Thursday, December 11, 2014

Ream and run for the triad of biconcavity, retroversion and posterior humeral subluxation

Can the Ream and Run Procedure Improve Glenohumeral Relationships and Function for Shoulders With the Arthritic Triad?

It is recognized that glenoid biconcavity, glenoid retroversion, and posterior displacement of the humeral head on the glenoid are associated with an increased risk of failure of the glenoid component in total shoulder joint replacement. The combination of these three pathologic elements have come to be known as the "bad arthritic triad" or BAT.

In that the ream and run procedure manages arthritic pathoanatomy without a glenoid component, these authors sought evidence that this procedure can be effective in improving the centering of the humeral head contact on the glenoid and in improving the comfort and function of shoulders with the arthritic triad without subjecting the shoulder to the risk of glenoid component failure.

They reviewed 30 shoulders in 30 patients that had the ream and run procedure for the arthritic triad and had two years of clinical and radiographic follow-up.  The average age of the patients was 56 ± 8 years; all but one were male.

Two of the 30 patients requested revision to total shoulder arthroplasty within the first year after their ream and run procedure because of their dissatisfaction with their rehabilitation progress.

For the 28 unrevised shoulders the mean followup was 3.0 years (range, 2–9.2 years). In these patients, the ream and run procedure resulted in improved centering of the humeral head contact point on the face of the glenoid - from 75% posterior to 59% posterior - notably without a significant change in the glenoid version.

Patient-reported function as assessed by the Simple Shoulder Test was improved from 5 ± 3 to 10 ± 4. Ten of the individual functions of the SST were significantly improved:

Comment: While this report shows that the ream and run can be successful in managing selected shoulders with the arthritic triad, the authors point out that this procedure is not for every patient with an arthritic shoulder and not for every surgeon. Patient selection and surgeon experience are critical to the outcome.


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