Rearm and run - clinical and radiographic outcomes

While an increasing number of shoulder surgeons report using the ream and run procedure to manage selected patients glenohumeral arthritis, there are very few publications of patient outcomes from centers other than Seattle.

Recently a team from Virginia Beach, published a Comparison of short- and mid-term outcomes in patients following ream-and-run and anatomic total shoulder arthroplasties. This was a retrospective study comparing 23 patients who underwent a RnR to 23 patients who underwent the aTSA procedure between 2017-2019. All patients had primary diagnoses of shoulder osteoarthritis and a minimum of 2-year follow-up. 

The ream and run procedures were all performed by an individual surgeon fellowship trained in this method. Three different implant systems were used (DePuy Global (19), Exactcch (3) and DJO (1). The shoulder was approached through a subscapularis peel, the labrum was preserved, and the glenoid was reamed to a diameter of curvature 2mm greater than that of the prosthetic humeral head selected. Reaming was conservative: only as much as necessary to create a single concavity without prioritizing change in glenoid version. Prosthetic humeral heads were typically 56 or 54 mm diameter of curvature and 15 to 18 mm in thickness. Anteriorly eccentric head components were used to manage excessive posterior translation (see this link).

These patients were matched by sex, age, height, weight, dominant arm, followup period, and preoperative ASES score (but not by disease severity, degree of decentering, or glenoid type) to patients having an aTSA procedures performed by one of 12 fellowship-trained surgeons using a single system (Equinoxe/Exactech). All patients were male.

Range of motion exercises were started the day of surgery; patients were encouraged to attain 160 degrees of assisted elevation within the first few days post op. 

At 3 months after surgery RnR patients reported significantly higher pain ratings and lower ASES scores, but similar Simple Shoulder Test scores compared to the aTSA group. All outcomes were similar at 6 months and beyond. 

Of the RnR patients, 14 had type A, glenoid pathology, 1 B1, 8 B2, 5 B3. 11 patients had posterior decentering preoperatively. 10 had postoperative imaging of which 7 had humeral heads centered on the glenoid (see below).

For the RnR patients, preoperative glenoid type was not associated with preoperative or 2 year postoperative comfort and function.

Comment: These results reinforce the potential benefit of the ream and run procedure for patients wishing to avoid the risks and limitations associated with the plastic glenoid component used in conventional total shoulder arthroplasty. 

The final outcome scores for the 23 patients with 2 year outcomes are impressive, as is the observation that most of this improvement occurred within the first 6 months of surgery.

Noting that 23 patients having ream and run procedures between 2017 and 2019 were available for two year followup, it would be of interest to know the total number of patients having this procedure during this time frame as well as the number and reasons for patients being lost to followup.

The average age of patients in this report was 56 years. Long term clinical and radiographic followup is necessary to evaluate functional outcomes and  glenoid wear over the years following their procedure. These studies are not easy to perform because of loss to followup from the original cohort and difficulties obtaining quality, comparable radiographs over time - especially for patients living at a distance from the surgeon. Yet such data are essential if we are to understand how this procedure compares in the long run to patients having conventional total shoulder arthroplasty and to those having hemiarthroplasty with alternative bearing surfaces.

Comments welcome at shoulderarthritis@uw.edu

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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).