Comparison of short- and mid-term outcomes in patients following ream-and-run and anatomic total shoulder arthroplasties.

ABSTRACT

BACKGROUND: Anatomic total shoulder arthroplasty (aTSA) may not be an ideal treatment option for young and active patients due to potential activity restriction and concerns about glenoid loosening. The Ream-and-run (RnR) allows for the continuance of high-level activity without concerns of a glenoid component failure. Initial RnR publications are promising though more outcomes studies are needed. Therefore, our primary purpose was to compare outcomes at multiple timepoints between matched aTSA and RnR cohorts. Secondarily, we sought to examine relationships between patient-reported outcomes and preoperative glenoid pathoanatomy in our RnR cohort. Lastly, we examined postoperative radiographs to determine if the RnR successfully corrected glenoid pathoanatomy and humeral head decentering. METHODS: We performed a retrospective matched-cohort study comparing patients who underwent a RnR versus patients who underwent the aTSA procedure between 2017-2019. All patients had primary diagnoses of shoulder osteoarthritis and a minimum of 2-year follow-up. Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES), and daily and worst pain outcomes were compared between groups at 3- and 6-months, and 1- and 2-years post-arthroplasty. Pre- and Postoperative glenoid anatomy and humeral decentering were measured radiographically, and correlation analyses were conducted to explore relationships between these factors and 2-year pain and function scores. RESULTS: Forty-six shoulders (23 RnR/ 23aTSA) belonging to 43 male patients with an average age of 56.2±8.3 were included. Eighteen matched pairs were available at 3- and 6- months, 21 matched pairs at 1 year, and all 23 matched pairs at the 2-year timepoint. RnR patients reported significantly higher daily pain ratings (P = .047) and lower ASES scores (P = .031) compared to the aTSA group 3 months after arthroplasty but reported similar outcomes at 6 months and beyond. Preoperative pathoantatomy outcomes were not directly related to final reported pain or function in RnR group. Additionally, the RnR was able to correct posterior humeral head decentering in our cohort. CONCLUSIONS: Young male patients undergoing RnR can likely expect similar short-term results as young male patients who undergo aTSA. Additionally, the RnR outcomes were not affected by preoperative glenoid wear or humeral head decentering. Our findings support the RnR as a viable surgical alternative for young, active patients with shoulder arthritis.