Ream and Run Questions Concerns

[EL84]

I’m interested in the Ream and Run Shoulder Procedure to repair my shoulder. I’m 64 and have been active in racket sports but mostly weightlifting since my teen years I’m also used to doing my own repairs around the house that require heavy overhead shoulder use like when performing carpentry repairs. The thought of being restricted on the amount of weight and other restrictions with a normal shoulder replacement surgery doesn’t sound like something I want to live with but my arthritic shoulder is getting pretty bad.

I’ve been researching this Ream and Run and I like the part of no restriction after full recovery but I don’t understand how there is no pain if they don’t replace the glenoid with the plastic glenoid. Won’t the new metal ball section of the shoulder joint (humeral head) cause pain moving against the existing glenoid socket that is not covered with a plastic prosthesis. I know they reshape the glenoid but there is no cushion between the bone and the new metal ball section.

 

[Jaycey]

@EL84 Welcome to BoneSmart!

Unlike shoulder replacement, the ream and run procedure replaces the humeral head with a smooth metal ball. Then the socket is smoothed (reamed) to fit the ball. If successful, in time the body grows a scar layer of cartilage.

One of the disadvantages of R&R surgery is that in the early stages of recovery there is no layer between the two surfaces. Recovery from this surgery is longer and more painful than from TSR surgery.

Please note that you may not be a candidate for this procedure. The surgeon will be the person to make the call on this option, given the condition of your shoulder now.

 

[Layla]

Hello and Welcome to BoneSmart!
In addition to, Jaycey‘s, informative post, I will add that while I don’t really know anything about Ream and Run, there is a short thread discussing it on the forum, that you may not have read through.

Shoulder Hemiarthropasty - Ream and Run?...

Anyone have experience with this shoulder replacement technique. Dr. Frederick Matsen in Seattle pioneered it. It is the same surgery (and OS) that Hope Solo had. On the humerus the surgery is the same as TSR. On the glenoid, instead of a plastic socket they gently ream the glenoid to ensure...

bonesmart.org

I also know of a member that experienced the Ream and Run and he’d be a good one to receive feedback from. I will tag him, but he may not catch the tag right away, so please check back periodically. @dapplega
Thanks for joining us!
@EL84

 

[Kssii]

Before you do anything, please consider PRP. I was told ten years ago I needed a shoulder replacement. I had a “clean out” in 2015 that didn’t work and in 2016 had PRP—still going strong. Check out my progress in my past posts.

 

[EL84]

Before you do anything, please consider PRP. I was told ten years ago I needed a shoulder replacement. I had a “clean out” in 2015 that didn’t work and in 2016 had PRP—still going strong. Check out my progress in my past posts.

Is PRP successful when the shoulder has no healthy joint cartilage (bone on bone)?

 

[Jaycey]

Is PRP successful when the shoulder has no healthy joint cartilage (bone on bone)?

Short answer - no. PRP injections are only indicated if the damage to the joint is minimal.

 

[Kssii]

In my MRI, I had multiple arthritic remodeling lesions along the glenoid, the head of the humerus flatten from artheritis as well as three partial rotator cuff tears. My shoulder would “lock down” nightly as I sat on the couch due to pain. I couldn’t fully lift or rotate my arm; I couldn't reach out my arm to close the car door. That was seven years ago. Then I got a PRP injection. Within days I was better and continued to improve for about a year. My PT guy, who I had been going to for six months and was a shoulder specialist, was amazed at my improvement. Seven years later I have full rotation, no problem closing the car door or putting dishes on the shelf above my head. Am I totally pain free? No, but on the occasion when I need to do so, the pain I have is totally controllable with ibuprofen or Tylenol--maybe half dozen times a year after driving the riding mower for three hours.

 

[EL84]

Is PRP successful when the shoulder has no healthy joint cartilage (bone on bone)?

Short answer - no. PRP injections are only indicated if the damage to the joint is minimal.

Ok both orthopedic surgeon I went to said there was nothing they could do except total shoulder replacement to help my situation.

 

[EL84]

@EL84
Unlike shoulder replacement, the ream and run procedure replaces the humeral head with a smooth metal ball. Then the socket is smoothed (reamed) to fit the ball. If successful, in time the body grows a scar layer of cartilage.

I had no idea your body could regrow cartilage. Why doesn't it repair or regrow without the smoothing or shaping the socket...

 

[EL84]

In my MRI, I had multiple arthritic remodeling lesions along the glenoid, the head of the humerus flatten from artheritis as well as three partial rotator cuff tears. My shoulder would “lock down” nightly as I sat on the couch due to pain. I couldn’t fully lift or rotate my arm; I couldn't reach out my arm to close the car door. That was seven years ago. Then I got a PRP injection. Within days I was better and continued to improve for about a year. My PT guy, who I had been going to for six months and was a shoulder specialist, was amazed at my improvement. Seven years later I have full rotation, no problem closing the car door or putting dishes on the shelf above my head. Am I totally pain free? No, but on the occasion when I need to do so, the pain I have is totally controllable with ibuprofen or Tylenol--maybe half dozen times a year after driving the riding mower for three hours.

Have you had images done of the area post PRP and if you have what exactly did it show?

 

[Jaycey]

Why doesn't it repair or regrow without the smoothing or shaping the socket...

Arthritis eats away surface of the joints. If you feel any grinding sensation it an uneven surface due to the joint wearing away. Smoothing the surface and reaming it to exactly fit the ball creates a healthy environment where regrowth can occur. Note that post op guidelines are very strict for this procedure.

 

[Kssii]

The only imaging I have had is incidental—upper body CT scan month ago. It was noted that I have severe appearing osteoarthritic changes of the right glenohumeral joint. Yes, you will spend some money out of pocket to do PRP, but if it saves you from an operation….

 

[dapplega]

Happy to answer any questions and also recommend you read Dr. Matsens blog. I can’t post the link here but you can easily google “Dr Matsen blog” and it should be first result. The blog has a wealth of info for all shoulder issues. This is a specialized surgery that requires experience. There are only a few OS I would consider for this. Luckily I’m in Seattle area where Dr. Matsen resides. It isn’t a perfect solution and recovery takes dedication with stretching 5x day for at least first six weeks. We hope the longevity is there. There are many power lifters and other top athletes who have chosen this option.

 

[EL84]

Happy to answer any questions and also recommend you read Dr. Matsens blog. I can’t post the link here but you can easily google “Dr Matsen blog” and it should be first result. The blog has a wealth of info for all shoulder issues. This is a specialized surgery that requires experience. There are only a few OS I would consider for this. Luckily I’m in Seattle area where Dr. Matsen resides. It isn’t a perfect solution and recovery takes dedication with stretching 5x day for at least first six weeks. We hope the longevity is there. There are many power lifters and other top athletes who have chosen this option.

Thanks I'll do that.

I've been in contact with Bradley C. Carofino, M.D. I'm only a few hours away from his office. I use to compete in Power Lifting nothing at the elite level but respectable. I'm not too interested in those weights anymore but would like to be able to train with heavier loads than what the surgeons that I saw said I'd be restricted to after shoulder replacement surgery.

 

[dapplega]

Great! I’ve heard excellent things about him and he trained under Matsen. He seems to be the go to on the East coast.

 

[EL84]

The only imaging I have had is incidental—upper body CT scan month ago. It was noted that I have severe appearing osteoarthritic changes of the right glenohumeral joint. Yes, you will spend some money out of pocket to do PRP, but if it saves you from an operation….

I should look more into this type of treatment.