Ellis Developments Limited
Nottingham, United Kingdom
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Ellis Developments Limited Nottingham, United Kingdom
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The Histological In-growth of Soft Tissue into the Nottingham Hood Prosthesis P Durani, I-H Jeon, TA McCulloch, A McLeod, WA Wallace Nottingham Shoulder & Elbow Unit Nottingham City Hospital The Nottingham Hood l A polyester soft tissue reinforcement device l Used as reinforcement for patients with shoulder arthroplasties complicated by medium or large tears of the rotator cuff (RCTs) l Introduced in 1987, number of modifications made since then l Used on a named patient basis for 10 years on humanitarian grounds – alternative option for patients with massive RCTs l 30 Nottingham Hoods inserted over the past 10 years Aim l Investigate the histological changes associated with the Nottingham Hood: • Amount of fibrous tissue ingrowth • Level of inflammatory reaction l How do the histological changes vary with length of time from implantation ?
Method l 4 patients who have had shoulder prostheses with a Hood inserted for associated massive RCTs l Re-operations for various reasons l Excised material subject to histological analysis l Excised biopsy material obtained at 6 weeks, 5 months, 9 months and 14 years l Routine and polarised light microscopy has been used in all cases RESULTS Patient 1 l 87 yr old lady with severe arthritis; bilateral TSRs – satisfactory left TSR but unstable right TSR. l Suffered CVA, left sided hemi-plegia – became dependent on Right shoulder for ADLs l Right TSR revision: glenoid component removed, glenoplasty, humeral head relocated with a Nottingham Hood to retain it in position l Operated shoulder re-dislocated while nursing staff moving patient in bed l Re-op: glenoid reconstructed, Hood removed
Results : Patient 2 l 76 yr old lady with bilateral lower limb amputations after an accident at 17 years old l Severe arthritis of weight-bearing left shoulder : left TSR carried out l Several revisions: stabilised anteriorly with reinforcement from Nottingham Hood l Visualised at a re-operation 5 months later, and biopsy taken
Results: Patient 3 l 73 year old man with severe arthritis, a complete rotator cuff tear and anterior dislocation of Left shoulder l Nottingham Hood inserted with a Left Neer prosthesis in 1989 l Revision operation 9 months later due to loose glenoid. Nottingham Hood removed at this time, and sent for histology.
Results: Patient 4 l 66 yr old with bilateral shoulder arthritis; right shoulder hemi-arthroplasty in 1988 l Co-existent massive RCT augmented with Nottingham Hood (early version) l Continued problems, Right revision hemi-arthroplasty in 2002 l Nottingham Hood (early version) removed and analysed; replaced with Nottingham Hood (latest version)
Summary of Results
Conclusion l Early organisational response to the insertion of the new material l Long-term incorporation into host tissues by fibrosis and scarring l Small fibrin and foreign body response lingers on l Suggests long-term implantation of polyester as reinforcement of RCTs is not associated with serious biological problems
END With acknowledgements to the authors: P Durani, I-H Jeon, TA McCulloch, A McLeod, WA Wallace
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