Outcomes of hemiarthroplasty and concentric glenoid reaming: a systematic review and meta-analysis of the ream and run technique

doi:10.1053/j.sart.2022.02.013

Seminars in Arthroplasty: JSES

Volume 32, Issue 3, September 2022, Pages 571-580

https://doi.org/10.1053/j.sart.2022.02.013 Get rights and content

Abstract

Background

Anatomic total shoulder arthroplasty is the gold standard surgical treatment for glenohumeral arthritis. Concerns for this procedure are glenoid bone loss and glenoid component wear, particularly in young and active individuals. The ream and run procedure using hemiarthroplasty and concentric glenoid reaming without placing a glenoid component has been proposed as an alternative. Only a few studies have assessed its outcomes and complications. This systematic review and meta-analysis aims to better quantify the ream and run’s outcomes and revision rates.

Methods

A systematic review on the outcomes of the ream and run procedure was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Descriptive statistics and pooled values were synthesized from the included studies to determine patient demographics, range of motion, patient-reported outcome measures, and revision rates. Values were compared with the minimum clinically important difference.

Results

From 82 initial search results, 5 studies (3 level III and 2 level IV) met our selection criteria. These included 470 shoulders from 468 patients with an average age of 56.7 years (range: 22-81 years) and average follow-up of 4.7 years (range: 0.7 – 16.0 years). Improvement in the Simple Shoulder Test (2 studies), Visual Analog Scale (2 studies), and American Shoulder and Elbow Surgeons score (4 studies) were 5.4, 4.5, and 43, respectively. This was greater than the minimum clinically important difference for each of these measures (2.4, 1.4, and 20.9, respectively). The mean postoperative forward elevation achieved was 143.5°, and external rotation was 44.0°. At the mean follow-up of 4.7 years, the revision rate was 7.6%, including 4.0% that underwent conversion to total shoulder arthroplasty.

Discussion

The ream and run technique to surgically treat glenohumeral arthritis leads to improvement of functional outcomes above the thresholds that predict patient satisfaction. These midterm results are similar to those achieved by anatomic total shoulder arthroplasty over the same follow-up period, but not enough long-term data exist to compare long-term survivorship. Outcomes across the same time frame are also very similar to those of traditional hemiarthroplasty. The ream and run remains an option for functional improvement and pain control in the short-term to midterm follow-up period.

Section snippets

Materials and methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in performing this systematic review.¹⁹ No similar reviews were found on International prospective register of systematic reviews, and our study was registered on this platform on July 13, 2021.

Two authors individually queried PubMed, Embase, and the Cochrane Library for publications to include in this systematic review. The following search algorithm was used in the 3 databases: (“ream and run”) OR

Statistical analysis

Descriptive statistics, Shapiro-Wilk test of normality, and pooled values were calculated using Microsoft Excel 2013. The annual revision rate was calculated as described by Hauer et al in terms of component years (CYs).¹³ The calculation is number of primary surgeries at follow-up (the total number of shoulders evaluated, 470) multiplied by the mean follow-up time (4.7 years). Then, the number of cases of revision surgery for any reason is divided by the number of CYs observed and multiplied

Results

After reviewing the full text articles and applying exclusion criteria, 5 publications were identified for inclusion in the systematic review (Fig. 1).⁹^,²³^,³⁹^,⁴⁰^,⁴⁶ Two studies³⁹^,⁴⁰ were case series, and 3 studies⁹^,²³^,⁴⁶ were retrospective cohort studies using prospectively collected data. Two studies included total shoulder arthroplasty groups for comparison; the former study matched the ATSA cohort to the RnR cohort.²³^,⁴⁶ No additional studies were included after evaluating references from

Discussion

Glenohumeral arthritis is the third most common degenerative joint disease, and numerous treatment modalities have been developed and compared to optimize outcomes for all patients.¹^,²⁶ Despite ATSA having reliable and reproducible results overall, questions remain regarding long-term outcomes and potential complications related to the glenoid component in the younger, higher demand subgroup of patients.³⁰^,³¹ In an analysis of 4079 ATSA procedures, the 10-year revision risk was 6%.¹⁶ An

Conclusion

The current systematic review of the RnR demonstrates that FE and ER as well as patient-reported outcome scores (pooled ASES, SST, and VAS) improved significantly after RnR in the midterm follow-up. With appropriate patient selection and technical expertise, the RnR may prove to be a viable alternative to ATSA for younger individuals where an ATSA has proven less durable than in older cohorts.

Disclaimers:

Funding: No funding was disclosed by the authors.

Conflicts of interest: Brent Ponce receives royalties from Stryker/Wright/Tornier and is a consultant at Stryker/Wright/Tornier, Smith & Nephew, and ODi (Orthopedic Designs North America Incorporated). The other authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.