Ream and Run for flattened head, Walch B2 and retroversion

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Yesterday we had the opportunity to perform a ream and run on a 50 year old muscular former weight lifter from the East Coast with bilateral osteoarthritis. 
His preoperative films are shown below. Note the Walch B2 glenoid and the retroversion of the glenoid.

His surgery was challenging because of his muscular build, his stiffness (ER minus 10, FF 80), his osteophytes, and the glenoid shape.  The flatness of his humeral head is shown here.

Using our standard approach for this situation, we reamed his glenoid to a diameter of curvature of 58 mm and used a 56 mm curvature humeral head. The glenoid reaming converted his B2 to a concentric glenoid; no attempt was made to alter his glenoid version. His 'drop back' was managed with an anteriorly eccentric humeral head and a rotator interval closure. At surgery his shoulder was stable to posteriorly directed force and had 160 degrees of flexion and 20 degrees of external rotation. His postoperative films are shown here.

Here he is doing his pulley exercise 13 hours after his surgery was complete. Pulley is particularly useful in cases such as this where both shoulders were arthritic. His as yet unoperated right shoulder is pulling down, lifting his freshly postoperative left arm.

He had the expected swelling and is squeezing the 'happy face ball' to pump the swelling away.

We will eagerly await his clinical outcome.

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