarly 
deficient. First, the fixation of the acetabular cups within corresponding 
sockets in the patient's hip is difficult because of their semispherical 
shape. In almost all instances, the cups are bonded to the pelvis with 
cement which, at various points over the exterior surfaces of the cups, is 
subjected to compression, shear or both. Over time, such unequal stressing 
of the bond is likely to lead to mechanical failure. 
Additionally, the semi-spherical shape of the acetabular cups makes it 
difficult to properly locate the cup in the socket and fix it. Attempts 
have been made to provide such cups with spikes or screws to mechanically 
lock them in position. However, as these are driven into the bone an 
uncontrolled and undesirable repositioning of the cups is almost 
impossible to prevent. 
As with femoral components, attempts have been made to improve the fixation 
of acetabular hip joint components by forming them with porous exterior 
surfaces to promote bone ingrowth and thereby establish a mechanical 
interlock between the patient's natural bone and the implant. Since such 
bone ingrowth requires immediate rigid fixation of the implant, cement 
continues to be used widely for initially securing the implant to the 
bone. Moreover, in the past it was thought desirable to attain bone 
ingrowth over as large a surface area of the acetabular component as 
possible. This results in bone ingrowth that is partially subjected to 
shear stresses along the sides of the cup. This makes it not only 
difficult to obtain bony ingrowth along the sides but can be harmful. If a 
bony ingrowth is obtained along the sides where shear stresses occur, 
there may occur an abnormal transference of stress to the top of the cup 
where most loading occurs in the natural state. The result will be stress 
shielding with resultant bone resorption about the top of the cup over a 
period of years, leading to potential mechanical failure of the device. 
U.S. Pat. Nos. 4,068,324 and 3,840,904 are examples of recent developments 
and improvements in the construction of femoral and acetabular hip joint 
components. 
SUMMARY OF THE INVENTION 
As contrasted with the prior art, the present invention takes a 
fundamentally different approach to implanting prosthetic devices in 
general and the acetabular and femoral components of prosthetic hip joints 
in particular. Instead of increasing the surface areas of the components 
which contact the bone, such contact is limited to points where the 
transmission of forces generates substantially only compressive stresses. 
In addition, the need for a cement bond for the initial fixation of the 
implant is altogether eliminated. In its stead, the implants are 
mechanically fixed to the surrounding bone so that, even without cement, 
the implants are completely immovable from the moment of implantation. As 
a result, the prosthetic hip of the present invention can be used full 
weight bearing by the patient from the very beginning, including the 
typical 6 to 8-week time period for adequate bone ingrowth into porous 
surfaces of the implants. 
To this end, the present invention provides separate femoral and acetabular 
components of a prosthetic hip joint which can be implanted and used 
separately or in combination. In addition, the present invention provides 
a procedure for implanting the components without the use of cement. This 
latter aspect in and of itself enhances the longevity and reliability of 
the implant. Failures as a result of differences in the modulus of 
elasticity between the bone and cement and between the cement and the 
implant are significantly reduced because there are only two materials, 
namely the implant and the bone, which have differing moduli of 
elasticity. 
More importantly, the present invention provides a prosthetic hip implant 
in which the transmission of forces between the bone and the implant 
generates substantially only compressive stresses and, at worst, generates 
only insignificant shear stresses. Additionally, the implant is 
constructed so that the bones, both the pelvis and the femur, are stressed 
in a manner which closely resembles their physiological stressing by a 
natural, healthy hip joint. Accordingly, both bone degeneration, due to 
unnatural stressing, and implant failures, due to a loosening of the 
implant, are substantially reduced or eliminated. 
Addressing first the acetabular component of the implant of the present 
invention, it employs an anchor which is immovably fixed, e.g. screwed 
into the pectineal line of the patient's pelvis which protrudes into an 
acetabular cavity of the pelvis that was prereamed to a diameter slightly, 
e.g. 1 to 4 mm and preferably 1 to 2 mm smaller than the spherical 
diameter of the acetabular cup so that the cup must be press-fit into the 
cavity for an initial, firm contact. An end of the anchor extends into a 
corresponding hole in the cup, securely and immovably positions the cup in 
the cavity and biases the cup into firm contact with the bone to enhance 
bone ingrowth. 
In one embodiment of the invention, the anchor has a head which directly 
engages the cup. In another embodiment, a separate screw is provided. It 
is disposed in the fixation hole of the cup and threadably engages the end 
of the anchor protruding into the acetabular cavity. It firmly compresses 
the cup into contact with the bone and firmly connects it to the anchor in 
the pelvis. In both embodiments, the cup is immovably fixed within the 
acetabular cavity from the very beginning. After bone ingrowth occurs 
about the surface of the cup, need for the anchor fixation is eliminated. 
Because of this, the anchor can be fabricated from resorbable 
biodegradable material, e.g., certain ceramics, such as calcium 
hydroxylapatite or tricalcium phosphate, polylactic acid, etc. as well as 
currently utilized non-absorbable metal and polymer materials. The end 
result is an acetabular component securely fixed to the pelvis by a bony 
ingrowth without evidence of the anchor system. 
To assure the most efficient load transfer from the pelvis to the 
acetabular cup, the anchor is oriented at an angle of approximately 
20.degree. from the center line of femur. To promote efficient bone 
ingrowth and to limit it to areas where the ingrowth is subjected to 
substantially only compressive stresses, a portion of the exterior surface 
of the cup surrounding the anchor is porous. The remainder of the exterior 
surface is smooth to inhibit bone ingrowth and substantially prevent any 
unloading of stresses about the top of the cup, where compressive stresses 
occur. 
The acetabular component also has a liner, constructed of a relatively low 
friction material. It is disposed within the cup and defines a generally 
semispherically shaped acetabular socket that engages a natural or 
artificial ball connected with the patient's femur. 
The femoral component of the present invention has an intertrochanteric 
body which completely fills a correspondingly shaped, slightly undersize, 
pre-reamed intertrochanteric cavity formed in the proximal femur after its 
head and neck have been resected. The intertrochanteric body of the 
femoral implant defines at least one interior load transferring surface 
which is inclined about 70.degree. from the longitudinal axis of the 
femur. In addition, the femoral implant preferably includes a similarly 
oriented exterior load transferring surface which engages a 
correspondingly inclined, planar face formed when the head and neck of the 
femur was resected. Thus, the load transfer between the femur and the 
femoral component takes place at the uppermost end of the femur. 
Consequently, the femur is stressed in a manner closely analogous to the 
physiological stressing of the femur in a normal hip. As a result, 
undesirable bone resorption and formation is substantially prevented. 
The initial fixation of the femoral implant is purely mechanical by 
press-fitting the intertrochanteric body into the slightly undersized 
intertrochanteric cavity. In addition, the entire body, including the 
interior and exterior load transferring surfaces are porous to promote 
bone ingrowth and assure a firm, permanent fixation of the implant. The 
absence of cement, which is not needed because the tight fit immovably 
secures the implant to the bone, enhances a quick and thorough bony 
ingrowth into the porous surfaces. 
The implant normally includes an elongated stem which extends downwardly 
into the medullary cavity. Its function is only to accurately guide and 
orient the femoral component during implantation. Load transfer from the 
elongated stem to the bone is eliminated in two ways. One method is to 
provide a smooth surface on a non-absorbable material, such as metal, 
polymer, ceramic, etc., to prevent bony ingrowth thus insuring the only 
fixation of the implant to bone being at the top in the intertrochanteric 
region, as is seen in the normal state. An alternative method is to 
utilize a resorbable biodegradable material, e.g., ceramic, polylactic 
acid, etc., for the stem which is fixed to the intertrochanteric body by 
threads or the like. This biodegradable resorbable material can be 
fabricated to resorb over any desired time period, allowing an adequate 
period of time to elapse for bony ingrowth about the intertrochanteric 
body portion. The end result is a stemless femoral component filling only 
the remaining neck and intertrochanteric region of the femur. This ensures 
a more physiologic stress transference to the femur. In this manner, 
undesirable shear stresses, and an unnatural loading of the femur (over 
the length of the stem) are prevented. 
The femoral implant includes also a neck and a replaceable ball. A Morse 
taper on the neck and in a corresponding bore of the ball is utilized to 
immovably secure the ball to the neck. With such a connection, a supply of 
different size balls having extensions of varying lengths can be provided 
so that the size of the implant, and particularly the effective length of 
the neck can be adjusted to suit patients of differing sizes and having 
varying hip joint configurations. This results in a significant reduction 
in the number of femoral components that must be carried in inventory and, 
thereby substantially reduces costs. 
The intertrochanteric body is defined by generally opposite and spaced 
apart anterior and posterior sides and generally opposite, spaced apart 
lateral and medial sides. The spacing between the lateral and medial sides 
decreases in a generally downward direction. The body has a pair of 
interior load transferring surfaces which are contiguous with the anterior 
and posterior body sides, face generally downwardly and are inclined about 
70.degree. to the longitudinal axis of the femur so that the applied 
loading forces act substantially perpendicular to the implant surfaces. 
Consequently, substantially only compressive forces are generated between 
the implant and the femur. 
Lastly, the present invention includes procedures for the implantation of 
the acetabular and femoral components. 
With respect to the acetabular component, the procedure provides that the 
acetabular socket in the pelvic bone of the patient be reamed to form a 
generally semi-circular acetabular cavity which is seized slightly smaller 
than the acetabular cup so that the latter is press-fit into the cavity. 
The cup is positioned in the cavity so that the fixation hole overlies the 
pectineal line of the pelvis. Following placement of a drill hole, the 
anchor is inserted through the bore into the pelvis and is immovably fixed 
to the pelvis. The cup is immovably connected to the free end of the 
anchor in a manner which enhances by compression the contact pressure 
between the cup and the bone and thereby promote bone ingrowth into the 
porous area of the exterior cup surface. 
Lastly, the low friction insert is snapped into the cup and locked in place 
to form the acetabular socket for cooperation with a femoral component of 
the patient's hip joint. 
With respect to the femoral component, the procedure of the present 
invention initially requires that the upper end of a femur be resected to 
expose the interior thereof. The intertrochanteric, upwardly open cavity 
is then shaped in the femur so that it has substantially parallel, spaced 
apart anterior and interior sides, a lateral side and a spaced apart 
medial side, and load transmitting, generally upwardly facing ledges at a 
lower end of the anterior and posterior sides which are angularly inclined 
relative thereto. The sides and ledges of the cavity are dimensioned to 
establish a press-fit with the cooperating sides and and interior load 
transferring surfaces of the femoral component when the latter is 
implanted. 
After formation of the cavity, the femoral implant is inserted into the 
femur by extending its resorbable or non-absorbable stem into the 
medullary cavity and pressing the intertrochanteric body into the 
intertrochanteric cavity to tightly seat the former in the latter. Lastly, 
the ball is secured to the neck of the femoral implant for placement into 
an acetabular socket.

DESCRIPTION OF THE PREFERRED EMBODIMENTS 
Referring first to FIG. 1, a prosthetic hip 2 constructed in accordance 
with the present invention comprises an acetabular component 4 fixed to a 
patient's pelvis 6 and a femoral component 8 attached to the patient's 
femur 10. Broadly speaking, the acetabular component is defined by an 
acetabular cup 12 connected to an anchor bolt 14 threaded into the pelvis 
along the pectineal line at an inclination of approximately 20.degree. 
relative to the longitudinal axis 16 of the femur. Disposed within the cup 
is a low friction liner or insert 18 which defines a spherically shaped 
acetabular socket 20 that moveably receives a ball 22 attached to the 
femoral implant 8. 
To enable the implantation of to the femoral component 8, the head and neck 
of the femur 10 are initially resected to form an exterior femoral face 24 
which is planar, generally perpendicular to the pectineal line 26 and, 
therefore, at an angle of approximately 70.degree. to the longitudinal 
femur axis 16. 
The femoral implant includes an intertrochanteric body 28 which is 
press-fit into a correspondingly shaped and appropriately dimensioned 
intertrochanteric, upwardly opening cavity 30 in the femur. A stem 32 
extends downwardly from the body into the medullary cavity 34 of the 
femur. The femoral component further has a neck 36 on its medial side 
which extends generally upwardly and in a medial direction and to which is 
mounted the ball 22 that cooperates with the socket 20 of the acetabular 
component. 
Referring now to FIGS. 1, 2, 5 and 6, the construction and implantation 
procedure for the acetabular component 4 is described in greater detail. 
The acetabular cup 12 has a substantially semi-spherical configuration, 
that is it typically extends over an arc of about 180.degree., although 
this may be increased or decreased as the need therefor may arise. The cup 
is constructed of a non-corroding, high strength material such as a 
cobalt-chromium alloy or a titanium alloy, for example. It includes a 
fixation hole or bore 38 which is positioned so that, upon implantation of 
the cup, the bore is aligned with the pectineal line of the patient's 
pelvis. The bore includes a recess 40 which defines an inwardly facing 
shoulder that, upon implantation, is engaged by a head 42 of a screw 44. 
The recess 40 has a sufficient depth to fully accommodate the screw head 
42. 
The liner 18 is disposed in the concavity of the cup 12 and is constructed 
of a suitable impact resistant, low friction material, such as plastic. To 
prevent relative movements between cup 12 and insert 18, a locking 
mechanism is provided, e.g. a protrusion 46 on the face of the cup which 
cooperates with a corresponding slot 47 in a flange 45 of the insert. 
For purposes more fully described hereinafter, in a preferred embodiment of 
the invention the insert extends over an arc slightly, e.g. 10.degree. 
larger than the arc over which the cup extends. The protrusion 46 on the 
cup and the slot 47 in insert flange 45 are positioned so that upon 
implantation the uppermost portion of the insert protrudes past the cup as 
is shown in FIGS. 1 and 2. 
Cup 12 includes an exterior porous surface area 50 which surrounds bore 38 
to promote bone ingrowth in the area of load transfer between the pelvis 
and the cup. To achieve the desired bone ingrowth, the pores are 
preferably of a size in the range of between about 250-450.mu.. The 
remainder of the exterior cup surface is smooth to inhibit bone ingrowth 
thereover. The exact dimensioning of the porous area 50 is not critical. 
In one embodiment it is generally circular and concentric with bore 38 and 
it extends to the upper end of the cup which is proximate the bore (as is 
illustrated by the arrow 52 in FIG. 2). For a cup having an exterior 
diameter in the range of between about 40 to 60 mm, the approximate 
diameter of the porous area will typically be in the range from about 25 
to about 55 mm, although deviations therefrom are readily accommodated. It 
is of importance, however, that the porous area 50 does not extend over 
the portion of the exterior cup surface which is not loaded, that is the 
surface portion which lies primarily below an imaginary, approximately 
horizontal plane (not illustrated) through the cup when it is implanted. 
The porous area may either be raised, level with the remaining surface of 
the cup, or indented. The porous area may be continuous as in the form of 
discrete, separated but closely adjacent sections or islands. 
To prevent any potential toxic effect of increased ion transfer as a result 
of the increased surface area about the porous surface 50, at least the 
porous surface area can be coated with a thin impervious layer, e.g., 
methylmethacrylate cement, carbon, calcium hydroxylapatite, tricalcium 
phosphate, etc. Such coatings are made commercially according to methods 
which are unknown to applicant and which applicant believes are maintained 
a trade secret. 
Referring again to FIGS. 1, 2, 5 and 6, anchor bolt 14 is cannulated, i.e. 
it has a concentric center bore 54 which extends over its length. A first, 
inner end of the anchor has an external thread 56 formed o cut into and 
firmly engage the bone structure. The opposite, free end 58 of the bolt 
includes a hexagonal or slotted recess (not shown) for engaging the bolt 
with a hexagonal (Allen) wrench or a conventional screwdriver. The center 
bore has an internal thread 60 which is engaged by screw 44. The anchor 
bolt is constructed of a suitably corrosion resistant and high strength 
material and such bolts are commercially available from such companies as 
Zimmer, Biomet, Howmedica or Richards, for example. The anchor bolt may be 
fabricated from a resorbable material such as biodegradable ceramics, 
polylactic acid, etc. The material can be designed to resorb at a 
predetermined time. For most applications this will coincide with a time 
period sufficient to allow mature bony ingrowth about the cup for adequate 
mechanical fixation of the implant do the pelvis. 
Turning now to the installation of the acetabular component, the surgeon 
initially prepares the pelvis for the receipt of the acetabular cup 12 by 
reaming out the natural acetabular socket with a tool (not shown) which 
has a spherical diameter slightly, e.g. 1-2 mm smaller than the exterior 
diameter of the cup that is to be implanted. To facilitate this procedure 
the surgeon is provided with a kit which includes a supply of acetabular 
cups of one or more external spherical diameters and one or more reaming 
tools which have spherical diameters slightly less than the diameter of 
the corresponding cup or cups. 
The acetabular cup 12 is then pressed into the reamed out acetabular cavity 
so that fixation bore 38 is in substantial alignment with the pectineal 
line. Thereafter, he pinpoints the location and desired orientation of the 
anchor bolt axis through the fixation bore so that the anchor bolt will 
extend along the pectineal line into the pelvic bone, and a hole (not 
separately shown) for the anchor bolt is drilled. 
To facilitate the drilling and prevent the drill from straying off the 
desired center line, a guide wire 62 can be initially forced into the 
pelvic bone in alignment with the desired anchor axis. The drilling 
operation is then performed with a cannulated drill (not shown) which 
extends over and is guided into the bone by the guide wire. Since the 
anchor bolt is cannulated, the guide wire can remain in place or, 
optionally, it can be removed after the hole has been drilled. 
Next, the anchor bolt is inserted through cup bore 38 and threaded into the 
drilled hole until the free end 58 of the bolt protrudes into the bore but 
ends short of the shoulder defined by the bore recess 40. Screw 44 is now 
tightened against the shoulder to firmly secure the cup to the anchor bolt 
and thereby compressing and increasing the contact pressure between the 
cup and the bone, particularly over the porous surface area 50 surrounding 
the fixation hole 38. 
Finally, insert 18, properly oriented so that protrusion 46 and slot 47 are 
aligned, is snapped into the cup to thereby complete the implantation of 
the acetabular component. Referring momentarily to FIG. 7, the cup 
includes a radially inwardly extending ring 61 which engages a cooperating 
exterior groove 63 on the insert 18. The cup and the insert are suitably 
chamfered to facilitate the snap fastening of the insert to the cup. 
After implantation, the insert is positioned so that an overhanging portion 
49 protrudes beyond the cup as shown in FIGS. 1 and 2. This provides for a 
better seating of the associated ball over a wider range of motions and 
helps prevent accidental dislocations of the ball and the socket. 
Referring now to FIGS. 7-9, in another embodiment of the invention, the 
acetabular cup 12 is constructed as previously described. However, this 
embodiment differs in the manner in which the cup is implanted. Instead of 
providing an anchor bolt-screw combination (as shown in FIGS. 1 and 2) to 
connect the cup to the anchor and increase the contact pressure between 
the exterior cup surface and the bone, an anchor bolt 65 is provided. It 
includes an integrally constructed head 67 which is disposed in fixation 
hole 38 and rests against bore recess 40. The cup illustrated in FIG. 7 
includes the above-described rough exterior surface finish or porous area 
50 which defines the bone ingrowth promoting, porous surface portion of 
the cup. 
This embodiment of the invention is implanted by first pressing the cup 
into the acetabular cavity and the drilling anchor hole as was described 
above. Thereafter, the anchor is threaded into the drilled hole until its 
head 67 engages the bore recess 40. The anchor bolt is tightened to 
establish a firm connection between the cup and the anchor bolt and to 
compress and increase the contact pressure between the cup and the bone. A 
hexagonal slot 69 is preferably formed in the anchor bolt for a convenient 
tightening thereof. 
Referring now to FIGS. 1, 3 and 4, the construction and implantation 
procedure for the femoral component 8 is discussed in detail. The 
intertrochanteric body 28 forms the principle connection of the femoral 
component to the patient's femur. It is defined by an anterior side 64 and 
a spaced apart, posterior side 66, a lateral side 68 which extends 
laterally between the anterior and posterior sides, and a medial side 70, 
which extends medially between the anterior and posterior sides. In 
addition, the body includes an interior load transferring surface 72 at 
the lowermost (innermost) end of the anterior and posterior sides 64, 66. 
Each load transferring surface extends from the corresponding body side 
towards the center of the body, so that it faces generally downwardly. In 
addition, it is angularly inclined relative to the femoral axis 16 by 
about 70.degree. (as is illustrated in FIG. 1) so that each load 
transferring surface also slopes downwardly by about 20.degree. in a 
medial direction. 
The body 28 is shaped so that it occupies most of the intertrochanteric 
cavity 30, which is shaped as is further described below. The lateral side 
68 is substantially flat and, in the preferred embodiment of the 
invention, lies on a substantially straight line with the lateral portion 
74 of the stem. The medial side 70 of the body is generally parallel to 
the neck axis 76 which, in the preferred embodiment of the invention, is 
at an angle of approximately 132.degree. as is illustrated in FIG. 3. The 
medial side is generally planar from its upper end to about the interior 
loading surface 72. There is a concave, arcuate transition between the 
medial side 70 and the medial portion 78 of the stem forming a smooth line 
composed of an upper curved part forming the arc of circle of 
approximately a 10 centimeter radius and a lower rectilinear part. The 
stem itself has no function other than acting as a guide to ensure proper 
placement of the femoral intertrochanteric body and keep it there until 
bony ingrowth has fixed the body to the femur. The stem has a smooth 
surface to prevent bony ingrowth and ideally is of a smaller diameter than 
the medullary cavity of the femur in which it is inserted, so that there 
will be no abnormal transference of stresses to this area of femur. 
Referring momentarily to FIGS. 10 and 11, another embodiment of the 
invention utilizes a stem section 94 fabricated from a biodegradable or 
resorbable material which is connected to an intertrochanteric body 100, 
preferably with a female thread 96 on the stem which cooperates with a 
corresponding male thread 98 depending from the intertrochanteric body. 
Locating the female thread 96 in the stem section prevents the formation 
of stress concentrations in the body 100. Examples of biodegradable 
materials utilized for the stem section are polylactic acid, ceramics, 
etc. The interconnection between intertrochanteric body and the stem 
section 94 typically is in the region of the stem where it straightens out 
in the lateral plane (see FIG. 11), though, if convenient, it may also be 
located at other sites along the stem. Once the femoral implant is firmly 
fixed by bony ingrowth in its proper position, the function of the stem 
section is over and it can be eliminated by letting it resorb. 
The final result is a stemless femoral component that allows a more 
physiologic transference of stresses to the proximal femur as opposed to a 
stemmed implant where there is the potential for fixation distally, 
thereby potentially causing stress shielding and bone resorption 
proximally with an increased chance of mechanical failure. 
The stem has a round cross-section at its lower end which gradually becomes 
oblong as the medial side thereof slopes away from the stem axis towards 
the medial body side 70. 
Referring to FIGS. 1, 3, 4, 10 and 11, in one embodiment (shown in FIGS. 3 
and 4) all sides of the intertrochanteric body are porous (with a 
preferred pore size of between 200-450.mu.) to promote bone ingrowth. At 
least, however, the interior loading surfaces 72 are porous. It may be 
elected to leave the porous finish off of the lateral side 68 (see FIG. 
11) and have only the three other sides 64, 66 and 70 porous, or both the 
lateral and medial sides 68, 70 may be left smooth, thus having just the 
anterior and posterior sides 64 and 66 porous. 
The femoral component also has a loading flange 80 at the upper end of the 
intertrochanteric body 28 which protrudes generally perpendicularly past 
the anterior, posterior and medial body sides 64, 66 and 70 as shown in 
FIGS. 3 and 4. In an alternative embodiment, a loading flange 81 (see FIG. 
10) protrudes only from the medial body side 70. In either embodiment, the 
flange defines a downwardly facing, external loading surface 82 which is 
parallel to the interior loading surface 72, that is which is at an angle 
of approximately 70.degree. to the femur axis 16 and which slopes 
downwardly in the medial direction. The external loading surface of the 
flange is porous (like the sides of the body 28) and, upon implantation, 
rests firmly against face 24 of the femur. 
The neck 36 of the femoral component extends upwardly in the medial 
direction from the loading flange 80 and includes an accurately machined 
end section 84 which defines a Morse taper. The ball 22 of the femoral 
component includes a cylindrical sleeve 88 and a bore 86 has a matching 
taper on neck end section 84 so that the ball can be firmly attached by 
pressing it onto the neck. This arrangement has the advantage that the 
effective length of the neck section of any given femoral implant can be 
adjusted as desired by providing a supply of balls 22 having varying 
cylindrical sleeve lengths and/or ball diameters. Inventory requirements 
are thereby substantially reduced and the surgeon has the ability to 
revise the neck length during implantation as may be required. 
In a preferred form of the invention, the femoral implant is constructed so 
that it duplicates the natural shape of a femur as closely as possible. 
This requires the provision of both a left hand and a right hand femoral 
implant. Stems having a length of up to 130 mm are straight with respect 
to the lateral axis (see FIG. 11). Longer stems, e.g., having a length of 
150 mm, preferably include an anterior bow which extends approximately 
over the bracketed length identified with the reference numeral 90 in FIG. 
4 to better conform it to the shape of the medullary cavity. In one 
embodiment of the invention the anterior bow extends over an arc of about 
4.degree.. 
Further, both the intertrochanteric body 28 (FIG. 4) or the body 100 (FIG. 
11) and the neck 36 of the femoral implant have an anteversion angle 92 
defined by an angular inclination of the body and the neck in the anterior 
direction of between about 7 to about 14.degree.. Typically, the angle is 
approximately 10.degree. from the femoral center line 16 as is illustrated 
in FIG. 4. 
Turning now to the implantation procedure for the femoral component, the 
head and neck of the femur are first resected to form the external femoral 
loading face 24 (see FIG. 1). The intertrochanteric cavity 30 is then 
shaped by removing soft (non-load bearing) bone tissue with an 
appropriately shaped broaching tool (not shown). In this phase of the 
procedure, care must be exercised to assure that the shape, orientation 
and spacing of the cavity walls that correspond to the intertrochanteric 
body sides 66-70 and the interior loading surface 72 are such that, upon 
implantation, the exterior and interior loading surfaces 82, 72 
simultaneously contact the corresponding bone surfaces. The entire 
intertrochanteric cavity is broached slightly undersize relative to the 
implant body to achieve a press-fit therewith. 
Next, the femoral component is implanted by placing the stem into the 
medulary cavity and then pressing the intertrochanteric body 28 into the 
intertrochanteric cavity until the the internal and external loading 
surfaces 72, 82, firmly engage the bone. If a biodegradable stem is 
utilized at this stage, prior to implanting, the stem is connected to the 
intertrochanteric body by screwing it into the body. Alternatively, the 
interconnection may be made by screwing the intertrochanteric body into 
the stem. 
During the implantation process the elongated stem acts as a guide which 
prevents an accidental misalignment of the intertrochanteric body during 
the insertion step, particularly when substantial forces must be applied 
to overcome the press-fit between the body and the cavity. Once inserted, 
however, the stem has no significant function. In particular, it is 
preferred that no firm contact exists between the femoral cortical bone 
and the stem (non-resorbable) to prevent any abnormal transference of 
stresses to the adjacent femoral bone. In the resorbable design with its 
resultant stemless implant, there are no distal stresses, as seen in the 
normal femur. The absence of such stresses about the femoral cortex 
adjacent to the stem, coupled with the transfer of loads at the loading 
surfaces 72, 82, assures that the femoral implant is top loaded in a 
manner analogous to the physiological loading of a femur in a healthy hip 
joint. Providing the stem with a smooth surface finish prevents the 
possibility of bone ingrowth. 
Finally, the implantation procedure is completed by selecting a ball 22 of 
the appropriate diameter and with the appropriate length of its sleeve 88 
and immovably securing the ball to the neck by firmly engaging the Morse 
taper connection between them.