Wednesday, September 28, 2016

The ream and run procedure for shoulder arthritis

Shoulder arthritis is a condition in which the cartilage normally covering the ball and socket is lost because of wear, injury or prior surgery. Here are photos of an arthritic humeral head and glenoid socket.

Arthritis of the shoulder frequently affects individuals who do not have expectations of high levels of physical activity. These individuals are well served by a standard total shoulder replacement in which the socket is replaced with a plastic component as shown below.

This procedure offers a great chance for regaining a comfortable shoulder that is capable of activities such as golf, swimming, and hiking. However, because of concern regarding the possible adverse effects on the plastic socket, this procedure is not advised for individuals who wish to return to high levels of activity, such as weight lifting, chopping wood, or heavy work

For the last two decades at the University of Washington we have been developing a surgical treatment for severe shoulder arthritis designed for highly motivated individuals who desire to return to high levels of activity without concern about damage to a plastic socket. This procedure involves replacing the arthritic ball side of the joint with a chrome cobalt ball attached to a titanium stem inserted down inside the humerus – the same type of implant used in total shoulder joint replacement. This component is inserted without cement, using the patient’s own bone for fixation.

Instead of replacing the arthritic socket with a plastic implant, the socket bone is reamed to the desired shape.

The raw reamed bone heals as the patient performs specific postoperative motion exercises. Because the recovery from this procedure can be long and difficult, it is only recommended for healthy and dedicated patients who understand that the result depends largely on the effort they put in to the rehabilitation.

Many patients with shoulder arthritis are not good candidates for this procedure. Others choosing to have a ream and run do not achieve the desired result and may require additional surgery. However, many of the hundreds of patients having had the ream and run have been able to achieve prolonged levels of high shoulder function as shown in this video (click here).  We are continuing to study the long-term results of this operation and the factors that favor an excellent outcome.

Click here to see a detailed PDF on this procedure: ream and run