Latarjet Surgery: Defining Failure, Reported Rates, and Influencing Factors

What is the failure rate of Latarjet surgery?

The failure rate for Latarjet surgery, primarily defined by recurrent shoulder instability or dislocation, is generally low, ranging from approximately 2% to 10% across various studies, with specific complications like non-union or nerve injury occurring at even lower rates.

Introduction to Latarjet Surgery

The Latarjet procedure is a highly effective surgical technique used to treat recurrent anterior shoulder instability, particularly in cases involving significant bone loss from the glenoid (shoulder socket) or humeral head (ball of the joint), or failure of previous soft tissue repair procedures. Unlike traditional soft tissue repairs (e.g., Bankart repair), the Latarjet procedure addresses bone deficiencies by transferring a piece of bone, specifically the coracoid process, along with its attached conjoined tendon (biceps short head and coracobrachialis muscles), to the anterior-inferior aspect of the glenoid. This creates a bony buttress that helps prevent the humeral head from dislocating anteriorly and provides a sling effect from the transferred muscles, enhancing stability.

Defining "Failure" in Latarjet Surgery

When discussing the "failure rate" of Latarjet surgery, it's crucial to understand what constitutes failure, as definitions can vary across studies and clinical contexts. Common metrics for failure include:

• Recurrent Instability/Dislocation: This is the most frequently cited measure of failure, indicating that the shoulder continues to dislocate or subluxate after surgery.
• Non-Union of the Bone Block: The transferred coracoid bone block fails to fuse properly with the glenoid. While it may not always lead to instability, it can compromise the structural integrity of the repair.
• Persistent Pain or Functional Limitation: Despite anatomical success, the patient experiences chronic pain or significant restrictions in range of motion or strength that limit their desired activities.
• Complications: This category includes a range of issues such as:
  • Nerve Injury: Damage to nearby nerves (e.g., musculocutaneous nerve, axillary nerve).
  • Infection: Post-operative infection at the surgical site.
  • Hardware Complications: Issues with the screws used to fix the bone block, such as loosening, breakage, or prominence requiring removal.
  • Graft Resorption: The transferred bone block diminishes significantly over time.
  • Stiffness: Excessive loss of shoulder motion.

Reported Failure Rates

The reported failure rates for Latarjet surgery are generally favorable, especially when considering the complex nature of the instability it addresses.

• Recurrent Instability: Studies and meta-analyses consistently report low rates of recurrent instability, typically ranging from 2% to 10%. This rate is often lower than that for isolated soft tissue repairs in patients with significant bone loss.
• Non-Union: The rate of non-union of the transferred bone block is also low, usually reported at less than 5%. In many cases, a stable fibrous union may form even if complete bony fusion is not achieved, and this may not necessarily lead to clinical failure.
• Nerve Injury: Transient nerve palsies, particularly of the musculocutaneous nerve, can occur in 1-3% of cases, but permanent nerve damage is rare, typically less than 1%.
• Infection: Similar to other orthopedic surgeries, the risk of infection is low, generally less than 1-2%.
• Hardware Complications: While hardware removal may be necessary in a small percentage of patients due to prominence or irritation, this is usually not considered a "failure" of the primary stabilization.

It is important to note that these rates can vary based on the specific patient population (e.g., contact athletes vs. general population), surgical technique (open vs. arthroscopic), surgeon experience, and length of follow-up in the studies.

Factors Influencing Failure Rates

Several factors can influence the success and potential failure rate of Latarjet surgery:

• Severity of Pre-operative Bone Loss: While Latarjet is indicated for bone loss, extremely severe glenoid bone loss can still pose challenges and influence outcomes.
• Patient Age and Activity Level: Younger patients, especially those involved in high-demand contact or overhead sports, may have a slightly higher risk of recurrence due to greater stress on the repair.
• Patient Compliance with Rehabilitation: Adherence to a structured, progressive post-operative rehabilitation program is critical for optimal healing, restoration of range of motion, and return to activity.
• Surgeon Experience and Volume: The technical demands of the Latarjet procedure mean that surgeon experience plays a significant role in minimizing complications and optimizing outcomes. Surgeons who perform a higher volume of these procedures often report lower failure rates.
• Smoking Status: Smoking is known to impair bone healing and can increase the risk of non-union.
• Concomitant Injuries: Unaddressed associated injuries, such as rotator cuff tears or SLAP lesions, could affect overall shoulder function and perceived success.
• Quality of Bone: Poor bone quality (e.g., osteoporosis) can affect the integrity of screw fixation and bone block integration.

Strategies to Mitigate Risk

To minimize the risk of failure and optimize outcomes following Latarjet surgery, the following strategies are crucial:

• Thorough Pre-operative Assessment: Comprehensive imaging (e.g., CT scan with 3D reconstruction) is essential to accurately assess the extent of glenoid and humeral bone loss and plan the surgical approach.
• Expert Surgical Technique: The procedure should be performed by an orthopedic surgeon with extensive experience in shoulder instability surgery and specific expertise in the Latarjet technique.
• Appropriate Patient Selection: Latarjet is not suitable for all types of shoulder instability; careful patient selection based on the specific pathology (e.g., significant bone loss, engaging Hill-Sachs lesion, failed previous surgery) is paramount.
• Meticulous Bone Block Fixation: Ensuring stable and anatomically correct fixation of the coracoid graft to the glenoid is vital for successful bony integration.
• Structured Post-operative Rehabilitation: A progressive, individualized rehabilitation program designed by a physical therapist familiar with Latarjet protocols is essential to regain strength, mobility, and stability while protecting the healing tissues.
• Patient Education and Compliance: Patients must be fully informed about the recovery process, potential risks, and the importance of adhering to activity restrictions and rehabilitation guidelines.

Conclusion

Latarjet surgery is a highly effective and reliable procedure for treating complex anterior shoulder instability, particularly when bone loss is a significant factor. While no surgical procedure is entirely without risk, the reported failure rate for Latarjet surgery, especially concerning recurrent instability, is remarkably low (2-10%). Success is heavily influenced by factors such as the surgeon's expertise, meticulous surgical technique, appropriate patient selection, and diligent adherence to post-operative rehabilitation. For individuals with the specific indications for Latarjet, it offers a robust and durable solution to restore shoulder stability and facilitate a return to desired activities.