Anterior glenoid reconstruction for unstable dislocating shoulders. Surgery to restore lost anterior glenoid bone and deep the socket with a bone graft can restore shoulder anatomy and lessen pain and improve function.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Friday, October 16, 2009
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Considering surgery
Types of surgery recommended
When the anterior soft tissues of the shoulder are deficient,
particularly if there is loss of the bone from the front of the socket,
iliac crest grafting to the anterior glenoid lip provides the most
robust of reconstruction techniques.
Other procedures, such as a repeat Bankart repair, may be of benefit
if the bony anatomy is normal and if adequate quantity and quality of
soft tissues remain.
Shoulder fusion can stabilize the shoulder, but takes away the mobility at the ball and socket joint.
Who should consider surgery to deepen the socket of anteriorly dislocating shoulders (using an anterior iliac crest bone graft)?
Iliac crest graft surgery is considered when dislocations or
instability of the shoulder have recurred after previous surgery for
dislocations.
If the patient and doctor decide to use this surgical procedure, it is important that:
- the instability is the problem,
- the patient is sufficiently healthy to undergo the procedure,
- the patient understands and accepts the risks and alternatives,
- the surgeon is experienced in shoulder reconstructive surgery, and
- the patient is dedicated to the rehabilitation program after the surgery.
What happens without surgery?
If the shoulder dislocates repeatedly, the dislocations tend to become more frequent and to require less force.
Recurrent dislocations may cause risk to the bone, the rotator cuff and to the nerves and blood vessels in front of the joint.
Surgical options
Several options exist for the patient with failed shoulder instability surgery.
One is to accept the tendency for dislocation and to control it with careful positioning of the shoulder and with exercises.
A second option is for the surgeon to attempt a repeat soft tissue
repair, assuming there is sufficient and sufficiently strong tissue.
The third option is to perform an anatomically contoured extracapsular iliac crest bone graft to the anterior glenoid lip.
A final option is to perform a fusion of the shoulder.
Effectiveness
If the problem is recurrent anterior glenohumeral instability after
surgery, anterior iliac crest grafting is usually very effective in
restoring stability. Once the glenoid graft is healed solidly (usually
after 3 months) the stability should not be lost with time unless a new
injury occurs.
Urgency
Surgery for failed instability surgery is an elective procedure that
can be scheduled when circumstances are optimal. It is not an urgent
procedure. The patient has plenty of time to become informed and to
select an experienced surgeon.
Risks
The risks of iliac crest grafting to the anterior glenoid lip include but are not limited to the following:
- infection,
- injury to nerves and blood vessels,
- fracture,
- stiffness or instability of the joint,
- loosening or wear of the bone graft,
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- screw loosening,
- arthritis,
- and problems at the bonegraft harvest site.
There are also risks to anesthesia.
A blood transfusion is only rarely required.
An experienced shoulder replacement team will use special techniques
to minimize these risks, but cannot totally eliminate them.
Managing risk
Most of the risks of iliac crest graft surgery can be effectively
managed if they are identified promptly and treated.
Infections may require a wash out in the operating room, possibility
with removal of the graft. Blood vessel or nerve injury may require
repair. Fracture may require surgical fixation. Stiffness or
instability may require exercises or additional surgery. Loosening of
hardware or wear of the graft may require surgical revision. Arthritis
of the shoulder may require joint reconstruction. If the patient has
questions or concerns about the course after surgery, the surgeon
should be informed as soon as possible.
Surgery for failed surgery for anterior dislocation at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA
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