Abstract:
A femoral stem  2  for artificial hip joint is provided that is capable of tightly fixing a greater trochanter and is suitable for treatment of transcervical fracture where it is necessary to fix the greater trochanter. The femoral stem  2  comprising: a stem member  20  including a distal part  21  of the stem member which is inserted in a medullary cavity of a femur and fixed therein and a proximal part  22  of the stem member which has a neck  26  for fixing an artificial head and is positioned at a proximal end of the distal part, the distal part and the proximal part being integrated or separable; a plate fixing portion  36  which is detachably attached at a top of the proximal part; and a greater trochanter plate  3  for depressing the greater trochanter  71 , the greater trochanter being fixed to the plate fixing portion  36  at a certain angle or fixed to the plate fixing portion so as to adjust an angle. Since the greater trochanter plate  3  is fixed onto the femoral stem  2  of the present invention, the greater trochanter is tightly fixing and thus the fixation can be stabilized. Furthermore, since the greater trochanter plate  3  is fixed at the top of the proximal part  22 , the greater trochanter plate  3  covers the top of the greater trochanter  71  when the greater trochanter  71  is fixed. Therefore upward displacement of the greater trochanter by a gluteus medius musculus can be effectively suppressed.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    The present invention relates to a femoral stem for artificial hip joint used in the treatment of transcervical fracture in the hip joint, and an artificial hip joint that includes the same, particularly to a femoral stem having a greater trochanter plate disposed at the top of the femoral stem and an artificial hip joint that includes the same. 
         [0003]    2. Description of the Related Art 
         [0004]    A femur of an elderly person is often weakened due to progressed osteoporosis. As a result, when the femur of the elderly person is subjected to an external force that is not normally experienced due to falling down or other incident, the femur may be broken in the neck of the proximal part of the fermur. Such a fracture is referred to as transcervical fracture. The transcervical fracture is classified into intracapsular fracture and extracapsular fracture by the position where the fracture occurs, whether it is inside or outside of the joint capsule. The intracapsular fracture and the extracapsular fracture require different methods of treatment. 
         [0005]    The extracapsular fracture is treated with a surgical operation that secures the head of femur and the femur by means of a internal fixation tool (CHS, nail, etc.) in anticipation of the coaptation of the bone. In case severing of the greater trochanter is involved, a treatment of securing the greater trochanter onto the femur is also carried out by using a greater trochanter plate. The greater trochanter plate is disposed on the outer surface of the greater trochanter and is fastened while being pressed toward the femur by means of a wire or the like, so that the greater trochanter is secured onto the femur. 
         [0006]    In the case of the intracapsular fracture, on the other hand, there is a possibility of blood vessel that serves the head of femur to have been cut off to cause necrosis of the head of femur, and therefore a surgery to replace the head of femur with artificial head of femur is carried out. The replacement surgery includes such a technique as the greater trochanter is once severed so as to remove the head of femur and replace it with a femoral stem having an artificial head of femur, and the greater trochanter that has been severed is secured at the original position (Chanley technique). The greater trochanter that has been severed is secured by using the greater trochanter plate, similarly to the case of the extracapsular fracture described above. 
         [0007]    The conventional greater trochanter plates that have been used include such forms that are called the plate or bone grip as disclosed in Japanese Unexamined Patent Publication (Kokai) No. 6-217992 and Japanese Unexamined Patent Publication (Kokai) No. 11-76280. These greater trochanter plates are both formed in such a configuration that fits to the curved exterior surface of the greater trochanter and has a plurality of through holes through which a cable is passed. These greater trochanter plates are used in such a way as the greater trochanter plate is disposed on the outside of the greater trochanter, a wire is passed through a through hole formed in the greater trochanter plate and through a hole, that has been formed in a lesser trocanter of the femur in advance, and is wound around the femur before being clamped. Thus the greater trochanter is secured onto the femur. 
         [0008]    Another form of the greater trochanter plate is disclosed in Japanese Unexamined Patent Publication (Kokai) No. 10-179605 that describes a holding member to be used together with a femoral stem that has an artificial head of femur. The holding member is fixed after inserting the femoral stem into the femur and securing it therein. The holding member has wires attached on both sides of the holding member. The holding member is disposed on the outer surface of the greater trochanter, and is secured by winding the wires on both sides around the femur. At this time, the wires cross the femoral stem and are guided in predetermined direction by notch formed in the femoral stem, so as to be wound around the femur and secured. 
         [0009]    The conventional treatment for extracapsular fracture is based on osteosynthesis. To achieve assimilation of a bone suffering from extracapsular fracture, firm fixation is an important factor as in the case of osteosynthesis for other part of the bone. The extracapsular fracture is divided into stable type and unstable type from the view point of the stability of reduction. In the stable type such as fracture in the horizontal plane, fixation can be achieved relatively satisfactorily, and therefore it is permitted to apply a load to the fractured bone in the early state in the case of some surgical techniques. However, post-surgery recovery may often be not satisfactory in elderly patients who have weakened bones. In the unstable type such as comminuted fracture of proximal femur accompanied by the fracture of the greater trochanter and/or lesser trocanter, it is very difficult to fix and therefore the fractured part must be relieved of load over a long period of time in order to prevent the bone from suffering dislocation again under load. With such a background, it is difficult for the patient to leave the sickbed and start walking in the early stage after surgery for the treatment of transcervical fracture, and there is little hope of keeping dementia from progressing and improving the QOL (quality of life). Thus the present-day requirements in the medical field are not yet satisfied. 
         [0010]    In the treatment of extracapsular fracture and intracapsular fracture that require it to fix the greater trochanter, the greater trochanter plate is secured onto the femur with wire thereby holding the greater trochanter on the outside of the femur. Since the holding force is applied in the horizontal direction, it is difficult to offset the force of the gluteus medius musculus that adheres to the greater trochanter and pulls up the greater trochanter. As a result, when the gluteus medius musculus repetitively pulls up the greater trochanter, the greater trochanter plate cannot resist the force of the gluteus medius musculus to pull up the greater trochanter and eventually it becomes impossible to secure the greater trochanter at a predetermined position of the femur thus allowing the greater trochanter to be displaced upward. Furthermore, there has been a possibility of the wire to break, thus making it necessary to do additional surgery. 
         [0011]    The greater trochanter plate disclosed in Japanese Unexamined Patent Publication (Kokai) No. 6-217992 and Japanese Unexamined Patent Publication (Kokai) No. 11-76280 are secured by forming a through hole for passing wire in the lesser trocanter of the femur. However, many of the patients who suffer from fracture in head of femur are elderly people with weak bones. Boring a hole in the femur of such an old patient often causes a secondary fracture. 
       SUMMARY OF THE INVENTION 
       [0012]    Accordingly, an object of the present invention is to provide a femoral stem for artificial hip joint that is capable of firmly secure the greater trochanter and is suitable for treatment of transcervical fracture that requires it to fix the greater trochanter, and an artificial hip joint that includes the same. 
         [0013]    A femoral stem of the present invention comprises a stem member including a distal part of the stem member which is inserted in a medullary cavity of a femur and fixed therein and a proximal part of the stem member which has a neck for fixing an artificial head and is positioned at a proximal end of the distal part, the distal part and the proximal part being integrated or separable, a plate fixing portion which is detachably attached at a top of the proximal part, and a greater trochanter plate for depressing a greater trochanter, the greater trochanter being fixed to the plate fixing portion at a certain angle or fixed to the plate fixing portion so as to adjust an angle. 
         [0014]    An artificial hip joint of the present invention comprises a femoral stem including a stem member including a distal part of the stem member which is inserted and fixed in the medullary cavity of a femur and a proximal part of the stem member which has a neck for fixing an artificial head and is positioned at a proximal end of the distal part, the distal part and the proximal part being integrated or separable, a plate fixing portion which is detachably attached at a top of the proximal part, and a greater trochanter plate for depressing a greater trochanter, the greater trochanter being fixed to the plate fixing portion at a certain angle or fixed to the plate fixing portion so as to adjust an angle; 
         [0015]    the artificial head fixing to the neck of the proximal part; and 
         [0016]    a cup which is fixed in an acetabulum of a pelvis and receiving the artificial head so as to compose a hip joint. 
         [0017]    In the artificial hip joint and the femoral stem of the present invention, since the greater trochanter plate is secured onto a femoral stem via the plate fixing portion, the greater trochanter can be secured more firmly, and more stable fixation can be achieved than in the prior art case where the greater trochanter plate is secured by wires only. Moreover, since the greater trochanter plate is secured at the top of the proximal part of the stem member, the greater trochanter plate covers the top of the greater trochanter when securing the greater trochanter, so that the greater trochanter can be effectively prevented from being displaced upward by the gluteus medius musculus. 
         [0018]    The artificial hip joint and the femoral stem of the present invention are designed on the assumption that the proximal part of a femur including the head of femur is excised and is replaced by an artificial head of femur. As a result, the present invention makes it unnecessary to have a period of forced rest for the preservation of the head of femur, or reduce the period far shorter than in the case of osteosynthesis. Also because the greater trochanter plate has a high strength of securing, it allows the patient to leave the sickbed and start walking before the greater trochanter that has been severed coapts. Thus the femoral stem of the present invention is capable of shortening the load-relieved period for the hip joint and enables the patient to leave the sickbed and start walking in the early stage. 
         [0019]    The artificial hip joint and the femoral stem of the present invention can be used in the reworking replacement surgery for intracapsular fracture and extracapsular fracture of the neck of femur and one accompanied by a defect in the proximal part of femur. The artificial hip joint and the femoral stem are particularly suited to transcervical fracture that requires it to fix the greater trochanter. The femoral stem of module construction where the proximal part of the stem member and the distal part of the stem member can be separated allows it to choose the distal part of the stem member in accordance to the patient&#39;s condition, and is suited to the reworking replacement surgery. 
         [0020]    It is the that, in general it is better to preserve the head of femur when treating the extracapsular fracture, and replacement with an artificial head of femur has not been practiced. However, from the view point of maintaining the comprehensive health and QOL of the patient, for example when the need to leave the sickbed and start walking in the early stage is taken into consideration for the purpose of preventing dementia from proceeding, measures for improving the post-surgery health including the replacement with an artificial head of femur should be sought after. When such a stance is taken, the present invention is suited also for the treatment of extracapsular fracture. 
         [0021]    The femoral stem of the present invention is most suitable for treating extracapsular fracture accompanied by the fracture of greater trochanter and the reworking replacement surgery for a case that involves a defect in the proximal part of femur. As for intracapsular fracture, the stem of the present invention provided with the greater trochanter plate is useful for manipulation that involves severing of the greater trochanter during surgery. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0022]      FIG. 1  is a perspective view of a femoral stem according to first embodiment of the present invention. 
           [0023]      FIG. 2  is an exploded perspective view of the femoral stem according to the first embodiment of the present invention. 
           [0024]      FIG. 3  is a perspective view of a femoral stem according to second embodiment of the present invention. 
           [0025]      FIG. 4  is an exploded perspective view of the femoral stem according to the second embodiment of the present invention. 
           [0026]      FIG. 5  is a perspective view of a femoral stem according to a modification of the present invention. 
           [0027]      FIG. 6  is a perspective view of a femoral stem according to third embodiment of the present invention. 
           [0028]      FIG. 7  is a side view of the femoral stem according to the third embodiment of the present invention as viewed from the outside. 
           [0029]      FIG. 8  is a partial sectional view showing a common artificial hip joint secured in a hip joint. 
       
    
    
     BRIEF DESCRIPTION OF REFERENCE NUMERALS 
       [0000]    
       
           1  Artificial hip joint 
           2  Femoral stem 
           21  Distal part of the stem member 
           22  Proximal part of the stem member 
           23  Top of proximal part of the stem member 
           24  Wire inserting opening of proximal part of the stem member 
           26  Neck 
           3  Greater trochanter plate of connected link members type 
           31 ,  32  Link members of greater trochanter plate 
           33  Through hole 
           34  Screw 
           36  Plate fixing portion (linkage means) 
           39  Clearance 
           4  Greater trochanter plate of integral construction 
           44  Claw 
           45  Plate setting screw 
           46  Plate fixing portion (linkage means) 
           49  Clearance 
           50  Rotation preventing ridge 
           51  Subsidence preventing ridge 
           6  Wire 
           63  Plate fixing portion (linkage means) 
           66  Auxiliary plate 
           67  Through hole of auxiliary plate 
           7  Femur 
           71  Greater trochanter 
           81  Artificial head of femur 
           91  Artificial hip joint 
       
     
       DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0058]    An artificial hip joint  1  is constituted roughly from a femoral stem  2  secured onto a femur  7 , an artificial head of femur  81  secured onto the tip on proximal side of the femoral stem  2  and a cup  91  secured onto an acetabulum of hip bone  94  of pelvis, as shown in  FIG. 8 . A head of femur articular surface  82  on the surface of the artificial head of femur  81  makes slidable contact with a cup articular surface  92  inside of a recess of the cup  81  so as to constitute a joint section. 
         [0059]    The articular surface  82  of the artificial head of femur  81  is finished to be very smooth. The artificial head of femur  81  is attached to the distal end of a neck  26  formed in a proximal part of the stem member  22  of the femoral stem  2 . The artificial head of femur  81  is formed in a ball shape that is partially cut away, and is made of a metal having high biocompatibility such as cobalt-chrome alloy or a ceramic material such as alumina or zirconia. 
         [0060]    The cup  91  is formed in a hollow semi-spherical shape from an ultra-high molecular weight polyethylene (UHMWPE). The articular surface  92  of the femoral stem  2  is an inner surface of hollow space that receives the artificial head of femur  81  freely rotatably and is finished smoothly as the articular surface  82  of the artificial head of femur  81 . 
         [0061]    The femoral stem  2  of the present invention can be used either individually or together with the cup  91 . For example, for a patient who has both the acetabulum of hip bone and the head of femur damaged by a disease such as rheumatism, a combination of the cup  91  and the femoral stem  2  may be used, while only the femoral stem  2  may be used for a patient whose acetabulum of hip bone is kept in a healthy state such as a case of transcervical fracture. 
       First Embodiment 
       [0062]    The femoral stem  2  of this embodiment is constituted from a stem member  20  secured onto the femur  7 , a linkage means  36  mounted at the top of the stem member  20 , and the greater trochanter plate  3  secured on the stem member  20  via the linkage means  36 , as shown in  FIG. 1 . 
         [0063]    The stem member  20  is constituted from a distal part of the stem member  21  inserted and secured in the medullary cavity of the femur  7 , and a proximal part of the stem member  22  that has a neck  26  whereon the artificial head of femur  82  is mounted and is secured at the proximal end of the distal part of the stem member  21 , which are separably combined. 
         [0064]    The linkage means  36  is a plate fixing portion for securing the greater trochanter plate  3  at the top  23  of the proximal part of the stem member  22 . The linkage means  36  can be removed from the proximal part of the stem member  22 , and can also be used as a femoral stem that does not use the greater trochanter plate. 
         [0065]    The linkage means  36  and the greater trochanter plate  3  are fastened to each other by means of a plate setting screw  35 . The angle between the greater trochanter plate  3  and the stem member can be adjusted while the plate setting screw  35  is loosened. The greater trochanter plate  3  and the stem member can be fastened to each other by tightening the plate setting screw  35 . Thus the femoral stem  2  of this embodiment allows it to freely adjust the angle of securing the greater trochanter plate  3  in accordance to the dimension and shape of the greater trochanter  71 . 
         [0066]    The greater trochanter plate  3  is composed by linking a plurality of link members  31 ,  32 ,  32  in a band shape, and at least one of the link members  31 ,  32 ,  32  has a through hole  33  for passing a wire  6 . The proximal part of the stem member  22  also has an opening  24  for inserting a wire  6  therethrough. 
         [0067]    By constituting the greater trochanter plate  3  from a plurality of link members  31 ,  32 ,  32 , it is made possible to adjust the dimensions of the greater trochanter plate  3  to match the size of the greater trochanter  71  by adjusting the number of link members. Also it is made possible to adapt the greater trochanter plate  3  to the external shape of the greater trochanter  71  by changing the extent of bend of the joint between the link members. 
         [0068]    The link members have different shapes between the link member  31  that is secured onto the proximal part of the stem member  22  and the other link members  32 . The link member  31  has a clearance  39  for passing the tendon of the gluteus medius musculus. 
         [0069]    The link members  31 ,  32 ,  32  may have spinal protrusions  38  on the front surfaces which contact the greater trochanter  71 . The spinal protrusions  38  exert frictional force on the surface of the greater trochanter  71  so as to restrict sliding when the greater trochanter  71  is held by the greater trochanter plate  3 . 
         [0070]    The stem member  20  is constituted by assembling the distal part of the stem member  21  and the proximal part of the stem member  22  which are prepared separately, as shown in  FIG. 2 . 
         [0071]    The proximal part of the stem member  22  has a though hole, so as to assemble the distal part of the stem member  21  and the proximal part of the stem member  22  into an integral piece by inserting the top end of the distal part of the stem member  21  into the bottom end of the through hole and inserting a distal bolt into the top end of the through hole and fastening these members by screwing in the through hole. 
         [0072]    The stem member  20  of the modular construction as described above has such an advantage as the distal part of the stem member  21  and the proximal part of the stem member  22  can be selected in accordance to the patient&#39;s condition. The stem member  20  of the modular construction is particularly advantageous for reworking replacement surgery in which the femoral stem is fixed again in a patient whose femoral stem has been removed. Selectively using the distal part of the stem member  21  makes it easier to assemble a femoral stem that is longer than the femoral stem previously used. This makes it possible to provide the femoral stem  2  suited to various cases of disease while reducing the number of component parts to be kept in the inventory. 
         [0073]    The femoral stem  2  of this embodiment also has such a feature that the base portion  29  of the neck  26  is formed larger than that of the femoral stem of the prior art. This configuration can be preferably used in the reworking replacement surgery. In a patient who requires reworking replacement surgery because of slackness and subsidence of the femoral stem  2 , partial or total defect is often found in the medial side of the proximal part of femur. In addition, the medullary cavity of the femur is enlarged and the cortical bone is thinned. It is difficult to prevent the stem from rotating relative to the femur and achieve compatibility in the proximal part of femur by using the conventional femoral stem in such a state of femur. With the femoral stem  2  of the present invention, in contrast, high level of compatibility can be achieved by selecting and assembling the distal part of the stem member  21  and the proximal part of the stem member  22  that match the medullary cavities in the distal part and proximal part of the femur  7 . Accordingly, it is made possible to achieve stability and rotation resistance of the femoral stem  2 . 
         [0074]    The femoral stem  2  of this embodiment further comprises rotation preventing ridges  50  that extend in the longitudinal direction and are provided before and behind the proximal part of the stem member  22  of the femoral stem  2 , which are capable of effectively preventing the femoral stem from rotating in the femur. 
         [0075]    The femoral stem  2  has such a configuration as a base  29  of the neck of the proximal part of the stem member  22  is formed to be larger and a subsidence preventing ridge  51  is formed to extend laterally below the base portion  29 . This configuration enables the femur that is significantly thinned on the inside of the proximal part to bear the load. As a result, the femoral stem  2  is prevented from subsiding in the femur  7  when the femoral stem  2  is loaded, thus achieving improved supporting capability of the femoral stem  2 . 
         [0076]    While the femoral stem of this embodiment has modular construction that combines the distal part of the stem member  21  and the proximal part of the stem member  22  of various dimensions, an integral femoral stem constituted from the distal part of the stem member  21  and the proximal part of the stem member  22  that are integrally formed may also be used in the present invention. 
         [0077]    A cylindrical bolt  28  is inserted and secured in the hole of the proximal part of the stem member  22 , and a linkage means  36  is secured at the top end of the cylindrical bolt  28  for connecting the proximal part of the stem member  22  and the greater trochanter plate  3 . One end of the greater trochanter plate  3  is fixed at the linkage means  36  by the plate setting screw  35 . 
         [0078]    In this embodiment, connection of the proximal part of the stem member  22  and the greater trochanter plate  3  is achieved by using the cylindrical bolt  28  and the linkage means  36  which are fastened by means of the plate setting screw  34 , although other internal fixation tools and fastening method may also be employed. 
         [0079]    In a surgery to secure the femoral stem  2  onto the femur  7 , the distal part of the stem member  21 , the proximal part of the stem member  22  and the greater trochanter plate  3  are prepared all in the assembled state, and the distal part of the stem member  21  is inserted into the medullary cavity through the distal part of the femur  7  that has been subjected to osteotomy. Then the extent of bending in the linkage section of the link members  31 ,  32 ,  32  is adjusted so that the greater trochanter plate  3  is adapted to the external shape of the greater trochanter  71 . Last, the greater trochanter is firmly clamped by the greater trochanter plate  3 . 
         [0080]    The greater trochanter plate  3  is preferably secured onto the femur  7  by passing the wire  6  through the through hole  33  formed in the link member  32 , as shown in  FIG. 1 . This is because, in case the plurality of link members  31 ,  32 ,  32  of the greater trochanter plate  3  are connected to each other by means of pins or the like, either the linkage between the link members is free to swing or the link members are connected with a weak force and therefore the greater trochanter  71  cannot be fastened with the greater trochanter plate  3  only. It is made possible to secure the greater trochanter  71  at the predetermined position of the femur  7  by means of the greater trochanter plate  3 , by passing the wire  6 , that is passed through the link member  31 , through the opening  24  of the proximal part of the stem member and winding the wire around the femur. 
         [0081]    Thus, the one end of the greater trochanter plate  3  is secured onto the top  23  of the proximal part of the stem member  22  by means of the plate setting screw  35 , the intermediate portion or the other end of the greater trochanter plate  3  is secured onto the opening  24  of the proximal part of the stem member  22  by the wire  6 . Therefore, the force applied to hold the greater trochanter  71  is distributed among the plate setting screw  35  and the wire  6 . As a result, the wire  6  is subjected to a weaker load than in the case of the conventional greater trochanter plate, so that the wire  6  is less likely to be elongated or broken. Also because the greater trochanter plate  3  is located also on top of the greater trochanter  71 , the greater trochanter  71  can be effectively prevented from being pulled up by the gluteus medius musculus. 
         [0082]    In the greater trochanter plate  3  constituted by linking the link members, it is also preferable that the link members can be temporarily fastened with each other after placing the greater trochanter  71  at the predetermined position. In this embodiment, the link member  32  can be fastened to the adjacent link members  32  by means of the screw  34 , and the assembly can be temporarily fixed in such a form that is adapted to the external shape of the greater trochanter. This makes it possible to prevent the link members from moving and thereby causing the greater trochanter plate to be displaced, during the period from the time when the greater trochanter plate  3  is disposed on the outside of the greater trochanter to the time when it is secured by the wire  6 , even when the linkage between the link members of the greater trochanter plate  3  is free to swing or the link members are connected with a weak force. 
         [0083]    The greater trochanter plate  3  attached to the femoral stem  2  of the present invention is similar to the conventional greater trochanter plate  3  in that the greater trochanter  71  is pressed inwardly into close contact with the femur, but is significantly different in the capability to depress the top of the greater trochanter  71 . When treating the greater trochanter  71  that has been severed, the greater trochanter  71  is likely to be displaced upward before healing since the greater trochanter  71  is repetitively pulled up by the gluteus medius musculus that is attached to the greater trochanter  71 . According to the present invention, however, the greater trochanter  71  is effectively suppressed upward displacement by depressing the top of the greater trochanter  71  and therefore the greater trochanter  71  that has been severed can be reliably secured at the predetermined position of the femur. 
         [0084]    The artificial hip joint  1  including the femoral stem  2  of the present invention is capable of firmly securing the greater trochanter  71  by mechanical means without need for boring a hole in the femur. As a result, the hip joint can be loaded within several days after the replacement surgery, thus enabling the patient to leave the sickbed and start walking in the early stage. 
       Second Embodiment 
       [0085]    The femoral stem  2  of this embodiment comprises a stem member  20  to be secured onto the femur  7 , a linkage means  46  attached to the top of the stem member  20 , and a greater trochanter plate  4  secured onto the stem member  20  via the linkage means  46 , as shown in  FIG. 3 . 
         [0086]    The stem member  20  is constituted from the distal part of the stem member  21  inserted and secured in the medullary cavity of the femur  7  and the proximal part of the stem member  22  that has the neck  26  whereon the artificial head of femur  82  is to bed attached and is secured at the proximal end of the distal part of the stem member  21 , which are separably combined. 
         [0087]    The linkage means  46  is a plate fixing portion for securing the greater trochanter plate  4  on the top  23  of the proximal part  22 . The linkage means  46  can be removed from the proximal part of the stem member  22 , and may also be used as a femoral stem that does not employ the greater trochanter plate. 
         [0088]    The linkage means  46  and the greater trochanter plate  4  are fastened by the plate setting screw  45 . The angle between the greater trochanter plate  3  and the stem member can be adjusted while the plate setting screw  45  is loosened. The greater trochanter plate  3  and the stem member can be fastened to each other by tightening the plate setting screw  45 . Thus the femoral stem  2  of this embodiment allows it to freely adjust the angle of securing the greater trochanter plate  4  in accordance to the dimension and shape of the greater trochanter  71 . 
         [0089]    The greater trochanter plate  4  is an integral plate member which has such dimensions and shape that the plate can be covered an outer surface of the greater trochanter. The greater trochanter plate  4  can be replaced by loosening the plate setting screw  45 , so as to select the greater trochanter plate  4  that matches the dimensions and shape of the greater trochanter  71  of the patient. 
         [0090]    One end of the greater trochanter plate  4  is secured onto the femoral stem  2 , and has a clearance  49  formed in the vicinity of the one end through which the tendon of the gluteus medius musculus bonding to the greater trochanter is passed. A claw  44  is preferably formed below the clearance  49  for hooking on the tendon of the gluteus medius musculus. The claw  44  makes the greater trochanter plate  4  less likely to move relative to the greater trochanter  71 , so as to stably secure the greater trochanter  71 . 
         [0091]    Spinal protrusions  48  may also be formed on the front surface of the greater trochanter plate  4  which contacts the greater trochanter  71 . The spinal protrusions  48  exert frictional force on the surface of the greater trochanter  71  so as to restrict sliding when the greater trochanter  71  is held by the greater trochanter plate  4 . 
         [0092]    The stem member  20  is constituted by assembling the distal part of the stem member  21  and the proximal part of the stem member  22  which are prepared separately, as shown in  FIG. 4 . The proximal part of the stem member  22  has a through hole, so as to assemble the distal part of the stem member  21  and the proximal part of the stem member  22  into an integral piece by inserting the top end of the distal part of the stem member  21  into the bottom end of the through hole and inserting a distal bolt into the top end of the through hole and fastening these members by screwing in the through hole. 
         [0093]    The stem member  20  of the modular construction as described above has such an advantage as the distal part of the stem member  21  and the proximal part of the stem member  22  can be selected in accordance to the patient&#39;s condition. The stem member  20  of the modular construction is particularly advantageous for reworking replacement surgery in which the femoral stem is fixed again in a patient whose femoral stem has been removed. Selectively using the distal part of the stem member  21  makes it easier to assemble a femoral stem that is longer than the femoral stem previously used. This makes it possible to provide the femoral stem  2  suited to various cases of disease while reducing the number of component parts to be kept in the inventory. 
         [0094]    The femoral stem  2  of this embodiment has also such a feature that has the base portion  29  of the neck  26  being formed larger than that of the femoral stem of the prior art. This configuration can be preferably used in the reworking replacement surgery. In a patient who requires reworking replacement surgery because of slackness and subsidence of the femoral stem  2 , partial or total defect is often found on the inner side of the proximal part of femur. In addition, the medullary cavity of the femur is enlarged and the cortical bone is thinned. It is difficult to prevent the stem from rotating relative to the femur and achieve compatibility in the proximal part of femur in such a state of the femur by using the conventional femoral stem. With the femoral stem  2  of the present invention, in contrast, high level of compatibility can be achieved by selecting and assembling the distal part of the stem member  21  and the proximal part of the stem member  22  that match the medullary cavity in the distal part and the proximal part of the femur  7 . Accordingly, it is made possible to achieve stability and rotation resistance of the femoral stem  2 . 
         [0095]    The femoral stem  2  of this embodiment further comprises the rotation preventing ridge  50  that are provided before and behind the proximal part of the stem member  22  of the femoral stem  2  to extend in the longitudinal direction, which are capable of effectively preventing the femoral stem from rotating in the femur. 
         [0096]    The femoral stem  2  has such a configuration as a base  29  of the neck of the proximal part of the stem member  22  is formed to be larger and a subsidence preventing ridge  51  is formed to extend laterally below the base portion  29 . This configuration enables even the femur that is significantly thinned on the inside of the proximal part to bear the load. As a result, the femoral stem  2  is prevented from subsiding in the femur  7  when the femoral stem  2  is loaded, thus achieving improved supporting capability of the femoral stem  2 . 
         [0097]    While the femoral stem of this embodiment has modular construction that combines the distal part of the stem member  21  and the proximal part of the stem member  22  of various dimensions, a femoral stem of integral type constituted from the distal part of the stem member  21  and the proximal part of the stem member  22  that are integrally formed may also be used in the present invention. 
         [0098]    The linkage means  46  is inserted and secured in the hole of the proximal part of the stem member  22 , and the top end of the greater trochanter  4  is secured by the plate setting screw  45  onto the fitting member  47  that protrudes on the side face of the linkage means  46 . 
         [0099]    The femoral stem has high strength because of the integral construction of the greater trochanter plate  4 , and is therefore capable of securing the greater trochanter  71  without using a wire. In this case, connection between the linkage means  46  and the greater trochanter plate  4  must be strong enough to resist the tension of the gluteus medius musculus. In order to achieve such a strong fastening, mechanical fitting by means of tapered configuration is employed in this embodiment. When a cylindrical inserted portion of the plate setting screw  45  is formed in a tapered shape, and the inside of a mating portion  47  is formed as a hole having the dimension and shape that match those of the inserted portion, a strong fitting that can endure a tension exceeding 160 kg can be achieved. Instead of taper fitting, other fitting method may be also employed such as screwing or other mechanical fitting method or chemical securing method using an adhesive or the like. 
         [0100]    In a surgery to secure the femoral stem  2  onto the femur  7 , the distal part of the stem member  21  and the proximal part of the stem member  22  are assembled and the greater trochanter plate  4  is temporarily secured rotatably in the proximal part of the stem member  22  in advance. Then the distal part of the stem member  21  is inserted into the medullary cavity through the distal part of the femur  7  that has been subjected to osteotomy. Then fine adjustment is made on the angle of linkage so that the greater trochanter plate  4  is adapted to the external shape of the greater trochanter  71 . Last, the greater trochanter is firmly clamped by taper fitting of the greater trochanter plate  4  into the proximal part of the stem member  22 . 
         [0101]    The greater trochanter plate  4  may also have a through hole  43  for passing a wire. Similarly to the first embodiment, the wire  6  passed through the through hole  43  of the greater trochanter plate  4  can be passed through the opening  24  of the proximal part of the stem member and wound around the femur. With this constitution, since the securing force of the wire is added to the securing force of the taper fitting, stable fastening can be achieved even when the patient is heavy in weight or the gluteus medius musculus exerts a high tension. 
         [0102]    Since the top end of the greater trochanter plate  4  is firmly secured by the plate setting screw  45  on the top  23  of the proximal part of the stem member  22 , there is no need to use a wire. Even when a wire is used for an auxiliary purpose, most of the load applied for holding the greater trochanter  71  is borne by the plate setting screw  45 , and therefore the wire  6  is subjected to a weaker load and the wire  6  is less likely to elongate or break. Also because the greater trochanter plate  4  is located also on top of the greater trochanter  71 , the greater trochanter  71  can be effectively prevented from being pulled up by the gluteus medius musculus. 
         [0103]    While the greater trochanter plate  4  attached to the femoral stem  2  of the present invention is similar to the conventional greater trochanter plate in that the greater trochanter  71  is pressed inwardly into close contact with the femur, it is significantly different in that the greater trochanter plate  4  holds the top of the greater trochanter  71 . When treating the greater trochanter  71  that has been severed, the greater trochanter is likely to be displaced upward before healing, since the greater trochanter  71  is repetitively pulled up by the gluteus medius musculus that is attached to the greater trochanter  71 . According to the present invention, however, the greater trochanter  71  is effectively suppressed from being pulled up, as the greater trochanter  71  is held by pressing on top of the greater trochanter  71 , and therefore the greater trochanter  71  that has been severed can be reliably secured at the predetermined position of the femur. 
         [0104]    The artificial hip joint  1  including the femoral stem  2  of the present invention is capable of firmly securing the greater trochanter  71  by mechanical means without need for boring a hole in the femur. As a result, the hip joint can be loaded within several days after the replacement surgery, thus enabling the patient to leave the sickbed and start walking in the early stage. 
       Modification 1 
       [0105]    A modification of the present invention shown in  FIG. 5  has such a constitution as the greater trochanter plate  4  of integral construction is disposed rotatably via a linkage means  63  on the proximal part of the stem member  2  of the femoral stem  2 . 
         [0106]    The linkage means  63  secured on the proximal part of the stem member  2  has a bearing section  61  that receives a shaft  62  that is formed at the top of the greater trochanter plate  4 . Since the shaft  61  and the bearing section  62  can rotate relative to each other, the greater trochanter plate  4  is secured onto the greater trochanter by passing a wire through the through hole  43  formed for passing wire. 
         [0107]    This modification, with a simple structure of connection between the greater trochanter plate  4  and the linkage means  63 , enables a significant cost reduction for the femoral stem. 
         [0108]    It is also preferable to provide wings  64  that extend laterally so as to enclose the outside of the greater trochanter as shown in  FIG. 5 , since this configuration makes the greater trochanter less likely to be displaced laterally. 
       Third Embodiment 
       [0109]    The femoral stem  2  of this embodiment comprises the stem member  20  fixed in the femur  7 , the linkage means  46  attached on top of the stem member  20 , the greater trochanter plate  4  fixed to the stem member  20  via the linkage means  46 , and at least two auxiliary plates  66  which extend from the proximal part of the stem member  22  to the right side and left side of a lower part of the greater trochanter, as shown in  FIG. 6 . The greater trochanter plate  4  and the auxiliary plates have through holes  43 ,  67 , respectively, for passing a wire. 
         [0110]    The stem member  20  is constituted from the distal part of the stem member  21  inserted and secured in the medullary cavity of the femur  7 , and the proximal part of the stem member  22  that has the neck  26  whereon the artificial head of femur  82  is to be mounted and is secured at the proximal end of the distal part of the stem member  21 , which are separably combined. 
         [0111]    The linkage means  46  is a plate fixing portion for securing the greater trochanter plate  4  at the top of the proximal part of the stem member  22 . The linkage means  46  can be removed from the proximal part of the stem member  22 , and can also be used as a femoral stem that does not use the greater trochanter plate. 
         [0112]    The greater trochanter plate  4  is constituted from an integral plate component formed with such dimensions and shape that cover the top surface of the greater trochanter, and is formed integrally with the linkage means  46 . Therefore, in case the size of the greater trochanter plate  4  or the angle between the greater trochanter plate  4  and the stem member  20  do not match the shape of the patient&#39;s greater trochanter, the linkage means  46  may be removed from the proximal part of the stem member  22  so as to replace the greater trochanter plate  4  and the linkage means  46  with those of more fitting size and shape. 
         [0113]    In this embodiment, the stem member  20  is constituted by assembling the distal part of the stem member  21  and the proximal part of the stem member  22  which are prepared separately, similarly to the first and second embodiments. The proximal part of the stem member  22  has a through hole, so as to assemble the distal part of the stem member  21  and the proximal part of the stem member  22  into an integral piece by inserting the top end of the distal part of the stem member  21  into the bottom end of the through hole and inserting a distal bolt into the top end of the through hole and fastening these members together by screwing within the through hole. 
         [0114]    The stem member  20  of the modular construction as described above has such an advantage as the distal part of the stem member  21  and the proximal part of the stem member  22  can be selected in accordance to the patient&#39;s condition. The stem member  20  of the modular construction is particularly advantageous for reworking replacement surgery in which the femoral stem is fixed again in a patient whose femoral stem has been removed. Selectively using the proper distal part of the stem member  21  makes it easier to assemble a femoral stem that is longer than the femoral stem previously used. This makes it possible to provide the femoral stem  2  suited to various cases of disease while reducing the number of component parts to be kept in the inventory. 
         [0115]    The femoral stem  2  of this embodiment also has such a feature that the base portion  29  of the neck  26  is formed larger than that of the femoral stem of the prior art. This configuration can be preferably used in a reworking replacement surgery. In a patient who requires the reworking replacement surgery because of slackness and subsidence of the femoral stem  2 , partial or total defect is often found on the inside of the proximal part of femur. In addition, the medullary cavity of the femur is enlarged and the cortical bone is thinned. It is difficult to prevent the stem from rotating relative to the femur and achieve compatibility in the proximal part of femur by using the conventional femoral stem, in such a state of the femur. With the femoral stem  2  of the present invention, in contrast, high level of compatibility can be achieved by selecting and assembling the distal part of the stem member  21  and the proximal part of the stem member  22  that match the medullary cavities in the distal part and the proximal part of the femur. Accordingly, it is made possible to achieve stability and rotation resistance of the femoral stem  2 . 
         [0116]    The femoral stem  2  of this embodiment further comprises the rotation preventing ridges  50  that are provided before and behind the proximal part of the stem member  22  of the femoral stem  2  to extend in the longitudinal direction, so as to more effectively prevent the femoral stem from rotating in the femur. 
         [0117]    The femoral stem  2  has such a configuration as a base  29  of the neck of the proximal part of the stem member  22  is formed to be larger and a subsidence preventing ridge  51  is formed to extend laterally below the base portion  29 . This configuration enables even a femur that is significantly thinned on the inside of the proximal part to bear the load. As a result, the femoral stem  2  is prevented from subsiding in the femur  7  when the femoral stem  2  is loaded, thus achieving improved supporting capability of the femoral stem  2 . 
         [0118]    While this embodiment employs the modular construction that combines the distal part of the stem member  21  and the proximal part of the stem member  22  of various dimensions, an integral femoral stem constituted from the distal part of the stem member  21  and the proximal part of the stem member  22  that are integrally formed may also be used according to the present invention. 
         [0119]    In this embodiment, the greater trochanter plate  4  and the linkage means  46  that connects the greater trochanter plate  4  to the proximal part of the stem member  22  are provided in an integral piece. However, the greater trochanter plate  4  and the linkage means  46  may also be prepared separately and assembled as in the first and second embodiments. 
         [0120]    With the femoral stem  2  of this embodiment, the greater trochanter  71  can be held onto the femur  7  by running the wire  6  through the through hole  43  of the greater trochanter plate  4  and the through hole  67  of the auxiliary plate  66  as shown in  FIG. 7 . 
         [0121]    In a surgery to secure the femoral stem  2  onto the femur  7 , the distal part of the stem member  21 , the proximal part of the stem member  22  and the greater trochanter plate  4  are prepared in the assembled state, and the distal part of the stem member  21  is inserted into the medullary cavity through the distal part of the femur  7  that has been subjected to osteotomy. Then the outside of the greater trochanter  71  is held by running the wire  6  crosswise so as to tie the greater trochanter plate  4  located above the greater trochanter  71  and the auxiliary plates  66  that extend to the right and left of the lower part of the greater trochanter together. 
         [0122]    Thus, since the greater trochanter plate  4  is secured at the top of the proximal part of the stem member  22 , it is capable of holding the top of the greater trochanter  71  so as to suppress the greater trochanter from being pulled upward. Also because the wire  6  is used to hold the greater trochanter  71  inwardly so as to secure it onto the femur  7 , the wire  6  is subjected to a weaker load than in the case of the conventional greater trochanter plate, so that the wire  6  is less likely to be elongated or broken. 
         [0123]    In this example, the greater trochanter plate  4  and the linkage means  46  are constructed in an integral piece, and therefore the greater trochanter plate  4  can be firmly secured onto the proximal part of the stem member  22  without using mechanical fitting means that connects the greater trochanter plate  4  and the linkage means  46 . 
         [0124]    The greater trochanter plate  4  attached to the femoral stem  2  of the present invention is similar to the conventional greater trochanter plate in that the greater trochanter  71  is pressed inwardly into close contact with the femur, but is greatly different in the capability to hold the top of the greater trochanter  71 . When treating the greater trochanter  71  that has been severed, the greater trochanter is likely to be displaced upward before healing since the greater trochanter is repetitively pulled up by the gluteus medius musculus that is attached to the greater trochanter. According to the present invention, however, the greater trochanter  71  is effectively suppressed from being pulled up by holding the top of the greater trochanter  71 , and therefore the greater trochanter  71  that has been severed can be reliably secured at the predetermined position of the femur. 
         [0125]    The artificial hip joint  1  including the femoral stem  2  of the present invention is capable of firmly securing the greater trochanter  71  by mechanical means without need for boring a hole in the femur. As a result, the hip joint can be loaded within several days after the replacement surgery, thus enabling the patient to leave the sickbed and start walking in the early stage.