Summary

Both aTSA and RnR offer improvement in shoulder PROMS. Incidence of complications is higher with RnR. Further high level studies are required to evaluate superiority of either technique.

Abstract

Background

Glenoid component loosening is a recognised leading cause for failure of anatomical Total Shoulder Replacement (aTSA). The introduction of Ream-and-Run (RnR) technique for GHJ OA has a positive potential in reducing failure rate and improve patient outcomes, especially in younger patients. A literature review was performed to compare clinical outcomes and complications of both procedures.

Methods

A systematic review and meta-analysis were conducted using Medline and Embase databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only comparative studies reporting functional outcome, complications or radiological outcomes in RnR and aTSA were included. Risk of bias was assessed using the Newcastle-Ottawa Score (NOS) tool.

Results

Eight studies met the inclusion criteria with a total of 1,548 patients. All eight studies were retrospective, cohort studies (Level III). There were 738 (47.7%) patients in the RnR group with 93.6% being male. There were 810 patients in the aTSA group of which 56.0% were male. Mean follow up ranged between two and eleven years.

Simple Shoulder Test (SST) was the commonest reported score in six studies. In the RnR group, mean SST score ranged from zero to 11.0 pre-operatively vs zero to 12.0 post-operatively. The mean SST score in aTSA ranged from zero to 10.0 pre-operatively vs zero to 12.0 post-operatively. No difference was observed in post-operative SST scores between the two groups [MD 0.25, 95% CI -0.32 – 0.82, P<0.04].

The American Shoulder and Elbow Surgeons (ASES) score was reported in four studies. In the RnR group, the mean ASES score ranged from 34.8 to 53 pre-operatively vs 77 to 94 post-operatively. In the aTSA group, the mean ASES score ranged from 33.3 to 54 pre-operatively vs 78 to 92 post-operatively. No difference was observed in post-operative ASES scores between RnR and aTSA [MD -1.20, 95% CI -5.34 – 2.93, P=0.57].

Range of motion was assessed as Forward Flexion (FF) or External Rotation (ER) and reported in two studies. No difference was observed in degree of post-operative FF between RnR and aTSA [MD -6.81, 95% CI -23.17 to 9.56, P<0.41]. There was a statistically significant difference in post-operative degree of ER, favouring RnR [MD -8.35, 95% CI -14.69 to -2.01, P<0.01].

Seven of the eight studies reported complications. The overall rate of complications in the RnR group was 15.4% (114 of 738) and 5.3% (43 of 810) in the aTSA group. The three commonest reported complications in RnR group were chronic pain and stiffness, 3.9% (n=29), humeral head problems, 2.6% (n=19) and culture-positive infection, 2.0% (n=15). Overall rate of return-to-theatre in the RnR group was 7% (52/738). In the aTSA group, the three most reported complications were soft tissue failure, 1.2% (n=10), chronic pain and stiffness, 1.2% (n=10) and loosening of glenoid prosthesis, 0.86% (n=7). Overall rate of return-to-theatre in the aTSA group was 2.7% (22 of 810).

Conclusion

Both aTSA and RnR offer improvement in shoulder PROMS with significant improvement in range of motion favouring RnR. The overall re-operation rate appeared higher in RnR group compared to aTSA. Further randomised control trials are needed to assess superiority in clinical, functional, and long-term outcomes of one technique over another.