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

INTRODUCTION: 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. STEP 1 SURGICAL APPROACH: 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. STEP 2 HUMERAL PREPARATION: 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. STEP 3 GLENOID PREPARATION: After performing an extralabral capsular release, remove any residual cartilage, drill the glenoid centerline, and ream the glenoid to a single concavity. STEP 4 HUMERAL PROSTHESIS SELECTION: Select a humeral prosthesis that fits the medullary canal and that provides the desired mobility and stability of the prosthesis. STEP 5 HUMERAL PROSTHESIS FIXATION: Fix the humeral component using impaction autografting. STEP 6 SOFT-TISSUE BALANCING: 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. STEP 7 REHABILITATION: Achieve and maintain at least 150° of flexion and good external rotation strength.
RESULTS: In our study, comfort and function increased progressively after the ream-and-run procedure, reaching a steady state by approximately twenty months. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.