A fifty-five year old outdoorsman presented with pain, stiffness and feelings of instability in the right shoulder.
An AP x-ray in the plane of the scapula showed osteoarthritis with overlap of the humeral and glenoid articular surfaces.
An axillary "truth" view showed osteoarthritis with a biconcave glenoid, severe posterior decentering and a cyst in the posterior glenoid.
Because of his active lifestyle, the patient elected a ream and run arthroplasty to avoid the risks and limitations of a plastic glenoid prosthesis. No CT scan, preoperative planning software or special components were needed prior to the ream and run procedure.The glenoid was reamed to 58 mm diameter without attempting change glenoid version. After trialing, a 56 mm diameter of curvature humeral head with a 21 mm thickness and anterior eccentricity and a 14 mm stem was impaction autografted into his humeral canal. No rotator interval plication was needed.
Now ten years after his ream and run procedure, his AP view shows a regenerated glenoid joint surface and a secure impaction grafted stem without evidence of stress shielding
His axillary "truth" view shows again a regenerated glenoid joint surface with centering of the anteriorly eccentric humeral head on the glenoid. The biconcavity and decentering evident on his preoperative axillary have been eliminated.
In a recent email he reported that his range of motion is essentially equal to that of his contralateral unaffected side. He is swimming laps
, tennis serving, throwing and engaging in his outdoor activities.
Interestingly he points out with regular stretching, his range of motion has progressively improved over the last decade.
He concludes that the ream and run "may not be for everyone, but those hoping to regain active use of their arm for sports and recreation, it’s a lifesaver. I have a high degree of confidence in the continued performance of the joint for the remainder of my active outdoor life."
To see a YouTube video on how the ream and run is done, click on this link.
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We have a new set of shoulder youtubes about the shoulder, check them out at this
link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this
link and this
link
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