What is Ream and Run Shoulder Arthroplasty?
Ream and run shoulder arthroplasty, also known as shoulder hemiarthroplasty with non-prosthetic glenoid arthroplasty, is a novel type of shoulder arthroplasty (replacement) procedure employed for the treatment of severe arthritis of the shoulder. Shoulder arthritis is a condition in which the cartilage on the glenoid and humeral head deteriorates resulting in significant pain and stiffness of the shoulder joint.
In a standard shoulder replacement procedure, the damaged or worn out articulating surfaces of the shoulder joint (surfaces of the humeral head and glenoid socket) are removed and replaced with artificial prostheses made of metal or plastic. A ream and run shoulder arthroplasty is a hemiarthroplasty (partial shoulder replacement) procedure in which only the ball section of the shoulder joint (humeral head) is substituted by a metal prosthesis, but the glenoid socket is not covered with a metal or plastic prosthesis. Instead, the glenoid socket is reshaped and smoothed down to match with the metal ball component of the humeral head. As the plastic socket implant is the weak link in shoulder arthroplasty, avoiding the placement of this greatly minimizes the risk of shoulder replacement failure due to wear loosening and fracture of the plastic socket.
The ream and run shoulder arthroplasty is a unique technique that is specially designed for patients who wish to maintain a high level of activity or are younger than the standard shoulder arthroplasty patients.
Anatomy of the Shoulder
The shoulder joint (glenohumeral joint) is a ball and socket joint where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid. The two articulating surfaces of the bones are covered by a smooth tissue called articular cartilage, which allows the bones to slide over each other without friction, enabling smooth movement. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.
The ream and run shoulder arthroplasty is recommended for patients who require active utilization of their shoulder replacement without any apprehension of glenoid component failure over time as in traditional shoulder arthroplasty. The "ream and run" technique allows active patients to pursue their vocational, recreational, and fitness goals without the risk of premature failure if standard shoulder replacement were to be done. Ream and run shoulder arthroplasty is indicated to treat the following conditions:
- Posttraumatic arthritis
- Primary and secondary osteoarthritis
- Capsulorrhaphy arthropathy
- Shoulder arthritis with failed conservative treatment
This procedure is contraindicated in patients with glenoid dysplasia, inflammatory arthritis, and those who have a significant history of tobacco abuse, narcotic medication usage, or poor mental and physical health concerns.
Preparation for Ream and Run Shoulder Arthroplasty
Preoperative preparation for ream and run shoulder arthroplasty may involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements for a week or two prior to surgery.
- You should refrain from alcohol or tobacco at least a week before and 2 weeks after surgery.
- You should not consume solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Ream and Run Shoulder Arthroplasty
In general, ream and run shoulder arthroplasty procedure will involve the following steps:
- You will lie on your back on the operating table under regional or general anesthesia.
- An incision is made over the affected shoulder and the underlying muscles are separated to expose the shoulder joint.
- The surgery may be performed as an open surgery, where a large incision is made, or minimally invasive, where small incisions are made to insert an arthroscope (a thin tube with a camera and light source) and surgical tools.
- The upper arm bone (humerus) is separated from the glenoid socket of the shoulder bone.
- The arthritic or damaged humeral head is cut and the humerus bone is hollowed out and filled with impaction bone graft, harvested from the removed humeral head and osteophytes.
- A metal ball with a stem is gently press-fit into the upper end of the humerus.
- Next, the arthritic part of the socket is reshaped using a special reamer to correct the orientation and shape of the socket affected by arthritis. The refinished glenoid socket now provides a smooth and stable surface for the humeral head to rotate and fit appropriately.
- The humeral component is attached into the smoothened glenoid socket to form the new shoulder joint.
- The shoulder joint is then tested through its range of motion, and the entire joint is irrigated and cleaned with a sterile solution.
- Upon completion, the incision is closed with absorbable sutures and covered with a sterile bandage.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after ream and run shoulder arthroplasty may involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may need to stay in the hospital for 2 to 3 days before discharge to home.
- You may notice some pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed.
- Your arm may be secured with assistive devices such as a sling or a cast for the first few weeks to facilitate healing with instructions on restricted weight-bearing.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking as it can negatively affect the healing process.
- Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol will be designed to help strengthen shoulder muscles and optimize shoulder function.
- Most patients are able to resume their normal activities in a month or two after surgery; however, return to sports may take at least 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Ream and run shoulder arthroplasty is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Postoperative pain
- Damage to nerves and vessels
- Thromboembolism or blood clots
- Anesthetic reactions