Wednesday, October 21, 2015

Ream and run for the B2, retroverted glenoid

Shoulder arthroplasty surgeons are justifiably concerned about the management of arthritic shoulders with the bad arthritic triad (BAT) of (a) glenoid retroversion, (b) glenoid biconcavity and (c) posterior decentering of the humeral head on the glenoid.

This situation was exemplified in a case from this week - a 63 year old physically active executive with a preoperative axillary view showing 40 degrees of retroversion, a biconcave glenoid, and posterior displacement of the head on the glenoid - all demonstrated by an axillary view taken with the arm in the functional position of forward elevation (the 'truth' view).

He desired a ream and run procedure to avoid the risks of a plastic socket. At surgery there was no attempt to 'correct' his glenoid version - reaming was only used to covert his biconcavity to a single concavity; thus the amount of bone removed was minimal. We used an anteriorly eccentric humeral head prosthesis to restore centering of his humeral articular surface in the reamed glenoid.

He is now well-launched on the active assisted range of motion program.


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