Review article
Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review

https://doi.org/10.1016/j.jse.2012.09.009Get rights and content

Background

Various methods of bony stabilization, including modifications of Bristow and Latarjet procedures, are considered gold-standard treatment for recurrent anterior shoulder instability but are associated with unique complications and risk of reoperation. The purpose of this study was to identify the prevalence of these complications. We hypothesized that the Bristow-Latarjet procedure would be a successful technique for treatment of shoulder instability but associated with a risk of recurrent postoperative instability, reoperation, and other complications.

Methods

A systematic review of multiple medical databases included studies reporting outcomes with complication and reoperation rates following original or modified versions of the Bristow or Latarjet shoulder stabilization surgeries.

Results

Forty-five studies were analyzed (1,904 shoulders) (all Level IV evidence). Most subjects were male (82%). The dominant shoulder was the operative shoulder in 64% of cases. Mean subject age was 25.8 years. Mean clinical follow-up was 6.8 years. Ninety percent of surgeries were done open; 9.3% were all-arthroscopic. Total complication rate was 30%. Recurrent anterior dislocation and subluxation rates were 2.9% and 5.8%, respectively. When reported, most dislocations occurred within the first year postoperatively (73%). Nearly 7% of patients required an unplanned reoperation following surgery.

Conclusion

Osseous stabilization shoulder surgery using original or modified Bristow and Latarjet procedures has a 30% complication rate. Rates of recurrent dislocation and reoperation were 2.9% and 7%, respectively. Mild loss of external rotation is common. Reoperation rates were lower following all-arthroscopic techniques. There was a greater loss of postoperative external rotation with all-arthroscopic surgery.

Section snippets

Materials and methods

A systematic review of multiple medical databases was performed. These databases were accessed and analyzed initially on October 21, 2011 and then repeated on April 1, 2012. The databases utilized were: PubMed, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, and the Cochrane Central Register of Controlled Trials. Five authors independently completed the search according to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and

Results

Forty-five studies were analyzed (1,904 shoulders) (all Level IV evidence, Table I).1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 23, 24, 25, 27, 29, 30, 31, 32, 33, 34, 36, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52 Most subjects were male (82%). The dominant shoulder was the operative shoulder in 64% of cases. Mean subject age was 25.8 years. Mean clinical follow-up was 6.8 years. Ninety percent of surgeries were done open, while 9.3% were

Discussion

The purpose of this study was to elucidate and summarize the unique set of complications and reoperations associated with the Bristow-Latarjet procedure for recurrent anterior shoulder instability. The study hypotheses were confirmed. Although a reliable and effective surgical technique for treatment of recurrent shoulder instability, there was a substantial complication and reoperation rate (30% and 7%, respectively) following Bristow-Latarjet. Most recurrent instability events were anterior

Limitations

There were limitations to this systematic review. All studies were Level IV evidence case series, relegating the review to the inherent limitations of this level of evidence. Selection bias, in addition to being present simply from extraction of certain aspects of study data in a systematic review (eg, complications during Latarjet shoulder stabilization), was evident in the different patient populations based on the following continuous and categorical variables: gender, age, shoulder

Conclusion

Bristow-Latarjet shoulder stabilization is an effective surgical treatment for recurrent shoulder instability associated with glenoid bone loss that is associated with a substantial risk of complications (30%), including recurrent dislocation (2.9%) and re-operation (6.9%). Mild loss of external rotation is common. Reoperation rates are lower following all-arthroscopic techniques. However, there was a greater loss of postoperative external rotation with all-arthroscopic surgery. The

Disclaimer

None of the authors, their immediate families and any research foundation with which they are affiliated received any financial payments or other benefits from any commercial entity related to the subject of this article.

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