A technique and patient-selection paper on the ream and run shoulder arthroplasty. The procedure replaces the humeral head and articulates it directly against a conservatively reamed glenoid, avoiding a polyethylene glenoid component. It frames candidacy around the '4Ps': patient, problem, procedure, and physician.
The central decision rule: the ream and run trades an implant problem for a rehabilitation problem. By removing the polyethylene glenoid, you eliminate the leading cause of total shoulder arthroplasty failure, but success now depends entirely on the patient regenerating a fibrocartilage surface over months of daily exercise.
That is why selection is so strict. Depression, poorly controlled comorbidities, substance use, or inability to commit to up to two years of rehab all predict poor results. Know the accepted indications (osteoarthritis, capsulorrhaphy arthropathy, posttraumatic arthritis) versus the diagnoses to avoid (rheumatoid arthritis, chondrolysis, cuff-tear arthropathy, avascular necrosis).
When a ream and run goes poorly, think stiffness first, and act early with manipulation rather than jumping to revision. This is a single-surgeon experience of just over 300 cases, so weight it as expert technique guidance rather than comparative evidence.
A technique and patient-selection paper on the ream and run shoulder arthroplasty. The procedure replaces the humeral head and articulates it directly against a conservatively reamed glenoid, avoiding a polyethylene glenoid component. It frames candidacy around the '4Ps': patient, problem, procedure, and physician.
The central decision rule: the ream and run trades an implant problem for a rehabilitation problem. By removing the polyethylene glenoid, you eliminate the leading cause of total shoulder arthroplasty failure, but success now depends entirely on the patient regenerating a fibrocartilage surface over months of daily exercise.
That is why selection is so strict. Depression, poorly controlled comorbidities, substance use, or inability to commit to up to two years of rehab all predict poor results. Know the accepted indications (osteoarthritis, capsulorrhaphy arthropathy, posttraumatic arthritis) versus the diagnoses to avoid (rheumatoid arthritis, chondrolysis, cuff-tear arthropathy, avascular necrosis).
When a ream and run goes poorly, think stiffness first, and act early with manipulation rather than jumping to revision. This is a single-surgeon experience of just over 300 cases, so weight it as expert technique guidance rather than comparative evidence.