These authors point out that the long-term outcomes of anatomic total shoulder arthroplasty (aTSA) can be compromised by glenoid loosening and failure: glenoid component failure after aTSA has been reported to be up to 17% at 10 years. Risk factors for failure include younger age, more active patients and patients with eccentric posterior glenoid wear. Management of aTSA with a failed glenoid component is challenging due to glenoid bone deficiency. Consequently, many surgeons recommend activity restrictions after aTSA to maximize survivorship of the implant.
The Ream and Run is an alternative treatment for advanced glenohumeral arthritis. This type of glenohumeral arthroplasty is distinct from a shoulder hemiarthroplasty in that the glenoid is reamed to a smooth concavity that articulates with the prosthetic humeral head. In this series, the glenoid was reamed to a diameter of curvature 4-6 mm greater than that or the humeral head component, preserving as much glenoid bone as possible.
Passive self-assisted motion was initiated immediately, and progressed to active-assisted motion after 6 weeks; strengthening exercises were initiated at 12 weeks after surgery.
They evaluated their outcomes for the Ream and Run in the treatment of advanced glenohumeral osteoarthritis in 49 shoulders (mean age 60 years, 43 male) with minimum 2 year follow-up.
Thirteen shoulders (26.5%) had previous nonarthroplasty shoulder surgery.
Nineteen shoulders (38.8%) had Walch Type A and 30 (61.2%) had Type B glenoids.
Active forward elevation and active external rotation improved from 112 to 139 and 13 to 39 degrees, respectively.
The mean Simple Shoulder Test (SST), ASES, DASH, and VAS shoulder pain at most recent follow-up were 10.5 (out of a maximum of 12), 86.6, 10.1, and 1.5, respectively.
The mean SST, ASES and VAS score improvements far exceeded the MCID and SCB thresholds that have been reported for anatomic total shoulder arthroplasty (aTSA).
The percent of maximal possible improvement (%MPI), averaged 80.6% for the SST score and 80.1% for the ASES score, values which exceeded those reported for patients who achieve excellent satisfaction after a total shoulder arthroplasty (aTSA).
Male sex and not having prior shoulder surgery were significantly associated with better absolute and greater change in outcomes; no radiographic measure was associated with the outcome - specifically the preoperative glenoid type was not associated with the outcomes.
Mean SF-6D significantly improved from 0.66 to 0.77 and mean Eq-5D significantly improved from 0.68 to 0.85.
The improvement in HRQoL was significantly associated with nondominant arm treatment, increased age, and greater pre-operative SST score.
No patients underwent manipulation under anesthesia or capsular release.
A concentric glenohumeral articulation was re-established and maintained in 29 of the 30 preoperatively eccentric glenoids (96.8%). Patients with B-type glenoids had significantly greater improvement in EQ-5D and SF- 6D scores. In contrast to reports for total shoulder arthroplasty, the revision rate was not higher for preoperative type B glenoids. Annual medialization of the humeral head center of rotation was 0.56 mm/year, although it is unknown if this medicalization plateaued with longer followup.
Six patients (12.2%) underwent a second procedure. One patient had an acute (14 days) post-operative infection with Cutibacterium and Coagulase-negative Staphylococcus aureus successfully treated with irrigation and debridement, exchange of the humeral implant, and intravenous antibiotics with an excellent outcome at 4 years. Five patients (10.2%) underwent revision for pain at a mean of 32.6 months. One of these patients had loosening of a short humeral stem.
The three that had revision to anatomic arthroplasty (2 repeat RnR and one aTSA) had positive Cutibacterium cultures at the time of revision, and all had a history of prior shoulder surgery. Two patients were revised to reverse shoulder arthroplasty, one had negative cultures and one was revised elsewhere without culture data available.
Of the 8 patients who underwent revision arthroplasty for pain (n=5) and those who were dissatisfied at final follow-up without undergoing revision arthroplasty (n=3), 7 had a history of prior shoulder surgery. It cannot be known if the three patients who were dissatisfied at final follow-up without undergoing revision had periprosthetic infections with Cutibacterium.
Comment: This is an important study. It is the largest reported series of Ream and Run procedures performed at a center outside the University of Washington. The results demonstrate that high levels of patient self-assessed comfort and function can be achieved with this procedure.
It is of particular importance that the Ream and run procedure was at least as effective for patients with posterior glenoid bone loss (type B glenoid pathoanatomy) as for patients without posterior bone loss.
Finally, this study demonstrates that patients with prior surgery are at increased risk for inferior outcomes, possibly due to pernicious infection from low virulence organisms such as Cutibacterium.
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