SEGMENTAL HUMERAL HEAD ALLOGRAFTS FOR RECURRENT ANTERIOR INSTABILITY OF THE SHOULDER WITH LARGE HILL-SACHS DEFECTS: A TWO TO 8 YEAR FOLLOW UP

Abstract

Although soft tissue capsulolabral repairs are the mainstay of treatment for recurrent anterior shoulder instability, bone defects are becoming more commonly recognized as additional problems for these patients. Humeral Head defects have been commonly ignored, however, there are a group of patients with failed procedures who have this as their main pathology.

The purpose of this paper is to present a review of patients with large Humeral Head impression defects with a large structural irradiated Allograft.

From April 1995 to January 2001, eighteen patients with recurrent anterior shoulder instability with Large Humeral Head Defects (> 25%) were treated with irradiated humeral allografts. Patients underwent physical and radiographic examination, subjective assessments including VAS scores for pain, instability, and satisfaction and completed a Constant and WOSI scores to determine clinical result. Radiograhic evaluation included standard radiographs and either MR or CT assessment.

Eighteen Patients with an average age of 31.5 (18–52) were reviewed at an average time of fifty months (24–96) following their surgical procedure. There were fourteen male and four female patients each having had an average of 2.1 (1–8) prior operative procedures. All patients had resolution of their instability with no documented recurrences. All patients had severe apprehension preop and this resolved completely in fifteen. Average loss of external rotation was forty degrees preop and improved to ten degrees postop. Two patients had partial collapse of the graft with symptoms of pain in External Rotation requiring screw removal. There were no other complications. Patients improved on WOSI from 1882 to 381 and had an avearage Constant score of eighty-seven postop. Subjectively all patients would have the procedure again and pain improved from 72.5 to 22.5.

There are certain situations where large humeral head defects contribute to the failure of instability repairs and ongoing instability. Allograft reconstruction with matched irradiated grafts is an excellent alternative for eliminating instability.

Funding: Smith and Nephew