Background: Latarjet surgery has emerged as a prevalent option for managing anterior glenohumeral instability. Despite its efficacy, concerns persist regarding the development of postoperative osteoarthritis (OA), a significant complication. Understanding arthritis pathogenesis in patients undergoing this procedure proves challenging, as OA can manifest even in cases without surgical repair. Additionally, studies suggest correlation between inadequate surgical technique and the occurrence of postoperative arthritis. Traditional radiographic imaging may also underestimate the identification of early OA. Therefore, the objective of this study aimed to analyze the risk factors associated with glenohumeral arthritis before and after the Latarjet procedure, with a minimum follow-up of five years, using computed tomography imaging (CT).
Methods: This retrospective study involved patients who underwent the Latarjet procedure between 2012 and 2017. Inclusion criteria were availability of preoperative and at least 5 years postoperative CT and physical examinations. The primary outcome studied was the presence of glenohumeral OA, classified preoperatively and postoperatively using CT scans. Risk factors for progression to pre and postoperative OA were assessed, including etiology, age at the initial injury, number of dislocation episodes before surgery, time interval from the initial injury to surgical stabilization, size of glenoid defect, position and presence of graft resorption, and screw position.
Results: Fifty joints of 45 patients were included in the final analysis. The presence of preoperative OA was found in 21 of 50 cases (42%). The risk of osteoarthritis (OA) was significantly associated with both shoulder dislocation following a seizure disorder and a larger glenoid size defect (p < 0.05). Of the 29 shoulders without preoperative arthritis, 8 developed arthritis postoperatively (27.5%). Of those 21 cases with preoperative osteoarthritis, progression occurred in 11 cases (52.3%) (p=0.25). When considering all cases with OA progression, significant risk factors were the presence of intraarticular screws and when both screws had angulation above 15o (p<0.06). When considering those patients with progression of OA above 2 grades, significant risk factors were lateral graft position, screw angulation and the presence of intraarticular screws.
Conclusion: Our study reveals a higher incidence of osteoarthritis than reported in the literature, likely attributed to the imaging method employed. Preoperatively, risk factors for the presence of OA included cases resulting from seizure disorders and larger glenoid bone defects. Postoperatively, the only factors related to the progression of osteoarthritis were those associated with potential surgical technique issues.
Keywords: Latarjet procedure; anterior shoulder instability; computed tomography; dislocation arthropathy; osteoarthritic change.
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