Prevention and management of post-instability glenohumeral arthropathy

Abstract

Post-instability arthropathy may commonly develop in high-risk patients with a history of recurrent glenohumeral instability, both with and without surgical stabilization. Classically related to anterior shoulder instability, the incidence and rates of arthritic progression may vary widely. Radiographic arthritic changes may be present in up to two-thirds of patients after primary Bankart repair and 30% after Latarjet procedure, with increasing rates associated with recurrent dislocation history, prominent implant position, non-anatomic reconstruction, and/or lateralized bone graft placement. However, the presence radiographic arthrosis does not predict poor patient-reported function. After exhausting conservative measures, both joint-preserving and arthroplasty surgical options may be considered depending on a combination of patient-specific and anatomic factors. Arthroscopic procedures are optimally indicated for individuals with focal disease and may yield superior symptomatic relief when combined with treatment of combined shoulder pathology. For more advanced secondary arthropathy, total shoulder arthroplasty remains the most reliable option, although the clinical outcomes, wear characteristics, and implant survivorship remains a concern among active, young patients.

Latarjet Procedure for Anterior Glenohumeral Instability: Early Postsurgical Complications for Primary Coracoid Transfer Versus Revision Coracoid Transfer After Failed Prior Stabilization

“…15,19 For this reason, some authors have recommended early operative management of anterior glenohumeral instability for the prevention of recurrent shoulder instability and subsequent degenerative arthritis. 5,36…”

“…15,19 For this reason, some authors have recommended early operative management of anterior glenohumeral instability for the prevention of recurrent shoulder instability and subsequent degenerative arthritis. 5,36 Multiple arthroscopic and open operative techniques exist for the management of anterior glenohumeral instability. These include labral repair (ie, Bankart repair), glenoid rim fracture reduction and fixation (ie, bony Bankart repair), capsular imbrication, capsular shift, remplissage of Hill-Sachs lesions, iliac crest bone grafting, use of allografts, and coracoid transfer (ie, Latarjet procedure).…”

Individualized coracoid osteotomy and 3D congruent arc reconstruction of glenoid for the treatment of recurrent anterior shoulder dislocation

“…10 ). The contact area was increased, and the contact pressure was decreased, which created the conditions for reducing osteoarthritis [ 31 ]. The lower incidence of shoulder OA in the individual group compared to the B-L group may provide clinical evidence (Fig.…”

The Epidemiology and Natural History of Anterior Shoulder Instability

“…Instability recurrence, greater cumulative instability burden, and increased duration of shoulder dislocation likely portend a heightened risk of requiring more advanced surgical intervention at the time of surgery, including remplissage for engaging HillSachs lesions and/or Latarjet for combined attritional glenoid bone loss [76]. Repetitive anterior instability events may also impart detrimental shear stress on the articular chondral surfaces, contributing to worse patient-reported outcome measures and increased risk of developing instability arthropathy [77]. Krych et al studied the effect of recurrent anterior instability on cartilage injury at the time of arthroscopic repair.…”