This narrative review and technique paper by Matsen et al. examines why the glenoid remains the unsolved problem in shoulder arthroplasty. It systematically analyzes the failure mechanisms of polyethylene, PMMA, and metal-backed glenoid components. It then presents the ream-and-run procedure as a biologic alternative, supported by canine model data and early clinical results in 110 patients.
Every glenoid component design — keeled, pegged, all-poly, metal-backed. Shares the same vulnerability: eccentric loading concentrates force at the rim, PMMA thermal injury starts the loosening clock at implantation, and polyethylene debris perpetuates it. No current prosthetic socket fully solves any of these three problems.
When you see a young, active patient with glenohumeral OA and a biconcave glenoid who wants to avoid lifelong implant-related risk, the ream-and-run is a legitimate alternative to total shoulder arthroplasty. It eliminates both PMMA and polyethylene from the construct.
For hemiarthroplasty specifically: do not offer it as a standalone solution when eccentric glenoid wear is present. The paper is explicit that hemiarthroplasty alone in this setting is associated with inferior outcomes. The problem cannot be addressed from the humeral side.
The ream-and-run is not for everyone. Smokers, patients on preoperative narcotics, and those unwilling to protect early motion are poor candidates. Patient selection is as important as surgical technique.
This narrative review and technique paper by Matsen et al. examines why the glenoid remains the unsolved problem in shoulder arthroplasty. It systematically analyzes the failure mechanisms of polyethylene, PMMA, and metal-backed glenoid components. It then presents the ream-and-run procedure as a biologic alternative, supported by canine model data and early clinical results in 110 patients.
Every glenoid component design — keeled, pegged, all-poly, metal-backed. Shares the same vulnerability: eccentric loading concentrates force at the rim, PMMA thermal injury starts the loosening clock at implantation, and polyethylene debris perpetuates it. No current prosthetic socket fully solves any of these three problems.
When you see a young, active patient with glenohumeral OA and a biconcave glenoid who wants to avoid lifelong implant-related risk, the ream-and-run is a legitimate alternative to total shoulder arthroplasty. It eliminates both PMMA and polyethylene from the construct.
For hemiarthroplasty specifically: do not offer it as a standalone solution when eccentric glenoid wear is present. The paper is explicit that hemiarthroplasty alone in this setting is associated with inferior outcomes. The problem cannot be addressed from the humeral side.
The ream-and-run is not for everyone. Smokers, patients on preoperative narcotics, and those unwilling to protect early motion are poor candidates. Patient selection is as important as surgical technique.