Arthroscopic findings after a ream and run shoulder hemiarthroplasty

Although the ream and run procedure has been a matter of debate among shoulder and elbow surgeons, it seems that for the young individual with glenohumeral arthritis there are not many alternative options. Glenoid components fail 10-15 years after surgery and some of these require difficult revision surgery as there is no bone left at the glenoid for reconstruction. The principle of ream and run surgery as developed by Dr Frederick Matsen at the University of Washington is that by reaming the glenoid to a smooth surface there is fibrocartilage regeneration, redistribution of the load and contact pressures to the entire glenoid and decrease in pain.

As reported by Dr Matsen:

"Earlier studies on hip and knee arthroplasty have provided encouraging evidence that reamed bone articulating with a convex metal prosthesis can remodel to a functional and durable arthroplasty concavity, sometimes lasting over four decades. Notably, the majority of so-called mold arthroplasty failures of the hip were on the femoral side and not on the acetabular side of the articulation. An analysis of pelvic specimens retrieved post mortem revealed that the concave acetabular joint surface was often covered with a smooth regenerated surface and had reestablished homogeneous and stable subsurface bone. Moreover, the tissue covering the acetabular concavity was found to resemble dermis and meniscus in terms of glycosaminoglycan content."


The case illustrated below is a of patient 1 year after a ream and run. During arthroscopy we found patchy formation of fibrocartilage on the glenoid side which probably accounts for the pain relief seen at the ream and run surgery. Pictures and video are demonstrated below.