Primary glenohumeral arthritis: treatment with the ream and run in comparison to total shoulder arthroplasty - 10 year followup

Glenohumeral arthritis in shoulders with an intact rotator cuff is the most common indication for shoulder arthroplasty. 

The safety, effectiveness and durability of anatomic arthroplasty - the ream and run (RnR) or the anatomic total shoulder (TSA) - is widely recognized. 

The authors of Minimum 10-year Follow-up of Anatomic Total Shoulder Arthroplasty and Ream-and-Run Arthroplasty for Primary Glenohumeral Osteoarthritis studied the patients and the minimum 10-year outcomes for the RnR (n=34) and TSA (n=29). In this practice, the patients chose their surgical procedure after a discussion of the risks and benefits of each.

The two groups differed in a number of important preoperative characteristics. The RnR patients were significantly younger than the TSA patients (60 ± 7 vs 68 ± 8, p<0.001), predominantly male (97% vs 41%, p<0.001), and were healthier as reflected by the American Society of Anesthesiologists score (p=0.018). 

Patient-assessed preoperative and postoperative function was documented by the Simple Shoulder Test (SST)

The preoperative and the postoperative SST scores were higher for the patients having the ream and run procedure than for those having total shoulders.

Total shoulder

In the TSA group, the pain score decreased from a preoperative average of 6.6 ± 2.2 to 1.2 ± 2.3 (p < 0.001), and the SST score improved from and average of 3.8 ± 2.6 to 8.9 ± 2.6 at 10-year follow-up. (p < 0.001). The percent of maximum possible improvement averaged 64%. No patient in the TSA group required reoperation; notably there were no cuff tears or glenoid loosenings.

Ream and Run

In the RnR group, the pain score decreased from a preoperative average of 6.5 ± 1.9 to 0.9 ± 1.3 (p < 0.001), while the SST score improved from and average of 5.4 ± 2.4 to 10.3 ± 2.1 at 10-year follow-up (p < 0.001).  The percent of maximum possible improvement averaged 83%. 

Four patients  underwent single-stage exchange to another hemiarthroplasty because of painful stiffness. Two of these 4 patients had positive cultures for Cutibacterium. One patient required manipulation under anesthesia. No patients had conversion to a TSA or reverse total shoulder. 

At followup, a larger percentage of RnR patients could perform high-level shoulder functions: SST questions 7, 8, 9, 10, and 12.

As an example, a 15-year post RnR followup x-ray of the shoulder shown at the beginning of this post is shown below. Note the stable humeral fixation and the seating of the humeral head centered in the healed glenoid concavity.

This patient (now 71 years old) continues to use his arm for heavy physical work and recreation. He has excellent range of motion, comfort and function and now returns for an RnR on his opposite shoulder.

 

Comment: Patients with glenohumeral osteoarthritis and their surgeons have the choice of the ream and run and anatomic total shoulder. This is one of the few long term studies of the patients having each of the procedures. It is notable that young, healthy, male patients preferred the ream and run procedure after a discussion of the pros and cons of each. The RnR patients had higher levels of function both before and after surgery - particularly for the more demanding activities assessed by the Simple Shoulder Test.

As is necessary for all clinical outcome studies, this article reported the number of patients enrolled in the database and the number and reasons groups of patients were not included in the final analysis. This is the standard "Figure 1", which seems absent in many reports.

This figure shows the challenge in achieving long term followup on a high percentage of patients.

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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).