Ream and Run - fine tuning the procedure

In the past, stiffness has been a problem for some of the patients having the ream and run procedure. On the other hand we've had no problems with instability, even though we make no specific effort to modify glenoid version. In light of these observations, we are shifting our technique slightly so that the shoulder has a bit more laxity at surgery by using thinner humeral head components and avoiding a rotator interval plication unless there is excessive posterior translation. This is enabling patients to regain their motion earlier and more completely.

Here are the x-rays of a man presenting with a long-standing painfully stiff shoulder.

 His axillary 'truth' view shows posterior decentering of the humeral head on a glenoid with 18 degrees of retroversion.

To be sure that we were not overstuffing his joint, we used a humeral head prosthesis with a thickness of 15 mm (diameter of curvature 56 mm). Use of this thinner head requires careful attention to prevent unwanted contact between the humeral bone and the glenoid in all glenohumeral positions (avoiding a Pooh corner issue and open booking, see this link).

His postoperative films are shown below Note the complete clearing away of the inferior osteophytes and the smooth, thin, impaction grafted humeral stem.

 His postoperative axillary 'truth' view showed centering of the humeral head on the reamed glenoid. No rotator interval plication was performed.

Within 24 hours after surgery, he had regained full comfortable passive motion.

To be clear, this is an exceptionally motivated patient, reinforcing the idea that in addition to surgical technique, patient selection is the other key component to achieving a great result from this procedure.

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