Latarjet Procedure
Overview
The Latarjet procedure is a highly effective surgical intervention for treating shoulder instability. This procedure is particularly helpful for patients who experience recurrent shoulder dislocations due to significant trauma or bone loss affecting either the humerus (the ball) or the glenoid (the socket) of the shoulder. When there is substantial bone loss, a labral repair alone may not suffice to restore stability, making the Latarjet procedure an essential option for patients seeking comprehensive shoulder instability and shoulder dislocation treatment.
Anatomy
Fig 1. Anatomy of Shoulder
The shoulder joint is a complex ball-and-socket structure comprising several key components:
- Humerus (ball): The upper arm bone that fits into the glenoid cavity, allowing for a wide range of motion.
- Glenoid (socket): A shallow socket in the shoulder blade (scapula) that holds the humeral head in place.
- Coracoid Process: A small, hook-like structure on the scapula, which serves as an attachment point for muscles that help stabilise the shoulder.
In cases of shoulder instability, bone loss can lead to a compromised shoulder socket or ball, increasing the risk of dislocation.
What Is the Latarjet Procedure?
Fig 2. Postoperative Latarjet Procedure
The Latarjet procedure involves harvesting a segment of bone from the coracoid process, along with its attached muscles, and transferring it to the glenoid cavity. This bone graft restores the contour of the socket while the attached muscles create a supportive “sling” effect, preventing dislocation. This combined approach of arthroscopic and open techniques is particularly beneficial in shoulder instability surgery, as it effectively addresses the significant bone loss.
Benefits and Risks
The Latarjet procedure offers several benefits, including its high effectiveness in restoring shoulder stability, particularly in cases of significant bone loss. It significantly reduces the risk of recurrent shoulder dislocations and helps prevent long-term joint degeneration and pain. Additionally, this procedure may allow for a quicker return to normal daily activities compared to other surgical methods.
While the Latarjet procedure is generally successful in restoring shoulder stability, as with any surgery, it carries certain risks, including:
- Infection at the surgical site.
- Nerve injury, leading to weakness or numbness.
- Failure of the graft to integrate, which may require additional surgery.
- Stiffness or limited range of motion post-operation.
What Should I Expect?
Before the Procedure:
Pre-operative imaging, including 3D CT and MRI scans, is essential for assessing the extent of bone loss and confirming the appropriateness of the Latarjet procedure. A comprehensive discussion about the procedure and any questions will occur during your pre-operative consultation.
During the Procedure:
The Latarjet procedure is performed under general anaesthesia, complemented by a nerve block to minimise pain. Using a mix of keyhole and open surgery techniques, Mr Chua removes a segment of the coracoid process, reshapes it, transfers it to the glenoid, and secures it in place with screws or metallic buttons, effectively restoring stability to the shoulder joint. Over time, the transferred bone graft will integrate with the glenoid through bone healing, effectively becoming part of the glenoid socket.
After the Procedure:
Post-surgery, expect some soreness as the nerve block wears off. Mr Chua and his team will prescribe pain relief medication to manage discomfort. Most patients will stay overnight in the hospital and can go home the next day. Waterproof dressings allow for immediate showering. All sutures/stitches are internal and do not need to be removed, as they dissolve once the wound has healed.
Your arm will be placed in a sling, permitting you to perform basic daily tasks. However, driving and operating heavy machinery should be avoided for at least six weeks. A physiotherapist will provide early exercises before discharge, with ongoing rehabilitation tailored to your specific injury.
Frequently Asked Questions
- How long will recovery take after the Latarjet procedure?
Recovery time varies, but most patients can expect to begin light activities within 6 weeks and return to more strenuous activities in 4-6 months, depending on individual healing. - Will I need on-going physical therapy after the Latarjet procedure?
Yes, physical therapy is crucial for recovery. Your physiotherapist will provide tailored exercises to help restore strength and mobility in your shoulder. - What should I do if I experience pain or complications after the Latarjet procedure?
It is vital to follow post-operative instructions and attend follow-up appointments. If you experience severe pain, swelling, or signs of infection, contact Mr Chua’s office immediately for guidance.