The ream and run in the face of severe posterior glenoid erosion

One of the biggest challenges we face in shoulder arthroplasty is the posteriorly eroded glenoid.
Here's a recent example. Note that the anteroposterior view doesn't look all that remarkable.

However a well done axillary shows the problem.

We know that in this circumstance, a plastic glenoid has an increased chance of failure because of rocking horse loosening.

On the other hand, doing a hemiarthroplasty alone does not address the glenoid biconcave deformity.

Our approach starts with a conservative capsular release, preserving the inferior glenohumeral ligament complex.

Next, we convert the glenoid biconcavity into a single concavity, without trying to change the glenoid version.

We then insert the humeral trial component to see if there is unwanted posterior translation - a positive 'drop back' sign when the arm is lifted forward,

If this occurs, in spite of using a large sized humeral head prosthesis, we use an eccentric humeral head with the eccentricity anterior to re-center the head in the glenoid.

If a positive drop back remains, we perform a rotator interval plication.

Here are some postoperative films showing the effectiveness of these methods in centering the head in the early postoperative period, using the case above as an example.

Additional support against posterior instability can be gained by external rotation strengthening exercises.

Managing this complex situation is difficult and requires careful attention to surgical technique and postoperative care.

See this post for an example of the effectiveness of this approach.

===
Consultation for those who live a distance away from Seattle.

Check out the new Shoulder Arthritis Book - click here.

Click here to see the new Rotator Cuff Book

To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

See the countries from which our readers come on this post.