Sunday, January 26, 2014

Can the glenoid be reamed after a biological resurfacing? Hemicap. Copeland. Ream and Run.

This email came in yesterday: "I had a hemiarthroplasty of my shoulder last February with a hemicap and the glenoid was biological resurfaced. Unfortunately my shoulder, at times, is still in significant amount of pain and stiff. My questions are: Is it possible to have the glenoid reamed after a biological resurfacing? Also, can the procedure be done with a hemicap or does the humeral head have to have a spherical resurfacing like a copeland?"

First, a few illustrations to clarify the situation. 

Here is an x-ray of a hemicap from the manufacturer's brochure. Note that only part of the humeral joint surface is covered, in this illustration the joint space is not congruent, and the inferior humeral osteophyte appears to be contacting the inferior glenoid.

Here is an x-ray after a ream and run procedure, in which the glenoid has been reamed to match the curvature of the new humeral head which is fixed without cement in the shaft of the humerus. The only bone that is removed in this procedure is that of the arthritic humeral head. The bone removed is used to help achieve a tight fit of the stem in the humeral shaft. Note the dark space between the humeral head and the glenoid where a new soft tissue layer has regenerated.

In answer to the question posed in the email, yes we have been able to ream the glenoid in cases of failed resurfacing. In these cases we routinely obtain cultures in that there seems to be a rather high rate of culture positivity for Propionibacterium in failed arthroplasties. In fact, here is a post of such a case after a Copeland arthroplasty.

In the ream and run procedure, we use a stemmed humeral component as shown in the x-ray above because it gives maximal security of fixation and maximal flexibility of head size, curvature, and position.

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