Ream and Run non-prosthetic glenoid arthroplasty for shoulder arthritis: Regenerative cementless surgery designed for individuals desiring higher levels of activity than recommended for traditional total joint replacement.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Monday, June 23, 2008
Figure 10 - Axillary incision Figure 12 - Arthritic glenoid Figure 13 - Arthritic glenoid after it has been reamed About the procedureTechnical details Shoulder hemiarthroplasty with non-prosthetic glenoid arthroplasty
is a highly technical procedure; each step plays a critical role in the
outcome.
After the anesthetic has been administered and the shoulder is
prepared, an incision is made across the front of the shoulder from the
middle of the collarbone to the middle of the arm bone as shown in
Figure 10. This incision allows access to the joint without damaging
the important deltoid or pectoralis muscles that are responsible for a
significant portion of the shoulder's power.
The muscles and other tissues near the shoulder are mobilized by
removing any scar tissue that may restrict their motion. The tendon of
the subscapularis muscle is cut to gain access to the joint and
released circumferentially (a 360-degree release) to restore its length
and mobility. Figure 11 shows where the arthritic humeral head (ball of
the joint) is removed. The bone spurs are removed to prepare the bone
for the humeral prosthesis.
The humeral implant is chosen by trialing different sizes and
selecting the one that best matches the patient's anatomy and best
restores the muscle balance in the joint without making the joint too
tight or too loose. The arthritic glenoid is then refinished using a
special spherical reamer. This reaming process corrects the shape and
orientation of the socket, both of which are affected by shoulder
arthritis. The curvature of the reamer nearly matches that of the
humeral ball and this matching surface allows smooth and stable
rotation of the ball in the socket. Figure 12 shows the arthritic
glenoid and figure 13 shows the glenoid after it has been reamed.
In this procedure, the glenoid shape and orientation are corrected,
but a glenoid prosthesis is not inserted. Once the reaming process is
completed, the final humeral component is inserted. The subscapularis
tendon is then carefully repaired and closure of the muscle and skin
layers completes the procedure. A drain is placed which is removed on
the second morning after surgery. This prevents blood from collecting
in the wound. Anesthetic Shoulder replacement surgery may be performed under a general
anesthetic or under a brachial plexus nerve block. A brachial plexus
block can provide anesthesia for several hours after the surgery. The
patient may wish to discuss their preferences with the anesthesiologist
before surgery.Length of non-prosthetic glenoid arthroplasty The procedure usually takes approximately two hours, however the
preoperative preparation and the postoperative recovery may add several
hours to this time. Patients often spend two hours in the recovery room
and two to four days in the hospital after surgery.Surgery for Arthritis of the Shoulder at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment.
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