Factors associated with success of ream-and-run arthroplasty at a minimum of 5 years

Abstract

Background: Ream-and-run arthroplasty offers improvements in shoulder pain and function for patients with primary glenohumeral arthritis who wish to avoid limitations associated with a polyethylene glenoid component. Longer-term clinical outcome assessments of the ream-and-run procedure are sparse in the literature. This study aimed to present minimum 5-year functional outcomes in a large cohort following ream-and-run arthroplasty to determine factors associated with clinical success and reoperation.

Methods: Patients who underwent ream-and-run surgery with a minimum of 5 years of follow-up were identified through a retrospective review of a prospectively maintained database from a single academic institution. To assess clinical outcomes, the Simple Shoulder Test (SST) was administered and assessed to determine achievement of the minimal clinically important difference, as well as the necessity for open revision surgery. Factors associated with P < .1 on univariate analysis were included in multivariate analysis.

Results: Of 228 patients who consented to undergo long-term follow-up, 201 (88%) were included in our analysis (mean follow-up period, 7.6 ± 2.1 years). The average age was 59.4 ± 8.8 years, and 93% of patients were men. The majority of patients had a diagnosis of osteoarthritis (79%) or capsulorrhaphy arthropathy (10%). SST scores improved from a mean of 4.9 ± 2.5 preoperatively to a mean of 10.2 ± 2.6 at latest follow-up. The minimal clinically important difference in the SST score of 2.6 was reached by 165 patients (82%). Male sex (P = .020), nondiabetic status (P = .080), and lower preoperative SST score (P < .001) were included in a multivariate analysis. Male sex (P = .010) and lower preoperative SST score (P < .001) were associated with clinically important improvements in SST scores on multivariate analysis. Open revision surgery was required in 22 patients (11%). Younger age (P < .001), female sex (P = .055), and higher preoperative pain score (P = .023) were included in a multivariate analysis. Only younger age was predictive of open revision surgery (P = .003).

Conclusions: Ream-and-run arthroplasty can provide significant and clinically important improvements in clinical outcomes at minimum 5-year follow-up. Successful clinical outcomes were significantly associated with male sex and lower preoperative SST scores. Reoperation was more common in younger patients.

Keywords: Ream-and-run arthroplasty; Simple Shoulder Test; glenohumeral arthritis; glenoid failure; glenoid reaming; humeral head replacement; shoulder arthroplasty.