Tuesday, January 27, 2015

The ream and run: not for every patient, every surgeon or every problem

The ream and run: not for every patient, every surgeon or every problem

This article was invited by International Orthopaedics. The abstract is reproduced here.

The purpose of this paper is to provide some essential and basic information concerning the ream and run technique for shoulder arthroplasty.

In a total shoulder arthroplasty, the humeral head prosthesis articulates with a polyethylene glenoid surface placed on the bone of the glenoid. Failure of the glenoid component is recognised as the principal cause of failure of total shoulder arthroplasty. By contrast, in the ream and run procedure, the humeral head prosthesis articulates directly with the glenoid, which has been conservatively reamed to provide a stabilising concavity and maximal glenohumeral contact area for load transfer. While no interpositional material is placed on the surface of the glenoid, animal studies have demonstrated that the reamed glenoid bone forms fibrocartilage, which is firmly fixed to the reamed bony surface. Glenohumeral motion is instituted on the day of surgery and continued daily after surgery to mold the regenerating glenoid fibrocartilage. When the healing process is complete - as indicated by a good and comfortable range of motion - exercises and activities are added progressively without concern for glenoid component failure. 

The experience to date indicates that a technically well done ream and run procedure can restore high levels of comfort and function to carefully selected patients with osteoarthritis, capsulorrhaphy arthroplathy, and posttraumatic arthritis.

Patients considering the ream and run procedure should understand that this technique avoids the risks and limitations associated with a polyethylene glenoid component, but that it requires strong motivation to follow through on a rehabilitation course that may require many months. The outcome of this procedure depends on the body’s regeneration of a new surface for the glenoid and requires rigorous adherence to a daily exercise program. This paper explains in detail the principal factors in patient selection and the key technical elements of the procedure. Clinical examples and outcomes are demonstrated.


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