Suttmiller Ashley M B, Snyder Brice A, Carofino Bradley C
Atlantic Orthopaedic Specialists, Virginia Beach, VA, USA.
Atlantic Orthopaedic Specialists, Virginia Beach, VA, USA.
J Shoulder Elbow Surg. 2025 Mar;34(3):794-802. doi: 10.1016/j.jse.2024.06.011. Epub 2024 Aug 3.
Anatomic total shoulder arthroplasty (aTSA) may not be an ideal treatment option for young and active patients because of potential activity restriction and concerns about glenoid loosening. The ream-and-run procedure (RnR) allows for the continuance of high-level activity without concerns of a glenoid component failure. Initial RnR publications are promising, although more outcomes studies are needed. Therefore, our primary purpose was to compare outcomes at multiple time points between matched aTSA and RnR cohorts. Second, we sought to examine relationships between patient-reported outcomes and preoperative glenoid pathoanatomy in our RnR cohort Last, we examined postoperative radiographs to determine if the RnR successfully corrected glenoid pathoanatomy and humeral head decentering.
We performed a retrospective matched-cohort study comparing patients who underwent an RnR vs. patients who underwent the aTSA procedure between 2017 and 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 Standardized Shoulder Assessment Form (ASES), and daily and worst pain outcomes were compared between groups at 3 and 6 months, and 1 and 2 years postarthroplasty. 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.
Forty-six shoulders (23 RnR and 23aTSA) belonging to 43 male patients with an average age of 56.2 ± 8.3 years 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 time point. RnR patients reported significantly higher daily pain ratings (P = .047) and lower ASES scores (P = .031) compared with the aTSA group 3 months after arthroplasty but reported similar outcomes at 6 months and beyond. Preoperative pathoanatomy outcomes were not directly related to final reported pain or function in the RnR group. Additionally, the RnR was able to correct posterior humeral head decentering in our cohort.
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.
解剖型全肩关节置换术（aTSA）对于年轻且活动量大的患者可能并非理想的治疗选择，因为存在潜在的活动受限以及对肩胛盂松动的担忧。扩髓-植入手术（RnR）允许患者继续进行高水平活动，而无需担心肩胛盂假体失败。RnR的初步研究成果很有前景，不过仍需要更多的结局研究。因此，我们的主要目的是比较配对的aTSA和RnR队列在多个时间点的结局。其次，我们试图在RnR队列中研究患者报告的结局与术前肩胛盂病理解剖之间的关系。最后，我们检查术后X线片，以确定RnR是否成功纠正了肩胛盂病理解剖和肱骨头偏心。
我们进行了一项回顾性配对队列研究，比较2017年至2019年间接受RnR手术的患者与接受aTSA手术的患者。所有患者的主要诊断均为肩关节骨关节炎，且至少随访2年。在术后3个月、6个月、1年和2年，比较两组患者的简单肩关节测试、美国肩肘外科医师协会标准化肩关节评估表（ASES）以及日常和最严重疼痛结局。通过X线片测量术前和术后肩胛盂解剖结构和肱骨头偏心情况，并进行相关性分析，以探讨这些因素与2年疼痛和功能评分之间的关系。
纳入了43例男性患者的46个肩关节（23个RnR和23个aTSA），平均年龄为56.2±8.3岁。在术后3个月和6个月有18对匹配病例，1年时有21对匹配病例，2年时所有23对病例均匹配。与aTSA组相比，RnR组患者在术后3个月时报告的日常疼痛评分显著更高（P = 0.047），ASES评分更低（P = 0.031），但在6个月及以后报告的结局相似。术前病理解剖结局与RnR组最终报告的疼痛或功能没有直接关系。此外，在我们的队列中，RnR能够纠正肱骨头后偏心。
接受RnR手术的年轻男性患者可能预期与接受aTSA手术的年轻男性患者有相似的短期结果。此外，RnR的结局不受术前肩胛盂磨损或肱骨头偏心的影响。我们的研究结果支持RnR作为年轻、活动量大的肩关节关节炎患者可行的手术替代方案。
