Rosenberg Nahum, Neumann Lars, Modi Amit, Mersich Istvan J, Wallace Angus W
The Nottingham Shoulder and Elbow Unit, City Hospital, Nottingham, UK.
BMC Musculoskelet Disord. 2007 Aug 4;8:76. doi: 10.1186/1471-2474-8-76.
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.
Survivorship 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.
The 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.
The 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.
非骨水泥型诺丁汉全肩关节置换假体系统（Nottingham TSR）是在考虑先前生物模块化肩关节假体植入失败原因的基础上研发而来。我们研究了Nottingham TSR假体设计的改变对其生存率的影响。
比较了三种非骨水泥型全肩关节置换假体（生物模块化假体、初代Nottingham TSR假体和当前Nottingham TSR假体系统，分别有11年、8年和4年的生存率数据）的生存率分析。所有这些假体均用于治疗原发性和继发性骨关节炎或类风湿关节炎所致的肩部致残性疼痛。每种研究的假体都植入连续的患者组中——90例患者植入生物模块化系统，103例植入初代Nottingham TSR假体，34例患者植入当前Nottingham TSR假体系统。根据配对t检验对三组在相同时段内的年度累积生存率值进行比较。
与报道的传统骨水泥型植入物的生存率相比，最初使用的改良型非骨水泥生物模块化假体的8年和11年生存率相对较低（分别为75.6%和71.7%）。非骨水泥型Nottingham TSR假体的8年生存率显著更高（81.8%），但仍未达到其他骨水泥型设计中90%以上的理想范围。肩胛盂部件松动是两种假体失败的主要因素，且主要发生在术后头4年。当前重新设计的带有羟基磷灰石涂层肩胛盂基板的Nottingham TSR假体的4年生存率显著更高，为93.1%，而之前的Nottingham TSR假体为85.1%。
初代诺丁汉肩关节假体的生存率显著高于非骨水泥生物模块化假体，但低于预期。随后重新设计的Nottingham TSR系统呈现出较高的短期生存率，这鼓励了其持续使用。
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