Total Shoulder Replacement

“Ream And Run” Technique

Ream and Run is a new type of total shoulder replacement surgery (arthroplasty) designed to address the needs of a younger and more active patient.

The shoulder represents a ball and socket joint. Over time, joint problems like arthritis make the surface of the ball and socket rough, which impedes the function and movement of the joint, much like a rusty trailer hitch, which in turn causes pain symptoms. With the shoulder, the ball component is called the humeral head and the socket is called the glenoid.

In traditional shoulder replacement the ball component (humeral head) is replaced with a smooth metal surface and the socket (glenoid) is covered with a smooth plastic implant component that is held in place with a special cement . This provides two new smooth surfaces to ideally replicate the normal healthy shoulder joint.

Where Ream and Run Shoulder Replacement differs from standard shoulder replacement surgery is how the socket side of the shoulder is addressed during surgery. With traditional shoulder replacement, a plastic component is cemented in place on the glenoid (socket). Conversely, in Ream and Run Shoulder Replacement the the surgeon uses special tools to shave down and shape the patient’s own bone in the shoulder to fit the humeral head ball component.

In some shoulder replacement cases a surgeon may do a memiarthroplasty where the humeral head is replaced with a smooth metal ball but the original socket is left in place. The problem with this approach is that only one half of the problem has been solved, as the ball of the shoulder joint is still rubbing against a rough arthritic socket joint.

With the Ream and Run technique, the humeral head is replaced with a metal ball component and the surgeon reshapes the patient’s own socket joint to match the metal ball component. Researchers found that over time, the body creates a new cartilage layer on top of the reshaped socket joint making the joint even smoother. So in a sense, with Ream and Run the post surgery outcome can actually IMPROVE over time as the body recreates this natural cartilage.

One of the key benefits is that the plastic socket component is not needed. Orthopedic surgeons found over the years that the plastic socket component was often the weakest link in the succes of total shoulder replacement. Over time and use, that plastic socket would either wear out or become loose requiring a second surgery. This can especially be the case with a younger patient who is very active, working out, playing sports that require shoulder rotation (golf, tennis, throwing abaseball or football) or pressure on the shoulder from lifting heavy objects at work. All these activities can cause that plastic component to wear out prematurely.

What is the downside to Ream & Run Shoulder Replacement?

Compared to a standard total shoulder replacement the Ream and Run procedure can require a longer recovery period after surgery, and there can be more discomfort post surgery as the body begins to recreate that cartilige surface. Researchers have found that the time period might be two years for it to match and exceed the performance of traditional shoulder replacement. But again the key benefit of Ream and Run is the lower risk of needing a follow up revision surgery.

For a person considering the Ream and Run Should Replacement technique, it is crucial to find a joint replacement surgeon who is proficient in the technique because a successful surgery is linked to the surgeon’s ability to identify which patients will do well with the technique, the surgical instrumentation used in rehaping the body’s own socket joint to match the metal ball component, and the skill needed to reshape the body’s own bone to match the new artificial metal ball joint.