OPEN SHOULDER INSTABILITY SURGERY : Complications - 08/09/11

Doi : 10.1016/S0278-5919(05)70182-4

Scott D. Mair, MD ^a, Richard J. Hawkins, MD, FRCS(C) ^b

^a Division of Orthopaedic Surgery, University of Kentucky College of Medicine; and the Section of Sports Medicine, University of Kentucky A.B. Chandler Medical Center, Lexington, Kentucky (SDM)

^b Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado, and the University of Texas Southwestern Medical Center at, Dallas, Texas; and the Steadman-Hawkins Clinic and Research Foundation, Vail, Colorado (RJH)

Resumen

More than 2400 years ago, Hippocrates discussed the potential complications of treating unstable shoulders with a white-hot poker.^{44 Matsen F.A., Thomas S.C., Rockwood C.A. , y al. Glenohumeral instability The Shoulder Philadelphia: WB Saunders (1998).
611-754

Haga clic aquí para ir a la sección de Referencias, 46 Moseley H. Recurrent Dislocations of the Shoulder Montreal: McGill University Press (1961).

Haga clic aquí para ir a la sección de Referencias} He warned the surgeons of his time about the possibility of devastating injury to the major nerves and vessels near the shoulder if the iron were allowed to contact these structures. As techniques for operative shoulder stabilization have evolved, with more than 150 procedures described, numerous complications have been reported. Some of these complications are inherent to the specific operative procedure that is selected, whereas others can occur with any technique. Historically, “failure” of a surgical stabilization procedure had been defined as recurrence of instability. By this criteria, nonanatomic operations, such as the Putti-Platt and Magnuson-Stack procedures, which tighten the subscapularis and limit external rotation by design, are, in general, successful; however, investigators have shifted the emphasis to obtaining stability while maintaining range of motion and maximizing shoulder function.^{51 Regan W.D., Webster-Bogaert S., Hawkins R.J. , y al. Comparative functional analysis of the Bristow, Magnuson-Stack, and Putti-Platt procedures for recurrent dislocation of the shoulder Am J Sports Med 1989 ; 17 : 42-48 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 66 Warner J.J.P., Cooper D.E., Warren R.F. Pitfalls and complications of surgery for anterior shoulder instability Techniques in Orthopedics 1997 ; 12 : 7-32 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 67 Warner J.J.P., Johnson D.L., Miller M.D. , y al. Technique for selecting capsular tightness in repair of anterior-inferior shoulder instability J Shoulder Elbow Surg 1995 ; 4 : 352-364 [cross-ref]

Haga clic aquí para ir a la sección de Referencias}

A long-term outcome report on the Bankart procedure found that the most common complaint of patients was not recurrent instability but decreased range of motion and intermittent pain, with patients placing a high value on full mobility, even to the exclusion of absolute stability.^{23 Gill T.J., Micheli L.J., Gebhard F. , y al. Bankart repair for anterior instability of the shoulder: Long-term outcome J Bone Joint Surg Am 1997 ; 79 : 850-857

Haga clic aquí para ir a la sección de Referencias} Preservation of function is particularly important in certain patient populations, such as throwing athletes, in whom small losses in range of motion and strength can preclude a successful return to competition, and thus results of surgery have been less predictable. For these patients, modified techniques, such as a subscapularis-splitting approach to the shoulder, have been devised in an effort to maximize function after stabilization.^{37 Jobe F.W., Giangarra C.E., Kvitne R.S. , y al. Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports Am J Sports Med 1991 ; 19 : 428-434 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} Arthroscopic techniques of shoulder stabilization are becoming increasingly common and have been shown to reduce some complications.^{24 Green M.R., Christensen K.P. Arthroscopic versus open Bankart procedures: A comparison of early morbidity and complications Arthroscopy 1993 ; 9 : 371-374 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} These techniques continue to evolve, and results will likely improve as modifications are made; however, rates of recurrent instability in published reports are generally higher with arthroscopic stabilization, and other complications occur, as documented (see article by Shaffer and Tibone, pp 737–767).

Open stabilization currently remains the gold standard for comparison. Cofield et al^{11 Cofield R.H., Kavanagh B.F., Frassica F.J. Anterior shoulder instability Instr Course Lect 1985 ; 34 : 210-227

Haga clic aquí para ir a la sección de Referencias} set forth goals of the ideal stabilization procedure— one that is technically reasonable to perform and allows identification and correction of the pathology responsible for instability. In addition, recurrence and other complications should be minimized, function and motion should be maintained, and osteoarthritis should not result.^{11 Cofield R.H., Kavanagh B.F., Frassica F.J. Anterior shoulder instability Instr Course Lect 1985 ; 34 : 210-227

Haga clic aquí para ir a la sección de Referencias} The following sections present the complications that have been reported with open instability surgery in the hope that such knowledge will help surgeons to minimize the frequency of their occurrence.