UW Shoulder and Elbow Academy: The ream and run

The ream and run: not for every patient, every surgeon or every problem.

In a total shoulder arthroplasty (see this link), the humeral head prosthesis articulates with a polyethylene glenoid surface placed on the bone of the glenoid. Failure of the glenoid component is recognized as the principal cause of mechanical failure of total shoulder arthroplasty.

By contrast, in the ream and run procedure (see this link), the humeral head prosthesis articulates directly with the glenoid, which has been conservatively reamed to provide a stabilizing concavity and maximal glenohumeral contact area for load transfer. While no inter positional material is placed on the surface of the glenoid, animal studies have demonstrated that the reamed glenoid bone forms fibrocartilage, which is firmly fixed to the reamed bony surface.

Glenohumeral motion is instituted on the day of surgery and continued daily after surgery to mold the regenerating glenoid fibrocartilage. When the healing process is complete - as indicated by a good and comfortable range of motion - exercises and activities are added progressively without concern for glenoid component failure.

The experience to date indicates that a technically well done ream and run procedure can restore high levels of comfort and function to carefully selected patients with osteoarthritis, capsulorrhaphy arthropathy, and post traumatic arthritis.

Patients considering the ream and run procedure should understand that this technique avoids the risks and limitations associated with a polyethylene glenoid component, but that it requires excellent surgical technique and strong patient motivation to follow through on a rehabilitation course that may require many months.

There are three groups of reasons not to consider a ream and run procedure:

(1)The patient is not right: prefers a total shoulder, lacks motivation, lacks understanding, poor physical health, poor emotional health, diabetic, smoker, narcotics, worker’s compensation

(2) The shoulder is not right: inflammatory arthropathy, chondrolysis, osteopenia, cuff deficiency, glenoid dysplasia, post-traumatic deformity

(3) The surgeon is not right: unconvinced that it works, unfamiliar with the concepts, unaware of the details of the technique, unwilling to be closely supportive of patient during recovery

However, under the right circumstances, the outcome from the ream and run can be rewarding for the patient.

Our ream and run technique is shown in this link.

A recent study (Ream and run and total shoulder: patient and shoulder characteristics in five hundred forty-four concurrent cases) found that when the two procedures (ream and run and total shoulder) are performed by equally experienced surgeons, the results are equivalent, as shown below, but the characteristics of the patients and the shoulders in the two groups are significantly different.