# Patent

## Title
Hip joint prosthesis

## Abstract

A femoral implant for fitting to a resected femur comprises a section having a frustoconical external form, a stem part extending away from the section to a distal end of the implant, and a femoral head extending directly away from the section to the proximal end of the implant. The implant could have the femoral head integral with the section, or as a separate component secured thereto, with the stem being a separate one piece component incorporating the section.

## Background
This invention relates generally to a hip joint prosthesis, and in particular to a method of fitting a femoral implant to a resected femur, and to the femoral implant per se.
Hip replacements involve the use of an implant stem which is fitted into the medullary canal of the femur. Generally such stems achieve optimum fixation when a tapered prosthesis 10 is fitted in the medullary canal of a tapering bone 11, as schematically shown in FIG. 1. This requirement is generally achieved with a conventional type total hip replacement stem 12 fitted into the proximal femoral portion 13 as shown in FIG. 2.
This form of treatment, however, suffers from the following disadvantages:

    1) It requires extensive bone resection of the femoral head and part of the femoral neck.
    2) It leads to loading of the shaft of the femur in a non-physiological fashion, leading to distal load transfer and proximal femoral shaft stress shielding.
    3) There can be loosening of the total hip replacement stem, as there is a cantilever effect with the point of loading on the prosthetic femoral head at a distance from the point of fixation in the proximal femoral shaft.


With young active patients it is now regular practice to insert a more conservative type of hip replacement known as a resurfacing, and this type of prosthesis overcomes in major part the three disadvantages listed above. However some patients are not suitable for hip resurfacing, mainly on account of poor bone in the zenith of the femoral head due to cystic destruction, as shown at 14 in FIG. 3. With young patients with such cystic destruction, there is a need for a more conservative type of hip replacement than the standard variety shown in FIG. 2.
An example of a more conservative hip replacement is disclosed in EP 0579868 A2. This type of implant attempts to conserve bone, load the femur more proximally and, by retaining most of the patient's femoral neck, resist torsional loading more satisfactorily than the standard total hip replacement. However this type of prosthesis does not fulfil the requirements referred to in relation to FIG. 1. In particular it can be seen from EP 0579868 A2 that the bone in the femoral neck expands into a widened bone in the proximal femoral shaft (inter-trochanteric region), thus not fulfilling the FIG. 1 requirements.
An object of the invention is to provide an improved method of fitting a femoral implant to a resected femur and also an improved femoral implant itself and an improved femoral implant stem.
According to a first aspect of the invention there is provided a method of fitting a femoral implant to a resected femur comprising resecting the femoral bone through the femoral head, machining said resected proximal end of the femur to form a frustoconical or generally frustoconical cavity in the bone, and inserting into said cavity a femoral implant, which in use extends into the medullary canal of the femur.
Preferably the femoral bone is resected through the base of the femoral head. Conveniently the cavity machined into the bone of the femur is symmetrical about a centre line thereof. Advantageously at or adjacent its proximal end the femoral implant is formed with a part having an external surface complementary to the surface of said cavity in the femoral bone. Conveniently a curved stem part of the implant extends away from said part of the implant, and is received in said medullary canal. Said stem part could however be straight.
According to a further aspect of the invention, a femoral implant comprises adjacent a proximal end thereof a section having an external surface of frustoconical or generally frustoconical form, a stem part extending away from said section to a distal end of the implant and a femoral head extending directly away from said section to the proximal end of the implant.
Preferably the femoral head is integral with said section. Advantageously the femoral head is separate from said section. Conveniently the separate femoral head is secured to said section by respective interfitting parts thereof. Desirably a frustoconical spigot extending from said section is received in a complementarily shaped cavity in the femoral head. More preferably the spigot is a tight frictional fit in said cavity, or is cemented therein. The central part of the femoral head is preferably hollow. Desirably the implant is manufactured of cobalt chrome. The stem part is preferably curved, but could be straight.
According to a still further aspect of the invention a stem of a femoral implant has a stem part extending to a distal end of the stem and a section from which the stem part extends, said section having an external surface which is of frustoconical or generally frustoconical form and which terminates at a free end of the section.
Conveniently a spigot extends from said free end of the section for connection, in use, of a femoral head to said stem. Preferably said spigot has a frustoconical external surface. Desirably the stem part is cemented in place or modified for suitable biological fixation, in use. The stem part is preferably curved, but could alternatively be straight.



The invention will now be described, by way of example, with reference to the accompanying drawings, in which:
FIG. 1 is a schematic view of an optimum fixation arrangement of a femoral prosthesis,
FIG. 2 is a similar view to FIG. 1, showing the fixing of a conventional type of total hip replacement stem,
FIG. 3 shows the proximal end of a femur, with three different positions of the level of resecting shown at A-A, B-B and C-C respectively,
FIG. 4 is a view like FIG. 2 showing a femoral prosthesis of the invention fitted by a method if the invention to a resected femur, the prosthesis including a stem also according to the invention, and
FIG. 5 is a view like FIG. 4, showing a one-piece femoral prosthesis.



To explain the present invention, reference is firstly made to FIG. 3 which shows the proximal end of a femur 15. The femur has a head 16 which is globular and forms rather more than a hemisphere. Connecting the head with the main shaft 17 of the femur is a neck 18, the transition between the head 16 and neck 18 being generally smoothly concavely curved as shown at 19. The superior border of the neck terminates at the great trochanter 20, whilst the inferior border of the neck terminates at the lesser trochanter 21.
In FIG. 3, the line A-A represents the resection level for a conventional total hip replacement, this section being taken towards the end of the neck furthest from the head 11. Line B-B represents the resection level for the prosthesis shown in EP 0579868 A2, this lying through the neck at or adjacent transition area 19 between the head and the neck of the femur.
With the present invention, as will be described, the resectioning is not carried out at a level through the neck 18, but instead is carried out through the femoral head. Accordingly the line C-C represents the resection level for one embodiment of the present invention. By resecting along the line C-C through the base of the femoral head, bone in the transition area between the femoral head and the femoral neck is retained, thus providing the opportunity for exploiting the requirements referred to in relation to FIG. 1.
Accordingly the first stage in the hip replacement method is to resect the proximal end of the femur at a level through the head 16, for example at the line C-C. By resecting the bone at this position through the base of the femoral head, it is possible then to machine the interior of the bone into the form of a truncated cone, i.e. in the form of an engine valve seating, with this frustoconical or generally frustoconical form of cavity produced thus for filling the requirements set out in relation to FIG. 1. As shown in FIG. 4, the cavity 22 is preferably symmetrical about a centre axial line E-E, and in this symmetrical form the shape of the cavity 22 facilitates milling at surgery. As will be appreciated, this machining which produces the cavity 22 is at the upper end of the medullary canal 23 which is generally curved as it extends downwardly from the neck into the main shaft 17 of the femur 15.
FIG. 4 shows an embodiment of the invention in which the femoral prosthesis is formed in two parts, namely an implant part 24 which is received in and fitted into the femur and a femoral head component 25 which is securely fitted to the implant part 24 as will be described. The implant part 24 has a curved stem part 26 which is received in and follows the shape of the medullary canal 23, the part 24 thus defining the distal end of the implant part 24. The stem part extends from a section 27 which has an external surface 28 shaped to match the internal surface of the cavity 22, i.e. the external surface of the section 28 is complementary to the frustoconical or generally frustoconical internal surface of the cavity 22 so as tightly to engage therein as shown in FIG. 4. It will be noted that the frustoconical form terminates at a free end of the section 27, in other words there is no transversely projecting collar or the like at the free end of the implant part 24 as is the case with the femoral rod shown in EP 0579868 A2. Integrally extending from the free end of the section 27 is a central outwardly tapered circular spigot 29, this spigot enabling the femoral prosthesis to be of said two-part modular type with said separate femoral head component 25 fitting onto the implant part 24 by virtue of the spigot 29 engaging in a complementarily shaped central recess 30 of the femoral head component 25. The connection between the spigot 29 and recess 30 can be frictional, or alternatively some form of adhesive cement could be used. As shown in FIG. 4, the free periphery of the femoral head component, when attached to the implant part 24, extends slightly over the resected area of the femoral bone. In an alternative embodiment, the reverse arrangement could be employed, i.e. the frustoconical spigot extends from the end of component 25 and enters a matching recess in the end of the section 27.
The prosthesis would typically be manufactured from cobalt chrome or other suitable metallic material, and the implant part 24 would generally either be cemented in place or modified for suitable biological fixation. The head component 25 could either be used as a hemi-arthroplasty with the head component articulating against the patient's normal acetabular cartilage or alternatively the head component could be articulated against a prosthetic acetabular component typically manufactured from cobalt chrome, ceramic or polyethylene material. It will thus be appreciated that with the prosthesis described and illustrated, the head component extends directly away from the section 27 received in the cavity 22 in contrast to the arrangement described and shown in EP 0579868 A2 where the head is connected via a connecting portion to the implant part so that the head is spaced from, and thus does not directly extend from the free end of the implant part which, in this prior art arrangement is constituted by the transversely projecting collar. Typically for different patients, the maximum diameter of the cavity 22, and thus effectively the maximum diameter of the section 27 received therein, is from 29 mm to 45 mm., and as shown in FIGS. 4 and 5, the cavity 22 at its maximum diameter extends across the whole, or substantially the whole of the end surface of the resected head.
Accordingly, in accordance with a method of the invention the proximal end of the femur is resected at the level of the line C-C shown in FIGS. 3 and 4, and the cavity 22 is then produced by machining, for example milling, this cavity being of frustoconical or generally frustoconical shape. As explained above, this cavity 22 is formed at the upper end of the medullary canal 23 which extends in curved fashion from the line D-D to T.
The implant part 24 is then fitted into the cavity 22 and medullary canal 23 as shown in FIG. 4 and secured therein as described above. The femoral head component 25 could already be fitted on this implant part 24 at the time of said insertion, or alternatively could be engaged onto the spigot 29 once the implant part 24 has been fitted in place. By virtue of the extent of the section 27 fitting complementarily in its machining cavity 22, the advantages of EP 0579868 are achieved in conjunction with the requirements of FIG. 1 also being satisfied to provide an improved prosthesis fixation. It will be understood that both the femoral prosthesis, including a head and an implant, either integral or separate, as well as an implant part per se are considered novel and inventive in addition to the method of fitting, including said resecting.
With regard to FIG. 5, this shows a further embodiment of a prosthesis fitted in place at the proximal end of a resected femur in a similar manner to that shown in FIG. 4. The difference here is that the prosthesis 31 is formed in one piece with the central part of its head being hollow as shown at 32. As with the embodiment shown in FIG. 4, the prosthesis would be manufactured out of cobalt chrome or similar material and the stem would be cemented in place, or modified for suitable biological fixation. Moreover as with FIG. 4, the head would, as mentioned in relation thereto, either articulate against the patient's normal acetabular cartilage or against a prosthetic acetabular component manufactured from cobalt chrome, ceramic or polyethylene material. In a similar manner to that of FIG. 5, the separate femoral head component 25 could have part thereof, for example a central part thereof, hollow.
In a further embodiment of the two-part prosthesis, the proximal end of the frustoconical aspect of section 27 could be extended to form a peripheral cone junction with the inner aspect of the femoral head component. In a still further embodiment the stem part of the one or two piece implant could be straight rather than curved.

## Claims

1. A femoral implant for a resected head of a femur, comprising:
(a) a femoral head, at a proximal end of the implant; and
(b) a stem part extending to a distal end of the implant; and
(c) a section with a free end, the free end having a base portion positioned adjacent to the femoral head at the proximal end of the implant, the stem part extending from the section remote from the free end, said section comprising a frustoconically-shaped portion having an external surface of frustoconical or generally frustoconical form, wherein said section tapers towards said stem part and away from said femoral head along a straight axis, said femoral head extends directly away from said section to the proximal end of the implant, and said section further includes, at its maximum diameter, a base portion which extends substantially axially away from the frustoconically-shaped portion and is substantially the same diameter as the end surface of the resected head into which said stem is to be inserted, whereby the external surface at the periphery of the base potion is positioned against the end surface of the resected head in use.

2. An implant as claimed in claim 1, wherein the femoral head is separate from said section.

3. An implant as claimed in claim 2, wherein the separate femoral head is secured to said section by respective interfitting parts thereof.

4. An implant as claimed in claim 3, wherein a frustoconical spigot extending from said section is received in a complementarily shaped cavity in the femoral head.

5. An implant as claimed in claim 4, wherein the spigot is a tight frictional fit in said cavity.

6. An implant as claimed in claim 4, wherein the spigot is cemented in said cavity.

7. An implant as claimed in claim 3, wherein a frustoconical spigot extending from said femoral head, is received in a complementarily shaped cavity in said section.

8. An implant as claimed in claim 1, wherein a central part of the femoral head is hollow.

9. An implant as claimed in claim 1, wherein the femoral head is integral with said section.

10. An implant as claimed in claim 1, which is manufactured of cobalt chrome.

11. An implant as claimed in claim 1, in which the stem is curved.

12. An implant as claimed in claim 1, wherein the stem part is straight.

13. An implant as claimed in claim 1, wherein a free periphery of the femoral head extends over and is directly adjacent to a proximal end of said section.

14. A stem for connecting to a femoral head of a femoral implant for a resected head of a femur, comprising:
a stem part extending to a distal end of the stem, and
a section, comprising a frustoconically-shaped portion along a straight axis and having an external surface of frustoconical or generally frustoconical form, wherein said section has a free end adjacent the femoral head at the proximal end of the implant and tapers towards said stem part, said section terminates at the free end of the section, and said section further includes, at its maximum diameter, a base portion which extends substantially axially away from the frustoconically-shaped portion and is substantially the same diameter as the end surface of the resected head into which said stem is to be inserted, whereby the external surface at the periphery of the base potion is positioned against the end surface of the resected head in use.

15. A stem as claimed in claim 14, wherein a spigot extends from the free end of the section for connection, in use, of a femoral head to said stem.

16. A stem as claimed in claim 15, wherein the spigot has a frustoconical external surface.

17. A stem as claimed in claim 14, wherein a recess is provided in the free end of the section for connection, in use, of a femoral head to the stem.

18. A stem as claimed in claim 14 , modified for biological fixation, in use, in the medullary canal of a patient.

19. A stem as claimed in claim 14, wherein the stem part is curved.

20. A femoral implant for a resected head of a femur, comprising:
(a) a femoral head, at a proximal end of the implant; and
(b) a stem part extending to a distal end of the implant; and
(c) a section with a free end, the free end having a base portion positioned adjacent to the femoral head at the proximal end of the implant, the stem part extending from the section remote from the free end, said section comprising a frustoconically-shaped portion along a straight axis and having an external surface of frustoconical or generally frustoconical form, wherein said section tapers towards said stem part and away from said femoral head, said femoral head being immediately adjacent to and extending directly away from said section to the proximal end of the implant, and said section further includes, at its maximum diameter, a base portion which extends substantially axially away from the frustoconically-shaped portion and is substantially the same diameter as the end surface of the resected head into which said stem is to be inserted, whereby the external surface at the periphery of the base potion is positioned against the end surface of the resected head in use.