Ream and run for the young active male patient with glenohumeral arthritis.

Young active male patients with glenohumeral arthritis pose a special challenge for shoulder arthroplasty:

(1) they have often had prior surgery

(2) they desire high levels of physical activity after arthroplasty, including loads, repetitions, and impact

(3) they have long post-operative life expectancy

(4) statistically, they are at higher risk for Cutibacterium periprosthetic infection.

For these reasons, these patients often consider a ream and run procedure which avoids the risks and limitations of a plastic glenoid component (see this link and this link).

Here is a current example of a 40 year old aspiring triathlete who presented with pain and stiffness of the left shoulder after a prior labral repair surgery. On examination his range of motion was as shown below.

His preoperative radiographs are shown below.

Culture of hIs preoperative shoulder skin swab grew 3+ Cutibacterium.

His procedure was performed without preoperative CT planning and without a brachial plexus block. At surgery, the humeral osteophytes and humeral head were resected. His glenoid was conservatively reamed to a diameter of curvature of 58mm. After Betadine lavage and insertion of topical Vancomycin in the medullary canal, a 56 18 12 humeral implant was securely fixed with impaction autografting (see this link).

After surgery he was placed on a 3 week course of oral Doxycycline prophylaxis and started on immediate assisted flexion exercises. He was discharged the morning following his procedure with 130 degrees of assisted flexion.

The patient adhered to the postoperative rehabilitation program (see this link).

At 6 months after surgery he reported "All is well! 70.3 Ironman training is going great. I’ve been working on the stretches you prescribed and I’m comfortable with 65-70lbs on a bench press. My swim times are improving. I “listen” to the shoulder and am being careful not to overdue it. I’m excited to get back to “normal” weight training."

He gave us permission to share these videos he provided at 6 months after his ream and run.

This report shows the early effectiveness of patient dedication to the post-ream and run rehabilitation program.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).