Monday, May 16, 2011

Ream and Run for Shoulder Arthritis - Genesis

  Three observations led us to consider the ream and run procedure for shoulder arthritis.
First, some our patients, of any age, did not want to have limits usually imposed by surgeons after a total shoulder joint replacement as we discussed in the May 2 post.
Second, patients with failed glenoid components often experienced substantial improvement after we revised their shoulder by removing the plastic glenoid component, reamed the remaining glenoid bone to a smooth concvity and avoided re-insertion of another glenoid component. Such an example is shown below. This shoulder had received a total shoulder by another surgeon. The glenoid component broke and the patient came to us for revision surgery. We removed the broken elements and the humeral head component, washing the joint thoroughly. We then reamed the glenoid bone to a smooth concavity and inserted a new humeral head component. The X-rays shown below are 8 months after surgery showing a smooth set of joint surfaces; the patient is now substantially improved with respect to comfort and function and is progressively returning to full activities. Close inspection of these images reveals a dark layer of regenerative tissue between the metal ball and the bone of the glenoid. Furthermore, the defect in the bone previously occupied by the polyethylene glenoid component has healed in without the need for bone grafting.

Third is the often forgotten experience with close inspection of the socket surface after mold arthroplasty of the hip reflected also in a second article on mold arthroplasty of the hip. Basically the experience was that inserting a mold in the hip joint between the smoothed ball and socket led to a smooth regenerative surface on the concave side of the joint (acetabulum) as shown in the figures below from these two articles.

We were thus led to the realization that the socket side of a joint had the capacity to regenerate a smooth bilogical covering, securely attached to the underlying bone that would be immune to the risk and limitations of plastic socket wear or loosening. Furthermore, it appeared that some patients could regain high levels of comfort and function without plastic, even though there was nothing interposed between the metal ball and the bone of the prepared socket.


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