Summary

Evaluation of clinical outcomes, recurrence rates, quality of life and radiological signs of glenohumeral osteoarthrosis at a minimum of 5 years follow-up after arthroscopic Latarjet procedure.

Abstract

Purpose

The Latarjet procedure is considered the standard surgical procedure for patients with recurrent shoulder instability after failed operative treatment or significant bone loss. Recurrence rate after arthroscopic Bankart increases significantly between one and five years follow-up; however, lower recurrence rates have been reported after open Latarjet procedure. The use of arthroscopic Latarjet procedure is increasing; however, there is still limited data on long term outcomes. The aim of this study was to evaluate clinical outcomes, recurrence rates, quality of life and radiological signs of glenohumeral osteoarthrosis (OA) after arthroscopic Latarjet procedure and a minimum 5 years follow-up.

Methods

A consecutive cohort of 51 patients operated with arthroscopic Latarjet procedure at Oslo University Hospital were prospectively registered from November 2014 until June 2017. All patients had a double screw fixation technique. Preoperatively, patient demographics and The Western Ontario Shoulder Instability Index (WOSI) were recorded. The WOSI score was repeated at one and five years follow-up. At 5 years follow-up, patient reported quality of life was assessed using the EQ-5D and EQ-VAS, and radiographs were performed to evaluate signs of OA. Complications and reoperations were recorded by reviewing patient’s medical records.

Results

Of the 51 patients operated, 40 patients had complete pre-operative data sets. Of the 40 patients, 5 patients were lost to follow-up, and 4 patients refused participating in the study, thus 31 were available for follow-up and were included in patient demographics and radiographic evaluation after 5 years. Two patients had incomplete or missing WOSI during follow-up, leaving 29 with complete data sets. The median age at the time of the procedure was 26.2 year (range 17.3- 46.4), the majority (26/31) were men and more than half (18/31) had a history of > 10 dislocations before surgery. A total of 15/31 were reoperations after former instability surgery. At five years, there was no recurrence of dislocations, however 7/29 reported experience of subluxation. The median preoperative WOSI score was 44.6 (IQR:24.2,57.8), and after minimum 5 years 75.7 (IQR: 58.2, 91.1) (p <0.001). Median WOSI after 1 year was 75.4 (IQR: 58.9, 89.6). There was no significant difference in WOSI between 1 year and 5 years (p=0.6). The EQ-5D at 5-years follow-up was 0.86 (SD 0.10) according to the Danish value set in the reference range -0.62, 1. At 5-year follow-up, radiological signs of shoulder OA were observed in 13/31 (42%), of which 4 presented with grade 1, 6 grade 2 and 3 grade 3, according to Samilson and Prieto classification. Reported complications requiring reoperations during follow-up was 8/31 (25.8%).

Conclusions

At five years follow-up after Arthroscopic Latarjet procedure there was a significant improvement in WOSI compared to pre-operative evaluation and low rates of recurrent dislocation. However, there was a relatively high (42%) rate of radiographic OA. There was no significant change in WOSI from one to five years follow-up, suggesting that the improvement from preoperative function was maintained at 5-years follow-up.