Sunday, July 16, 2017

Ream and run at 10 years after surgery

Ten years ago we met a 58-year-old right-hand dominant male who had a traumatic injury to the left shoulder in 1966, described as an anterior shoulder dislocation with three subsequent dislocations after that. He had an open surgical repair in 1970 described as "muscles were transferred". While there were no dislocations after that surgery, the patient did have limitations in the range of motion.

In the three years before our visit he experienced increased soreness, pain, “freezing up” of the left shoulder, also with night pain. His preoperative radiographs showed flattening of his humeral head and glenoid. His exam showed essentially no motion at the glenohumeral joint.


After discussion of the option of total shoulder, he elected a ream and run procedure to avoid the potential risks and limitations associated with a polyethylene glenoid component.

At our invitation he returned to the office for a 10 year followup. His shoulder was asymptomatic and allowed him to participate in all his desired activities, including clamming, fishing, and day-to-day work around the house.

His 10 year films are shown below. Note the secure fixation of his impaction autografted stem (without cement or bony ingrowth), the regenerated glenoid joint surface and the centering of the head in the glenoid concavity.


Using the Kinect, we measured his range of motion (left/right): abduction 166/165, flexion 154/179, external rotation in abduction 69/85, and internal rotation in abduction 30/45.

He kindly allowed us to make a video of his motion to share with interested readers of the blog

video



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