Monday, January 19, 2015

Arthritis after a Bristow-Latarjet procedure

Risk of arthropathy after the Bristow-Latarjet repair: a radiologic and clinical thirty-three to thirty-five years of follow-up of thirty-one shoulders.

These authors report long term followup on 31patients (mean age, 26.7 years) who had a Bristow-Larjet repair from 1977 to 1979.

One patient required revision surgery because of recurrence and another because of repeat dislocation. Six patients reported subluxations. Eighteen patients (58%) were very satisfied, and 13 (42%) were satisfied. The mean Western Ontario Shoulder Instability Index score was 85/100, and the median score was 93/100. According to Samilson-Prieto classification of arthropathy of the shoulder, 39% were classified as normal, 27% as mild, 23% as moderate, and 11% as severe. The classification of arthropathy varied with observers and radiologic views. Age younger than 22 years at the primary dislocation was associated with less arthropathy at follow-up.

Comment: The Latarjet procedure has become a popular method for stabilizing shoulders with recurrent instability. Some surgeons reserve it for failed anatomic repairs or for cases with substantial anterior glenoid bone loss while others use it routinely for the surgical repair of instability.  The cases reported here were done quite a long time ago and it is likely that the surgical techniques have changed substantially since that time. In these cases it is not clear how much of the arthropathy is due to the episodes of instability and how much to the surgical procedure. We have previously posted regarding capsulorrhaphy arthropathy, including arthropathy after a Latarjet as shown here.

For comparison, a recent review found a 30% complication rate with this type of procedure.

While their method of single screw fixation of the coracoid in the 'standing' position led to 25% failure of bony union, the authors opine that fixation of the transferred coracoid in the 'lying' position with two screws may increase the risk of hardware complications.

In our practice, we reserve bony transfer procedures for shoulders in which an anatomic repair has failed or for those with major glenoid bone defects.


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