Results
The last two decades have shown the great value of the ream and run to well-motivated, active patients who wish to avoid the risks and limitations associated with a plastic glenoid component. This presentation shares some of the lessons we have learned over the past 20 years about the ream and run and the patients to elect to have this procedure.
We are inspired by what dedicated patients have accomplished after a technically well-done ream and run. Therefore, we will start by presenting some inspirational cases. Please click on the titles below.
One way to present the outcomes of the ream and run procedure is in terms of the Simple Shoulder Test scores achieved by patients after the procedure. The chart below displays these outcomes from 176 patients having surgery early on in our practice (from The prognosis for improvement in comfort and function after the ream-and-run arthroplasty for glenohumeral arthritis: an analysis of 176 consecutive cases)
This chart shows three important findings: (1) many patients achieved full shoulder function (SST of 12 out of 12), (2) the average outcome is an SST of 10 out 12, (3) some patients (those in the lower right hand quadrant) did not get the results we and they wanted.
We have compared the patients who did well after the ream and run to those who did not achieve the desired outcome. We learned that young patients, those with preoperative stiffness, and those having had prior surgery can be at greater risk for postoperative stiffness and pain. In such patients we now:
(1) counsel these patients before surgery that their extra dedication to the rehabilitation program will be essential,
(2) modify the surgical technique (more vigorous capsular releases, use thinner humeral head components,
(3) assure that the shoulder can be forward flexed to at least 150 degrees after the subscapularis repair,
(4) follow the patient at risk closely to make sure they stay on target to maintain at least 150 degrees of flexion, and
(5) discuss manipulation of the shoulder with the patient if the shoulder is stiff at 6 weeks after surgery.
Our research has also revealed that patients who develop delayed painful stiffness after an initial "honeymoon period" of good recovery may have a perioprosthetic infection with a bacteria from their skin, Cutibacterium. We have learned that this risk is increased in young male patients, patients having had prior surgery, and patients taking supplemental testosterone. In patients at risk for this complication, we use extra preventative measures in addition to intravenous ceftriaxone and vancomycin, such as irrigation of the wound with antibiotics and Betadine, topical in-wound antibiotics, and postoperative oral antibiotics.
Because Cutibacterium periprosthetic infections can be very difficult to diagnose with laboratory tests on blood or joint fluid, we will discuss a single stage revision, deep cultures and postoperative antibiotics with patients who develop otherwise unexplained pain and stiffness after surgery that does not respond to non-operative management.
In the great majority of cases, wear of the bony glenoid is minor and not of clinical significance. In the rare case of clinically significant wear, revision to a reverse total shoulder is more straightforward than after an anatomic total shoulder because of the increased bone preservation with a ream and run procedure.
Here is a recent case of a man who was 60 years old when he had bilateral ream and run procedures. While his left side remains comfortable and functional without significant wear, his right side has clinically significant wear (below right) since his original surgery 20 years ago (below left).
At 81 years of age his right shoulder was revised to a reverse total shoulder without difficulty.
It is important to recognize that the outcomes of the ream and run cannot be directly compared to those of conventional total shoulder arthroplasty because the patients having these two procedures have signficantly different characteristics at baseline. This point is emphasized in Can We Reliably Compare Outcomes of Ream-and-Run and Anatomic Total Shoulder Arthroplasty?: Commentary on an article by James Levins, MD, et al.: "Comparison of Humeral-Head Replacement with Glenoid-Reaming Arthroplasty (Ream and Run) Versus Anatomic Total Shoulder Arthroplasty. A Matched-Cohort Study" and in Minimum 10-year follow-up of anatomic total shoulder arthroplasty and ream-and-run arthroplasty for primary glenohumeral osteoarthritis
For those interested in taking a deeper dive into our analysis of our results after the ream and run, please click on the publications listed below (in reverse chronological order).
Factors associated with success of ream-and-run arthroplasty at a minimum of 5 years
Risk Factors for Stiffness Requiring Intervention After Ream-and-Run Arthroplasty
Shoulder Hemiarthroplasty with Nonprosthetic Glenoid Arthroplasty: The Ream-and-Run Procedure
Clinical and Radiographic Outcomes of the Ream-and-Run Procedure for Primary Glenohumeral Arthritis
The ream and run: not for every patient, every surgeon or every problem
Shoulder hemiarthroplasty with concentric glenoid reaming in patients 55 years old or less
Comparison of patients undergoing primary shoulder arthroplasty before and after the age of fifty
Thanks for reading. Comments welcome at shoulderarthritis@uw.edu