Abstract
BackgroundThe uncemented Nottingham Total Shoulder Replacement prosthesis system (Nottingham TSR) was developed from the previous BioModular® shoulder prosthesis taking into consideration the causes of the initial implant's failure.We investigated the impact of changes in the design of Nottingham TSR prosthesis on its survivorship rate.MethodsSurvivorship analyses of three types of uncemented total shoulder arthroplasty prostheses (BioModular®, initial Nottingham TSR and current Nottingham TSR systems with 11, 8 and 4 year survivorship data respectively) were compared. All these prostheses were implanted for the treatment of disabling pain in the shoulder due to primary and secondary osteoarthritis or rheumatoid arthritis. Each type of the prosthesis studied was implanted in consecutive group of patients – 90 patients with BioModular® system, 103 with the initial Nottingham TSR and 34 patients with the current Nottingham TSR system.The comparison of the annual cumulative survivorship values in the compatible time range between the three groups was done according to the paired t test.ResultsThe 8-year and 11-year survivorship rates for the initially used modified BioModular® uncemented prosthesis were relatively low (75.6% and 71.7% respectively) comparing to the reported survivorship of the conventional cemented implants. The 8-year survivorship for the uncemented Nottingham TSR prosthesis was significantly higher (81.8%), but still not in the desired range of above 90%, that is found in other cemented designs. Glenoid component loosening was the main factor of prosthesis failure in both prostheses and mainly occurred in the first 4 postoperative years. The 4-year survivorship of the currently re-designed Nottingham TSR prosthesis, with hydroxylapatite coating of the glenoid baseplate, was significantly higher, 93.1% as compared to 85.1% of the previous Nottingham TSR.ConclusionThe initial Nottingham shoulder prosthesis showed significantly higher survivorship than the BioModular® uncemented prosthesis, but lower than expected. Subsequently re-designed Nottingham TSR system presented a high short term survivorship rate that encourages its ongoing use
Highlights
The uncemented Nottingham Total Shoulder Replacement prosthesis system (Nottingham TSR) was developed from the previous BioModular® shoulder prosthesis taking into consideration the causes of the initial implant's failure.We investigated the impact of changes in the design of Nottingham TSR prosthesis on its survivorship rate
Glenoid component loosening was the main factor of prosthesis failure in both prostheses and mainly occurred in the first 4 postoperative years
We evaluated the short and midterm survivorship of the Nottingham TSR cementless prosthesis, with comparison to the survivorship of the BioModular® total shoulder arthroplasty (TSA) prosthesis from which the Nottingham TSR evolved, in order to estimate the ability of these implants to achieve the desirable survivorship rates
Summary
The uncemented Nottingham Total Shoulder Replacement prosthesis system (Nottingham TSR) was developed from the previous BioModular® shoulder prosthesis taking into consideration the causes of the initial implant's failure.We investigated the impact of changes in the design of Nottingham TSR prosthesis on its survivorship rate. The pioneering successful prostheses for total shoulder arthroplasty have been based on an unconstrained design, i.e. a metal spherical head component fixed to a metal intramedullary stem articulating with a high-density polyethylene socket (Table 1). These components are stabilized in the adjacent bone using polymethylmethacrylate bone cement [1]. Neer for the cemented total shoulder arthroplasty (TSA) is almost the single one with well documented outcomes [5] with 87% fifteen year survivorship rate for Neer I & II cemented shoulder prostheses This implant has become the gold standard, against which all the successive prosthetic designs are compared
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