By Moby Parsons, MD

Some people develop severe shoulder arthritis at a young age, sometimes in their forties or early fifties. When the damage to the joint surface becomes advanced, less invasive treatment options like arthroscopic release and debridement may not be able to successfully address the pain and stiffness that develop. On the other hand, traditional shoulder replacement, which involves the placement of a plastic socket on the native shoulder blade, may not be able to withstand the demands that young and active patients wish to pursue. Outcome studies have shown that these plastic sockets may be prone to wear, loosening, and breakage between five and ten years after surgery. Given these sobering results, there is a need for procedure that provides long lasting pain relief, that can address the damage the joint incurs from severe degeneration, and that can withstand the forces and demands that patients will subject the shoulder to.

Enter the Ream and Run procedure. Pioneered by Frederick A. Matsen, MD at the University of Washington in Seattle, this operation involves a resurfacing replacement of the humeral head (ball) and a smoothing and contouring of the socket without socket replacement. By re-establishing a smooth concave socket that has a near matching curvature to the metal ball, the Ream and Run allows for better load distribution across the joint. By releasing the contracted ligaments and capsule around the joint, the operation also balances the soft tissue tension, allowing the ball to recenter itself in the socket and rotate in a smooth and stable fashion. Replacing the bone-on-bone with metal-on-bone helps relieve pain and improve motion and strength. These benefits, in turn, lead to functional gains that allow patients to return to sports, physically demanding jobs, and recreational activities.

The Ream and Run has been performed for roughly 15 years. This has allowed for enough time to perfect the technique and to establish what qualities make a candidate suitable to undergo this procedure successfully. For some patients whose joint damage is too severe, the Ream and Run may not be able to achieve the necessary goals to restore a concave socket in the proper orientation.  In these cases, a conventional shoulder replacement may be necessary.

In my own practice, I have patients who are now 10 years after a Ream and Run with no decline in function over time. X Ray follow has shown a stable concave socket with minimal recurrence of wear. I have patients who have returned to throwing, weight-lifting and construction and who have no specific limitations in their recommended activities. As with every operation, there is a range of outcomes and a subset of patients for whom this procedure is not successful. These patients may require conversion to a standard shoulder replacement if they continue to have pain on the socket side of the partial replacement.