Pre-Surgery examinations and selecting the surgeon for the Latarjet procedure

I arranged appointments with four different shoulder specialists to get different perspectives and to be able to compare their approaches. 3 out of 4 specialist that I saw recommended the Latarjet procedure to treat the instability. 2 out of the 3 were recommending the open Latarjet procedure while one surgeon had specialized in the arthroscopic procedure. The specialists that recommended this procedure also had a lot of experience performing the surgery. This is a key point when you select the surgeon for a Latarjet procedure. Even today in Germany for example, this procedure is not widely used and usually reserved for contact athletes or people with previous surgeries that did not help. This is not something you want to get done by a surgeon next door who takes care of hip replacements, knees, shoulders and whatever comes his/her way. You really want an experienced surgeon that specializes in shoulders and has done the Latarjet procedure many times before. The procedure itself is more complex than the Bankart-Repair and the risk of complications (during and after the surgical procedure) is significantly higher when performed by an inexperienced surgeon.

During the examinations, it was confirmed that I had suffered from bone loss of the glenoid in a range of 15 to 20%. It is unclear when exactly the bone loss occurred, but it happened most likely already before the second Bankart-Repair. The bone loss was diagnosed to be the root cause of my recurrent shoulder instability. There was not much left of the labrum, so the only way to reconstruct the glenoid was by performing a bone transfer procedure. The CT below shows a 3d reconstruction of my shoulder joint. I've marked the area where a significant piece of bone was missing.

After a few days of thinking about whether I should get surgery, I decided to go for it and picked my surgeon. You might want to know why I decided to go for surgery even though I’m already a bit older than the usual Latarjet patients and don’t compete in contact sports. Although I dislocated my shoulder ~15 times over the years, I never got used to the feeling and pain that comes with each occurrence. I didn’t want to make this a part of my life. Especially when it dislocated while swimming in the sea, I realized that dislocations could also be more dangerous depending on the situation that you’re in when it happens. I enjoy being outdoors and there might not always be a hospital close by to treat a dislocation in case I can’t reposition it myself. I also wanted to be able to do sports without having to constantly worry about my shoulder.

Now I had to pick the surgeon. All three surgeons that recommended the Latarjet procedure were very knowledgeable and experienced specialists. I decided against the arthroscopic procedure because there seemed to be less data/studies available compared to the open Latarjet. Even though the data that exists shows almost similar results for arthroscopic and open Latarjet, I felt more comfortable going for the more widely used approach.

One of the remaining surgeons was only able to perform same day surgery without keeping me in the hospital over night which sounded a bit rough to me for that kind of procedure. The remaining surgeon who recommended an open Latarjet procedure and suggested to stay in hospital for at least two nights made a good impression on me. He took his time to look at MRI and CT scans, explained what he saw in detail, confirmed the instability by several apprehension tests and answered all my questions. I also knew someone who underwent this procedure with this surgeon and was not having any issues two years later. With that information I felt comfortable to pick him as the surgeon and I scheduled the surgery for March 15th 2018.