Latarjet Procedure

Q1. What is the Latarjet procedure, and why is it performed?

The Latarjet procedure is a surgical operation designed to treat recurrent shoulder instability and frequent dislocations. It is typically recommended when there is significant bone loss from the shoulder socket (glenoid) due to repeated dislocations. By transferring a small piece of bone to the front of the socket, the procedure restores the shoulder's natural bone structure and prevents the ball of the joint from slipping out of its socket.

Q2. How does the Latarjet procedure help stabilize the shoulder?

This procedure stabilizes the shoulder through three mechanisms, often called the "triple effect":

• Bone Block: The transferred bone piece (the coracoid process) is attached to the front of the socket, increasing the surface area and restoring lost bone.
• Sling Effect: The muscles and tendons attached to the transferred bone create a natural sling that tightens and supports the front of the shoulder when the arm is rotated outward.
• Capsular Repair: The joint capsule (the tissue surrounding the joint) is reattached to the transferred bone, restoring additional structural support.

Q3. Who is a good candidate for this surgery compared to a standard labral repair?

A Latarjet procedure is usually recommended for patients who have:

• Experienced multiple shoulder dislocations leading to bone loss on the socket.
• Failed a previous arthroscopic labral repair (Bankart repair).
• A high risk of recurrent dislocation, such as young athletes participating in contact sports.
• Significant joint laxity or tissue weakness that makes soft-tissue repairs less likely to succeed.

Q4. What happens during the preoperative preparation for a Latarjet procedure?

Preparing for surgery involves several key steps to ensure your safety and a smooth recovery:

• Medical Clearance: You may need blood tests, an electrocardiogram (ECG), or a general physical exam.
• Imaging Studies: High-resolution CT scans or MRI scans are often performed to assess the exact amount of bone loss.
• Medication Adjustments: You must stop taking blood thinners, anti-inflammatory drugs, or certain supplements as directed by your surgical team.
• Fasting: Do not eat or drink anything after midnight the night before your surgery.
• Home Prep: Arrange for a family member or friend to drive you home and assist you with daily tasks for the first few days.

Q5. What type of anesthesia is used during the surgery?

The surgery is performed using a combination of two types of anesthesia for your comfort and safety:

• General Anesthesia: You will be fully asleep and unconscious during the entire procedure.
• Regional Nerve Block: An injection is given near the nerves in your neck or shoulder to numb the entire arm. This provides excellent pain relief that lasts for several hours to a day after the operation.

Q6. How is the surgery performed (open vs. arthroscopic)?

The Latarjet procedure is traditionally performed as an open surgery. The surgeon makes an incision (typically 2 to 3 inches long) at the front of the shoulder. This provides direct visualization and access to safely shape the bone, transfer it, and secure it with screws. In some specialized cases, the procedure can be performed arthroscopically using small incisions and a camera, but the open approach remains the standard of care for optimal bone placement and fixation.

Q7. What are the primary risks and potential complications of a Latarjet procedure?

While the Latarjet procedure has a high success rate, as with any surgery, there are potential risks, including:

• Infection at the incision site.
• Stiffness or reduced range of motion, particularly in outward rotation.
• Nerve injury, as major nerves pass very close to the surgical area.
• Non-union, where the transferred bone block fails to heal or fuse to the socket.
• Hardware issues, such as the screws backing out or causing irritation.
• Recurrent instability, though this is much less common than with soft-tissue repairs.

Q8. How long does the Latarjet surgical procedure take?

The surgery typically takes between 1.5 to 2.5 hours to complete. This time can vary depending on the complexity of your shoulder anatomy, the extent of the bone loss, and whether any additional procedures are performed at the same time. You will spend additional time in the preoperative holding area and the recovery room before being discharged or transferred to a hospital room.

Q9. What should I expect immediately after surgery in the recovery room?

When you wake up in the recovery room, you will experience the following:

• Your arm will be placed in a protective shoulder sling.
• Your arm will feel numb and heavy if a nerve block was administered.
• Nurses will monitor your vital signs, check the circulation in your hand, and manage any initial pain or nausea.
• You will be encouraged to gently wiggle your fingers and move your wrist to promote blood flow.

Q10. Do I need to wear a sling after the Latarjet procedure, and for how long?

Yes, wearing a sling is critical to protect the healing bone block and tendons. You will need to wear the sling continuously, including while sleeping, for approximately 4 to 6 weeks. You may temporarily remove it for showering and performing basic elbow, wrist, and hand exercises as instructed by your surgeon. You should not actively lift your arm or carry any weight during this initial recovery phase.

Q11. What is the best way to sleep comfortably and safely after the surgery?

Sleeping can be challenging during the first few weeks. To rest comfortably and protect your shoulder:

• Sleep reclined: Sleep in a reclining chair or prop yourself up with pillows in bed at a 45-degree angle. This reduces gravity's pull on your shoulder and minimizes throbbing.
• Support the elbow: Place a small pillow behind your elbow on the surgical side to keep your arm from falling backward and putting tension on the front of the joint.
• Wear your sling: Keep the sling secured throughout the night to prevent accidental movements.

Q12. How is pain managed in the days following the procedure?

Your surgical team will provide a multi-modal pain management plan to keep you comfortable:

• Nerve Block: Provides numbness and pain relief for the first 12 to 24 hours.
• Prescription Pain Medications: Oral narcotics may be prescribed for the first few days. Use them exactly as directed.
• Anti-inflammatory Medications: Over-the-counter or prescription anti-inflammatories may be used to reduce swelling and pain.
• Ice Therapy: Applying ice packs or using a cold therapy unit for 20-30 minutes at a time, several times a day, is highly effective at reducing pain and inflammation.

Q13. When can I start physical therapy, and what does the rehabilitation process look like?

Physical therapy typically begins within the first 1 to 2 weeks after surgery. Rehabilitation progresses in structured phases:

• Phase 1 (Weeks 1-6): Focuses on protecting the repair, managing pain, and starting gentle passive range-of-motion exercises (where a therapist or your other arm moves the shoulder).
• Phase 2 (Weeks 6-12): Active movement begins as the bone block fuses. Exercises focus on restoring full range of motion and starting gentle strengthening.
• Phase 3 (Months 3-6): Focuses on advanced strengthening, scapular stabilization, and training specific to your daily activities or sports.

Q14. When can I return to daily activities, driving, and sports?

Timeline for returning to activities varies by patient, but general guidelines are:

• Desk Work: 1 to 2 weeks, provided you can work with your arm in a sling.
• Driving: 4 to 6 weeks, once you are out of the sling, off narcotic pain medications, and have sufficient control of your arm.
• Light Manual Work: 3 months.
• Heavy Lifting / Contact Sports: Typically 4 to 6 months, after imaging confirms the bone block has completely fused and you have regained full strength.
• Success Rate: Over 90% stable shoulders and return to desired level of activity.

Q15. What is the long-term success rate of the Latarjet procedure for preventing future dislocations?

The Latarjet procedure has an excellent long-term success rate. Studies show that over 90% of patients achieve stable shoulders and return to their desired level of activity, including high-impact sports. The rate of recurrent dislocation is extremely low (typically less than 5%), making it one of the most reliable and durable procedures for treating severe shoulder instability with bone loss.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.