Thursday, May 5, 2016

The ream and run and its relation to the most cited orthopedic article (by Bill Harris)

A few years ago, CORR published the 100 most cited orthopedic articles (see this link). At the top of the list was

 This is a case series of mold arthroplasties performed between 1945 and 1965 by three orthopaedic icons: M.N. Smith-Peterson, Otto E. Aufranc, and Morton Smith-Peterson. In this procedure the acetabulum was reamed and the reamed femoral head was covered with a metallic cup. Some of the preoperative and followup radiographs are shown below.

All of the procedures is-crc standard arthroplasties with
decortication arid reaming of both the head and acetabulum except for tis’o in ‘which
the cup was placed on the mid-portion of the femoral head ansd tivo in is-hich the cup
‘was seated against the periphery of the acetabulum in preference to inserting it
more deeply insto an e;;kxploded socket
 The clinical results as summarized by the authors are shown below.
kxploded socket
While there are few histological studies of the effect of this early hip procedure the one below suggests the presence of fibrocartilage over the reamed acetabular surface.

It was actually this figure that inspired our exploration of the ream and run procedure (see this link). Histology from an animal model shown below immediately after reaming (left) and six months after showing growth of fibrocartilage over the reamed surface (right).

In case you're curious, American English has no "mould", and British English has no "mold". In other words, the word referring to (1) the various funguses that grow on organic matter or (2) a frame for shaping something is spelled the same in both uses, and the spelling depends on the variety of English.

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