Sunday, September 24, 2017

Addressing arthritic posterior decentering with the ream and run

Here are examples of the standardized AP and axillary x-rays we obtain prior to shoulder arthroplasty. The AP view shows joint space narrowing and osteophytes.

 while the axillary "truth" view shows posterior decentering when the arm is placed in the functional position of elevation in the plane of the scapula.
Whether the glenoid 'type' is a severe B1 or a mild B2 is not an important surgical consideration. It is of interest, however, that the humeral head is decentered posteriorly even though there is no glenoid retroversion. 
We find that we can obtain all the radiographic information we need for characterizing this shoulder and for preoperative planning without a CT scan and without patient specific instrumentation.

This shoulder was managed with a ream and run using an anteriorly eccentric humeral head component connected to a thin, smooth impaction grafted standard length humeral body.
 The postoperative axillary projection is essentially the same as the preoperative film shown above, enabling comparison. Note that the head is now centered in the reamed glenoid.
In comparing the preoperative and postoperative radiographs, note the conservative nature of the procedure with maximal preservation of the patient's native bone and without a glenoid component.

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