Partial humeral head resurfacing and Latarjet coracoid transfer for treatment of recurrent anterior glenohumeral instability.

摘要

Bone deficiencies of either the humeral head or glenoid fossa may cause recurrent shoulder instability following soft tissue stabilization procedures. The engaging Hill-Sachs lesion, a major risk factor for instability, has been identified in a majority of patients with recurrent anterior instability. Guidance for surgical management of large humeral head deficiency presents few available options, with even fewer clinical data to support any one technique. Anteroinferior glenoid deficiency has also been a well-documented source of recurrent instability. The Latarjet coracoid transfer procedure corrects the glenoid defect by restoring the architecture of the inferior rim. Although coracoid transfer addresses containment on the glenoid, a concomitant large humeral head defect is at risk for engagement on the corrected glenoid. This article describes a case of a 50-year-old man presenting with recurrent right shoulder dislocations status post-open stabilization procedure 10 years prior. Radiologic evaluation demonstrated a large Hill-Sachs lesion with adjacent chondral derangement and a nonunion bony Bankart lesion. The Arthrosurface HemiCap humeral head resurfacing prosthesis (Arthrosurface Inc, Franklin, Massachusetts) was used to address the Hill-Sachs lesion with a Latarjet coracoid transfer procedure. We were unable to identify examples in the literature of the HemiCap used in the correction of a Hill-Sachs lesion for recurrent anterior instability. The HemiCap prosthesis has the benefit of correcting the Hill-Sachs lesion and adjacent chondral defect while preserving uninvolved articular surface. The combination of surgical interventions produced a successful result.