An active man from a state on the opposite side of the country presented with pain and limited function in both shoulders. His Simple Shoulder Tests are shown below.
Standard plain x-rays of the right shoulder showed severe osteoarthritis, loose bodies, and posterior humeral decentering on a biconcave retroverted (B2) glenoid seen on the axillary truth view.
Standard plain x-rays of the left shoulder showed severe osteoarthritis, loose bodies, and humeral head centering on a monoconcave, non-retroverted (A2) glenoid as seen on the axillary truth view.
After discussion of the alternatives of anatomic and reverse total shoulder, he elected a ream and run procedure to avoid the risks and limitations associated with the other two procedures.
The procedures were performed 6 months apart with no preoperative CT or MRI and no 3D planning. General anesthesia was used without a nerve block. The biceps tendons were preserved. The glenoids were conservatively reamed to a single concavity. No attempt was made to change or "correct" glenoid version on either side. Smooth standard length humeral stems were fixed with impaction autografting. On the right side an anteriorly eccentric humeral head component was used to manage posterior humeral decentering.
He returned for routine followup 7 years after his ream and run procedures. He could perform 11/12 Simple Shoulder Test functions on each side.
His 7 year followup x-rays are shown below. Note the absence of the stress shielding that has been associated with other stem designs. Note the absence of glenoid erosion with this standard chrome-cobalt humeral head. Note also the centering of the anteriorly eccentric humeral head on the retroverted glenoid of the right shoulder.
The patient was pleased with the outcome.
Of note the costs of CT scans, 3-D planning, brachial plexus blocks, polyethylene glenoids, cement, pyrocarbon humeral heads, special ingrowth humeral stems and reverse total shoulders were avoided without compromise of the clinical outcome.
Sadly, the DePuy Global Advantage simple, standard-length, uncoated humeral stem that had reliably served patients like this man for decades is no longer manufactured, in spite of its excellent service record, low cost, and lack of implant related complications. It has been "replaced" by more complex and more expensive stems, some of the many "options" are shown here.
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