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Scientific Articles   |    
Current Technique for the Ream-and-Run Arthroplasty for Glenohumeral Osteoarthritis
Frederick A. Matsen, III, MD1; Steven B. Lippitt, MD2
1 Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Box 356500, 1959 N.E. Pacific Street, Seattle, WA 98195. E-mail address: matsen@u.washington.edu
2 Akron General Medical Center, 224 West Exchange, Suite 440, Akron, OH 44302-1718
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Based on an original article: J Bone Joint Surg Am. 2012 July 18;94(14):e102



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Oct 24;2(4):e20 1-15. doi: 10.2106/JBJS.ST.L.00009
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Extract

Overview
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

Indications

Contraindications

Pitfalls & Challenges

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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