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

[Introduction][1] 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. ![Figure][2] ![Figure][2] ![Figure][2] [Step 1: Surgical Approach][3] 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. ![Figure][2] [Step 2: Humeral Preparation][4] 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. ![Figure][2] [Step 3: Glenoid Preparation][5] After performing an extralabral capsular release, remove any residual cartilage, drill the glenoid centerline, and ream the glenoid to a single concavity. ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] [Step 4: Humeral Prosthesis Selection][6] Select a humeral prosthesis that fits the medullary canal and that provides the desired mobility and stability of the prosthesis. ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] [Step 5: Humeral Prosthesis Fixation][7] Fix the humeral component using impaction autografting. ![Figure][2] ![Figure][2] [Step 6: Soft-Tissue Balancing][8] 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. ![Figure][2] [Step 7: Rehabilitation][9] Achieve and maintain at least 150° of flexion and good external rotation strength. [Results][10] 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][11] [Indications][12] [Contraindications][13] [Pitfalls & Challenges][14] [Introduction][1] 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. ![Figure][2] ![Figure][2] ![Figure][2] [Step 1: Surgical Approach][3] 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. ![Figure][2] [Step 2: Humeral Preparation][4] 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. ![Figure][2] [Step 3: Glenoid Preparation][5] After performing an extralabral capsular release, remove any residual cartilage, drill the glenoid centerline, and ream the glenoid to a single concavity. ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] [Step 4: Humeral Prosthesis Selection][6] Select a humeral prosthesis that fits the medullary canal and that provides the desired mobility and stability of the prosthesis. ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] ![Figure][2] [Step 5: Humeral Prosthesis Fixation][7] Fix the humeral component using impaction autografting. ![Figure][2] ![Figure][2] [Step 6: Soft-Tissue Balancing][8] 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. ![Figure][2] [Step 7: Rehabilitation][9] Achieve and maintain at least 150° of flexion and good external rotation strength. [Results][10] 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][11] [Indications][12] [Contraindications][13] [Pitfalls & Challenges][14] [1]: #sec-11 [2]: pending:yes [3]: #sec-12 [4]: #sec-13 [5]: #sec-14 [6]: #sec-15 [7]: #sec-16 [8]: #sec-17 [9]: #sec-18 [10]: #sec-19 [11]: #sec-20 [12]: #sec-21 [13]: #sec-22 [14]: #sec-23