Ream and Run for Shoulder Arthritis - patients under 55 years - research foundation 7

It is well known that patients with shoulder arthritis who are 55 years of age or younger have special challenges related to their activity levels, their expected longevity, and their more complex forms of arthritis. Shoulder fellows Saltzman and Mercer investigated our results with the ream and run procedure in patients in this younger age group. Among 65 shoulders, nine required revision surgery. These had had an average of 3 surgeries on their shoulder prior to the ream and run, in contrast to the 56 unrevised shoulders which had had an average of 1 prior surgery. For the 56 unrevised surgery the Simple Shoulder Test functions that could be performed improved from a mean of 4 before surgery to a mean of 9.5 at an average of 43 months after surgery (p<.001). The results are shown in more detail below.

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Ream and Run for Shoulder Arthritis - comparison to total shoulder - research foundation 6

We are often asked to compare the ream and run procedure to the total shoulder in the treatment of shoulder arthritis. Shoulder fellows Clinton, Franta and Lenters matched 35 consecutive patients for whom we had performed the ream and run to a similar group of patients for whom we had performed a total shoulder; they presented the results in an article comparing these two procedures. The characteristics of the two groups are shown in the table below.

The time course for recovery is shown in the table and figure below.

We concluded that in the hands of a surgeon experienced in the procedure, the ream and run procedure can offer similar functional recovery to that achieved in similar patients having total shoulder arthroplasty.

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Ream and Run for Shoulder Arthritis - is wear an issue? - research foundation 5

We know that shoulder arthritis affects both sides of the joint as shown below.

 This alters the normal load distribution (below left) to one of load concentration and progressive wear (below right)

Simply replacing the humeral head (ball of the shoulder joint) alone, does not address the glenoid wear and can be associated with progressive glenoid wear.

The ream and run procedure restores the glenoid surface to a concentric concavity.

We wanted to know if there was wear of the glenoid bone after this procedure. Shoulder fellows Mercer and Saltzman developed a method for documenting the position of the humeral head center relative to the scapula on standardized plain radiographs that can answer this question. In this method, standardized templates (shown below) are placed over the x-rays to track the position of the center of the head of the humerus.

They used this method in assessing glenoid wear at a minimum of two years after hemiarthroplasty with concentric glenoid reaming. They found that the average wear rate was minimal: the movement of the head center towards the scapula was less than 0.4 mm per year.

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Ream and Run for Shoulder Arthritis - clinical series - research foundation 4

Our first major publication on the ream and run procedure was co authored by shoulder fellows Lynch, Franta, and Lenters along with resident Montgomery; a link to this article, "Self Assessed Outcome Two to Four Years after Shoulder Hemiarthroplasty with Concentric Glenoid Reaming" can be found here. Our patients assessed their own comfort and function before and sequentially after the ream and run using the Simple Shoulder Test. The patients ranged in age from 35 to 80 years of age.  Their scores improved from 4.7 to 9.4 out of a possible 12. These results were very similar to the results from our series of total shoulder joint replacements as shown in Table II of the article, shown below.

Using the ream and run, we were able to able treat shoulders with severe posterior erosion of the glenoid bone as shown below

and to center the prosthetic humeral head on a reconfigured and regenerated joint surface as shown below.

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Total shoulder for arthritis: the results

In considering the value of a procedure, it is important to measure its effect on the overall health of the patient. Our shoulder fellow Boorman did such a study for total shoulder replacement and found that the effect of total shoulder arthroplasty on self-assessed health status is comparable to that of total hip arthroplasty and coronary artery bypass grafting.

As the reader will recall from previous posts regarding the Simple Shoulder Test (SST), we consider the patient's own assessment of shoulder comfort and function to be the 'gold standard' for evaluating the result of the treatment of a shoulder condition. Over fifteen years ago, we published a study on the Early Effectiveness of Shoulder Arthroplasty for Patients Who Have Primary Glenohumeral Degenerative Joint Disease, using the SST. Subsequently, our shoulder fellows Fehringer , Boorman, and Churchill used this tool in Characterizing the Functional Improvement After Total Shoulder Arthroplasty for Osteoarthritis. They found that total shoulder arthroplasty substantially improved the Simple Shoulder Test self-assessments of comfort and function in individuals with shoulder arthritis. On average, shoulders achieved approximately two-thirds of the maximum possible improvement, regardless of the preoperative level of function. A similar study, The magnitude and durability of functional improvement after total shoulder arthroplasty for degenerative joint disease, was published by our shoulder fellow Goldberg. The key data from this study are shown in the figure below.

Our fellows Antoniou and Rozencwaig studied the Correlates with comfort and function after total shoulder arthroplasty for degenerative joint disease. They found that male gender, preoperative physical function, social function, mental health and shoulder function before surgery were the strongest predictors of the quality of the result from total shoulder replacement. These same authors had previously investigated the correlation of comorbidity with function of the shoulder and health status of patients who have glenohumeral degenerative joint disease.

Our shoulder fellows Saltzman and Mercer published an important study entitled, Comparison of patients undergoing primary shoulder arthroplasty before and after the age of fifty. They found that younger patients having shoulder joint replacement were more likely to have complex forms of shoulder arthritis,  such as capsulorrhaphy arthropathy, rheumatoid arthritis, and posttraumatic athritis. Only 21% of the younger patients had primary degenerative joint disease, whereas 66% of the older patients had that diagnosis. These more complex forms of arthritis may complicate the surgery, the rehabilitation and the outcome of shoulder joint replacement.

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