Can the Ream and Run Procedure Improve Glenohumeral Relationships and Function for Shoulders With the Arthritic Triad?

Abstract

Background The arthritic triad of glenoid biconcavity, glenoid retroversion, and posterior displacement of the humeral head on the glenoid is associated with an increased risk of failure of total shoulder joint replacement. Although a number of glenohumeral arthroplasty techniques are being used to manage this complex pathology, problems with glenoid component failure remain. In that the ream and run procedure manages arthritic pathoanatomy without a glenoid component, we sought evidence that this procedure can be effective in improving the centering of the humeral head contact on the glenoid and in improving the comfort and function of shoulders with the arthritic triad without the risk of glenoid component failure.Questions/purposes We asked, for shoulders with the arthritic triad, whether the ream and run procedure could improve glenohumeral relationships as measured on standardized axillary radiographs and patient-reported shoulder comfort and function as recorded by the Simple Shoulder Test. Methods Between January 1, 2006 and December 14, 2011, we performed 531 primary anatomic glenohumeral arthroplasties for arthritis, of which 221 (42%) were ream and run procedures. Of these, 30 shoulders in 30 patients had the ream and run procedure for the arthritic triad and had two years of clinical and radiographic follow-up. These 30 shoulders formed the basis for this case series. The average age of the patients was 56 ± 8 years; all but one were male. Two of the 30 patients requested revision to total shoulder arthroplasty within the first year after their ream and run procedure because of their dissatisfaction with their rehabilitation progress. For the 28 shoulders not having had a revision, we determined on the standardized axillary views before and after surgery the glenoid type, glenoid version (90°minus the angle between the plane of the glenoid face and the plane of the body of the scapula), and location of the humeral contact point with respect to the anteroposterio dimension of the glenoid (the ratio of the distance from the anterior glenoid lip to the contact point divided by the distance between the anterior and posterior glenoid lips). We also recorded the patient's self-assessed shoulder comfort and function before and after surgery using the 12 questions of the Simple Shoulder Test. Results For the 28 unrevised shoulders the mean followup was 3.0 years (range, 2-9.2 years). In these patients, the ream and run procedure resulted in improved centering of the humeral head on the face of the glenoid (preoperative: 75% ± 7% posterior; postoperative: 59% ± 10% posterior; mean difference 16% [95% CI, 13%-19%]; p \ 0.001), notably this improved centering was achieved

Age-dependent variation of glenohumeral anatomy: a radiological study

“…This finding underlines that an increase of head size is not necessarily caused by the development of osteophytes in osteoarthritis. When performing reconstruction and replacement procedures that solely address the humeral head like the ream and run procedure, one should consider that a physiological increase in humeral head diameters has to be expected during the aging process [17].…”

Surgical management of the biconcave (B2) glenoid

“…The proponents of this method report that the reamed glenoid remodels with fibrocartilage to create a new concentric surface that balances the humeral head [30]. This technique has been shown to improve centering of the humeral head contact point on the face of the glenoid when evaluated on axillary radiographs at average 3-year follow-up [31]. The main limitation of the ream and run procedure is that it invariably produces joint line medialization.…”

“…The convex pin guide must be placed parallel to this surface in order place the pin in anatomic version and inclination biconcavity. This may result in soft tissue laxity and persistent posterior instability in the setting of a B2 glenoid and require additional procedures for posterior stabilization, such as posterior capsular plication, rotator interval plication, increased humeral head anteversion, or anterior offset of the humeral head [31,32]. Additional studies are needed to further define the limits of the ream and run procedure as well as the longterm outcome.…”

Alternative Behandlungsoptionen am Glenoid

“…In einer aktuellen Untersuchung berichten Matsen et al [28] über die Ergebnisse des Ream-and-run-Verfahrens bei vorliegender "arthritic triad", definiert als die Kombination aus posteriorer Subluxationsstellung des Humeruskopfes, Retroversionsstellung der glenoidalen Gelenkfläche und bikonkaver Glenoidmorphologie. In der Fallserie bestehend aus 30 Patienten wurden innerhalb des ersten postoperativen Jahres 2 Patienten aufgrund von "Unzufriedenheit" mit dem postoperativen Ergebnis auf eine TEP revidiert (6,7 %).…”

“…Das mittlere Follow-up für die verbliebenen 28 Patienten betrug 3 (2-9,2) Jahre. Es konnte postoperativ eine signifikante Reduktion der posterioren Subluxationsstellung nachgewiesen werden, ohne dass dabei ein signifikanter Einfluss auf die Retroversion genommen wurde (p < 0,001, [28]). Die funktionellen Ergebnisse auf Basis des Simple-shoulderTests zeigten ebenfalls eine signifikante Verbesserung im Vergleich zu präopera-tiv (p < 0,001).…”