Stemless ream and run: the importance of handcraft.

We have found that stemless humeral components can work well with the ream and run procedure. Our experience has taught us that - even in this age of 3D CT planning and cutting guides - a well-done freehand cut yields precision and accuracy of humeral head position. 

We preserve the biceps tendon, remove the anterior and inferior osteophytes, mark the superior margin of the articular surface (the "hinge point"), make the cut at 135 degrees with the shaft and in 30 degrees of retroversion while aiming the saw so that it exits the humerus just anterior to the posterior cuff insertion. Everyone on the surgical team "coaches the cut". 

Using the x-rays obtained in the recovery room, we "grade" each of our cases with respect the position of the humeral head prosthesis while the case is still fresh in our mind.

We measure the varus/valgus angulation, comparing it to the desired 135 degrees. We also fit a circle to the humeral articular surface, comparing it to the desired "perfect circle", shown below.

When there is deviation from the desired position, the shoulder is likely to have restricted motion from overstuffing as in this case from an outside institution.

Here are some of our most recent cases. While they are not all perfect, grading them immediately after surgery helps us learn to do better on the next case.

Comment: In our practice, the ream and run with a stemless component depends on handcraft.

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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).