Abstract:
A method for manufacturing a prosthetic hip acetabulum includes the following steps. First, one provides an insertion cup ( 1 ) having an inner concave receiving surface ( 3 ) having an opening surface ( 5 ) contained in an opening plane (P), and having an outer annular receiving structure ( 6 ). Next, one provides an installation and positioning insert ( 7 ) having a peripheral annular attachment structure ( 10 ) shaped to engage with the receiving surface ( 9 ) of the structure ( 6 ), fitting around that structure. Next, one heats the insert ( 7 ) in order to increase its size. Next, one fits the attachment structure ( 10 ) around the receiving surface ( 9 ) of the receiving structure ( 6 ). Finally, one cools the insert ( 7 ) to room temperature to reduce its size and achieve radial tightening of the attachment structure ( 10 ) on the outer annular receiving structure ( 6 ).

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This is a continuation of U.S. patent application Ser. No. 13/498,358, filed Mar. 27, 2012, which is a U.S. national phase application of Patent Cooperation Treaty application No. PCT/IB2010/054341. 
     
    
     TECHNICAL FIELD OF THE INVENTION 
       [0002]    The present invention relates to a method for manufacturing a prosthetic acetabulum intended to replace the natural acetabulum of the hip. 
         [0003]    A total hip prosthesis comprises two parts constituting a ball-and-socket joint, namely a female part intended to replace the natural acetabulum of the hip, and a male part intended to replace the head of the femur. The male part of the joint generally has a shaft which is intended to engage in the medullary canal of the femur and of which the proximal end is connected by a neck to a spherical head intended to engage in the female part. The female part of the joint, which has to replace the natural acetabulum of the hip, usually comprises a substantially hemispherical insertion cup, which is accommodated in a prepared acetabular cavity in the pelvic bone. The insertion cup is usually made of metal. 
         [0004]    When fitting the insertion cup in the acetabular cavity, it must be possible to use an impactor for holding and manipulating the insertion cup and for applying a force to drive the cup into the acetabular cavity in the bone with a good orientation and for long enough for a cement to set between the outer surface of the insertion cup and the acetabular cavity of the bone. 
         [0005]    The document FR 2 909 541 A1 describes an insertion cup with a convex and hemispherical outer anchoring face. To hold this cup during its impaction, an outer annular groove is provided near its free annular edge. This annular groove permits the fixation of an impactor comprising a main body with at least two hook-shaped elastic tabs. 
         [0006]    In this document, the force with which the cup is retained by the impactor is in correlation with and substantially equal to the force that has to be applied to spread apart the elastic tabs. This means that the better the hold of the cup by the impactor, the more difficult it is to spread the tabs apart, and this causes the user more effort to fix the impactor to the cup. 
         [0007]    There is a need to permit easy fixation of an impactor to a cup while providing a reliable hold of the cup. 
         [0008]    The document WO 2006/040483 A1 describes a prosthetic hip acetabulum comprising an insertion cup with:
       a substantially hemispherical convex outer anchoring face designed to be anchored in an acetabular cavity of the pelvis of a patient,   a concave inner receiving face with an annular edge and with an opening face that is contained in an opening plane,   an annular receiving structure designed in such a way that an impactor can be fixed to said annular receiving structure for impaction of the cup in the acetabular cavity of the pelvis of a patient.       
 
         [0012]    In the document WO 2006/040483 A1, the installation and orientation insert is cooled so as to contract and permit its introduction into the insertion cup, and it is then brought back to room temperature in order to expand and attach itself strongly to the insertion cup. In order to sufficiently reduce the dimensions of the installation and orientation insert, the latter is cooled in a refrigerated vessel. The presence of liquid has sometimes been observed inside the refrigerated vessel, resulting from a condensation phenomenon. Condensate liquids contaminated by bacteria or microbes can thus form and/or settle on the installation and orientation insert, which then contaminates the insertion cup after the installation and orientation insert and the insertion cup have been joined together. This is particularly critical when the installation and orientation insert is made of plastic: the plastics that can be used for the installation and orientation insert, for example polyethylene, have a tendency to absorb the liquids. There is therefore a risk that the installation and orientation inserts made of plastic will absorb condensate liquids contaminated by bacteria or microbes, which then causes deep-rooted contamination of the installation and orientation inserts. 
         [0013]    Moreover, it is also expedient to provide, between the cup and the impactor, a stronger join than is made possible by the teaching of the document WO 2006/040483 A1. 
       SUMMARY OF THE INVENTION 
       [0014]    A problem addressed by the invention is that of making available a method for manufacturing a prosthetic hip acetabulum with insertion cup that can be fixed more reliably and more firmly to an impactor, while limiting the forces to be applied and avoiding any risk of contamination. 
         [0015]    To achieve these objects, and others, the invention proposes a manufacturing method comprising the steps of: 
         [0016]    a) providing an insertion cup having a concave inner receiving face with an opening face contained in an opening plane, and having an outer annular receiving structure, 
         [0017]    b) providing an installation and orientation insert having a peripheral annular fixing structure designed to cooperate with the receiving face of the outer annular receiving structure by engaging around the outer annular receiving structure, 
         [0018]    c) heating the installation and orientation insert in order to increase the dimensions thereof, 
         [0019]    d) engaging the peripheral annular fixing structure around the receiving face of the outer annular receiving structure, 
         [0020]    e) bringing the installation and orientation insert back to room temperature in order to reduce the dimensions thereof, so as to achieve a radial clamping of the peripheral annular fixing structure on the outer annular receiving structure. 
         [0021]    Such a manufacturing method makes it possible to obtain satisfactory radial clamping of the installation and orientation insert on the insertion cup. 
         [0022]    The engagement of the installation and orientation insert around the outer annular receiving structure takes place without too much force, on account of the expansion of the installation and orientation insert by heating. 
         [0023]    However, the separation of the cup and the installation and orientation insert requires substantial forces after cooling, and this permits satisfactory impaction and orientation of the cup. 
         [0024]    The forced retention of the installation and orientation insert on the insertion cup by radial clamping ensures reliable and secure fixation, by means of which it is possible to withstand the forces applied during the impaction of the insertion cup. The radial clamping of the peripheral annular fixing structure on the outer annular receiving structure makes it possible to achieve this reliable fixation without over-complicating the shape of the outer annular receiving structure. 
         [0025]    The retention of the installation and orientation insert on the insertion cup is more reliable than that of document WO 2006/040483 A1, especially by virtue of the fact that the radial clamping takes place on an annular receiving structure which is external and which thus has a greater contact surface with the installation and orientation insert. 
         [0026]    Finally, the radial clamping of the peripheral annular fixing structure on the outer annular receiving structure induces a state of prestressing in the insertion cup, and this prestressing limits the risks of deformation of the insertion cup during its impaction in the acetabulum of the pelvis of a patient. The reason is that, when the insertion cup has a relatively small thickness near its upper annular edge, for example of less than 3 mm, phenomena of ovalization of the insertion cup sometimes occur (if the insertion cup is made of a deformable material such as metal or plastic for example), and these phenomena then make it impossible for the male part of the prosthetic joint to engage in the insertion cup, or they generate unequally distributed internal mechanical stresses likely to lead to the breakage of the insertion cup (if the latter is made of a weak material such as ceramic for example) or generate unequally distributed internal mechanical stresses likely to subsequently damage the articular insert, especially if the latter is made of ceramic. 
         [0027]    In the manufacturing method of the present invention, by means of providing an insertion cup having an outer annular receiving structure on which an installation and orientation insert is clamped by being brought back to room temperature after expansion by heating, it is possible to avoid the problem of contamination of the installation and orientation inserts, especially when these are made of polyethylene. 
         [0028]    Within the context of the present invention, the concave inner receiving face can be a slide face for receiving an articular insert that is movable with respect to the insertion cup (for an acetabulum with dual mobility for example) or can be designed to receive an articular insert that is stationary with respect to the insertion cup (for an acetabulum with single mobility for example). 
         [0029]    Advantageously, before fixing the installation and orientation insert on the insertion cup, the method can comprise the supplementary step b1) of inserting an articular insert in the concave inner receiving face of the insertion cup. 
         [0030]    The insertion cup, the articular insert and the installation and orientation insert can thus be pre-assembled at the place of manufacture, such that the surgeon simply has to impact the unit thus formed without having to concern himself with the articular insert. In addition, the articular insert can then be positioned correctly in the insertion cup without any involvement of the surgeon. This therefore limits the risks of poor positioning of the articular insert in the insertion cup, which can lead to premature breaking of the articular insert. 
         [0031]    Advantageously, provision can be made that:
       the articular insert is made of ceramic,   the installation and orientation insert has elastic means for holding the articular insert in the insertion cup,   when the installation and orientation insert is fixed to the insertion cup, the installation and orientation insert comes into contact with the articular insert only via the elastic means for holding the articular insert in the insertion cup.       
 
         [0035]    The elastic holding means keep the articular insert correctly positioned in the insertion cup during transport and storage and when being handled by the surgeon. When the surgeon applies an impaction force on the insertion cup by way of the installation and orientation insert, no shock will be transferred to the ceramic articular insert, since the elastic holding means will deform. There is therefore no risk of the surgeon breaking the ceramic articular insert during the impaction. 
         [0036]    Advantageously, the method can additionally have a step f) during which the unit thus formed and packed in a microbial protection envelope is sterilized. 
         [0037]    Preferably, provision can be made that the articular insert is made of ceramic, and that the step f) of sterilization is carried out by bombardment with gamma rays, advantageously at a dose of between approximately 25 kGy and approximately 40 kGy. 
         [0038]    In the document WO 2006/040483 A1, the annular receiving structure comprises a cylindrical or slightly conical annular retention surface that continues the surface of the concave inner receiving face. 
         [0039]    However, this substantially cylindrical continuation limits the possible angular clearance of the prosthetic femoral shaft. In addition, the cylindrical continuation increases the risk that the prosthetic femoral shaft, which is generally made of metal, comes into contact with the insertion cup. In the event of such contact, if the insertion cup is made of metal, a phenomenon of metallosis occurs through degradation of the edge of the insertion cup and/or of the prosthetic femoral shaft. This degradation produces metal debris that can impregnate the surrounding tissues and/or damage the prosthesis. Moreover, when the cup is not made of metal, and is in particular made of ceramic or a plastic such as PEEK for example, there is a risk of partial or total breakage of the insertion cup. 
         [0040]    This is why the annular receiving structure can preferably be external and be situated set back from the opening plane. 
         [0041]    When the annular receiving structure for fixation of the impactor is situated set back from the opening plane, in the direction of the summit of the substantially hemispherical convex outer anchoring face, this annular receiving structure no longer limits the angular clearance of the prosthetic femoral shaft that will be fitted. At the same time, the risk of contact between the prosthetic femoral shaft and the edge of the insertion cup is limited, thereby reducing the risk of metallosis and/or breakage. 
         [0042]    Preferably, the installation and orientation insert can have an assembly structure on which an impactor can be fixed removably. 
         [0043]    It is thus possible to mount the installation and orientation insert on the insertion cup at the place of manufacture, such that the surgeon then simply has to fix the impactor on the installation and orientation insert in order to perform impaction of the insertion cup. There is no risk of the surgeon damaging the concave inner receiving face of the insertion cup, the latter being protected by the installation and orientation insert. 
         [0044]    Advantageously, provision can be made that:
       the outer annular receiving structure comprises a continuous or interrupted peripheral radial shoulder of the annular edge, with a receiving face directed toward the outside,   the installation and orientation insert has a continuous or interrupted peripheral annular fixing structure with a connecting face directed toward the inside and designed to cooperate with the receiving face of the outer annular receiving structure.       
 
         [0047]    According to a first variant, provision can be made that:
       the receiving face of the outer annular receiving structure has an interrupted peripheral locking groove,   the connecting face of the peripheral annular fixing structure of the installation and orientation insert has a plurality of locking ribs distributed peripherally and designed so as to engage in the interrupted peripheral locking groove.       
 
         [0050]    According to a second variant, provision can be made that:
       either the receiving face of the outer annular receiving structure or the connecting face of the peripheral annular fixing structure has a continuous peripheral annular locking groove,   the other of the connecting face of the peripheral annular fixing structure or the receiving face of the outer annular receiving structure has a continuous or interrupted peripheral annular locking rib designed so as to engage in the continuous peripheral annular locking groove.       
 
         [0053]    The locking groove and the one or more locking ribs participate in retaining the installation and orientation insert on the insertion cup. This also greatly increases the strength of the join between the installation and orientation insert and the insertion cup in order to withstand orientation torques that the surgeon transfers by way of the impactor. 
         [0054]    Advantageously, provision can be made that:
       the peripheral radial shoulder of the annular edge has a thickness of between approximately 0.7 mm and approximately 1.2 mm,   said interrupted peripheral locking groove or said continuous peripheral annular locking groove of the outer annular receiving structure has a radial thickness of between approximately 0.2 mm and approximately 0.6 mm.       
 
         [0057]    Such dimensions are compatible with an insertion cup having a small thickness near its upper annular edge, for example of less than 3 mm. The use of an insertion cup having a small thickness near its upper annular edge makes it possible to increase the diameter of the spherical head of the male part of the joint and thus limit the risk of dislocation. 
         [0058]    Preferably, provision can be made that the peripheral radial shoulder of the annular edge has a height of between approximately 1 mm and approximately 4 mm. 
         [0059]    Such a height of the peripheral radial shoulder provides a sufficient contact surface between the installation and orientation insert and the insertion cup for the radial clamping, without thereby excessively diminishing the surface area of the convex outer anchoring face intended to come into contact with the bone. This is all the greater in view of the fact that the outer anchoring surface part situated substantially in the vicinity of the equatorial plane thereof is a part that participates substantially in the retention of the insertion cup in the acetabular cavity of the pelvis. 
         [0060]    Advantageously, provision can be made that said interrupted peripheral locking groove or said continuous peripheral annular locking groove of the outer annular receiving structure has a height of between approximately 0.4 mm and approximately 3 mm. 
         [0061]    Preferably, provision can be made that the installation and orientation insert and the outer annular receiving structure of the insertion cup are designed in such a way that, when the installation and orientation insert is fixed on the outer annular receiving structure of the insertion cup, the installation and orientation insert does not protrude outside a substantially hemispherical surface defined by the substantially hemispherical convex outer anchoring face of the insertion cup. This therefore avoids any risk of conflict of the installation and orientation insert with the bone substance present near the prepared acetabular cavity of the pelvis of the patient. 
         [0062]    Advantageously, the peripheral annular fixing structure of the installation and orientation insert can have a radial thickness substantially equal to or less than the thickness of the radial shoulder of the annular edge. 
         [0063]    Preferably, the installation and orientation insert can be made of polyethylene. Polyethylene is commonly used in the medical field and is inexpensive and easy to machine. Moreover, polyethylene does not risk damaging an insertion cup made of metal, of ceramic, of PEEK or of a material harder than polyethylene. 
         [0064]    Preferably, the assembly structure can comprise a fixation hole with internal thread made in the installation and orientation insert, permitting the screwing of a corresponding threaded portion of the impactor. 
         [0065]    Advantageously, the fixation hole can be a through-hole able to cooperate with a disconnecting tool that has a threaded rod able to be screwed into the through-hole and which has a distal end designed to bear, directly or indirectly, against the concave inner receiving face of the insertion cup when the threaded rod is screwed into the through-hole. Preferably, provision can be made that:
       the installation and orientation insert is designed in such a way that a free space remains between the installation and orientation insert and the bottom of the concave inner receiving face, or, if appropriate, between the installation and orientation insert and the articular insert, once the installation and orientation insert is fixed to the outer annular receiving structure of the insertion cup,   the installation and orientation insert bears in a sealed manner across its connecting face against the receiving face of the outer annular receiving structure,   the fixation hole is a through-hole via which the free space between the installation and orientation insert and the bottom of the concave inner receiving face or, if appropriate, between the installation and orientation insert and the articular insert is brought into communication with the outside and which is dimensioned for leaktight engagement of the end of a syringe.       
 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0069]    Other subjects, features and advantages of the present invention will become clear from the following description of particular variants, said description making reference to the attached figures, in which: 
           [0070]      FIG. 4  is a perspective view of an insertion cup of a prosthetic acetabulum according to a first variant of the invention; 
           [0071]      FIG. 5  is a side view of the cup from  FIG. 4 ; 
           [0072]      FIG. 6  is a perspective view of an installation and orientation insert intended to be joined to the insertion cup from  FIGS. 4 and 5 ; 
           [0073]      FIG. 7  is a sectional view of the installation and orientation insert from  FIG. 6 ; 
           [0074]      FIG. 8  is a perspective view of an installation and orientation insert and of an insertion cup of a prosthetic hip acetabulum according to a second variant of the invention; 
           [0075]      FIG. 9  is a sectional view of the installation and orientation insert from  FIG. 8 ; 
           [0076]      FIG. 10  is a partial sectional view of the insertion cup from  FIG. 8 ; 
           [0077]      FIG. 11  is a partial sectional view of the installation and orientation insert from  FIG. 9 ; 
           [0078]      FIG. 12  is a partial sectional view of the insertion cup and of the installation and orientation insert from  FIGS. 10 and 11 ; 
           [0079]      FIG. 13  is a perspective view of the insertion cup and of the installation and orientation insert from  FIG. 8 , with a stationary articular insert; 
           [0080]      FIG. 14  is a sectional view of the elements from  FIG. 13  once they have been assembled; and 
           [0081]      FIG. 15  is a sectional view of an insertion cup and of an installation and orientation insert once they have been assembled. 
           [0082]    Some of the attached figures illustrate subject matter that is not part of the present invention but that is described below and that may form the subject of independent protection. These figures are the following: 
           [0083]      FIG. 1 , which is a perspective view of an insertion cup of a prosthetic acetabulum; 
           [0084]      FIG. 2 , which is a perspective view of an installation and orientation insert intended to be joined to the insertion cup from  FIG. 1 ; and 
           [0085]      FIG. 3 , which is a sectional view of the installation and orientation insert from  FIG. 2 . 
       
    
    
     DESCRIPTION OF PREFERRED EMBODIMENTS 
       [0086]    Each one of  FIGS. 1 ,  4 ,  5  and  8  shows an insertion cup  1  of a prosthetic hip acetabulum. This insertion cup  1  comprises:
       a substantially hemispherical convex outer anchoring face  2 , designed to be anchored in a prepared acetabular cavity of the pelvis of a patient, and a concave inner receiving face  3 , with an annular edge  4  and with an opening face  5  that is contained in an opening plane P,   an annular receiving structure  6  designed in such a way that an impactor can be fixed to said annular receiving structure  6  for the impaction of the insertion cup  1  in the acetabular cavity of the pelvis of a patient.       
 
         [0089]    The annular receiving structure  6  is external and is situated set back from the opening plane P. In other words, the annular receiving structure  6  is offset, with respect to the opening plane P, in the direction of the summit S of the outer anchoring face  2 . 
         [0090]    The annular receiving structure  6  is therefore not situated in the continuation of the inner receiving face  3  continuing the latter past the summit S. It is thus possible to avoid limiting the angular clearance of the prosthetic femoral shaft, and the risk of metallosis and/or breakage is reduced. 
         [0091]      FIGS. 2 ,  3 ,  6 ,  7  and  9  show an installation and orientation insert  7  intended to be joined to an insertion cup  1 . The installation and orientation insert  7  of  FIGS. 2 and 3  is intended to be joined to the insertion cup  1  from  FIG. 1 . The installation and orientation insert  7  of  FIGS. 6 and 7  is intended to be joined to the insertion cup  1  from  FIGS. 4 ,  5  and  8 . The installation and orientation insert  7  of  FIG. 9  is intended to be joined to the insertion cup  1  from  FIG. 8 . 
         [0092]    Each installation and orientation insert  7  can be fixed removably to the outer annular receiving structure  6  of the insertion cup  1  and has an assembly structure  8  on which an impactor can be removably fixed. 
         [0093]    In  FIGS. 1 ,  5  and  8 , it will be seen that the outer annular receiving structure  6  comprises a continuous or interrupted peripheral radial shoulder d of the annular edge  4 , with a receiving face  9  directed toward the outside. It will be seen in  FIGS. 2 ,  3 ,  6 ,  7  and  9  that each installation and orientation insert  7  has a continuous or interrupted peripheral annular fixing structure  10  with a connecting face  11  directed toward the inside and designed to cooperate with the receiving face  9  of the outer annular receiving structure  6 . 
         [0094]    In the subject matter of  FIGS. 1 to 3 , the receiving face  9  of the outer annular receiving structure  6  has an external thread  12 , while the connecting face  11  of the peripheral annular fixing structure  10  of the installation and orientation insert  7  has an internal thread  13  designed to cooperate with the external thread  12  by screwing. 
         [0095]    The subject matter of the present invention is illustrated in  FIGS. 4 to 13 . In these figures, the outer annular receiving structure  6  and the peripheral annular fixing structure  10  are designed in such a way that the installation and orientation insert  7  is engaged with force around the outer annular receiving structure  6  and is retained forcibly by a radial clamping of the peripheral annular fixing structure  10  on the outer annular receiving structure  6 . 
         [0096]    In order to further improve the hold of the installation and orientation insert  7  on the insertion cup  1 , a supplementary cooperation can be provided between the installation and orientation insert  7  and the insertion cup  1  by means of one or more locking ribs that engage in a locking groove. 
         [0097]    In a first variant, illustrated in  FIGS. 4 to 7 , provision is made that:
       the receiving face  9  of the outer annular receiving structure  6  has an interrupted peripheral locking groove  14 ;   the connecting face  11  of the peripheral annular fixing structure  10  of the installation and orientation insert  7  has a plurality of locking ribs  15   a  to  15   d  which are distributed about the periphery and are designed so as to engage in the interrupted peripheral locking groove  14 .       
 
         [0100]    In a second variant, illustrated in  FIGS. 8 and 9 , the receiving face  9  of the outer annular receiving structure  6  has a continuous peripheral annular locking groove  16 , while the connecting face  11  of the peripheral annular fixing structure  10  has a continuous peripheral annular locking rib  17  designed so as to engage in the continuous peripheral annular locking groove  16 . 
         [0101]    In this second variant, it is also possible that the connecting face  11  of the peripheral annular fixing structure  10  has an interrupted peripheral annular locking rib. The installation and orientation insert  7  can then be similar to that of the first variant of the second embodiment of the invention, illustrated in  FIGS. 6 and 7 . 
         [0102]      FIG. 10  is a partial sectional view of the annular edge  4  of the insertion cup  1  from  FIG. 8 . It will be seen more particularly in  FIG. 10  that the outer annular receiving structure  6  comprises a peripheral radial shoulder d with a receiving face  9  directed toward the outside. The peripheral radial shoulder d has a thickness e 1  of between approximately 0.7 mm and approximately 1.2 mm. 
         [0103]    The receiving face  9  has the continuous peripheral annular locking groove  16 . The continuous peripheral annular locking groove  16  has a radial thickness e 2  of between approximately 0.2 mm and approximately 0.6 mm. 
         [0104]    The insertion cup  1  has a thickness e 4  near its annular edge  4 . The thickness e 4  can be small, for example less than 3 mm. 
         [0105]    The peripheral radial shoulder d of the annular edge  4  has a height h 1  of between approximately 1 mm and approximately 4 mm. 
         [0106]    Finally, the continuous peripheral annular locking groove  16  has a height h 2  of between approximately 0.4 mm and 3 mm. 
         [0107]    All the dimensions given above in connection with the second variant are valid for the first variant and also for the subject matter of  FIGS. 1 to 3 . 
         [0108]    As will be seen from  FIG. 11 , the peripheral annular fixing structure  10  of the installation and orientation insert  7  has, with its connecting face  11  and its continuous peripheral annular locking rib  17 , a shape and dimensions matching the receiving face  9  and the continuous peripheral annular locking groove  16 . The installation and orientation insert  7  and the insertion cup  1  can thus be joined very intimately, as is illustrated in  FIG. 12 . 
         [0109]    In order to avoid any conflict of the installation and orientation insert  7  with the bone substance around the natural acetabular cavity of the pelvis of the patient, the installation and orientation insert  7  and the outer annular receiving structure  6  of the insertion cup  1  are designed in such a way that, when the installation and orientation insert  7  is fixed to the outer annular receiving structure  6  of the insertion cup  1 , the installation and orientation insert  7  does not protrude outside a substantially hemispherical surface S 1  (illustrated by broken lines in  FIG. 12 ) defined by the substantially hemispherical convex outer anchoring face  2  of the insertion cup  1 . 
         [0110]    To do this, the peripheral annular fixing structure  10  of the installation and orientation insert  7  has a radial thickness e 3  substantially equal to or less than the thickness e 1  of the radial shoulder d of the annular edge  4 . 
         [0111]    So as not to risk damaging the insertion cup  1 , the installation and orientation insert  7  is advantageously made of plastic, preferably of polyethylene, which is an inexpensive material that is easy to machine. 
         [0112]    Within the context of the invention, the concave inner receiving face  3  can be a slide face  3   a  for receiving a movable articular insert, for example for an acetabulum with dual mobility. In this case, the slide face  3   a  is intended to receive a spherical movable articular insert ( FIG. 15 ). 
         [0113]    Still within the context of the invention, the concave inner receiving face  3  can be designed to receive a stationary articular insert  18 , for example for an acetabulum with single mobility, as is illustrated in  FIG. 14 . The stationary articular insert  18  is immobilized in the insertion cup  1  by a conical engagement. 
         [0114]    It will be seen more particularly in  FIG. 14  that it is possible, at the place of manufacture, to carry out pre-assembly and sterile packaging of the articular insert  18  engaged in the insertion cup  1  with the installation and orientation insert  7  fixed to the insertion cup  1 . This results in a pre-assembled unit ready for impaction by the surgeon, as a result of which the operating times can be reduced. In addition, the articular insert  18  is already fitted in the correct place in the insertion cup  1 , which limits the risk of poor positioning thereof by the surgeon. This is particularly important when the articular insert  18  is made of ceramic, since poor positioning then very often leads to premature breaking of the ceramic. 
         [0115]    It will be seen more particularly in  FIG. 14  that the installation and orientation insert  7  has elastic means  19  for holding the ceramic articular insert  18  in the insertion cup  1 . The elastic means  19  prevent any displacement of the articular insert  18  in the insertion cup  1  during transport, storage and handling of the pre-assembled insertion cup and articular insert  18 . 
         [0116]    So as not to risk damaging the ceramic articular insert  18  during impaction of the insertion cup  1 , when the installation and orientation insert  7  is fixed to the insertion cup  1 , the installation and orientation insert  7  comes into contact with the articular insert  18  only via the elastic holding means  19 . It will be seen more particularly in  FIG. 12  that the installation and orientation insert  7  is designed in such a way that a space E remains between the installation and orientation insert  7  and the articular insert  18 . Therefore, no impaction shock is transferred to the ceramic articular insert  18 , which is held in the bottom of the insertion cup  1  by the elastic means  19 . 
         [0117]    It will be seen more particularly in  FIGS. 14 and 15  that the assembly structure  8  of the installation and orientation insert  7  comprises a fixation hole  20  with internal thread  21 . The internal thread  21  permits the screwing of a corresponding threaded portion of the impactor (not shown). 
         [0118]    After the impaction of the insertion cup  1  in the acetabular cavity of the pelvis of the patient, it is necessary to withdraw the installation and orientation insert  7 . This withdrawal has to be performed without inducing stresses between the outer anchoring face  2  and the acetabular cavity of the pelvis of the patient, so as not to destroy the join made between them during the impaction. 
         [0119]    A first solution to permit separation thus consists in the fixation hole  20  being a through-hole that is able to cooperate with a disconnecting tool having a threaded rod with a distal end designed to bear directly or indirectly against the concave inner receiving face  3  of the insertion cup  1  when the threaded rod is screwed into the through-hole. In  FIGS. 14 and 15 , the fixation hole  20  has a first portion  20   a  of diameter D 1  and a second portion  20   b  of smaller diameter D 2 . The threaded rod of the disconnecting tool has an external diameter designed such that it can be screwed into the portion  20   b  of diameter D 2  of the fixation hole  20 . 
         [0120]    A second solution permitting separation is one in which:
       the installation and orientation insert  7  is designed such that a free space E 1  remains between the installation and orientation insert  7  and the bottom of the concave inner receiving face  3  ( FIG. 15 ) or, if appropriate, between the installation and orientation insert  7  and the articular insert  18  ( FIG. 14 ), once the installation and orientation insert  7  is fixed to the outer annular receiving structure  6  of the insertion cup  1 ,   the installation and orientation insert  7  bears in a sealed manner across its connecting face  11  against the receiving face  9  of the outer annular receiving structure  6 ,   the fixation hole  20  is a through-hole via which the free space E 1  is brought into communication with the outside and which is dimensioned for leaktight engagement of the end of a syringe.       
 
         [0124]    In the case of  FIGS. 14 and 15 , the syringe end has an external diameter designed to engage in a leaktight manner in the portion of diameter D 2  of the fixation hole  20 . 
         [0125]    A liquid such as water or physiological saline is thus injected at pressure into the free space E 1  in order to induce a force of separation between the insertion cup  1  and the installation and orientation insert  7 . 
         [0126]    In order to obtain a sealed contact between the installation and orientation insert  7  and the insertion cup  1 , use will preferably be made of the insertion cup  1  and the installation and orientation insert  7  that are illustrated in  FIGS. 8 and 9 . 
         [0127]    Within the context of the present invention, when assembling the unit comprising the insertion cup  1  and an installation and orientation insert  7  (and if appropriate a stationary articular insert  18 ), it is important not to damage the annular receiving structure  6  and the peripheral annular fixing structure  10 . In order to achieve a radial clamping of the peripheral annular fixing structure  10  on the outer annular receiving structure  6 , it is necessary that the peripheral annular fixing structure  10  has diameter dimensions equal to or less than those of the outer annular receiving structure  6 . 
         [0128]    An assembly method involving expansion and subsequent shrinkage is therefore used, during which the installation and orientation insert  7  is heated so as to increase its dimensions, after which the peripheral annular fixing structure  10  is engaged around the receiving face  9  of the outer annular receiving structure  6 , and, finally, the installation and orientation insert  7  is brought back to room temperature in order to reduce its dimensions. 
         [0129]    Such a method permits assembly without blunting or damaging the one or more locking ribs  15   a - 15   d  or  17 , which thus retain sharp edges for a stronger connection between the installation and orientation insert  7  and the insertion cup  1 . 
         [0130]    This method of manufacture by heating also makes it possible to avoid the abovementioned disadvantages of the method of manufacture by cooling as described in document WO 2006/040483 A1. 
         [0131]    On its return to room temperature, a radial clamping of the peripheral annular fixing structure  10  on the outer annular receiving structure  6  is obtained. For assembling the unit illustrated in  FIG. 14 , it is possible, before fixing the installation and orientation insert  7  on the insertion cup  1 , to insert an articular insert  18  in the concave inner receiving face  3  of the insertion cup  1 . 
         [0132]    It is then possible to proceed to a step of sterilization of the unit thus formed and packed in a microbial protection envelope. A satisfactory sterilization will be achieved by bombardment with gamma rays, preferably at a dose of between approximately 25 kGy and approximately 40 kGy. 
         [0133]    It is expressly underlined that the method of manufacture and assembly of the units in  FIGS. 14 and 15 , by heating the installation and orientation insert  7  and then returning it to room temperature, can be used with an insertion cup  1  whose outer annular receiving structure  6  is not necessarily situated set back from the opening plane P. The method of manufacture may thus be the subject of protection independently of the position of the outer annular receiving structure  6  with respect to the opening plane P of the insertion cup  1 . 
         [0134]    The present invention is not limited to the embodiments that have been explicitly described, and instead it includes the variants and generalizations contained within the scope of the attached claims.