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.
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
Pitfalls & Challenges