A somewhat misleading article "comparing" ream and run to anatomic total shoulder.

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



You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link

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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).

The ream and run - the shoulder joint replacement for active individuals.

The ream and run shoulder arthroplasty is an established shoulder replacement procedure for active individuals with disabling shoulder arthritis (see this link). In this procedure the rough arthritic joint surface of the humerus is replaced with a securely fixed, smooth metal implant, while the irregular arthritic glenoid socket is conservatively reamed to a smooth concavity (see this link).

This procedure is an option for active individuals who wish to avoid the risks and limitations associated with the plastic socket used in conventional total shoulder replacement. It is useful in addressing severe arthritis in the shoulders of young individuals, including those having failed prior shoulder surgery. 

Below are the preoperative x-rays from a 40 year old athlete showing displacement of the humeral head on the glenoid, severe arthritis and retained hardware from a previous operation.

As is our practice, the ream and run is performed without preoperative MRI or CT scans, preoperative 3-D planning, intraoperative navigation, augmented reality, cement, plastic, ingrowth component, or nerve block -  making it a cost-effective procedure.

His postoperative x-rays are shown below

This man was vigorous in his rehabilitation. Here's his assisted motion the morning after surgery.

He pursued his dedicated rehabilitation. He shared this video at five months after surgery

Recently he reported: "16 months post ream and run and I can play basketball again. Able to shoot long range 3-pointers, dribble, make hook shots and do a chest pass with no problem. My shoulder hasn’t felt this good in 25 yrs." He kindly gave us permission to share this recent video

Results such as this do not come automatically after the ream and run, but rather result from dedicated, persistent adherence to the defined rehabilitation program (see this link). Patients must "do the work".

Patients provide frequent followup to their surgeon with videos such as those shown below for two patients in the first two weeks after their ream and run procedures (shared with their permission).

Comment: A successful outcome after a ream and run procedure depends on four things:

(1) informed selection of the right procedure for the right patient

(2) excellent surgical technique 

(3) patient dedication to the rehabilitation program

(4) frequent communication between the surgeon and the patient during the recovery.

You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.

Follow on twitter: https://twitter.com/shoulderarth
Follow on facebook: click on this link
Follow on facebook: https://www.facebook.com/frederick.matsen
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/

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).

Ream and Run for patients living over 1,000 miles away

 A 60 year old active man presented with quality of life limiting shoulder pain and stiffness.

His preoperative x-rays showed severe degenerative joint disease or the right shoulder

Because he wished to avoid the risks and limitations associated with a polyethylene glenoid component, he elected to have a ream and run procedure.

His immediate postoperative x-ray shows the humeral head centered in the reamed glenoid and an impactioned grafted standard stem.    

After an overnight stay in the medical center and a couple of days in town, he returned to his home over 1,000 miles away.

One week after surgery he sent this photo of his range of motion,

He will be followed closely at a distance by email, photographs and videos.

How you can support research in shoulder surgery Click on this link.

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).