Patent Publication Number: US-2011054610-A1

Title: Textile Prosthesis

Description:
CROSS REFERENCES TO RELATED APPLICATIONS 
     The present application is a divisional of U.S. patent application Ser. No. 12/042,311 filed Mar. 4, 2008, now U.S. Pat. No. 7,828,855, which is a divisional of U.S. patent application Ser. No. 10/398,883 filed Jul. 10, 2003, now U.S. Pat. No. 7,338,531, which is the National Stage Entry of PCT/GB01/04512 filed Oct. 11, 2001, which claims benefit of priority to United Kingdom 0024903.7 filed Oct. 11, 2000, the entire contents of which are hereby expressly incorporated by reference into this disclosure as if set forth fully herein. 
    
    
     BACKGROUND OF THE INVENTION 
     I. Field of the Invention 
     The present invention relates in particular, but not exclusively, to a textile prosthesis and a method of producing a textile prosthesis. The prosthesis may be used to regenerate an external fleshy body part such as an ear or may be a surgical implant. 
     II. Discussion of the Prior Art 
     In the design of textile surgical implants, it is often desirable to apply a tensile load to the textile structure. For example, in orthopaedic applications the textile implant may be used to replace a damaged ligament. Ligaments join bones to bones and during movement of the body, a load is applied to the ligaments. To anchor the replacement ligament in place, it may be convenient or desirable to use a screw fixation device to anchor the textile implant to the bone so that the load may be properly transferred across the joint. 
     With a conventional woven textile, if a screw is pushed through the interstices of the woven structure, any load that is applied to the textile will be concentrated at one part of the weave structure, often on a single weft yarn causing the loaded yarn to move within the woven structure causing the weave to become distorted and the point of fixation on the fabric to change. In order to prevent this structural distortion, a number of methods have been suggested to overcome this difficulty. These methods include the use of staples to straddle a number of warp ends of the fabric so concentrating the load on a greater number or width of weft fibres; grommets have also been used which spread the load, not only across the width of the woven fabric but also extending the load bearing down the length of the fabric. However, this approach still results in some distortion of the woven structure, particularly when spaces are forced in the fabric to pass a grommet through. 
     It is also known that tubular braided structures are difficult to fix in place using conventional screws. The fibres in such a structure are usually angled at between 30.degree. and 60.degree. from the longitudinal axis of the fabric; this permits distortion which is greater than occurs with woven fabrics (where the weft is at approximately 90.degree. to the warp of the fabric), because less load is taken up by the yarn at an angle to the direction of the load. 
     It may also be necessary for the textile implant to be secured to soft tissue, such as muscle. It is therefore desirable for the textile implant to be capable of being mechanically secured to soft tissue, for example by suturing whilst being able to transfer tensile loadings to the tissue to which it is secured. 
     It may also be desirable for the textile implant to be capable of promoting tissue ingrowth in order to enable the implant to be biologically connected to the soft tissue. 
     SUMMARY OF THE INVENTION 
     A general aim of the present invention is to provide a textile prosthesis, in particular but not exclusively, a surgical implant, which is better able to accommodate tensile loadings with less structural distortion. 
     According to an aspect of the present invention there is provided a textile prosthesis comprising a unitary body of predetermined shape having structural integrity, the body including at least one anchorage body portion for attachment to an anatomical body part, the body being composed of a combination of binding yarns and tensile load bearing filaments, the binding yarns being located at least in the or in each of said anchorage body portions and being interconnected to one another by sewn stitches, the tensile load bearing filaments being located inbetween said stitches so as to be constrained to extend through said unitary body along predetermined pathways extending in one or more predetermined directions so as to render the body resistance to stretch when a tensile load is applied in said one or more predetermined directions. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various aspects of the present invention are hereinafter described with reference to the accompany drawings in which: 
         FIG. 1  is a diagrammatic representation of an example of a textile prosthesis according to the invention; 
         FIG. 2  is a diagram illustrating the inter-relationship between the binding and tensile load bearing yarns in accordance with a first aspect of the present invention; 
         FIG. 3  is a section along line I-I in  FIG. 2 ; 
         FIG. 4  is a section along line II-II in  FIG. 2 ; 
         FIG. 5  is a section along line III-III in  FIG. 2 ; 
         FIG. 6  is a diagram illustrating the inter-relationship between the binding and tensile load bearing yarns in accordance with a second aspect of the present invention, particularly suitable for forming an aperture; 
         FIG. 7  is a diagram illustrating the incorporation of additional yarns for the formation of an aperture; 
         FIG. 8  is a diagrammatic plan view of a surgical implant according to a first embodiment of the present invention; 
         FIG. 9  is an exploded view of the implant of  FIG. 8 ; 
         FIG. 10  is an enlarged part plan view of the implant of  FIG. 8  showing an alternative structure; 
         FIG. 11  is a diagram illustrating formation of chain-links for interconnecting a pair of apertures; 
         FIG. 12  is a diagrammatic plan view of a second embodiment according to the present invention; 
         FIG. 13  is a diagrammatic plan view of a third embodiment according to the present invention; 
         FIG. 14  is a diagrammatic plan view of a fourth embodiment according to the present invention; 
         FIG. 15  is a diagrammatic plan view of a fifth embodiment according to the present invention. 
         FIG. 16  is a diagrammatic plan view of a sixth embodiment according to the present invention; 
         FIG. 17  is a diagrammatic plan view showing a modified version of the sixth embodiment; 
         FIG. 18  is a schematic diagram of a metal prosthesis to which the sixth embodiment may be attached; 
         FIG. 19  is a diagrammatic view showing the modified sixth embodiment attached to the metal prosthesis of  FIG. 18 ; 
         FIG. 20  is an enlarged schematic diagram of the modified sixth embodiment; 
         FIG. 21  is a diagrammatic plan view of a seventh embodiment according to the present invention; 
         FIG. 22  is a diagrammatic plan view of an eighth embodiment according to the present invention; 
         FIG. 23  is a diagrammatic plan view of a ninth embodiment according to the present invention; 
         FIG. 24  is a diagrammatic sketch showing the ninth embodiment in situ. 
     
    
    
     DESCRIPTION OF PREFERRED EMBODIMENT 
     A textile prosthesis constructed in accordance with the principles of the present invention is schematically illustrated in  FIGS. 1 to 5  and comprises a body  10  which is composed of binding yarns  30  which are interconnected by sewn stitches and tensile load bearing yarns  20  which are encased within the body by being located in-between the binding yarn stitches. 
     The sewn stitches of the binding yarns  30  and the placement of the tensile load bearing yarns  20  are preferably created using embroidery techniques on a computer controlled embroidery machine, such as a Tajima or Barudan embroidery machine. 
     Generally such a machine includes a sewing head located above a base fabric and a looper head located below the base fabric. The sewing head supplies a sewing thread which is preferably interlaced with a looper thread supplied by the looper head. Accordingly during the sewing operation a sewing thread is laid upon the upper surface of the base fabric and a looper thread is laid upon the lower surface of the base fabric. The base fabric is normally held in a frame which is moved under the control of the computer by a pantograph. 
     By this conventional technique any stitch may be placed at any point within the embroidery frame, and the yarn length portions between successive stitches may be positioned at any angle and be of any length, subject to the dimensions of the embroidery frame. 
     In the present invention the base fabric on which the embroidery is performed may be removed, preferably by dissolution in a suitable solvent, after completion of the embroidery operation in order to leave the textile prosthesis as a body having its own structural integrity. 
     Alternatively the base fabric may remain to provide additional structural or tensile support. 
     As indicated in  FIG. 1 , and byway of example, the body  10  is illustrated as including two anchorage portions ST and B which when attached to two separate anatomical body parts transmits loads between those parts in a direction LD. 
     In accordance with the invention, the body  10  may include any number of anchorage portions ST and/or B. 
     In certain applications, such as the creation of an artificial anatomical body part, the body  10  may include only one anchorage body portion and this may be either a body portion ST or a body portion B. 
     In accordance with the invention, the binding yarns  30  co-operate with the load bearing yarns  20  so that the load bearing yarns  20  are constrained to follow predetermined pathways through the body  10 . In some areas of the body  10 , in particular body portion ST, the binding yarns  30  may interact with one another to define a non-stretchable stable ground fabric structure, preferably of mesh-like form MS as shown in greater detail in  FIGS. 2 to 5 . 
     The ground fabric structure MS shown in  FIGS. 2 to 5  includes a first series (FS) of stitches  31  of upper and lower binding yarns  30   a.    30   b  having stitch lengths  35  extending in one direction and a second series (SS) of stitches  32  of upper and lower binding yarns  30   c,    30   d  having stitch lengths  36  extending in a different direction, which in the illustrated example is 90.degree. to the direction of the first series FS. It will be appreciated however that the directional angular relationship between the first and second series FS, SS may be greater or less than 90.degree. 
     In  FIGS. 3 and 4 , a base fabric BF is shown into which the stitches  31 ,  32  are formed. Base fabric BF is subsequently removed to form the mesh-like ground fabric MS. 
     The stitches  31 ,  32  of the binding yarns  30  are spaced apart to define open spaces OS in the mesh-like fabric MS. The size of spaces OS may be changed to vary the density of the mesh-like fabric as desired by for example changing the stitch length between adjacent stitches  31  or adjacent stitches  32 , changing the spacing between the series of stitches FS and SS, changing the size of the binding yarns  30  and/or introducing additional series of binding yarn stitches (i.e. have more than two series of stitches). For instance it is possible to create a relatively open mesh-like structure for promoting tissue ingrowth or a relatively closed mesh-like structure for inhibiting tissue ingrowth. 
     It is also possible by suitable choice of the stitch and/or yarn sizes to vary the flexibility of the mesh-like structure to provide the desired amount of flexure to the prosthesis. In other areas of the body the binding yarns  30  may interact so as only to constrain the load bearing yarns  20  along said pathways. In other areas the stitching together of binding yarns  30  may be performed so as to layer the binding yarns on top of one another in order to define a predetermined three dimensional shape to a predetermined region of the body  10 . 
     As indicated in  FIG. 2  the tensile load bearing yarns  20  are placed so as to have length portions  21  which extend in the direction of a predetermined tensile load bearing direction LD of the prosthesis body. As seen more clearly in  FIG. 5 , the tensile load bearing yarns  20  are located inbetween upper and lower stitch lengths  35  so as to be trapped within the mesh-like fabric MS. 
     This is achieved by securing the load bearing yarns  20  to the base fabric to follow its circuitous path and then after securing the load bearing yarn  20  to the base fabric, subsequently producing sewn stitches from the binding yarn  30 . This ensures that the sewn stitches produced by the binding yarns  30  encase the previously laid load bearing yarns  20 . 
     Prior to laying the load bearing yarns  20 , it is envisaged that a precursor layer of binding yarns  20  may be stitched into the base fabric which are subsequently overlaid by the load bearing yarn  20 . 
     The precursor layer may be of any desired shape and extent in order to provide desired reinforcement and/or increased density of the body in selected areas. 
     Preferably the stitches  31  are closely spaced to the outer sides of the yarns  20  so that the stitch lengths  35  of the binding yarns act to restrain lateral displacement of the tensile load bearing yarns  20 . In addition, the stitches  31  and size of yarn  30  are preferably chosen so that the length portions  35  are closely spaced side by side along the length portions  21 . 
     In order for the loading bearing yarns  20  to be trapped inbetween stitch lengths  35  it is necessary for the load bearing yarns  20  to be placed in position first and for the binding yarn  30  forming the first series of stitches FS to be sewn second. 
     Placement of the load bearing yarns  20  may be performed by creating sewn stitches  27  between upper and lower yarns  20   a,    20   b  (as seen in  FIG. 5 ). 
     Preferably, the load bearing filament  20  is supplied from the looper of the embroidery machine and the thread supplied from the needle of the sewing machine is chosen to be much finer than the load bearing filament so that when stitches are formed between the needle thread and the load bearing filament  20 , the load bearing filament remains flat against the base fabric and are not drawn through the base fabric by the needle thread. Alternatively, yarns  20  may be placed in position by a laying-in technique wherein the yarns  20  are temporarily held in position whilst sewn stitches  31  are created. With laying-in techniques, a single yarn end of yarn  20 , or a desired multiple number of yam ends of yarn  20  may be laid-in during each laying-in process. 
     As indicated above, in  FIGS. 2 to 5  the load bearing yarns  20  are placed in position by creating stitches  27  between upper and lower yarns  20   a,    20   b.    
     The stitch lengths  28  between adjacent stitches  27  is preferably chosen to be the maximum distance required for ensuring correct directional placement of the yarns  20  during the embroidery process. In this respect, the stitch lengths  28  are relatively long along rectilinear length portions  21  whereas they are relatively short along curved length portions  21   a.    
     By placing the yarns  20  in position by the embroidery process, it will be appreciated that the sewing of each single series of stitches  27  locates in place two yarns  20 . Accordingly, prior to encasing the yarns  20  within the binding yarns  30 , it will be appreciated that more than one series of stitches  27  may be created so that more than one pair of upper and lower yarns  20   a,    20   b  are located inbetween each pair of stitch lengths  35 . 
     In the example illustrated in  FIGS. 2 to 5 , only one series of stitches  31 , i.e. the series Fs of stitches, is shown as extending across the load bearing yarns  20 . It will be appreciated that additional series of stitches of binding yarns  30  may be provided so that the load bearing yarns  20  are encapsulated between more than one series of stitches. 
     As indicated in  FIG. 1 , the body  10  includes an anchorage portion ST for attachment to an anatomical body part defined by soft tissue such as muscle. 
     The anchorage portion ST of the present invention is preferably defined by a planar areal portion of stretch resistive fabric formed by said binding and load bearing yarns. 
     In the anchorage portion ST, the binding yarns  30  are preferably sewn together to define the mesh-like structure MS in which one series of stitches M, extend in one transverse direction across the load bearing yarn  20  and in which a second series of stitches M.sub. 2  extend in an opposite transverse direction across the load bearing yarn  20 . 
     The mesh-like structure formed by the binding yarns  30 , in effect defines a ground fabric structure which is relatively non-stretchable and through which the load bearing yarns  30  are constrained to pass along predefined pathways. 
     Preferably in the anchorage portion ST.sub. 1  the mesh-structure MS is open to promote tissue ingrowth such that the anchorage portion ST is able to be secured biologically to soft tissue. 
     In order to spread the load throughout portion ST.sub. 1  when the body  10  is placed under a tensile loading, the load bearing yarns  20  are laid along a circuitous route through the anchorage body portion ST such that at certain locations within the body the load bearing yarn  20  is looped relative to the load bearing direction LD to define opposed loops  22 ,  23 . Accordingly, when a load is applied in the load bearing direction LD, the load tends to tighten the loops  22 ,  23  in direction LD and attempts to pull opposed loops  22  and loops  23  toward one another. However, such movement is resisted by the mesh-structure MS due to the loops  22 ,  23  being trapped in the mesh-structure MS, and if provided, by the interaction of stitches  27  of the load bearing yarns  20  with the stitches  31 ,  32  of the mesh structure MS. 
     In use an anchoring thread, such as a suture thread is passed through the mesh-like structure MS and into the soft tissue to which it is to be connected. The suture thread will therefore pass through the open spaces OS in the mesh-like structure and will secure the mesh-like structure to the soft tissue. After tissue ingrowth, the mesh-like structure will also be biologically secured to the soft tissue. 
     Accordingly after securance of the mesh-like structure to the soft tissue, the mesh-like structure will resist movement of opposed loops  22 ,  23  toward one another and, due to the load bearing yarn  20  being constrained along a circuitous path across a relatively large areal portion, loads are dissipated over a relative large area to the soft tissue. 
     The body  10  illustrated in  FIG. 1  also includes an anchorage portion B which is intended to enable the body  10  to be anchored to a relatively hard anatomical body part such as bone by a fixing means such as a screw. 
     The anchorage portion B includes at least one aperture  18  and the arrangement shown in  FIG. 6  demonstrates how an aperture  18  may be formed for accommodating a fixing means such as a bone screw. 
     In  FIG. 6 , the tensile load bearing yarns  20  extend around the circumference of the aperture  18  and are held in position by a star shaped stitch formation  40 , preferably formed from binding yarns  30 . The star formation  40  is defined by successive stitches  41 , 42  which are spaced about the circumference of the aperture  18 . The stitches  41 , 42  are spaced apart to embrace one or more yarns  20 . The yarn portions  45  which extend between successive stitches  41 , 42  define reinforcement arms  44  which project radially outwardly from the aperture  18 . Accordingly when the prosthesis body is exposed to a tensile load, the yarn length portions  45  tend to be placed in tension to resist the applied load whilst maintaining anchorage of the yarns  20 . In  FIG. 6  the load bearing yarn  20  is illustrated as extending partly about the circumference of the aperture  18 . It is envisaged that the load bearing yarn  20  may extend continuously around the circumference of the aperture  18  for one or more turns. 
     As an addition or an alternative to placement of yarns  20  about the periphery of the aperture  18 , an additional reinforcement yarn  50  may be included as shown in  FIG. 7 . The reinforcement yarn  50  is placed so as to extend continually around the circumference of the aperture  18  for a desirable number of turns to define an annulus  51 . The annulus  51  defined by the yarn  50  is enclosed between successive stitches  41 , 42 . The annulus  50  assists in resisting deformation of the shape of the aperture  18  when tensile loads are applied. 
     Although the shape of the aperture in  FIGS. 6 and 7  is shown as circular, it will be appreciated that the same structural arrangement of the yarns may be adopted for forming apertures of any desirable shape, such as slot shaped. 
     In addition, if desired the aperture  18  may be closed by fabric, for instance a mesh-like fabric created by binding yarns  30 . 
     It will be appreciated that the aperture  18  constructed in accordance with  FIG. 6  or  7  may be formed in a mesh-like structure defined by binding yarns  30 . In such a case, the binding yarns defining the stitch formation  40  preferably interact with the binding yarns forming the mesh-like structure MS to anchor the stitch formation  40  to the mesh-like structure MS. 
     Optionally, as shown in  FIG. 1 , the body  10  may include a pull string or ribbon PS which is composed of the binding yarns  30  and load bearing yarns  20 . 
     The load bearing yarns  20  of the string or ribbon PS are connected with the remainder of the body  10 , preferably by forming a continuation of the load bearing yarns  20  passing through the remainder of the body  10 , such that tensile loads applied to the ribbon PS are transmitted through the body  10 . This is advantageous in that it enables a surgeon to attach a first anchorage portion (in the case of  FIG. 1  anchorage portion ST) and then pull on the ribbon PS to tension the body  10  whilst attaching the second anchorage portion B. This ensures that the load bearing yarns  20  extending between the anchorage portion ST and B are placed under a desired amount of tension. The ribbon PS may then be severed and removed. 
     Alternatively, the ribbon PS may provide the surgeon with an alternative or additional means for securing the body  10  to an anatomical body part by tying the ribbon PS to that part. 
     It will be appreciated that the binding yarns  30  and load bearing yarns  20  may be combined to create many different types of body  10  made up of various combinations of anchorage portions, fabric constructions and/or three dimensional shapes tailored for specific implant applications. 
     Described below, by way of example, are various specific embodiments. In  FIG. 8  there is shown a first embodiment which is a surgical implant suitable for the repair of the shoulder of a human being, intended to reinforce the natural, but damaged tissue. 
     The implant comprises a body  10  which is generally planar and includes a first discrete body portion  14 , a second discrete body portion  15  and a third discrete body portion  16 . 
     The first body portion  14  defines an anchorage body portion ST, comprising a mesh-like structure MS.sub. 1  formed from binding yarns  30  in which load bearing yarns  20  are trapped. The anchorage portion ST is intended to be sutured to the natural tendon material forming the rotator cuff of the shoulder. 
     The body portion  15  defines an anchorage body portion B and preferably includes three apertures  18  each of which enable a bone screw to pass therethrough for securing the body portion  15  to the humeral bone. Three apertures  18  are provided in order to provide alternative sites for the bone screw and/or provide a plurality of sites for enabling more than one bone screw to be used. 
     It will be appreciated that the number of apertures  18  may be less or more than three. The apertures  18  each have a structure based upon that described with reference to  FIGS. 6 and 7 . 
     The body portion  16  defines ribbon PS to enable the surgeon to pull the body  10  after attaching body portion  14  so as to apply tension prior to attaching body portion  15 . 
     After attachment of both body portions  14  and  15 , body portion  16  may be removed by severance from body portion  15 . 
     The body  10  is constructed using a plurality of yarns which are interconnected by sewn stitches. 
     The structure of the implant  10  is more clearly shown in  FIG. 9 . 
     The tensile load bearing yarn  20  is placed upon the base fabric (not shown) by stitches  27  being formed between upper and lower yarns  20   a,    20   b  at least at each point of change of direction for the yarn  20 . This provides long length portions  21  of yarn  20 . 
     Preferably as seen in  FIG. 9 , the yarn  20  runs continuously from the terminal end of body portion  14 , through body portion  15  and into body portion  16 . 
     Preferably the same yarn  20  (composed of one or more yarn ends which are either stitched together or laid-in) is placed along a circuitous route so as to pass continuously along body portions  14 ,  15  and  16  and to extend continuously across the area of body portion  14 . 
     Preferably as seen in  FIG. 8 , yarn  20  starts outside body  12  at point SP and finishes outside body  12  at point FP. 
     The yarn  20  is placed within body portion  15  so as to define a window  17  corresponding to the location of apertures  18 . 
     Annuli  51  of reinforcement yarn  50  are placed upon the yarn portions  21  of body portion  15  and star formations  40  are then placed so as to contain the spirals  51  and also the yarn portions  21 . 
     Finally binding yarns  30  are placed in position by creating successive stitches to form the mesh-like structure MS, which encase the tensile load bearing yarns  20  as described above. 
     A modified construction of the anchorage portion B for the first embodiment is illustrated in  FIGS. 10 ,  11 . 
     In  FIG. 10 , the load bearing yarn  20 , instead of extending to define an elongate window  17 , extend around the apertures  18  and are encased within star formations  40 . 
     The yarn  20  is laid along a pathway which, in effect, defines chain-links  28  (shown schematically in  FIG. 11 ) which are each joined about an aperture  18 . 
     The connection between the chain-links  28  ensures that loads applied in direction LD between the anchorage body portion ST and pulling ribbon PS are transmitted through body portion  15  without causing distortion. 
     Preferably the chain-links  28  are each self-supporting such that if one chain link  28  is severed, the load bearing capability of the next adjacent chain link  28  is unaffected. 
     This means, for example, after attachment of the anchorage portion B by insertion of a bone screw through aperture  18   b,  the body portion  15  may be severed along line S.sub.v to enable the surgeon to remove the pulling ribbon PS and the remaining portion of body portion  15  attached thereto. After severance along line S.sub.v, the chain-link  28   a  is still intact and so is able to transmit loads between aperture  18   b  and the anchorage portion ST. 
     Formation of each chain-link  28  is preferably achieved as illustrated schematically in  FIG. 11 . 
     A first chain-link  128  is formed by placing load bearing yarn  20  along a looped path as indicated by single arrows A.sub. 1  about a first pair of adjacent apertures  18   a,b . The shape of the looped path is determined by location of stitches  27  between upper and lower yarns  20   a,    20   b  and creates a relatively long rectilinear link portion  130  and a curved link portion  131  which extends approximately halfway about the circumference of aperture  18 . 
     The yarn  20  is looped for a desired number of turns, for example 6 turns, and then is looped along the next adjacent looped path as indicated by double arrow A.sub. 2  about a second pair of adjacent apertures  18   b,    18   c.  The process is then repeated to create the next chain-link  28 . 
     Preferably star formations  40  and/or annuli  51  are provided to reinforce each aperture  18 . 
     In  FIG. 12  a prosthesis  300  is illustrated which includes several anchorage apertures  18  which are inter-linked by chain-links  28  to provide a spread of loadings in several different directions. 
     In prosthesis  300 , apertures  18   a,    18   b  are interconnected by a chain-link  28   a.  Aperture  18   b  is inter-linked with two additional apertures  18   c,    18   d  by chain-links  28   b  and  28   c  respectively. 
     In  FIG. 13  a prosthesis  400  suitable for use as an anterior spinal plate is illustrated. 
     The prosthesis  400  includes six arms  401  each formed by a series of apertures  18  interconnected by chain-links  28 . The arms  401  radiate from three main fixation apertures  18   a ,  18   b  and  18   c.  These apertures  18   a,    18   b  and  18   c  are attached to the LS vertebra of a patient and the arms  401  are attached to the sacrum. Due to the multiplicity of arms  401  and the plurality of apertures  18  they contain, it is possible to obtain good anchorage on the complex, three dimensional shape of the sacrum. 
     Preferably, as shown in  FIG. 13 , the end aperture  18   d  of each of the outer pair of arms  401  is preferably interconnected by a link  28   a  to at least two of the apertures  18   a - 18   c  in order to provide a desired spread of loadings. 
     In  FIG. 14  there is illustrated a prosthesis  500  which is suitable for use as a spinal strap for securing together adjacent vertebrae in a spine. 
     The prosthesis  500  includes two apertures  18   a,    18   b  which are interconnected by a chain-link  28  formed by load bearing filament  20 . Load bearing filaments  20  are preferably also directed between the apertures  18   a,    18   b  to define diagonal portions  28   c.  The diagonal portions  28   c  enable the strap to be twisted without losing its load bearing efficiency. 
     Preferably the load bearing filaments  20  are encased within a mesh structure MS defined by binding yarns  30 . Preferably the central region MSd of the mesh structure is denser than the remainder of the mesh structure MS in order to resist the load bearing filaments cutting into the bone of the vertebrae of the spine. It is envisaged that the chain-link portions  28   a  which extend between apertures  18   a,    18   b  may be omitted such that apertures  18   a,    18   b  are interconnected by diagonal portions  28   c  only. 
     This is particularly advantageous if apertures  18   a  and  18   b  are not lying in the same two dimensional plane in that the diagonal links  18   c  facilitate an element of axial twist while maintaining overall tension between the apertures. 
     In  FIG. 15  there is shown a second embodiment  60  of the present invention which is a prosthesis having three anchorage body portions ST.sub. 1 , ST.sub. 2 , ST.sub. 3  defined by body portions  61 ,  62  and  63  each of which is designed to be attached to one of the three tendons of the rotator cuff. The body portions  61 ,  62  and  63  extend from an annular body portion  67  having a central hole  68 . The annular body portion is formed from an annulus  51  and a star formation  40 . The yarn  20  extends from each body portion  61 ,  62 ,  63  to be securely anchored by the star formation  40  and the binding yarns  30 . The body portions  61 ,  62  and  63  are generally of fan shape and the yarn portions  21  of the tensile load bearing yarn are preferably provided with intermediate loop portions  27  to provide substantially equal spacing between yarn portions  21  despite the fanning out of the yarn portions as the fan shaped body portion becomes wider. Each of the body portions  61 ,  62  and  63  is preferably constituted by said mesh-like structure MS and preferably has additional reinforcement yarns  66  running circumferentially to the central hole  68 . This additional reinforcement yarn  66  is intended to aid and assist the surgeon in placing the stitches to retain the wing of the implant to the tendon, and also indicate a site beyond which the device can be cut or trimmed to shape, the radially extending yarn portions  21  providing an extra strength area to minimise the possibility of any disintegration of the textile structure. 
     It will be appreciated that the region of the central hole  68 , through which fits the stem of a modular humeral head, is reinforced using an annulus  51  and star formation  40  and these in combination with the binding yarns  30  hold the tensile load bearing yarns  20  running out into the body portions  61 ,  62 ,  63 . This is desirable as the load bearing on the prosthesis  60  can be quite high in the first phase of the rehabilitation of the patient. 
     The embodiment  80  illustrated in  FIG. 16  is a multiple ligament reinforcement prosthesis. Prosthesis  80  includes three fan shaped anchorage body portions ST.sub. 1 , ST.sub. 2 , ST.sub. 3  defined by body portions  81 ,  82  and  83  which are joined together by a connecting body portion  84 . 
     The body portions  81 ,  82  and  83  are of a similar structure to body portions  61 ,  62 ,  63  described above with the exception that the reinforcement yarn  66  is replaced by a reinforcement yarn  86  which is placed by a succession of stitches  87  which define arcuate zig-zag formations  88  which serve to prevent the fabric fraying after a surgeon has cut inbetween the formations  88 . Preferably the yarn  86  has a contrasting colour to the other yarns in order to give the surgeon an easily recognisable guide for cutting. 
     Preferably the prosthesis  80  includes two arm portions  90  which form pulling ribbons PS connected to body portion  84 . Load bearing yarns  20  extend continuously through both arm portions  90  and the connecting body portion  84 . Arm portions  90  assist in the securing of the textile prosthesis to a metal prosthesis anchored within the bone of the patient. Optionally, additional ribbons  91  of similar structure to arms  90 , depend from the connecting body portion  84  for further assisting in the anchoring of the textile prosthesis around the metal prosthesis. 
     As illustrated in  FIG. 17  the prosthesis  80  may be modified to incorporate a pair of apertures  85  for enabling the prosthesis  80  to be connected to the metal prosthesis. 
     In this regard, a suitable metal prosthesis  300  is illustrated in  FIG. 18  which has a body  301  intended to be attached, by for example bone screws, to a bone of the patient. The body  301  includes a flange  303  which includes at least one bore  304  passing therethrough. 
     An anchor member  310  is provided which has a generally U-shaped body  311  which can be inserted through a bore  304  as illustrated. 
     The body  311  has two arms  312  which have hook formations  314  at their terminal ends. 
     The hook formations  314  are spaced apart by a distance corresponding to the distance between apertures  85  to thereby enable the prosthesis  80  to be attached to the anchor member  310  by inserting the hook formations  314  into apertures  85 . 
     As more clearly seen in  FIG. 20 , the load bearing yarns  20  extending through an arm portion  90  preferably loops around the nearest aperture  85 . This enables the arm portion  90  to directly transmit loads along the load bearing yarn  20  from the hook portion  314  passing through the aperture  85 . 
     Similarly, load bearing yarns  20  which extend through the central body portion  82  also loop around apertures  85  to enable loads to be directly transmitted from the hook formations  314  and in a direction along the length of the central body portion  82 . 
     Embodiment  100  illustrated in  FIG. 21  comprises a body  12  having two discrete anchorage body portions B.sub. 1 , B.sub. 2  defined by two body portions  101 ,  102  which are connected to one another only by tensile load bearing yarn length portions  21 . 
     The yarn  20  is secured within body portions  101 ,  102  by star formations  40  and binding yarns  30  which preferably form a mesh-like structure MS. The yarn lengths  21  cross over from right to left and left to right as they extend between the body portions  101 ,  102 . By suitable placement using the embroidery machine, each length portion  21  is of a predetermined length so that all length portions  21  have the same tensile load applied thereto when body portions  101 ,  102  are pulled part. This has the advantage that there will not be a cascade failure of one yarn length  21  breaking after another once a first one of the lengths  21  has broken. 
     Embodiment  110  illustrated in  FIG. 22  is a textile prosthesis in the shape of an ear. 
     The prosthesis  110  includes three apertures  18  for bone screws (not shown). Each of the apertures  18  are formed by an annulus  51  and star formation  40  as described above. 
     Tensile load bearing yarns  20  extend through the body of the prosthesis along a predetermined circuitous path in order to provide reinforcement at desired locations and provide desired shape and volume to the prosthesis. 
     The prosthesis  110  may be placed in a cell culture medium to allow tissue ingrowth into the textile fabric of the prosthesis before being placed in position adjacent to the head of the patient to allow further tissue ingrowth from the body of the patient. 
     Embodiment  120  illustrated in  FIGS. 23 ,  24  is an example of a prosthesis according to the invention which can be used as an automotive transfer device. 
     The automotive transfer device of  FIG. 23  is intended for generating movement about the elbow of a patient. The prosthesis includes a body  10  having a first discrete region  121 , a second discrete region  122  and a third discrete region  123 . 
     The first region  121  is defined by an anchorage body portion ST which is intended to be wrapped about and secured to the posterior deltoid muscle DM as shown schematically in  FIG. 23 . The anchorage portion ST is first secured by suturing and then biologically by tissue ingrowth. 
     The third discrete region  123  is secured to the lower arm, for example by a bone anchor or a screw. 
     In order to enable contractions of the posterior deltoid muscle to be translated into axial displacement of the third region  123 , it is necessary for the intermediate, second discrete region  122  to remain free to move axially relative to the tissue of the patient through which it passes (typically just underneath the patients&#39; skin) The second region  122  therefore includes a closed mesh-like structure MSc formed from binding yarns  30  which discourages tissue ingrowth. 
     In the above examples, when placing the tensile load bearing yarns  20 , or the binding yarn  30  or forming the annuli  51  or star formations  40 , the same type of yarn is used for both the sewing and looper heads of the embroidery machine. However, it will be appreciated that different yarns may be used in the sewing and looper head if desired. In addition, the yarn used for the tensile load bearing yarn  20  is preferably a polyester braided thread as used for sutures. Preferably the load bearing yarn  20  has a diametric size varying between 0.2 to 0.5 mm, more preferably is about 0.35 mm. Other types of yarn could also be used if desired, for example polypropylene, polyethylene, polyamide. 
     Instead of a yarn, other types of material made into filaments may be used, eg. wire of suitable metals such as a SMA (Shape Memory Alloy), aramid fibres, glass strands, etc. 
     In general, it is envisaged that any filament having the desired tensile load bearing capabilities and flexibility for bending to lie along a circuitous pathway may be used. 
     Preferably the yarn used for the binding yarns  30  is also a polyester braided thread. Preferably the binding yarn  30  has a diametric size varying between 0.1 to 0.2 mm. 
     It will be appreciated from the above that the present invention provides an improved method of placing fibres so as to manufacture textile prostheses, such as surgical implants (and other products), whereby the fabric structure of body portions of the prosthesis are stronger and/or have better integrity and/or have better load spreading characteristics and/or have better load concentration characteristics and/or exhibit less distortion around holes, and/or are stronger and/or distort less under load and/or creep less under load and/or have improved mesh characteristics to improve tissue ingrowth and/or have a structure intended to reduce tissue ingrowth. 
     Although the above embodiments are directed to textile prostheses which are primarily used for connecting parts of a body to one another, it is to be appreciated that the principles of the present invention may be used to create textile connector, in particular connectors, which can be used for connecting mechanical components together. The textile connector of the present invention may also form reinforcement for encapsulation within a matrix material, e.g. a synthetic resin, in order to form a composite component or may have elements that are encapsulated in a matrix material and elements that extend outside the matrix material, i.e. elements which are unconstrained.