WO2011161291A1 - Femoral prosthesis extractor for checks and extraction method - Google Patents

Femoral prosthesis extractor for checks and extraction method Download PDF

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Publication number
WO2011161291A1
WO2011161291A1 PCT/ES2011/070438 ES2011070438W WO2011161291A1 WO 2011161291 A1 WO2011161291 A1 WO 2011161291A1 ES 2011070438 W ES2011070438 W ES 2011070438W WO 2011161291 A1 WO2011161291 A1 WO 2011161291A1
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WO
WIPO (PCT)
Prior art keywords
extractor
prosthesis
rod
distal end
proximal end
Prior art date
Application number
PCT/ES2011/070438
Other languages
Spanish (es)
French (fr)
Inventor
Marcelo Oscar Feijoo
Original Assignee
Marcelo Oscar Feijoo
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Filing date
Publication date
Application filed by Marcelo Oscar Feijoo filed Critical Marcelo Oscar Feijoo
Publication of WO2011161291A1 publication Critical patent/WO2011161291A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4607—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of hip femoral endoprostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4619—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof for extraction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4625—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
    • A61F2002/4627—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4625—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
    • A61F2002/4628—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about an axis transverse to the instrument axis or to the implantation direction, e.g. clamping
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4681—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor by applying mechanical shocks, e.g. by hammering

Definitions

  • the present invention relates to the devices, apparatus, arrangements and methods used in the medical field, particularly in surgical operations where revision or removal of a prosthesis implanted in a bone piece is necessary, and more particularly it refers to a breast extractor.
  • Femoral prosthesis for revision operations where a damaged or poorly functioning prosthesis should be removed and that is already cemented or osteointegrated within a femur, allowing the extractor, with its appropriate components to remove either a portion of the prosthesis embedded in the bone , with scarce external access, or a prosthesis that has an accessible portion, avoid excessively traumatic traditional surgeries that propose breaking the bone to access the prosthesis anchored therein.
  • prostheses usually of metallic materials and special alloys that are used in the repair of bone pieces.
  • these prostheses may comprise stems or stems inserted in the bone core to support it and regenerate its osseointegration.
  • stems or stems inserted in the bone core to support it and regenerate its osseointegration.
  • prostheses have complex shapes and are subjected to cyclic, axial, torsion loads, etc. that usually break the prosthesis after a few years of implantation.
  • hip repair prostheses consisting of a femoral prosthesis, inserted into the femur and a hip cup inserted into the iliac bone.
  • Femoral prostheses for hip repair consist of a stem embedded in the femur and a spherical head coupled to the cup implanted in the iliac bone of the hip.
  • the prosthesis must withstand the loads and tensions generated when walking, sitting, standing and, in general, when performing all natural movements of the leg.
  • the prosthesis When the prosthesis is broken, it usually does so in a section between the spherical head and the upper part of the stem, inside the bone. Then it becomes necessary to remove the stem that has been fixed inside the femur.
  • Stem removal Prosthetic femoral canal, in a prosthetic hip replacement, is a complex surgical procedure.
  • the average time of this operation is longer than that used for primary surgery and a high experimental demand of the surgical team, being a potential source of complications, especially perforations or femoral fractures. Usually the remaining bone tissue is damaged and loss of bone stock is caused.
  • Osteotomies are performed with drill bits, chisels or oscillating saw.
  • the bone window is lifted by wide osteotomes, that is, the femur is opened longitudinally. Violation of the femoral canal indemnity mostly increases the bleeding and morbidity of the patient.
  • the osteotomy consists of "OPEN" literally the proximal end of the femur with a "controlled” fracture and then, with the help of chisels and hammer, produce the loosening of the femoral stem and its subsequent extraction. After the removal of the broken stem, the osteotomized bone is reconstructed with circumferential wire handles, which does not always leave a stable component.
  • the osteotomizing technique allows a bone consolidation of the fracture in an average time of 3 months.
  • US Patent 4,222,382 describes an extractor consisting of a straight rod which also has a sliding mass that moves with the hand and is struck against a proximal butt end of the rod. At the distal end, the rod has a base portion and a lobed ring where the spherical head of a femoral prosthesis is attached.
  • the prosthesis must be of the monobloc type, that is to say in one piece with the spherical head attached to the stem, otherwise, this extractor cannot be used in the removal of the prosthesis and much less can be used in the case of a broken stem that has been embedded in the femur without parts accessible from the outside.
  • US Patent 4,459,985 discloses a knee prosthesis extractor that has an adjustment means that exerts a force on the tibia tray.
  • the extraction method is performed by hooking the knee prosthesis and moving a sliding mass arranged around a rod, causing said mass to strike against a proximal abutment end of the extractor.
  • the implant extraction process is based on hitting said sliding mass towards a stop, but none of the cases mentioned above foresee a solution for the extraction of prostheses of the type that do not have a spherical head at the proximal end of said prostheses, or that have said spherical head but this must be removed from the prosthetic stem, thus making it impossible to grab a portion of the prosthesis, then an osteotomy must also be necessary.
  • It is also another object of the present invention to provide a femoral prosthesis extractor comprising a retention connector having a proximal end that removably attaches to a distal end of said extractor rod and a distal end that removably connects to said screw head.
  • It is also another object of the present invention to provide a femoral prosthesis extractor comprising a grip nozzle having a proximal portion that is removably fixed to the distal end of said extractor rod and a tubular distal portion having adjustable clamping means to firmly retain a proximal end of said prosthesis, said proximal portion of the nozzle disposed on an arm thereof forming an angle with respect to to said tubular distal portion of the nozzle to exert a pulling force aligned with the prosthesis to be removed.
  • an anchor screw to said prosthesis, which has a head and a threaded rod inserted into a hole drilled in said prosthesis,
  • a retaining connector having a proximal end that removably attaches to a distal end of said extractor rod and a distal end that removably connects to said screw head, and
  • a gripping nozzle having a proximal portion that removably attaches to the distal end of said extractor rod and a tubular distal portion having adjustable clamping means to removably retain a proximal end of said prosthesis, said proximal portion of the nozzle disposed on an arm thereof that forms an angle with respect to said tubular distal portion of the nozzle.
  • a retention connector that has a proximal end and a distal end
  • an extractor rod that has a proximal end which includes an impact stop and a slide hub on the rod,
  • Figure 1 shows a sectional view of a femur within which is a prosthesis of the type comprising a removable spherical head, anchored and cemented in the femur, which must be removed due to some type of deficiency;
  • Figure 2 shows a sectional view of a femur into which a split stem of a prosthesis of the type comprising a spherical head, removable or not removable, has been anchored and cemented, illustrating the broken stem in line and the broken line. part of the prosthesis that has been detached and that can be simply removed with the fingers after surgery;
  • Figure 3 shows a perspective view of a femur within which, in dashed line, a prosthesis of the monoblock type is located and which is being extracted by means of the prosthetic extractor of the type of US Patent 4,222,382;
  • Figure 4 shows a perspective and partially sectioned view of a femur within which find the broken stem of a prosthesis about to begin being removed according to the invention
  • Figure 5 shows a perspective view of the prosthetic extractor of the present invention, with a retaining connector and anchor screw arranged at its distal end;
  • Figure 6 shows a sectional view of a femur and the split prosthetic stem to which the extractor of the present invention has already been fixed;
  • Figure 7 shows a sectional view of the gripper nozzle of the present extractor attached to the proximal end of a prosthesis to which the spherical head has already been removed to proceed to remove the prosthesis from the femur;
  • Figure 8 shows a top view of the distal end of the extractor of the present invention with the gripping nozzle of Figure 7.
  • a femoral prosthetic implant can be seen that is housed in a femur 1, and more particularly a prosthesis 2 of the type comprising at its proximal end a removable spherical head 3, attached to a prosthetic stem 4 which is anchored within the femur 1.
  • the spherical head 3 is more precisely fixed at a proximal end 5 of the prosthesis 2, generally by means of a "Morse" cone connection that is arranged so much on said head spherical 3 as in the conical proximal end 5 of the prosthesis.
  • implantation of a prosthesis 2 within the bone generally requires a cementation 6 around the prosthesis and in the femoral canal in order to ensure a firm and exact position of the prosthesis 2 within said canal.
  • a prosthesis of this type must be removed from the femur, the head must first be removed, 3 which would not support any tensile effort when trying to pull it to remove the prosthesis.
  • the part of the end 5 would be the only portion of the prosthesis accessible to be taken and removed with force, however, there are no extractors capable of firmly fixing this portion to produce its effective extraction.
  • Figure 2 illustrates a prosthesis that can be of the same type as that of Figure 1, whereby the same reference numbers will be preserved, but unlike the situation in Figure 1 in this case the prosthesis has been match leaving its stem 4 fixed inside the femur.
  • This stem unlike the case illustrated in Figure 1, does not have accessible parts outside the femur to be taken and removed and, on the other hand, it only has a section or face 7 that cannot be taken by any known extractor.
  • Figure 3 shows the case in which it is desired to remove a prosthesis 8 of the monobloc type, that is to say that its stem and a spherical head 9, at its proximal end, form a single piece.
  • this type of prosthesis should be removed from the femur, when it is It finds whole, that is to say it does not present any break in its prosthetic stem 5, there are already known tools.
  • the femoral prosthesis extractor described in the prior art is used, particularly the extractor of US Patent 4,222,382, comprising an extractor 10 of the type having an extractor rod 11 with a proximal end in which includes an impact stop 12, which officiates in addition to a handle, and a mass 13 capable of sliding on the rod 11 to be moved along it and impacted against said stop 12.
  • the rod 11 has at its distal end an eyelet 14 having a section of greater diameter to be able to insert it over the head 9 of the prosthesis and a section of smaller diameter, distal, capable of clinging to said head 9.
  • the club 13 moves along the rod 11 and it is impacted against the stop 12.
  • a new method of extraction and a new prosthetic extractor are then needed, which can solve this type of situation as well as the situation of extraction of a prosthesis in its entirety, of the type that does not have a spherical head at its proximal end, or that the present but is of the removable type, a task that cannot be performed either by the embodiments described in the prior art.
  • Figure 4 shows a portion or stem 4 of prosthesis that has been embedded in a bone piece, wherein said portion or prosthetic stem 4 is firmly anchored within the bone piece and has little external access.
  • the initial step is carried out consisting of drilling a hole 15 in the accessible face 7 of said prosthetic portion 4. Because the prostheses are generally manufactured in stainless steel, at the time of drilling , it is difficult to generate a hole on the accessible face since the drill would slide on said face, making it impossible to make a hole 15 in A certain point.
  • a perforating wick guide 16 that has an exterior configuration of a quadrangular section with a grip handle 17 and an inner longitudinal duct 18 for the passage and guidance of a perforating wick (not shown).
  • the conduit 18 will guarantee to keep the wick in position when drilling the conduit 18.
  • the guide 16 will have an external conformation similar to that of the stem 4 so that it can be inserted into the available space within the bone 1 and fit inside it so as not to move and maintain the position of the punching wick. It is known to any person who understands that this problem can be solved in different ways, such as by using a punch that can be struck with a hammer to mark a starting point of drilling.
  • a thread is formed inside it, using a male tap. Once the thread is made, an anchor screw 19 is inserted into said hole 15.
  • the screw 19 has a threaded rod 20 provided with a thread equal to that made inside the hole 18, and a preferably quadrangular or faceted head 21.
  • the screw 19 forms part of the femoral prosthesis extractor 25 of the invention which further comprises, as best seen in Figures 5 and 6, an extractor rod 22 having a proximal end in which an impact stop 23 and a mass 24 slidable on the rod 22 to be moved along thereof and impacted against said abutment 23.
  • the rod 22 has a threaded distal end 26 in which it is threaded and removably connected to the proximal end 27, internally threaded, of a retaining connector 28 that has a cup shape and has a distal end 29 having a through hole 30 that communicates with the inside of the connector 28.
  • the screw 19 is inserted into the connector 28 by passing the threaded rod 20 through the hole 30 so that from the head 21 of the screw 19 is retained within said interior of the cup-shaped connector 28.
  • the screw 19 is first placed inside the connector 28 and then screwed into the hole 15 of the prosthesis portion 4. Then reintroduces the threaded distal end 26 of the rod 22 into the connector 28 and it is adjusted so that the screw is firmly retained, then the screw stem 20 is screwed tightly into the hole 15.
  • the internal threaded surface 31 preferably extends from its proximal end 27 to an internal distance approximately corresponding to the height of the head 21 of the anchor screw 19. Due to the cup shape of the retaining connector 28, said head of the anchor screw 19 is removably fixed to the distal end of the retaining connector 28, said head being imprisoned 21 being retained and prevented from rotating within said interior of the connector 28.
  • said hub 24 is moved in a reciprocating manner along said extractor rod 22 generating impacts of the hub 24 against said impact stop 23 at the proximal end of the extractor rod 22 so as to generate extractive or pulling impacts on the prosthetic portion 4 implanted in the bone piece 1, until it is extracted from said bone piece.
  • the distal end 26 of the rod 22 is provided with a threaded hole 32 whose thread is equal to that of the screw 19.
  • the stem 20 of the screw 19 is introduced. into the threaded conduit 32 of the extractor rod 22 and the hub is moved again as it was being done to generate the necessary extraction impacts.
  • Figures 7 and 8 represent another situation in which it is desired to remove a prosthesis 33 in an integral state of the type comprising a spherical head fixed by Morse cone as illustrated in Figure 1, said head having been previously removed in order to extract the bone prosthesis in which it is cemented. It is worth remembering that said head needs to be removed because it would not resist any extraction force when trying to remove, by impact, the prosthesis 33 from the bone. To the Remove the spherical head 3, only the tapered proximal end 5 is available, which must be taken firmly to be able to pull the prosthesis and remove it.
  • a gripping nozzle 34 having a tubular proximal portion 35 having its threaded interior to removably fix to the distal end 26 of said extractor rod 22.
  • the type fixing between the proximal end 35 of the nozzle 34 and the distal end 26 of the stem 22 may not be threaded, for example it may comprise a bayonet coupling or the like.
  • the proximal portion 35 of the nozzle 34 is disposed on an arm thereof that forms an angle with respect to a tubular distal portion 36 of the nozzle 34 which may have its slightly conical interior and adjustable fastening means, preferably formed by screws 37 which fit inside holes 38 to removably retain the proximal end 5 of said prosthesis 33. Said screws pass through and are threaded into said distal tubular portion 36 and are directed towards a longitudinal central axis X of said tubular distal portion 36.
  • the prosthetic stem of the prosthesis is removed. same way that was described for the previous situation, that is to say by operating the hub 24 so that it hits the stop 23 of the extractor rod 22. It is It is important to mention that the projection of the shaft of the rod 22 coincides as far as possible with the direction of the prosthetic stem 4 anchored in the bone in such a way that when exerting the extraction force there are no lateral forces that can damage the patient's bone structure.

Abstract

A femoral prosthesis extractor for checks and extraction method in which it is necessary to remove damaged or malfunctioning prostheses that have been cemented or osseointegrated into a bone, such as the femur, in which the extractor comprises an extraction bar that includes a mass for generating extraction impacts on an anchoring bolt that is attached to a portion of the prosthesis to be extracted or onto an extraction tip to be attached to an accessible portion of said prosthesis to be removed, said anchoring bolt being attachable to the extraction rod by means of a retaining connector that is in turn attached removably to said extraction bar.

Description

EXTRACTOR DE PRÓTESIS FEMORAL PARA OPERACIONES DE REVISIÓN  FEMORAL PROSTHETIC EXTRACTOR FOR REVIEW OPERATIONS
Y MÉTODO DE EXTRACCIÓN AND EXTRACTION METHOD
ESTADO DEL ARTE DE LA INVENCION STATE OF THE ART OF THE INVENTION
Campo de la Invención  Field of the Invention
La presente invención se relaciona con los dispositivos, aparatos, disposiciones y métodos empleados en el campo médico, particularmente en operaciones quirúrgicas donde se hace necesaria la revisión o remoción de una prótesis implantada en una pieza ósea, y más particularmente se refiere a un extractor de prótesis femoral para operaciones de revisión donde debe removerse una prótesis dañada o de funcionamiento deficiente y que se encuentra ya cementada u osteointegrada dentro de un fémur, permitiendo el extractor, con sus componentes adecuados para remover ya sea una porción de la prótesis embutida en el hueso, con acceso exterior escaso, o una prótesis que presenta una porción accesible, evitar las cirugías tradicionales excesivamente traumáticas que proponen la rotura del hueso para acceder a la prótesis anclada en el mismo .  The present invention relates to the devices, apparatus, arrangements and methods used in the medical field, particularly in surgical operations where revision or removal of a prosthesis implanted in a bone piece is necessary, and more particularly it refers to a breast extractor. Femoral prosthesis for revision operations where a damaged or poorly functioning prosthesis should be removed and that is already cemented or osteointegrated within a femur, allowing the extractor, with its appropriate components to remove either a portion of the prosthesis embedded in the bone , with scarce external access, or a prosthesis that has an accessible portion, avoid excessively traumatic traditional surgeries that propose breaking the bone to access the prosthesis anchored therein.
Aún cuando en la presente descripción se haga particular referencia a la remoción de una parte rota de una prótesis o una porción de prótesis o una prótesis completa anclada en un fémur, debe quedar claro que la invención es aplicable así mismo a la remoción de dicha prótesis o partes de la misma desde cualquier otra pieza ósea donde el presente extractor pueda ser utilizado. Descripción del arte previo Even if in the present description particular reference is made to the removal of a broken part of a prosthesis or a portion of prosthesis or a complete prosthesis anchored in a femur, it should be clear that the invention is also applicable to the removal of said prosthesis or parts thereof from any other bone piece where the present extractor can be used. Description of the prior art
Existe un sinnúmero de prótesis, generalmente de materiales metálicos y aleaciones especiales que se utilizan en la reparación de piezas óseas. En el caso de huesos largos, estas prótesis pueden comprender tallos o vástagos insertados en el núcleo del hueso para sostenerlo y regenerar su osteointegración . Existen reparaciones especiales donde intervienen diferentes huesos de importancia donde las piezas óseas deben estar articuladas entre si y donde las prótesis presentan formas complejas y se ven sometidas a cargas cíclicas, axiales, de torsión, etc. que suelen romper la prótesis luego de algunos años de implantadas. Este es el caso de las prótesis para reparación de cadera consistentes en una prótesis femoral, insertada en el fémur y un cotilo de cadera insertado en el hueso ilíaco. There are countless prostheses, usually of metallic materials and special alloys that are used in the repair of bone pieces. In the case of long bones, these prostheses may comprise stems or stems inserted in the bone core to support it and regenerate its osseointegration. There are special repairs where different bones of importance intervene where the bone pieces must be articulated with each other and where the prostheses have complex shapes and are subjected to cyclic, axial, torsion loads, etc. that usually break the prosthesis after a few years of implantation. This is the case of hip repair prostheses consisting of a femoral prosthesis, inserted into the femur and a hip cup inserted into the iliac bone.
Las prótesis femorales para reparación de cadera consisten en un tallo embutido en el fémur y una cabeza esférica acoplada al cotilo implantado en el hueso ilíaco de la cadera. De esta manera se establece la articulación natural existente entre la pierna y la cadera y la prótesis debe soportar las cargas y tensiones generadas al caminar, al sentarse, al pararse y, en general, al, realizar todos los movimientos naturales de la pierna. Cuando se rompe la prótesis generalmente lo hace en una sección entre la cabeza esférica y la parte superior del tallo, dentro del hueso. Entonces se hace necesario remover el tallo que ha quedado fijado dentro del fémur. La extracción del tallo protésico del canal femoral, en un reemplazo protésico de cadera, es un procedimiento quirúrgico complejo. Femoral prostheses for hip repair consist of a stem embedded in the femur and a spherical head coupled to the cup implanted in the iliac bone of the hip. In this way the natural joint between the leg and the hip is established and the prosthesis must withstand the loads and tensions generated when walking, sitting, standing and, in general, when performing all natural movements of the leg. When the prosthesis is broken, it usually does so in a section between the spherical head and the upper part of the stem, inside the bone. Then it becomes necessary to remove the stem that has been fixed inside the femur. Stem removal Prosthetic femoral canal, in a prosthetic hip replacement, is a complex surgical procedure.
El tiempo promedio de dicha operación es más prolongado que el utilizado para una cirugía primaria y una alta demanda experimental del equipo quirúrgico, siendo fuente potencial de complicaciones especialmente perforaciones ó fracturas femorales. Por lo general se daña el tejido óseo remanente y se ocasiona pérdida del stock óseo .  The average time of this operation is longer than that used for primary surgery and a high experimental demand of the surgical team, being a potential source of complications, especially perforations or femoral fractures. Usually the remaining bone tissue is damaged and loss of bone stock is caused.
Los procedimientos para la extracción de un tallo protésico en el canal femoral, cuando éste se encuentra firmemente alojado, son en su gran mayoría realizados por osteotomías ó ventanas óseas practicadas por el cirujano en el fémur del paciente. La técnica se llama osteotomía femoral extendida.  The procedures for the removal of a prosthetic stem in the femoral canal, when it is firmly housed, are mostly performed by osteotomies or bone windows performed by the surgeon in the patient's femur. The technique is called extended femoral osteotomy.
Las osteotomías se practican con brocas, cinceles ó sierra oscilante. Mediante osteótomos anchos se levanta la ventana ósea, es decir se abre longitudinalmente el fémur. La violación de la indemnidad del canal femoral en su gran mayoría aumenta el sangrado y la morbilidad del paciente. La osteotomía consiste en "ABRIR" literalmente el extremo proximal del fémur con una fractura "controlada" para luego, con la ayuda de escoplos y martillo, producir el aflojamiento del tallo femoral y su posterior extracción. Finalizada la remoción del tallo roto se reconstruye el hueso osteotomizado con asas circunferenciales de alambre, lo cual no siempre deja un componente estable. La técnica de osteotomizar permite una consolidación ósea de la fractura en un tiempo promedio de 3 meses. Para los casos más sencillos donde las prótesis estén en estado integro y de una solo pieza o "monoblock" tal que sean fácilmente accesibles de manera que presenten porciones de donde pueden ser asidas o tomadas, existen diversos tipos de extractores de fácil manipulación. Por ejemplo la Patente US 3.585.994 describe un extractor consistente en una varilla recta en la cual se dispone una masa deslizante que se mueve con la mano y se hace golpear contra un extremo de tope proximal de la varilla. En el extremo distal la varilla presenta un gancho para insertarse dentro de un ojal presente en la prótesis a extraer. Este extractor no puede ser utilizado en la remoción de un tallo roto que ha quedado embutido en el fémur si este tallo no cuenta con un ojal previsto para este fin y, lamentablemente, no existen en la actualidad tallos de ese tipo. Osteotomies are performed with drill bits, chisels or oscillating saw. The bone window is lifted by wide osteotomes, that is, the femur is opened longitudinally. Violation of the femoral canal indemnity mostly increases the bleeding and morbidity of the patient. The osteotomy consists of "OPEN" literally the proximal end of the femur with a "controlled" fracture and then, with the help of chisels and hammer, produce the loosening of the femoral stem and its subsequent extraction. After the removal of the broken stem, the osteotomized bone is reconstructed with circumferential wire handles, which does not always leave a stable component. The osteotomizing technique allows a bone consolidation of the fracture in an average time of 3 months. For the simplest cases where the prostheses are in an integral state and of a single piece or "monoblock" so that they are easily accessible so that they have portions of where they can be grasped or taken, there are various types of easy-to-handle extractors. For example, US Patent 3,585,994 describes an extractor consisting of a straight rod in which a sliding mass is disposed that moves by hand and is struck against a proximal butt end of the rod. At the distal end the rod has a hook to be inserted into an eyelet present in the prosthesis to be extracted. This extractor can not be used in the removal of a broken stem that has been embedded in the femur if this stem does not have an eyelet provided for this purpose and, unfortunately, there are currently no such stems.
Por otra parte la Patente US 4.222.382 describe un extractor consistente en una varilla recta la cual también dispone de una masa deslizante que se mueve con la mano y se hace golpear contra un extremo de tope proximal de la varilla. En el extremo distal, la varilla presenta una porción de base y un anillo lobulado de donde se sujeta la cabeza esférica de una prótesis femoral. Nuevamente, la prótesis debe ser del tipo monobloque, es decir de una sola pieza con la cabeza esférica unida al tallo, de lo contrario, este extractor no puede ser utilizado en la remoción da la prótesis y mucho menos puede emplearse en el caso de un tallo roto que ha quedado embutido en el fémur sin partes accesibles desde el exterior. También, la Patente US 4.459.985 divulga un extractor de prótesis de rodilla que presenta un medio de ajuste que ejerce una fuerza sobre la bandeja de la tibia. El método de extracción se realiza enganchando la prótesis de rodilla y moviendo una masa deslizante dispuesta alrededor de una varilla, haciendo golpear dicha masa contra un extremo de tope proximal del extractor. On the other hand, US Patent 4,222,382 describes an extractor consisting of a straight rod which also has a sliding mass that moves with the hand and is struck against a proximal butt end of the rod. At the distal end, the rod has a base portion and a lobed ring where the spherical head of a femoral prosthesis is attached. Again, the prosthesis must be of the monobloc type, that is to say in one piece with the spherical head attached to the stem, otherwise, this extractor cannot be used in the removal of the prosthesis and much less can be used in the case of a broken stem that has been embedded in the femur without parts accessible from the outside. Also, US Patent 4,459,985 discloses a knee prosthesis extractor that has an adjustment means that exerts a force on the tibia tray. The extraction method is performed by hooking the knee prosthesis and moving a sliding mass arranged around a rod, causing said mass to strike against a proximal abutment end of the extractor.
Como se observa, el proceso de extracción de implantes se basa en golpear dicha masa deslizante hacia un tope, pero ninguno de los casos mencionados arriba prevén una solución para la extracción de prótesis del tipo que no presentan una cabeza esférica en el extremo proximal de dicha prótesis, o que presentan dicha cabeza esférica pero esta debe extraerse del tallo protésico, imposibilitándose asi asir una porción de la prótesis, debiendo entonces ser también necesaria la realización de una osteotomía.  As can be seen, the implant extraction process is based on hitting said sliding mass towards a stop, but none of the cases mentioned above foresee a solution for the extraction of prostheses of the type that do not have a spherical head at the proximal end of said prostheses, or that have said spherical head but this must be removed from the prosthetic stem, thus making it impossible to grab a portion of the prosthesis, then an osteotomy must also be necessary.
En virtud del actual estado de la técnica disponible para la remoción de porciones rotas de prótesis implantadas dentro de una pieza ósea, en donde se somete al paciente a tan traumática operación, resultaría muy conveniente contar con una nueva tecnología, tal como una nueva metodología y un nuevo extractor de tallos femorales mediante el uso del cual ya no sea necesario partir el fémur longitudinalmente para acceder al tallo partido que ha quedado cementado dentro del mismo.  Under the current state of the art available for the removal of broken portions of prostheses implanted within a bone piece, where the patient is subjected to such a traumatic operation, it would be very convenient to have a new technology, such as a new methodology and a new femoral stem extractor through the use of which it is no longer necessary to split the femur longitudinally to access the split stem that has been cemented within it.
BREVE DESCRIPCION DE LA INVENCION Es por lo tanto un objeto de la presente invención proveer una nuevo extractor de prótesis femoral para operaciones de revisión de prótesis de cadera, siendo un extractor del tipo que presenta una varilla extractora con un extremo proximal en el que se incluye un tope de impacto y una maza deslizable sobre la varilla para ser movido a lo largo del mismo e impactada contra dicho tope de manera de trasladar los impactos a una prótesis que desea ser removida del anclaje en un hueso, presentando el extremo distal de la varilla un conector que se fija removiblemente a una sección rota del tallo a extraer. BRIEF DESCRIPTION OF THE INVENTION It is therefore an object of the present invention to provide a new femoral prosthesis extractor for hip prosthesis revision operations, being an extractor of the type having an extractor rod with a proximal end in which an impact stop is included and a sliding hub on the rod to be moved along it and impacted against said stop so as to transfer the impacts to a prosthesis that wishes to be removed from the anchor in a bone, the distal end of the rod presenting a connector that is fixed removably to a broken section of the stem to be extracted.
Es aún otro objeto de la presente invención proveer un extractor de prótesis femoral que incluya un tornillo de anclaje a dicha prótesis para poder fijar la prótesis a un conector y este a una varilla extractora.  It is yet another object of the present invention to provide a femoral prosthesis extractor that includes an anchor screw to said prosthesis to be able to fix the prosthesis to a connector and this to an extractor rod.
Es todavía otro objeto de la presente invención proveer un extractor de prótesis femoral que incluye un tornillo de anclaje que presente un vástago roscado insertable dentro de un orificio perforado en dicha prótesis partida y embutida dentro del fémur.  It is yet another object of the present invention to provide a femoral prosthesis extractor that includes an anchor screw that has a threaded rod inserted into a hole drilled in said split prosthesis and embedded within the femur.
Es además otro objeto de la presente invención proveer un extractor de prótesis femoral que comprenda un conector de retención que presenta un extremo proximal que se fija removiblemente a un extremo distal de dicha varilla extractora y un extremo distal que se conecta removiblemente a dicha cabeza del tornillo.  It is also another object of the present invention to provide a femoral prosthesis extractor comprising a retention connector having a proximal end that removably attaches to a distal end of said extractor rod and a distal end that removably connects to said screw head. .
Es además otro objeto de la presente invención proveer un extractor de prótesis femoral que comprenda una boquilla de agarre que presenta una porción proximal que se fija removiblemente al extremo distal de dicha varilla extractora y una porción distal tubular que presenta medios de sujeción regulables para retener firmemente un extremo proximal de dicha prótesis, estando dicha porción proximal de la boquilla dispuesta en un brazo de la misma que forma un ángulo con respecto a dicha porción distal tubular de la boquilla para ejercer una fuerza de tiro alineada con la prótesis a remover. It is also another object of the present invention to provide a femoral prosthesis extractor comprising a grip nozzle having a proximal portion that is removably fixed to the distal end of said extractor rod and a tubular distal portion having adjustable clamping means to firmly retain a proximal end of said prosthesis, said proximal portion of the nozzle disposed on an arm thereof forming an angle with respect to to said tubular distal portion of the nozzle to exert a pulling force aligned with the prosthesis to be removed.
Es aún otro objeto de la presente invención proveer un extractor de prótesis femoral para operaciones de revisión de prótesis de cadera, siendo un extractor del tipo que presenta una varilla extractora con un extremo proximal en el que se incluye un tope de impacto y una maza deslizable sobre la varilla para ser movido a lo largo de la misma e impactada contra dicho tope de manera trasladar los impactos a una prótesis que desea ser removida del anclaje en un hueso, en donde el extractor comprende:  It is yet another object of the present invention to provide a femoral prosthesis extractor for hip prosthesis revision operations, an extractor of the type having an extractor rod with a proximal end which includes an impact stop and a sliding hub. on the rod to be moved along it and impacted against said stop so as to transfer the impacts to a prosthesis that wishes to be removed from the anchor in a bone, where the extractor comprises:
un tornillo de anclaje a dicha prótesis, que presenta una cabeza y un vástago roscado insertable dentro de un orificio perforado en dicha prótesis,  an anchor screw to said prosthesis, which has a head and a threaded rod inserted into a hole drilled in said prosthesis,
un conector de retención que presenta un extremo proximal que se fija removiblemente a un extremo distal de dicha varilla extractora y un extremo distal que se conecta removiblemente a dicha cabeza del tornillo, y  a retaining connector having a proximal end that removably attaches to a distal end of said extractor rod and a distal end that removably connects to said screw head, and
una boquilla de agarre que presenta una porción proximal que se fija removiblemente al extremo distal de dicha varilla extractora y una porción distal tubular que presenta medios de sujeción regulables para retener removiblemente un extremo proximal de dicha prótesis, estando dicha porción proximal de la boquilla dispuesta en un brazo de la misma que forma un ángulo con respecto a dicha porción distal tubular de la boquilla. a gripping nozzle having a proximal portion that removably attaches to the distal end of said extractor rod and a tubular distal portion having adjustable clamping means to removably retain a proximal end of said prosthesis, said proximal portion of the nozzle disposed on an arm thereof that forms an angle with respect to said tubular distal portion of the nozzle.
Es además otro objeto de la presente invención proveer un método parea la remoción una porción de una prótesis embutida en una pieza ósea, en donde la porción de prótesis se encuentra anclada firmemente dentro de la pieza ósea y presenta escaso acceso desde el exterior del hueso, en donde el método comprende las etapas de:  It is also another object of the present invention to provide a method for removing a portion of a prosthesis embedded in a bone piece, wherein the prosthesis portion is firmly anchored within the bone piece and has little access from outside the bone, where the method comprises the steps of:
taladrar un orificio sobre una cara accesible de dicha porción de prótesis,  drilling a hole on an accessible face of said prosthetic portion,
formar una rosca dentro de dicho orificio, insertar dentro de dicho orificio un vástago roscado de un tornillo de anclaje que presenta además una cabeza,  forming a thread within said hole, inserting into said hole a threaded rod of an anchor screw which also has a head,
proveer un conector de retención que presenta un extremo proximal y un extremo distal,  provide a retention connector that has a proximal end and a distal end,
fijar removiblemente dicha cabeza del tornillo de anclaje al extremo distal del conector de retención,  removably securing said anchor screw head to the distal end of the retaining connector,
proveer una varilla extractora que tiene un extremo proximal en el que se incluye un tope de impacto y una maza deslizable sobre la varilla,  provide an extractor rod that has a proximal end which includes an impact stop and a slide hub on the rod,
fijar dicho extremo proximal del conector de retención al extremo distal de la varilla extractora,  fixing said proximal end of the retention connector to the distal end of the extractor rod,
mover dicha maza en forma de vaivén a lo largo de dicha varilla extractora generando impactos de la maza contra dicho tope de impacto en el extremo proximal de la varilla extractora de manera de generar impactos extractores sobre la porción de prótesis implantada en la pieza ósea hasta lograr su extracción de la pieza ósea. moving said sway-shaped hub along said extractor rod generating impacts of the hub against said impact stop at the proximal end of the extractor rod so as to generate impacts extractors on the prosthetic portion implanted in the bone piece until its removal from the bone piece.
BREVE DESCRIPCION DE LOS DIBUJOS BRIEF DESCRIPTION OF THE DRAWINGS
Para mayor claridad y comprensión del objeto de la presente invención, la misma ha sido ilustrada en varias figuras, en las que se ha representado al invento en una de las formas preferidas de realización, todo a titulo de ejemplo, en donde: For greater clarity and understanding of the object of the present invention, it has been illustrated in several figures, in which the invention has been represented in one of the preferred embodiments, all by way of example, where:
La figura 1 muestra una vista en corte de un fémur dentro del cual se encuentra una prótesis del tipo que comprende una cabeza esférica removible, anclada y cementada en el fémur, la cual debe removerse por algún tipo de deficiencia;  Figure 1 shows a sectional view of a femur within which is a prosthesis of the type comprising a removable spherical head, anchored and cemented in the femur, which must be removed due to some type of deficiency;
La figura 2 muestra una vista en corte de un fémur dentro del cual ha quedado anclado y cementado un tallo partido de una prótesis del tipo que comprende una cabeza esférica, removible o no, ilustrándose en linea llena el tallo partido y en linea de trazos la parte de la prótesis que se ha desprendido y que puede extraerse simplemente con los dedos una vez hecha la cirugía;  Figure 2 shows a sectional view of a femur into which a split stem of a prosthesis of the type comprising a spherical head, removable or not removable, has been anchored and cemented, illustrating the broken stem in line and the broken line. part of the prosthesis that has been detached and that can be simply removed with the fingers after surgery;
La figura 3 muestra una vista en perspectiva de un fémur dentro del cual se encuentra, en línea de trazos, una prótesis del tipo monobloque y que está siendo extraída por medio del extractor de prótesis del tipo de la Patente US 4.222.382;  Figure 3 shows a perspective view of a femur within which, in dashed line, a prosthesis of the monoblock type is located and which is being extracted by means of the prosthetic extractor of the type of US Patent 4,222,382;
La figura 4 muestra una vista en perspectiva y parcialmente en corte de un fémur dentro del cual se encuentra el tallo partido de una prótesis a punto de comenzar a ser removida de acuerdo con la invención; Figure 4 shows a perspective and partially sectioned view of a femur within which find the broken stem of a prosthesis about to begin being removed according to the invention;
La Figura 5 muestra una vista en perspectiva del extractor de prótesis de la presente invención, con un conector de retención y tornillo de anclaje dispuestos en su extremo distal;  Figure 5 shows a perspective view of the prosthetic extractor of the present invention, with a retaining connector and anchor screw arranged at its distal end;
La figura 6 muestra una vista en corte de un fémur y del tallo protésico partido al cual ya se ha sido fijado el extractor de la presente invención;  Figure 6 shows a sectional view of a femur and the split prosthetic stem to which the extractor of the present invention has already been fixed;
La Figura 7 muestra una vista en corte de la boquilla de agarre del presente extractor sujeta al extremo proximal de una prótesis a la cual ya se le ha removido la cabeza esférica para proceder a remover la prótesis del fémur; y  Figure 7 shows a sectional view of the gripper nozzle of the present extractor attached to the proximal end of a prosthesis to which the spherical head has already been removed to proceed to remove the prosthesis from the femur; Y
La Figura 8 muestra una vista en planta desde arriba del extremo distal del extractor de la presente invención con la boquilla de agarre de la figura 7.  Figure 8 shows a top view of the distal end of the extractor of the present invention with the gripping nozzle of Figure 7.
DESCRIPCION DETALLADA DE LA INVENCION DETAILED DESCRIPTION OF THE INVENTION
Comenzando la descripción correspondiente a la figura 1, se puede ver un implante protésico femoral que se encuentra alojado en un fémur 1, y más particularmente una prótesis 2 del tipo que comprende en su extremo proximal una cabeza esférica extraible 3, adosada a un tallo protésico 4 que se ancla dentro del fémur 1. La cabeza esférica 3 se fija más precisamente en un extremo proximal 5 de la prótesis 2, generalmente por medio de una conexión de cono "Morse" que se dispone tanto en dicha cabeza esférica 3 como en el extremo proximal cónico 5 de la prótesis. Como se mencionó anteriormente, la implantación de una prótesis 2 dentro del hueso requiere generalmente de una cementación 6 alrededor de la prótesis y en el canal femoral de manera de asegurar una posición firme y exacta de la prótesis 2 dentro de dicho canal. Cuando, por alguna razón, una prótesis de este tipo debe ser removida del fémur, primero debe extraérsele la cabeza, 3 la cual no soportaría ningún esfuerzo de tracción al intentar tirar de la misma para remover la prótesis. La parte del extremo 5 sería la única porción de la prótesis accesible para ser tomada y extraída con fuerza, sin embargo, no existen extractores capaces de fijar firmemente esta porción para producir su extracción efectiva. Beginning the description corresponding to Figure 1, a femoral prosthetic implant can be seen that is housed in a femur 1, and more particularly a prosthesis 2 of the type comprising at its proximal end a removable spherical head 3, attached to a prosthetic stem 4 which is anchored within the femur 1. The spherical head 3 is more precisely fixed at a proximal end 5 of the prosthesis 2, generally by means of a "Morse" cone connection that is arranged so much on said head spherical 3 as in the conical proximal end 5 of the prosthesis. As mentioned above, implantation of a prosthesis 2 within the bone generally requires a cementation 6 around the prosthesis and in the femoral canal in order to ensure a firm and exact position of the prosthesis 2 within said canal. When, for some reason, a prosthesis of this type must be removed from the femur, the head must first be removed, 3 which would not support any tensile effort when trying to pull it to remove the prosthesis. The part of the end 5 would be the only portion of the prosthesis accessible to be taken and removed with force, however, there are no extractors capable of firmly fixing this portion to produce its effective extraction.
En la figura 2 se ilustra una prótesis que puede ser del mismo tipo que aquel de la figura 1, por lo cual se conservarán los mismos números de referencia, pero que a diferencia de la situación de la figura 1 en este caso la prótesis se ha partido quedando su tallo 4 fijado dentro del fémur. Este tallo, a diferencia del caso ilustrado en la figura 1, no presenta partes accesibles fuera del fémur para poder ser tomado y extraído y, en cambio, solo posee una sección o cara de rotura 7 que no puede ser tomada por extractor conocido alguno.  Figure 2 illustrates a prosthesis that can be of the same type as that of Figure 1, whereby the same reference numbers will be preserved, but unlike the situation in Figure 1 in this case the prosthesis has been match leaving its stem 4 fixed inside the femur. This stem, unlike the case illustrated in Figure 1, does not have accessible parts outside the femur to be taken and removed and, on the other hand, it only has a section or face 7 that cannot be taken by any known extractor.
En la Figura 3 se representa el caso en que se desea remover una prótesis 8 del tipo monobloque, es decir que su tallo y una cabeza esférica 9, en su extremo proximal, forman una sola pieza. En el caso que este tipo de prótesis debe ser removida del fémur, cuando la misma se encuentra entera, es decir no presenta ninguna rotura en su tallo protésico 5, se cuenta con herramientas ya conocidas. Para esto se procede a utilizar, por ejemplo, el extractor de prótesis femorales descrito en el arte previo, particularmente el extractor de la Patente US 4.222.382, que comprende un extractor 10 del tipo que presenta una varilla extractora 11 con un extremo proximal en el que se incluye un tope de impacto 12, que oficia además de manija, y una masa 13 capaz de deslizarse sobre el vástago 11 para ser movida a lo largo del mismo e impactada contra dicho tope 12. La varilla 11 presenta en su extremo distal un ojal 14 que tiene una sección de mayor diámetro para poder insertarla sobre la cabeza 9 de la prótesis y una sección de menor diámetro, distal, capaz de agarrarse a dicha cabeza 9. En esta condición, como se dijo, se mueve la maza 13 a lo largo de la varilla 11 y se la impacta contra el tope 12. De esta manera se trasladan los impactos de dicha masa 13 sobre el tope 12 a la prótesis 8. Este tipo de situación que implica la extracción de una prótesis en estado integro puede resolverse de manera fácil, como se ha visto, con la herramienta conocida. Como se verá seguidamente, en las situaciones de las figuras 1 y 2, esta herramienta no es de utilidad y es allí donde aparece la importancia de la presente invención como será explicado más adelante. Figure 3 shows the case in which it is desired to remove a prosthesis 8 of the monobloc type, that is to say that its stem and a spherical head 9, at its proximal end, form a single piece. In the case that this type of prosthesis should be removed from the femur, when it is It finds whole, that is to say it does not present any break in its prosthetic stem 5, there are already known tools. For this purpose, for example, the femoral prosthesis extractor described in the prior art is used, particularly the extractor of US Patent 4,222,382, comprising an extractor 10 of the type having an extractor rod 11 with a proximal end in which includes an impact stop 12, which officiates in addition to a handle, and a mass 13 capable of sliding on the rod 11 to be moved along it and impacted against said stop 12. The rod 11 has at its distal end an eyelet 14 having a section of greater diameter to be able to insert it over the head 9 of the prosthesis and a section of smaller diameter, distal, capable of clinging to said head 9. In this condition, as stated, the club 13 moves along the rod 11 and it is impacted against the stop 12. In this way the impacts of said mass 13 are transferred on the stop 12 to the prosthesis 8. This type of situation that involves the removal of a prosthesis in an integral state pu It can be solved easily, as seen, with the known tool. As will be seen below, in the situations of Figures 1 and 2, this tool is not useful and that is where the importance of the present invention appears as will be explained later.
En la situación más grave y complicada, es decir aquella de la figura 2, el tallo protésico 5 se presenta partido, generalmente como producto de alguna falla del material o simplemente por fractura debido a la fatiga del material. Esta situación, en la que se desea remover el tallo protésico 4 anclado en el canal femoral cementado 6 no puede ser resuelta por ninguna de las realizaciones de extractores de prótesis descritas en el arte previo, debiendo recurrirse a la realización de osteotomías o ventanas óseas practicadas en el fémur del paciente. Como ya se explicó, dichas prácticas aumentan el sangrado y la morbilidad del paciente. Se necesita entonces un nuevo método de extracción y un nuevo extractor de prótesis, que pueda solventar este tipo de situación así como también la situación de extracción de una prótesis en estado íntegro, del tipo que no presenta una cabeza esférica en su extremo proximal, o que la presente pero sea del tipo extraíble, tarea que no puede ser realizada tampoco por las realizaciones descritas en el arte previo. Seguidamente se hará referencia al método y al nuevo extractor, de acuerdo con la invención, en relación con las Figuras 4 a 8. In the most serious and complicated situation, that is that of Figure 2, the prosthetic stem 5 is split, usually as a result of some failure of the material or simply by fracture due to fatigue of the material. This situation, in which it is desired to remove the prosthetic stem 4 anchored in the cemented femoral canal 6 cannot be solved by any of the embodiments of prosthetic extractors described in the prior art, having to resort to performing osteotomies or bone windows performed in the patient's femur. As already explained, such practices increase the bleeding and morbidity of the patient. A new method of extraction and a new prosthetic extractor are then needed, which can solve this type of situation as well as the situation of extraction of a prosthesis in its entirety, of the type that does not have a spherical head at its proximal end, or that the present but is of the removable type, a task that cannot be performed either by the embodiments described in the prior art. Reference will now be made to the method and the new extractor, according to the invention, in relation to Figures 4 to 8.
En la figura 4 se representa una porción o tallo 4 de prótesis que ha quedado embutido en una pieza ósea, en donde dicha porción o tallo protésico 4 se encuentra anclado firmemente dentro de la pieza ósea y presenta escaso acceso exterior. De acuerdo con el método de la invención, se lleva a cabo la etapa inicial consistente en taladrar un orificio 15 en la cara 7 accesible de dicha porción de prótesis 4. Debido a que las prótesis generalmente son manufacturadas en acero inoxidable, al momento de taladrar, se dificulta generar un orificio sobre la cara accesible ya que la broca resbalaría sobre dicha cara, imposibilitando la realización de un orificio 15 en un punto determinado. Para resolver este problema se dispone de un guiador de mecha perforadora 16 que presenta una configuración exterior de sección cuadrangular con una manija de agarre 17 y un conducto longitudinal interior 18 para el paso y guiado de una mecha perforadora (no ilustrada) . El conducto 18 garantizará mantener la mecha en posición al realizar el taladrado del conducto 18. De manera preferible, el guiador 16 presentará una conformación exterior similar a aquella del tallo 4 de manera de poder ser insertado dentro del espacio disponible dentro del hueso 1 y calzar dentro del mismo para no moverse y mantener la posición de la mecha perforadora. Es conocido para cualquier entendido de la materia que dicho problema se puede solventar de diferentes maneras como por ejemplo mediante la utilización de un punzón que puede ser golpeado con un martillo para marcar un punto de inicio de perforación. Luego de realizar dicho orificio 11 se procede a formar una rosca dentro de él, utilizando una terraja macho. Una vez hecha la rosca, se inserta dentro de dicho orificio 15 un tornillo de anclaje 19. El tornillo 19 presenta un vástago roscado 20 provisto con una rosca igual a la hecha dentro del orificio 18, y una cabeza 21 preferiblemente cuadrangular o facetada. Figure 4 shows a portion or stem 4 of prosthesis that has been embedded in a bone piece, wherein said portion or prosthetic stem 4 is firmly anchored within the bone piece and has little external access. In accordance with the method of the invention, the initial step is carried out consisting of drilling a hole 15 in the accessible face 7 of said prosthetic portion 4. Because the prostheses are generally manufactured in stainless steel, at the time of drilling , it is difficult to generate a hole on the accessible face since the drill would slide on said face, making it impossible to make a hole 15 in A certain point. To solve this problem, there is a perforating wick guide 16 that has an exterior configuration of a quadrangular section with a grip handle 17 and an inner longitudinal duct 18 for the passage and guidance of a perforating wick (not shown). The conduit 18 will guarantee to keep the wick in position when drilling the conduit 18. Preferably, the guide 16 will have an external conformation similar to that of the stem 4 so that it can be inserted into the available space within the bone 1 and fit inside it so as not to move and maintain the position of the punching wick. It is known to any person who understands that this problem can be solved in different ways, such as by using a punch that can be struck with a hammer to mark a starting point of drilling. After making said hole 11, a thread is formed inside it, using a male tap. Once the thread is made, an anchor screw 19 is inserted into said hole 15. The screw 19 has a threaded rod 20 provided with a thread equal to that made inside the hole 18, and a preferably quadrangular or faceted head 21.
El tornillo 19 forma parte del extractor de prótesis femoral 25 de la invención el que además comprende, según mejor se ve en las Figuras 5 y 6, una varilla extractora 22 que tiene un extremo proximal en el que se incluye un tope de impacto 23 y una masa 24 deslizable sobre el vástago 22 para ser movida a lo largo del mismo e impactada contra dicho tope 23. El vástago 22 presenta un extremo distal roscado 26 en el cual se conecta roscadamente y en forma removible al extremo proximal 27, roscado internamente, de un conector de retención 28 que presenta una forma de copa y posee un extremo distal 29 que presenta un orificio pasante 30 que se comunica con el interior del conector 28. El tornillo 19 se inserta dentro del conector 28 haciendo pasar el vástago roscado 20 a través del orifico 30 de manera que de la cabeza 21 del tornillo 19 queda retenida dentro de dicho interior del conector 28 en forma de copa. De acuerdo con el método de la invención, se coloca primero el tornillo 19 dentro del conector 28 y luego se procede a enroscarlo en el orificio 15 de la porción de prótesis 4. Luego reintroduce el extremo distal roscado 26 de la varilla 22 dentro del conector 28 y se lo ajusta de modo de retener firmemente el tornillo procediéndose entonces a roscar el vástago 20 del tornillo fuertemente dentro del orificio 15. The screw 19 forms part of the femoral prosthesis extractor 25 of the invention which further comprises, as best seen in Figures 5 and 6, an extractor rod 22 having a proximal end in which an impact stop 23 and a mass 24 slidable on the rod 22 to be moved along thereof and impacted against said abutment 23. The rod 22 has a threaded distal end 26 in which it is threaded and removably connected to the proximal end 27, internally threaded, of a retaining connector 28 that has a cup shape and has a distal end 29 having a through hole 30 that communicates with the inside of the connector 28. The screw 19 is inserted into the connector 28 by passing the threaded rod 20 through the hole 30 so that from the head 21 of the screw 19 is retained within said interior of the cup-shaped connector 28. In accordance with the method of the invention, the screw 19 is first placed inside the connector 28 and then screwed into the hole 15 of the prosthesis portion 4. Then reintroduces the threaded distal end 26 of the rod 22 into the connector 28 and it is adjusted so that the screw is firmly retained, then the screw stem 20 is screwed tightly into the hole 15.
En el interior de dicho conector 28 la superficie interna roscada 31, se extiende preferiblemente desde su extremo proximal 27 hasta una distancia interna que aproximadamente corresponde a la altura de la cabeza 21 del tornillo de anclaje 19. Debido a la forma de copa que presenta el conector de retención 28, se fija removiblemente dicha cabeza del tornillo de anclaje 19 al extremo distal del conector de retención 28, aprisionando dicha cabeza 21 quedando esta retenida e impedida de girar dentro de dicho interior del conector 28. Una vez que se ha fijado firmemente dicha cabeza 21 del tornillo de anclaje 19 al extremo distal del conector de retención 28, dicho extremo proximal 27 del conector de retención 28 al extremo distal 26 de la varilla extractora 22 y dicho tornillo 19 dentro del orificio 15 de la pieza protésica a extraer, se procede a mover dicha maza 24 en forma de vaivén a lo largo de dicha varilla extractora 22 generando impactos de la maza 24 contra dicho tope de impacto 23 en el extremo proximal de la varilla extractora 22 de manera de generar impactos extractores o de tiro sobre la porción de prótesis 4 implantada en la pieza ósea 1, hasta lograr su extracción de dicha pieza ósea. Para el eventual caso que la cabeza del tornillo se rompiera, el extremo distal 26 de la varilla 22 está provisto de un orificio roscado 32 cuya rosca es igual a la del tornillo 19. En ese caso se procede a introducir el vástago 20 del tornillo 19 dentro del conducto roscado 32 de la varilla extractora 22 y se vuelve a mover la maza como se lo estaba haciendo para generar los impactos de extracción necesarios . Inside said connector 28 the internal threaded surface 31 preferably extends from its proximal end 27 to an internal distance approximately corresponding to the height of the head 21 of the anchor screw 19. Due to the cup shape of the retaining connector 28, said head of the anchor screw 19 is removably fixed to the distal end of the retaining connector 28, said head being imprisoned 21 being retained and prevented from rotating within said interior of the connector 28. Once said head 21 of the anchor screw 19 has been firmly fixed to the distal end of the retention connector 28, said proximal end 27 of the retention connector 28 to the distal end 26 of the extractor rod 22 and said screw 19 inside the hole 15 of the prosthetic piece to be extracted, said hub 24 is moved in a reciprocating manner along said extractor rod 22 generating impacts of the hub 24 against said impact stop 23 at the proximal end of the extractor rod 22 so as to generate extractive or pulling impacts on the prosthetic portion 4 implanted in the bone piece 1, until it is extracted from said bone piece. In the event that the screw head breaks, the distal end 26 of the rod 22 is provided with a threaded hole 32 whose thread is equal to that of the screw 19. In this case, the stem 20 of the screw 19 is introduced. into the threaded conduit 32 of the extractor rod 22 and the hub is moved again as it was being done to generate the necessary extraction impacts.
Las Figuras 7 y 8 representan otra situación en la que se desea remover una prótesis 33 en estado integro del tipo que comprende una cabeza esférica fijada por cono Morse tal como se ilustra en la Figura 1, habiendo sido dicha cabeza removida con anterioridad para poder extraer la prótesis del hueso en la que se encuentra cementada. Vale recordar que dicha cabeza necesita ser retirada porque no resistiría ninguna fuerza de extracción al pretender removerse, por impactos, la prótesis 33 del hueso. Al removerse la cabeza esférica 3 solo queda disponible el extremo proximal conificado 5 el cual debe ser tomado firmemente para poder tirar de la prótesis y extraerla. Para esto, de acuerdo con la invención, se dispone de una boquilla de agarre 34 que presenta una porción proximal tubular 35 que presenta su interior roscado para fijarse removiblemente al extremo distal 26 de dicha varilla extractora 22. Por supuesto puede también interpretarse que el tipo de fijación entre el extremo proximal 35 de la boquilla 34 y el extremo distal 26 del vástago 22 puede no ser roscado, por ejemplo puede comprender un acoplamiento de bayoneta u otro similar. La porción proximal 35 de la boquilla 34 está dispuesta en un brazo de la misma que forma un ángulo con respecto a una porción distal tubular 36 de la boquilla 34 que puede presentar su interior ligeramente cónico y medios de sujeción regulables, conformados preferiblemente por tornillos 37 que se ajustan dentro de orificios 38 para retener removiblemente el extremo proximal 5 de dicha prótesis 33. Dichos tornillos pasan a través de y están roscados en dicha porción tubular distal 36 y están dirigidos hacia un eje central longitudinal X de dicha porción distal tubular 36. Figures 7 and 8 represent another situation in which it is desired to remove a prosthesis 33 in an integral state of the type comprising a spherical head fixed by Morse cone as illustrated in Figure 1, said head having been previously removed in order to extract the bone prosthesis in which it is cemented. It is worth remembering that said head needs to be removed because it would not resist any extraction force when trying to remove, by impact, the prosthesis 33 from the bone. To the Remove the spherical head 3, only the tapered proximal end 5 is available, which must be taken firmly to be able to pull the prosthesis and remove it. For this, according to the invention, there is a gripping nozzle 34 having a tubular proximal portion 35 having its threaded interior to removably fix to the distal end 26 of said extractor rod 22. Of course it can also be interpreted that the type fixing between the proximal end 35 of the nozzle 34 and the distal end 26 of the stem 22 may not be threaded, for example it may comprise a bayonet coupling or the like. The proximal portion 35 of the nozzle 34 is disposed on an arm thereof that forms an angle with respect to a tubular distal portion 36 of the nozzle 34 which may have its slightly conical interior and adjustable fastening means, preferably formed by screws 37 which fit inside holes 38 to removably retain the proximal end 5 of said prosthesis 33. Said screws pass through and are threaded into said distal tubular portion 36 and are directed towards a longitudinal central axis X of said tubular distal portion 36.
Una vez que se ha fijado la porción proximal 35 de la boquilla tubular 34 en el extremo distal 26 del vástago 22 y la porción distal 36 de la boquilla 34 en el extremo proximal 5 de la prótesis 22 se procede a extraer el tallo protésico de la misma forma que fue descrita para la situación anterior, es decir accionando la maza 24 para que golpee contra el tope 23 de la varilla extractora 22. Es importante mencionar que la proyección del eje de la varilla 22 coincide en lo posible con la dirección del tallo protésico 4 anclado en el hueso de manera tal que al ejercer la fuerza de extracción no se producen fuerzas laterales que puedan dañar la estructura ósea del paciente. Once the proximal portion 35 of the tubular nozzle 34 has been fixed at the distal end 26 of the stem 22 and the distal portion 36 of the nozzle 34 at the proximal end 5 of the prosthesis 22, the prosthetic stem of the prosthesis is removed. same way that was described for the previous situation, that is to say by operating the hub 24 so that it hits the stop 23 of the extractor rod 22. It is It is important to mention that the projection of the shaft of the rod 22 coincides as far as possible with the direction of the prosthetic stem 4 anchored in the bone in such a way that when exerting the extraction force there are no lateral forces that can damage the patient's bone structure.
Si bien todo lo mencionado anteriormente fue descrito para prótesis implantadas en un canal femoral cementado también pueden aplicarse las realizaciones descritas en la extracción de prótesis no cementadas recubiertas con una superficie porosa con medios de fijación biológica, como por ejemplo la hidroxiapatita .  Although all of the above mentioned was described for prostheses implanted in a cemented femoral canal, the described embodiments can also be applied in the extraction of cementless prostheses coated with a porous surface with biological fixation means, such as hydroxyapatite.

Claims

REIVINDICACIONES Habiendo así especialmente descrito y determinado la naturaleza de la presente invención y la forma como la misma ha de ser llevada a la práctica, se declara reivindicar como de propiedad y derecho exclusivo: CLAIMS Having thus specifically described and determined the nature of the present invention and the manner in which it is to be carried out, it is claimed to claim as exclusive property and right:
1. Un extractor de prótesis femoral para operaciones de revisión de prótesis de cadera, siendo un extractor del tipo que presenta una varilla extractora con un extremo proximal en el que se incluye un tope de impacto y una maza deslizable sobre la varilla para ser movido a lo largo de la misma e impactada contra dicho tope de manera trasladar los impactos a una prótesis que desea ser removida del anclaje en un hueso, estando el extractor caracterizado porque comprende: 1. A femoral prosthesis extractor for revision operations of hip prostheses, being an extractor of the type that has an extractor rod with a proximal end which includes an impact stop and a sliding hub on the rod to be moved to along it and impacted against said stop so as to transfer the impacts to a prosthesis that wishes to be removed from the anchor in a bone, the extractor being characterized in that it comprises:
un tornillo de anclaje a dicha prótesis, que presenta una cabeza y un vástago roscado insertable dentro de un orificio perforado en dicha prótesis,  an anchor screw to said prosthesis, which has a head and a threaded rod inserted into a hole drilled in said prosthesis,
un conector de retención que presenta un extremo proximal que se fija removiblemente a un extremo distal de dicha varilla extractora y un extremo distal que se conecta removiblemente a dicha cabeza del tornillo, y  a retaining connector having a proximal end that removably attaches to a distal end of said extractor rod and a distal end that removably connects to said screw head, and
una boquilla de agarre que presenta una porción proximal que se fija removiblemente al extremo distal de dicha varilla extractora y una porción distal tubular que presenta medios de sujeción regulables para retener removiblemente un extremo proximal de dicha prótesis, estando dicha porción proximal de la boquilla dispuesta en un brazo de la misma que forma un ángulo con respecto a dicha porción distal tubular de la boquilla. a gripping nozzle having a proximal portion that removably attaches to the distal end of said extractor rod and a tubular distal portion having adjustable clamping means to removably retain a proximal end of said prosthesis, said proximal portion of the nozzle disposed in an arm thereof that forms an angle with respect to said tubular distal portion of the nozzle.
2. Un extractor de acuerdo con la reivindicación 1, caracterizado porque dicho conector de retención presenta una forma de copa y su extremo proximal se encuentra roscado internamente para acoplarse al extremo distal de dicha varilla extractora. 2. An extractor according to claim 1, characterized in that said retention connector has a cup shape and its proximal end is internally threaded to engage the distal end of said extractor rod.
3. Un extractor de acuerdo con la reivindicación 2, caracterizado porque dicho extremo distal del conector de retención en forma de copa presenta un orificio pasante que comunica con el interior del conector en forma de copa y en el cual se recibe el vástago roscado de dicho tornillo mientras que la cabeza del tornillo queda retenida dentro de dicho interior del conector en forma de copa. 3. An extractor according to claim 2, characterized in that said distal end of the cup-shaped retention connector has a through hole that communicates with the inside of the cup-shaped connector and in which the threaded rod of said cup is received screw while the screw head is retained within said interior of the cup-shaped connector.
4. Un extractor de acuerdo con la reivindicación 3, caracterizado porque dicha cabeza del tornillo queda retenida e impedida de girar dentro de dicho interior del conector en forma de copa. 4. An extractor according to claim 3, characterized in that said screw head is retained and prevented from rotating inside said cup-shaped connector.
5. Un extractor de acuerdo con cualquiera de las reivindicaciones precedentes, caracterizado porque dicha porción proximal de la boquilla es tubular y presenta su interior roscado para fijarse por rosca al extremo distal de dicha varilla extractora. 5. An extractor according to any of the preceding claims, characterized in that said proximal portion of the nozzle is tubular and has its threaded interior to be threaded to the distal end of said extractor rod.
6. Un extractor de acuerdo con la reivindicación 5, caracterizado porque dicha porción distal tubular de la boquilla presenta su interior ligeramente cónico. 6. An extractor according to claim 5, characterized in that said tubular distal portion of the nozzle has its slightly conical interior.
7. Un extractor de acuerdo con cualquiera de las reivindicaciones 5 y 6, caracterizado porque dichos medios de sujeción regulables comprenden una pluralidad de tornillos pasantes y roscados a través de dicha porción distal tubular y están dirigidos hacia un eje central longitudinal de dicha porción distal tubular. 7. An extractor according to any of claims 5 and 6, characterized in that said adjustable fastening means comprise a plurality of through and threaded screws through said tubular distal portion and are directed towards a longitudinal central axis of said tubular distal portion .
8. Un extractor de acuerdo con cualquiera de las reivindicaciones precedentes, caracterizado porque comprende además un guiador de mecha perforadora que presenta una configuración exterior de sección cuadrangular con una manija de agarre y un conducto longitudinal interior para el paso de una mecha perforadora. 8. An extractor according to any of the preceding claims, characterized in that it further comprises a perforating wick guide having an external configuration of a quadrangular section with a grip handle and an internal longitudinal conduit for the passage of a perforating wick.
9. Un extractor de acuerdo con cualquiera de las reivindicaciones precedentes, caracterizado porque dicho extremo distal de la varilla extractora presenta un conducto roscado para recibir dicho vástago roscado del tornillo . 9. An extractor according to any of the preceding claims, characterized in that said distal end of the extractor rod has a threaded conduit for receiving said threaded rod of the screw.
10. Un método parea la remoción una porción de una prótesis embutida en una pieza ósea, en donde la porción de prótesis se encuentra anclada firmemente dentro de la pieza ósea y presenta escaso acceso desde el exterior del hueso, estando el método caracterizado por comprender las etapas de : 10. A method for removing a portion of a prosthesis embedded in a bone piece, where the prosthesis portion is firmly anchored within the bone piece and has poor access from the outside of the bone, the method being characterized by understanding the steps of:
taladrar un orificio sobre una cara accesible de dicha porción de prótesis,  drilling a hole on an accessible face of said prosthetic portion,
formar una rosca dentro de dicho orificio, insertar dentro de dicho orificio un vástago roscado de un tornillo de anclaje que presenta además una cabeza,  forming a thread within said hole, inserting into said hole a threaded rod of an anchor screw which also has a head,
proveer un conector de retención que presenta un extremo proximal y un extremo distal,  provide a retention connector that has a proximal end and a distal end,
fijar removiblemente dicha cabeza del tornillo de anclaje al extremo distal del conector de retención,  removably securing said anchor screw head to the distal end of the retaining connector,
proveer una varilla extractora que tiene un extremo proximal en el que se incluye un tope de impacto y una maza deslizable sobre la varilla,  provide an extractor rod that has a proximal end which includes an impact stop and a slide hub on the rod,
fijar dicho extremo proximal del conector de retención al extremo distal de la varilla extractora,  fixing said proximal end of the retention connector to the distal end of the extractor rod,
mover dicha maza en forma de vaivén a lo largo de dicha varilla extractora generando impactos de la maza contra dicho tope de impacto en el extremo proximal de la varilla extractora de manera de generar impactos extractores sobre la porción de prótesis implantada en la pieza ósea hasta lograr su extracción de la pieza ósea.  moving said swing-shaped hub along said extractor rod generating impacts of the hub against said impact stop at the proximal end of the extractor rod so as to generate extractor impacts on the prosthetic portion implanted in the bone piece until achieving its removal of the bone piece.
PCT/ES2011/070438 2010-06-24 2011-06-17 Femoral prosthesis extractor for checks and extraction method WO2011161291A1 (en)

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ARP100102234A AR078129A1 (en) 2010-06-24 2010-06-24 FEMORAL PROTESIS EXTRACTOR FOR REVISION OPERATIONS AND EXTRACTION METHOD.

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