Friday, May 27, 2011

Ream and Run for Shoulder Arthritis - is wear an issue? - research foundation 5

We know that shoulder arthritis affects both sides of the joint as shown below.

 This alters the normal load distribution (below left) to one of load concentration and progressive wear (below right)

Simply replacing the humeral head (ball of the shoulder joint) alone, does not address the glenoid wear and can be associated with progressive glenoid wear.

The ream and run procedure restores the glenoid surface to a concentric concavity.

We wanted to know if there was wear of the glenoid bone after this procedure. Shoulder fellows Mercer and Saltzman developed a method for documenting the position of the humeral head center relative to the scapula on standardized plain radiographs that can answer this question. In this method, standardized templates (shown below) are placed over the x-rays to track the position of the center of the head of the humerus.
They used this method in assessing glenoid wear at a minimum of two years after hemiarthroplasty with concentric glenoid reaming. They found that the average wear rate was minimal: the movement of the head center towards the scapula was less than 0.4 mm per year.


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