Current Technique for the Ream-and-Run Arthroplasty for Glenohumeral Osteoarthritis.

Abstract

The ream and run is a technically demanding shoulder arthroplasty for the management of glenohumeral arthritis that avoids the risk of failure of the glenoid component that is associated with total shoulder arthroplasty. After administration of prophylactic antibiotics and a thorough skin preparation, expose the glenohumeral joint through a long deltopectoral incision, incising the subscapularis tendon from its osseous insertion and the capsule from the anterior-inferior aspect of the humeral neck while carefully protecting all muscle groups and neurovascular structures. Gently expose the proximal part of the humerus, resect the humeral head at 45° to the orthopaedic axis while protecting the rotator cuff, and excise all humeral osteophytes. After performing an extralabral capsular release, remove any residual cartilage, drill the glenoid centerline, and ream the glenoid to a single concavity. Select a humeral prosthesis that fits the medullary canal and that provides the desired mobility and stability of the prosthesis. Fix the humeral component using impaction autografting. After the definitive humeral prosthesis is in place, ensure the desired balance of mobility and stability. If there is excessive posterior translation, consider a rotator interval plication. Achieve and maintain at least 150° of flexion and good external rotation strength. In our study, comfort and function increased progressively after the ream-and-run procedure, reaching a steady state by approximately twenty months. IndicationsContraindicationsPitfalls & Challenges.