The results of the Mark 2 design were published in 2001 [20]. 103
shoulders were implanted into 94 patients (9 bilateral). There were
73 females and 21 males. The mean age at the time of surgery was
64.3 years (Range 22-88y). Total shoulder replacement (TSR) was used
in 68 cases and Hemiarthroplasty in 35. The average length of
follow-up was 6.8 years (Range 5 years to 10 years).
1. Constant Scores The pre-operative average Constant Score was 15.4 points or
24% after adjustments for age and gender. Post-operative Constant
Scores at follow-up was 52.4 points or 75.2% after adjustments for
age and gender. Best results were achieved in cases of primary
Osteoarthritis with Constant scores of 93.7% for TSR and 73.5% for
Hemiarthroplasty. The poorest results were encountered in patients
with cuff arthropathy, Instability arthropathy and other causes (arthropathy
post septic arthritis) with adjusted Constant Scores of 61.3%, 62.7%
and 58.7% respectively. Active elevation improved by an average of
69 degrees to an average of 133 degrees for Osteoarthritis and
avascular necrosis and to an average of 105 degrees for Rheumatoid
Arthritis. For Instability arthropathy and Cuff arthropathy this
increased to an average of 97 degrees and 73 degrees, respectively.
Pre-operative and post-operative differences were statistically
significant for all the disease groups (p<0.001).
2. Patients subjective assessment 93.9% reported that their shoulder was much better or
better. 6.1% of patients were disappointed and considered themselves
to be the same as before surgery, usually because of limited range
of motion but they were satisfied with pain relief .
3. Radiological results There was a 5.1% incidence of progressive lucent lines of
more than 2mm, with signs of definite loosening. Since using the
hydroxyapatite-coated implants, no lucent lines have been observed.
The relevance of the radiolucent line is uncertain, but seems
unrelated to the outcome.
In 5 shoulders some degree of mild humeral prosthesis subsidence was
found. There seemed to be no effect of the mild subsidence on the
clinical result.
5. Revision surgery The revision rate at five to ten years of using the Mark 2
design has been 6%. The indications were:
1. Instability following total shoulder resurfacing arthroplasty for
instability arthropathy in two patients.
2. One periprosthetic fracture following a fall
3. One disassociation of the polyethylene glenoid from the metal
part of the glenoid component
4. One glenoid loosening following a fall
5. Two aseptic loosening - One involved both humerus and glenoid,
and one glenoid only.
Removal of the humeral surface component was easily and speedily
done as no cement or prosthetic stem had to be exposed and removed.
Removal of cemented stemmed prosthesis is associated with loss of
bone stock, perforation and fracture of the humeral shaft.
top
top