The authors of Ream-and-run technique offers equivalent clinical outcomes as anatomical total shoulder arthroplasty but with a high rate of complications: A systematic review and meta-analysis reviewed some of the literature on the outcomes of these two types of anatomic shoulder arthroplasty. The authors reviewed included 738 patients having ream and run (R&R) and 810 having anatomic total shoulder (aTSA). These groups were not comparable with respect to important predictive factors; for example: 94% of the RnR patients were male, while only 56% of the aTSA patients were male; 61% of the RnR patients had type B or C pathoanatomy in comparison to 47% of the aTSA patients; the mean ± standard deviations for the length of followup were not provided. There was no attempt to control for these influential variables in the statistical analysis.
The authors reported that they found no clinically significant differences in patient reported outcome measures or in range or motion between the two procedures.
The revision-free survivorship was 93% for the ream and run patients and 97% for the aTSA patients.
In the RnR group 3.9 % had chronic pain and stiffness, 2.6 % had unspecified "humeral head problems" and 2% had culture-positive infection.
In the aTSA group 1.2 % had soft tissue failure, 1.2 % and chronic pain and stiffness; 0.86 % had loosening of the glenoid prosthesis.
Some articles in the Discussion section were incorrectly reported, such as "However, Schiffman et al. reported post-operative SST statistical improvement only within the aTSA group post-operatively (aTSA p = 0.01, RnR p = 0.65). " This is a misstatement; this paper referred to the Impact of previous non-arthroplasty surgery on clinical outcomes after primary anatomic shoulder arthroplasty and reported "Previous surgery is associated with inferior clinical outcomes and higher revision rates in patients undergoing index TSA but not in those undergoing the ream-and-run procedure."
Comment: The presentation of RnR and aTSA outcomes in this review indicates that each of the two procedures can yield excellent clinical outcomes for appropriately selected patients. The aTSA remains the preferred procedure for most patients having osteoarthritis with an intact rotator cuff, especially for women and for those who do not wish to participate in heavy or impact activities.
The RnR remains a consideration for young, active male patients
who wish to avoid the risks and limitations associated with a polyethylene glenoid component.
A respected friend suggested that I "feather in" some of my bird photos, so here you go.
Be thoughtful
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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).
