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There are two types of surgery- a conventional or open technique wherein the incisions are larger and do not require specialized equipment. The other type is arthroscopy or key-hole technique wherein specialized instruments are used to perform the surgery using very small skin incisions.
There are different ways to treat the pathology causing shoulder dislocation. All the techniques can be done either open or through arthroscopy. In patients who have few shoulder dislocations with less bone loss and documented bank arts lesion, bankart repair can be performed using small implants called suture anchors. In patients with several episodes of shoulder dislocation, poor tissue quality and severe glenoid bone loss transfer of a piece of bone called the coracoid process from the shoulder is done to increase the bone diameter called Latarjet transfer.
The current literature reports an 85% success rate after arthroscopic Bankarts repair and a slightly higher success rate after the Latarjet procedure. However, the advantage of Bankarts repair is that the native tissue is fixed in its anatomic position and in case of failure the option of Latarjet is available whereas the same cannot be said of the Latarjet procedure
The common complications are delayed wound healing, infection, re-dislocation, nerve injury which however are rare in nature. Failure of the repaired labrum to the bone in bank arts repair or absorption of transferred coracoid bone in Latarjet procedure can result in failure of the surgery.
Immediately after surgery, patients are given a shoulder immobilizer and ice pack, analgesics are given for pain control. Gentle shoulder pendulum exercises along with elbow and wrist ROM exercises are initiated. Patients are instructed not to put their shoulders in a position of abduction and external rotation for three months. However, patients can start doing basic works like writing, driving 3- 4 weeks after surgery. Patients can start playing sports requiring overhead shoulder movements such as cricket, tennis 6 months after surgery.
The treatment depends on the cause of failure and the previous technique of shoulder stabilization surgery done. If the failure is after an arthroscopic Bankarts repair and has been due to improper surgical technique, then a revision arthroscopic Bankarts repair can be done if the labral tissue is good. However, if the tissue is of poor quality then a Latarjet procedure is recommended.
In patients who had a failure after the Latarjet procedure, the surgical options are very limited and the outcomes are guarded. The most commonly done procedure is the transfer of a block of bone from your hip blade bone called iliac crest transfer.
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