Ream-and-run technique offers equivalent clinical outcomes as anatomical total shoulder arthroplasty but with a high rate of complications: A systematic review and meta-analysis

Purpose: This review aims to explore if the Ream and Run (RnR) technique is associated with better outcomes and lower complications than the traditional Anatomical Total Shoulder Replacement (aTSA) for osteoarthritis. Methods: A systematic search of the literature was conducted using Medline, Embase and Cochrane in accordance with the PRISMA guidelines on March 2, 2024. Only comparative studies of adult patients with glenohumeral osteoarthritis (OA) comparing RnR and aTSA were included. Basic demographics, patient-reported outcome measures (PROMs) and complications were extracted and analysed. Quality assessment was performed using the Newcastle-Ottawa Score (NOS) tool and meta-analysis of outcomes reported by two or more studies was performed using Cochrane RevMan Web. Results: A total of 1548 patients were pooled from eight studies [RnR 738 vs aTSA 810]. Mean age in the RnR group ranged from 52.8 to 60.3 years with 93.6 % being male, compared with age range of 53-67.5 years in the aTSA group with 56 % being male. Five patients in the RnR group were Walch grade C or D, compared with three patients in the aTSA. No difference was observed between the two groups in post-operative SST score [P < 0.04], post-operative ASES score [P = 0.57] or degree of post-operative forward flexion [P < 0.41]. There was a statistically significant improvement in post-operative degree of external rotation, favouring RnR [MD -8.35, 95 % CI -14.69 to -2.01, P < 0.01] but without a significant clinical importance. The overall rate of complications in the RnR group was 15.4 % and 5.3 % in the aTSA group. The commonest reported complication in RnR group was chronic pain and stiffness (3.9 %) and soft tissue failure in the aTSA group (2.7 %). Overall rate of return-to-theatre was 7 % in RnR and 2.7 % in aTSA group. Conclusion: Both aTSA and RnR offer improvement in shoulder PROMS. However, the overall re-operation rate and complications appeared high in RnR group. The choice of technique should be tailored to the patient's pre-operative baseline, activity level and desired goals.