**7. Post-operative protocol**

Immediate range of motion exercises are begun under the supervision of the therapist. Forward elevation to 140 degree and external rotation to 40 degree is allowed along with

Humeral Hemiarthroplasty with Spherical Glenoid

ensure and adequately healed subscapularis

focus on flexibility.

**8. Complications** 

Run procedure.

**8.1 Glenoid wear and erosion** 

**8.2 Subscapularis rupture** 

Reaming: Theory and Technique of The Ream and Run Procedure 597

Around 4 weeks, progressive return to maximal range of motion is permitted and exercises such as wall walks can be added. Active internal rotation is discouraged to protect the subscapularis. Patients are instructed to still limit use of the arm for physical activities and

At 8 weeks, the focus continues on maximizing range of motion. The subscapularis repair must still be protected from active internal rotation but patients can begin some posterior

Assuming adequate progress and a negative belly-press test at 12 weeks, patients can start internal rotation strengthening and progressive use of the arm for normal daily activities. Return to physically demanding activities and sports requires at least 4 or more months to

In the author's experience in trying to accelerate the rehabilitation protocol, the subscapularis must be protected at all costs. Rupture can occur all the way out to three months despite what appears to be a very durable repair at the time of surgery. Rupture tends to occur from overzealous therapy or patient non-compliance and thus both parties

By six months after surgery a full range of activities are permitted as tolerated by the patient's comfort and demands. Given the absence of concern about failure of a prosthetic glenoid, no specific restrictions are placed on patients activities. Maintenance stretching and strengthening exercises are strongly encouraged for up to 2 years as pain relief, motion and function see to go

Complications of shoulder arthroplasty are well-documented and the Ream and Run is no exception to the conventional and well-accepted adversities that can occur from any open shoulder surgery such as infection and axillary nerve injury. The following discussion will focus on complications that are particularly pertinent though not exclusive to the Ream and

As has been previously discussed, overzealous reaming or the need for excessive glenoid version correction can result in penetration of the subchondral plate and exposure of cancellous bone in the glenoid vault. It can also result in narrowing of the anterior-posterior dimensions of the glenoid concavity, which reduces the overall surface area for contact stress distribution and predisposes to instability. In these situations, patients will continue to experience pain following humeral hemiarthroplasty and may demonstrate recurrent glenoid erosion both medially and posteriorly. Thus patient selection and work-up are critical to predicting who is the ideal candidate likely to have a good outcome and all patients must be counseled about the potential need for glenoid replacement if the principles and goals of non-prosthetic glenoid arthroplasty cannot be met intraoperatively. Rhee and colleagues have shown that the results of salvage glenoid replacement after failed hemiarthroplasty are inferior to primary total shoulder arthroplasty.48 This highlights the

Despite the added security afforded by lesser tuberosity osteotomy, failure can still occur if undue stress is placed on the repair. While the contention maintains that lesser tuberosity

capsular stretching and light deltoid, trapezius and periscapular strengthening.

must be educated about realistic goals and expectations during the early recovery.

hand-in-hand in their potential to improve throughout this prolonged interval.

importance of doing the right operation the first time around.

external rotation isometrics, scapular pinches and cervical and elbow range of motion. Patients are instructed on how to perform active-assisted range of motion exercises and encouraged to do so several times daily. Positional exercises, such as placing the arm on the rest of a couch are also permitted. This holds a static position of stretch for a period of time that does not jeopardize the repair. Most patients are discharged from the hospital with home services and transition to outpatient therapy after their first postoperative visit around 10-14 days.

Fig. 14. A and B: Postoperative AP and axillary lateral radiographs demonstrating anatomical reconstruction of the humerus with creation of a smooth concavity.

Around 4 weeks, progressive return to maximal range of motion is permitted and exercises such as wall walks can be added. Active internal rotation is discouraged to protect the subscapularis. Patients are instructed to still limit use of the arm for physical activities and focus on flexibility.

At 8 weeks, the focus continues on maximizing range of motion. The subscapularis repair must still be protected from active internal rotation but patients can begin some posterior capsular stretching and light deltoid, trapezius and periscapular strengthening.

Assuming adequate progress and a negative belly-press test at 12 weeks, patients can start internal rotation strengthening and progressive use of the arm for normal daily activities. Return to physically demanding activities and sports requires at least 4 or more months to ensure and adequately healed subscapularis

In the author's experience in trying to accelerate the rehabilitation protocol, the subscapularis must be protected at all costs. Rupture can occur all the way out to three months despite what appears to be a very durable repair at the time of surgery. Rupture tends to occur from overzealous therapy or patient non-compliance and thus both parties must be educated about realistic goals and expectations during the early recovery.

By six months after surgery a full range of activities are permitted as tolerated by the patient's comfort and demands. Given the absence of concern about failure of a prosthetic glenoid, no specific restrictions are placed on patients activities. Maintenance stretching and strengthening exercises are strongly encouraged for up to 2 years as pain relief, motion and function see to go hand-in-hand in their potential to improve throughout this prolonged interval.
