What is Ream and Run Arthroplasty?
A Ream and Run arthroplasty is specifically designed for patients who are younger or more active than the typical shoulder replacement patient. In this operation, the humeral head is replaced with a metal prosthesis. This part of the operation is identical to a standard shoulder replacement. What is unique about this surgery is the treatment of the glenoid or “socket” side of the shoulder. In a typical total shoulder replacement the socket is covered with a plastic socket which is cemented in place. In the ream and run the socket is not covered with plastic. Instead the patient’s own bone is smoothed down and shaped to fit the humeral head. This is performed using specialized reamers which the surgeon uses to reshape the bone of the socket.
What is the theory/ science behind the Ream and Run?
In order to explain the concept of of the Ream and Run, we will need to lay some groundwork.
Shoulder Arthritis
The shoulder is a ball and socket joint. The ball is the humeral head and the socket is the glenoid. Normally both of these are extremely smooth like two sheets of ice. In arthritis the smooth cartilage is worn away and now both the ball and socket become rough. Imagine a mortar and pestle grinding on each other.
Total Shoulder Replacement
In this operation the rough arthritic ball is replaced with a smooth metal ball, and the rough socket is covered with a smooth plastic socket that is cemented into place. Now we have two smooth surfaces like in a normal shoulder.
Hemiarthroplasty
This means “half replacement.” In this operation the humeral head is replaced with a smooth metal ball but the rough socket is left in place. This operation addresses only half of the problem as the ball of the shoulder is still rubbing against a rough surface. As an analogy, imagine putting brand new tires on your car but driving it on a gravel road. It will still be a bumpy ride.
Ream and Run
The humeral head is replaced with a smooth metal ball. The socket is reshaped and smoothed to match the metal ball. So, we’ve replaced the car’s tires and paved the road. Also, with time the body regrows a scar cartilage layer on top of the socket which makes that surface even smoother. This explains why the results of the operation improve with time. Regrowth of this cartilage layer has been demonstrated in research studies and on X-rays.
What is the history of Ream and Run?
The Ream and Run procedure was originated by Dr. Frederick Matsen at the University of Washington in Seattle. Dr. Matsen has performed over 8,000 shoulder replacements and is one of the most experienced shoulder surgeons in the United States. He has been doing this operation for more than 15 years.
Why choose Ream and Run Arthroplasty?
The advantage of the ream and run is that a plastic socket is not required. This is important because the plastic socket is the main cause of failure of a standard total shoulder replacement; it is essentially the “weak link.” Over time, plastic sockets often wear out and become loose, which may require revision surgeries. Furthermore, most shoulder surgeons do not recommend a total shoulder replacement for young patients or individuals who are very active and lift heavy weights because these individuals will wear out a plastic socket very quickly. The Ream and Run arthroplasty offers an advantage for these specific patients because there is no plastic socket to worry about and patients may perform all activities such as weight lifting, chopping wood, pull-ups, etc. Also, young patients do not have to worry about the plastic socket wearing out as they age.
What are the disadvantages of Ream and Run Arthroplasty?
The main disadvantage to this operation compared to a standard total shoulder replacement is that the recovery takes longer, and there is more discomfort during the first several months.
What are the results of Ream and Run?
This is a relatively new operation. However, research studies have shown that by two years after surgery Ream and Run is as good as a total shoulder replacement. Also, the results appear durable, meaning there is no indication that patients’ shoulders will get worse with time after the procedure.
How can you find a surgeon who performs the Ream and Run operation?
As with any operation you would like to find someone who is experienced and has been appropriately trained. This is a relatively new operation and not all shoulder surgeons have gained experience in this area. For instance, there are some fine points to the surgery that will maximize your results, such as the use of specialized Ream and Run reamers, maximizing the surface area of the implant, and appropriate patient selection. Dr.Carofino completed a year-long shoulder fellowship with Dr. Rick Matsen, who developed this procedure. Dr. Carofino is one of a handful of surgeons on the East Coast who was trained by Dr. Matsen.
