Long-term outcomes of anatomic total shoulder arthroplasty (aTSA) can be compromised by glenoid loosening and failure. The purpose of this study was to evaluate the short- and mid-term outcomes of humeral head replacement with glenoid reaming arthroplasty (Ream and Run) for the treatment of advanced glenohumeral osteoarthritis, and to identify associations between pre-operative factors and outcomes.
Forty-nine shoulders (mean age 60±7 years) with minimum 2 year follow-up (mean 4.6±1.7) were evaluated. Forty-three (87.8%) were male. Thirteen (26.5%) had previous non-arthroplasty shoulder surgery. There were 19 (38.8%) Walch Type A and 30 (61.2%) Type B glenoids. Pre- and post-operative shoulder motion, patient reported outcome (PROMs) and health related quality of life (HRQoLs) were assessed. Pre and post-operative plain radiographs were evaluated. Mixed effects models were utilized to investigate factors associated with outcomes.
Active forward elevation and active external rotation improved from 111.7 ± 23.8° to 139.2 ± 21.1° and 13.3 ± 20.7° to 38.7 ± 14.7°, respectively (p<0.001). The mean ASES, DASH, SST, and VAS shoulder pain at most recent follow-up were 86.6±19.9, 10.1±14.1, 10.5±2.2 and 1.5±2.3, respectively. The mean changes of PROMs were significant and exceeded the minimal clinically important difference for aTSA. The percent maximal possible improvement for ASES, DASH, and SST were greater than 75 percent. Male sex (p<0.008) and not having prior shoulder surgery (p<0.04) were significantly associated with better absolute and greater change in PROMs. Age, preoperative shoulder motion, and Walch glenoid classification were not associated with PROMs. Five (10.2%, 95% CI = 1.8-18.6%) patients underwent revision for pain. Three additional patients were dissatisfied at final follow-up without undergoing revision, resulting in 16.7% (95% CI = 6.1-27.2%) of patients being dissatisfied with their outcome after their initial RnR. Mean SF-6D improved from 0.66±0.12 to 0.77±0.13 and mean Eq-5D improved from 0.68±0.20 to 0.85±0.17 (p<0.001). Improvement in HRQoL was significantly associated with nondominant arm treatment, increased age, and greater pre-operative SST. Annual medialization of the humeral head center of rotation was 0.56±1.6mm/year. No radiographic measure was associated with long-term PROMs.
Ream and Run can provide significant and clinically important improvement in PROMs and HRQoL for a high percentage of patients at short and mid-term follow-up. This procedure is an appropriate alternative to aTSA in select patients.

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