A 55 year old may presents with pain and stiffness in his left shoulder that came on after a stemless ream and run procedure performed almost two years prior. His pre ream and run film is shown below.
Below is his postoperative film at the time of his presentation to us showing overstuffing related in part to a conservative head cut.
On examination his active and passive flexion were limited to 30 degrees limited by extreme pain.
After discussion of the options, he decided to proceed with a revision ream and run arthroplasty after discussion of the risks and alternatives of total shoulder arthroplasty.
At surgery there was no evidence of synovitis. Specimens were sent for Cutibacterium-specific cultures; a vigorous release of the sub scapulars and capsule was preformed. The prior implant was removed, preserving as much bone a possible. A new head cut was made using the hinge point as a reference. The glenoid was re-reamed to a smooth surface. Impaction grafting was used to fix a #2 nucleus and a 50 18 humeral head. The subscapularis was securely repaired. The postoperative films are shown below, showing restoration of the desired anatomy.
His procedure was performed under general anesthesia without a plexus block. The morning after surgery he had assisted elevation to 160 degrees.
