Glenoid component wear and loosening are the principal causes of mechanical failure following traditional total shoulder arthroplasty; glenoid component failure typically occurs years after the index arthroplasty. The ream and run is a glenohumeral arthroplasty that is considered by patients who wish to avoid the activity constraints and potential longer-term consequences associated with polyethylene glenoid components, including wear, loosening, and subsequent glenoid bone loss that may complicate revision. In the ream and run, instead of inserting a prosthetic glenoid component, the native glenoid is reamed to a monoconcave surface removing the least amount of bone possible to provide a stabilizing concavity for the articulation of the humeral component. Recent studies with minimum two-year followup have shown that ream-and-run arthroplasty can improve patient-reported outcomes to a degree similar to the outcomes of anatomic total shoulder arthroplasty. To assess the longer term value of the ream and run arthroplasty, it is important that outcome studies extend beyond the typical two year followup period.
The authors of Factors Associated with Success of Ream-and-Run Arthroplasty at a Minimum of Five Years conducted such a study. Patients undergoing ream-and-run surgery with a minimum of 5-years and mean of 7.6 ± 2.1 years of follow-up were collected through a retrospective review of a prospectively maintained database. 201 of 228 patients (88%) consenting for long-term follow-up were included in the analysis. Average age was 59 ± 9 years; 93% of patients were male with the majority having the diagnosis of osteoarthritis (79%) or capsulorrhaphy arthropathy (10%).
Most patients had type B glenoid pathoanatomy.
For all patients having the ream and run (including those revised) the SST scores improved from a mean of 4.9 ± 2.5 preoperatively to a mean of 10.2 ± 2.6 at latest follow-up. This outcome is similar to the typical SST scores of 9.8 ± 0.8 achieved after total shoulder arthroplasty as found in a recent review, Assessing the Value to the Patient of New Technologies in Anatomic Total Shoulder Arthroplasty 165 ream and run patients (82%) reached the minimal clinically important difference (MCID) for the Simple Shoulder Test (SST) of 2.6.
Male sex and lower preoperative SST scores were associated with clinically important improvements (i.e. improvement in SST scores >MCID) on multivariate analysis. BMI, alcohol use, nicotine use, diabetes, narcotics, work status, insurance type, prior shoulder surgery, glenoid type, and preoperative VAS were not predictive of the clinical outcomes.
Twenty-two patients (11%) with unsuccessful rehabilitation required open revision surgery for pain and stiffness. On multivariate analysis, only younger age was predictive of open revision surgery. The revision surgeries included single-stage component exchange usually with down sizing of the size of the humeral head prosthesis (15), open débridement and capsular release (3), revision to cuff tear arthropathy (CTA) hemiarthroplasty (1), antibiotic spacer (1), removal of prominent glenoid suture anchors (1), and an unknown revision at an outside facility (1). No patient was revised to a total shoulder arthroplasty. Of the 22 patients that underwent revision, 7 patients (32%) had 2 or more positive cultures. All 7 patients grew Cutibacterium acnes; one patient concomitantly grew coagulase-negative Staphylococcus.
Comment: This study provides insight into the longer term outcomes for the ream and run procedure. It is of interest that none of these patients experienced instability. This observation suggests that relatively thinner humeral head components
may allow greater joint laxity and facilitate rehabilitation reducing the need for subsequent procedures to manage refractory stiffness.
The fact that one third of the patients requiring revision had positive cultures suggests that surgeons may wish to consider (1) extraordinary prophylactic measures (e.g. Betadine lavage, topical in-wound antibiotics, post operative antibiotics) in patients at higher risk for infection, i.e. young male patients with high testosterone, positive skin surface cultures for Cutibacterium, and prior surgery and (2) routinely obtaining multiple deep specimens for culture at the time of revision surgery to check for subtle Cutibacterium periprosthetic infections.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
