The Bone block procedure for shoulder instability

This leaflet will advise you on the above procedure and outline recovery after surgery. 

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Why do you need this operation? 

Your shoulder is a ball-and-socket joint made up from the head of your upper arm bone (humerus) and shoulder socket (glenoid) which is part of the shoulder blade (scapula). Dislocation of the shoulder damages the ligaments initially. Due to violent or recurrent dislocations there has been erosion of the bone at the front of your shoulder socket (glenoid) resulting in greater instability. 

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The operation 

The aim of the operation is to replace lost bone from the side of the socket. This can be done by using the end of the collar bone (clavicle) from the same shoulder and attaching it to the front of the shoulder socket to fill in the defect in the bone. Sometimes this bone is harvested from you pelvis or from a donor. An alternative is to use a bony prominence (corocoid process) from just below the collar bone (the Latarjet procedure). The bone is attached to the glenoid usually using metal buttons and strong sutures. With the Latarjet procedure a tendon (conjoint tendon) is also moved which is attached to the front of the coracoid process which acts as a seat belt across the front of the shoulder joint further increasing stability. This procedure can be performed using either open or keyhole (arthroscopic) surgery or a combination. 

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Potential complications 

Even when an operation goes well and achieves what it meant to do, there are a small proportion of patients (about 5%) who do not improve following surgery. Unfortunately any operation has a chance of having a complication. Fortunately the chance of having a complication is small (<5%) and having a significant complication that will have a negative effect on the outcome of surgery is even smaller (<1%). The following are specific complications associated with a latarjet procedure: 

Re-dislocation even with an excellent surgical repair it is not possible to restore your shoulder to its pre-injury stability. After recovery and appropriate rehabilitation you can return to sports as you wish but you will be at some risk of re-dislocation especially if you partake in contact, overhead or competition level sports. 

Stiffness a degree of stiffness is expected and desired after this operation as the process of stabilising the joint involves tightening it up. You will regain a full functional range of movement between 3 and 6 months after surgery although you may have a permanent loss of external rotation but you are unlikely to be aware of this. Sometimes stiffness can be severe and take longer to resolve. It may be up to a year for normal movement to come back - this is called a "frozen shoulder". 

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Nerve injury the surgeon has to work close to the main nerves going to the arm during this operation. Sometimes nerves can get compressed or squashed during surgery which will present will numbness and weakness but this is likely to resolve within a weeks days. Permanent nerve injury is exceptionally rare but would lead to significant permanent disability. 

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Arthritis as soon as the shoulder has dislocated there is damage to the cartilage covering the joint. To a degree the amount of cartilage damage is proportionate to number of times the joint has been dislocated. Although the latarjet repair will stabilise the shoulder it cannot heal the cartilage or necessarily prevent its progression. It may be that once the shoulder is stabilised the cartilage will not progress to arthritis but some cases it will and eventually require a shoulder replacement but this may be after many years. 

Infection superficial wound infections are more common and can often be treated with a short course of antibiotics. Deep infections within the joint are rare but would require you to come into hospital to have the shoulder washed out and go on intravenous antibiotics 

Non-union - the operation essentially is to position and fix of the bone block onto the side of the glenoid so the 2 bones heal to each other to eventually become one. In a small number of cases (increased risk if you smoke) the 2 bones do not unite and the bone block detaches after a few months. In most cases this does not effect the outcome of surgery and the shoulder will remain stable 

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The shoulder joint after surgery 

Length of hospital stay: Usually 1 night 

Arm immobilisation: Sling or brace (see image) for 4 weeks 

Total recovery period: 6 to 9 months 

Return to driving: 6 to 8 weeks 

Return to work: Desk based job - 2 to 4 weeks Manual job - 3 months 

Return to sports: Non-contact from 3 months Contact/overhead from 6 months 

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