What is the Ream and Run Surgery?
There is a special type of shoulder replacement that has a unique nickname—it is called the “ream and run” surgery. In short, this is a shoulder replacement surgery that replaces the “ball” of the ball and socket; the socket is reamed smooth to the appropriate size just larger than the ball, but no plastic liner is placed. The labrum or “O-ring” of the shoulder is also preserved when possible.
The surgical approach, including the incision, separating the deltoid and pectoralis major muscles, bone spur removal, and peeling the subscapularis tendon from the humerus bone is done in the same way for both the anatomic total shoulder arthroplasty (aTSA) and the ream and run. The ream and run surgery is different from an aTSA (a.k.a replacement) because only one side of the joint has an artificial implant. This is called a hemiarthroplasty. By avoiding the placement of the plastic (polyethylene) glenoid component, the socket can resurface biologically over time with fibrocartilage. At the end of the surgery, the subscapularis tendon is repaired in the same way as an aTSA surgery with 6 transosseous sutures.
Why would a surgeon consider only replacing half of a shoulder? The main reason is that the plastic glenoid (socket) liner in an anatomic total shoulder replacement can loosen or wear out over time. These situations can cause pain and bone loss—both big problems which can lead to a failed shoulder joint replacement. Revision surgery, with increased risks and less predictable outcomes, can often be needed to treat a loose glenoid component.
To prevent the polyethylene glenoid component from loosening, shoulder surgeons typically recommend that patients with an anatomic TSA avoid contact sports, “action” sports, heavy weight training, and other activities that are high risk for stressing the glenoid component. This is very limiting for 2 main groups of people: those who must work in high-intensity jobs (e.g., construction worker, flooring installation specialist) or those who live with a very active lifestyle (e.g., crossfit enthusiasts, bodybuilders, and martial artists).
To avoid this complication, the adage “less is more” applies well to shoulder replacements. The ream and run shoulder surgery enables the shoulder to gain stability, range of motion, and smoothness but without the risks of loosening for the plastic glenoid component. Placing the plastic socket would be more limiting for some patients because they could not safely continue their high-intensity work or their active lifestyle. After the ream and run surgery, many of my patients have returned to heavy labor jobs, intense weight training, and sports. This level of intensity cannot be safely performed with traditional placement of the glenoid plastic liner due to the risks of loosening and wear as discussed above.
The ream and run, however, is not for everyone. The rehabilitation program is longer and more challenging than for an aTSA. Certain patients are better served with a different surgery due to the challenging and often painful recovery, which can take up to 1 to 2 years before the full potential of the ream and run can be achieved. Research shows that it is not a reliable surgery for patients with diabetes, tobacco smokers, those on opioids, lacking appropriate social/home support, those without good physical health, and with poor emotional health. Additionally, certain shoulder diagnoses make other surgical implants a better option, including rotator cuff tear arthropathy, post-traumatic deformities, osteoporosis, and inflammatory arthritis. A reverse shoulder arthroplasty (RSA) or an anatomic TSA would be preferred depending on each patient’s individual situation.
One of the biggest predictors of success with ream and run surgery in my experience is a patient’s resilience and support system. Resilience, as defined by Merriam-Webster.com is the “ability to recover from or adjust easily to misfortune or change” and “the ability to be happy, successful, etc. again after something difficult or bad has happened” at CambridgeDictionary.com. Patients with the best prognosis for success with the ream and run are prepared for the challenges of a ream and run rehab program because of their resilient behaviors that will allow them to navigate the rough waters of the daily physical therapy and home exercises. Resilient patients often have a strong support system to help them through the recovery process. This can be a spouse, a friend, family member or sometimes the physical therapy team that helps the patient “stay the course.” Sometimes the daily, diligent work doesn’t feel important. But it is. Resilient work and support from important people are very important for the recovery after the ream and run surgery (and other surgeries too!).
The ream and run surgery is different from other types of shoulder replacements. By only doing a “partial” replacement, patients can return to heavy weight-lifting and sports without concern for loosening of the glenoid component. While the ream and run is not the best surgery for all patients (e.g., those with a rotator cuff tear), it can be a great surgery to optimize function for certain resilient patients looking to continue living a very active lifestyle.
The three preoperative X-rays demonstrate severe shoulder arthritis with a large inferior humeral bone spur. There are two X-rays of the ream and run with good alignment of the humeral stem and metal humeral head. Fibrocartilage has formed on the socket side which is seen as a thin layer of gray space between the ball and socket.
REFERENCE:
Matsen, F.A. The ream and run: not for every patient, every surgeon or every problem. International Orthopaedics (SICOT) 39, 255–261 (2015). https://doi.org/10.1007/s00264-014-2641-2
Matsen FA 3rd, Lippitt SB. Current Technique for the Ream-and-Run Arthroplasty for Glenohumeral Osteoarthritis. JBJS Essent Surg Tech. 2012 Oct 10;2(4):e20. doi: 10.2106/JBJS.ST.L.00009. PMID: 31321140; PMCID: PMC6554086.
Matsen FA 3rd, Clark JM, Titelman RM, Gibbs KM, Boorman RS, Deffenbaugh D, Korvick DL, Norman AG, Ott SM, Parsons IM 4th, Sidles JA. Healing of reamed glenoid bone articulating with a metal humeral hemiarthroplasty: a canine model. J Orthop Res. 2005 Jan;23(1):18-26. doi: 10.1016/j.orthres.2004.06.019. PMID: 15607870.
Somerson JS, Neradilek MB, Service BC, Hsu JE, Russ SM, Matsen FA 3rd. Clinical and Radiographic Outcomes of the Ream-and-Run Procedure for Primary Glenohumeral Arthritis. J Bone Joint Surg Am. 2017 Aug 2;99(15):1291-1304. doi: 10.2106/JBJS.16.01201. PMID: 28763415.
Schiffman CJ, Jurgensmeier K, Yao JJ, Wu JC, Whitson AJ, Jackins SE, Matsen FA 3rd, Hsu JE. Risk Factors for Stiffness Requiring Intervention After Ream-and-Run Arthroplasty. JB JS Open Access. 2023 Apr 27;8(2):e22.00104. doi: 10.2106/JBJS.OA.22.00104. PMID: 37123506; PMCID: PMC10132725.
