Shoulder Reconstruction Surgery

What is a Shoulder Reconstruction Surgery?

Shoulder reconstruction is required for patients with Shoulder Instability to improve stability, restore function and prevent recurrent dislocations of the shoulder joint.

Shoulder reconstruction surgery involves repair of the torn or stretched ligaments so that they are better able to hold the shoulder joint in place.

Types of Shoulder Reconstruction Surgery

Shoulder reconstruction surgery can be done

Arthroscopically, involves use of smaller incisions and tiny instruments to perform the repair - Bankart Repair Surgery
Open Surgery - involves larger incision over the shoulder to perform the repair.

Labrum Repair Surgery

Arthroscopic Labrum Repair Surgery is a type of shoulder reconstruction and stabilisation surgery.

This procedure can be considered for patients who have torn or stretched ligaments and other soft tissues in the shoulder that cause Shoulder Instability

Remplissage Procédure

The remplissage procedure can be added to the arthroscopic Bankart repair to increase shoulder stability. The procedure is reserved for individuals who have a large crush fracture in the back of the humeral head (Hill-Sachs Lesion), with minimal bone loss on the socket.

In the remplissage procedure, the fracture surface is freshened and anchors with sutures are used to tie the adjacent rotator cuff tendon into the defect. The humeral head compressed bone is excluded from the joint and can no longer engage over the front of the socket.

Shoulder Stabilisation surgery can also be performed arthroscopically, depending on the patient’s particular situation, with much smaller incisions. Rarely, arthroscopic surgery may need to be converted to open surgery to properly repair the damage to internal structures.

Bone Deficient Anterior Instability

In shoulder instability there can be loss of bone on the socket, humeral head or both. The failure rate for Arthroscopic Labral Repair in contact athletes with significant bone defects has been reported as high as 2/3.

For Bone Deficient Instability the Latarjet procedure is considered when a repair of the labrum does not correct the damage of the shoulder joint (ie: recurrent instability caused by a bony Bankart lesion)

The Latarjet procedure is a salvage procedure for difficult instability cases and is indicated for anterior shoulder instability that is . It is becoming a preferred method of treatment for anterior shoulder instability in certain situations.

relocating a piece of bone from the shoulder blade with an attached tendon to the shoulder joint.

Latarjet procedure is also considered in higher-risk individuals where a standard Bankart repair may have a higher risk of failing. This includes younger active patients, particularly involved in collision sports such as AFL

When is Reconstructive Shoulder Surgery Indicated

Reconstructive Shoulder Surgery is indicated for the following reasons:

Failure of treatment such as immobilisation, prescription medicines, physical therapy, closed reduction or manipulation and occupational therapy fails to relieve the shoulder instability,
Revision Surgery - Latarjet Procedure indicated
Severe pain
Shoulder instability or tendency to dislocate.
Stiffness, Swelling, and Reduced range of motion

Steps of Latarjet Shoulder Surgery

The procedure is performed after appropriate diagnostic assessments, pre surgery checks and preparations are complete in hospital and takes typically less than 2 hours. The Latarjet Surgery involves as an open procedure +/- arthroscopy and involve:

Performed under general anaesthesia with the patient in a semi-reclined or beach-chair position, it involves
Small incisions are made from your shoulder blade towards the armpit.
Muscles are moved to expose the coracoid process and its attached tendons.
Coracoid process is freed of its attachments and along with the conjoined tendon is transected from its base.
Holes are drilled into the transected coracoid process.
Subscapularis muscle, which passes in front of the shoulder joint is split in line with its fibres.
Capsule of the shoulder joint is entered and the glenoid is exposed and prepare to receive the coracoid.
Transected coracoid with the conjoined tendon is passed through the separated subscapularis muscle and fixed to the glenoid rim with screws through the previously drilled holes to increase the glenoid surface and stabilize the joint.
Conjoined tendon and subscapularis muscle provide additional stability by acting as a sling.
Upon completion, the instruments are withdrawn, the incision is closed and covered with a sterile bandage.

Preparation for Reconstructive Shoulder Surgery

Once you and the doctor have decided that surgery is required, preparation is necessary to achieve the best results and a quick and problem free recovery.

Infections - Treat any tooth, gum, bladder or bowel problems before surgery to reduce the risk of infection
Smoking - Stop or cut down smoking to reduce your surgery risks and improve your recovery
Weight - Consider losing weight (if overweight) before surgery
Medications - Refrain from taking medications or dietary supplements that may increase your risk of bleeding - refer Medication Information
Fasting - Depending on the type of anaesthesia used, your doctor may advise you to refrain from eating and drinking six to twelve hours before the procedure.
Getting Home - You will not be allowed to drive yourself home after the procedure, so make arrangements for someone to pick you up. If you live alone, arrange for someone to check on you that evening or, ideally, to stay with you for the rest of the day.
Loose Clothing - If you're having surgery, wear loose, comfortable clothing, such as baggy gym shorts and slip-on shoes, so you can easily undress and dress

Things to Avoid
- Stop or cut down on smoking to reduce your surgery risks and improve your recovery
- Avoid chemical peels and needling
Pre Surgery Tests
- Pain medications are prescribed to help with pain during the recovery phase.
- After your operation, you will have a drip in your arm for pain medication and antibiotics.
- You may need between 1 - 3 nights in hospital.
- If any postoperative problems arise with your knee, such as redness, increasing pain or fevers, do not hesitate to contact the doctor. If unavailable, seek advice from the hospital or your doctor.
- Going home remember to arrange for someone to take you home, no driving is recommended.

Medication Information
- Regardless of whether you are expecting to have treatment or just a consultation please advise the doctor of any medications you are taking, including:
- Aspirin, Anti-inflammatory or Blood-thinning medications,
- discuss which ones should be stopped before surgery like aspirin, warfarin, anti-inflammatory medications or drugs that increase the risk of bleeding 7 days before surgery to minimise bleeding
- review blood replacement options (including banking blood) with your doctor
Physical & Mental Prep
Physical Preparation
- Eat a well-balanced diet, supplemented by a daily multivitamin with iron.
- consider losing weight (if overweight) before surgery to help decrease the stress on the new joint.
- Treat any tooth, gum, bladder or bowel problems before surgery to reduce the risk of infection
Mental Preparation
Preparing mentally and physically for surgery is an important step toward a successful result.

Your doctor will create a treatment plan and patients will also need to understand the process and their role in it

Returning Home After Surgery

When you go home you need to take special precautions around the house to make sure it is safe. Your post operative plans should include:

Detachable showerhead: You'll probably need to keep your incision dry for a while. Shower heads with detachable heads make it easier to avoid getting your incision wet.
Shower chair: Because you can sit down while showering, a shower chair reduces your risk of falling. These are useful after surgery or if you're taking pain relievers that can make you dizzy or tired.
Waterproof bandages or plastic bags with athletic tape: You may want to cover your incision with a large waterproof bandage or plastic bag with tape until your doctor says it is safe to do so.
Pump soap: Using soap from a pump container makes showering with one arm easier.

Assess your home situation to ensure you have adequate home support in the first few weeks following surgery. If you live alone it may be necessary to arrange a package of community care to help during the first few weeks at home.

Reconstructive Shoulder Surgery Process

Day of Surgery
- Report any infections to me prior to surgery as the procedure cannot be performed until all infections have cleared up.
- Do not consume alcohol - 24 hours prior to treatment,
- Do not eat or drink anything, including water, for 6 hours before surgery
- Avoid vigorous physical activity or exercise 24 hours prior to surgery
Surgery Recovery
In the recovery ward
- You will awaken after surgery in the recovery ward
- You will be observed & monitored
- Advised of pain relief & what is next
- When appropriate you will be moved to the ward

During Surgery
- Administration of General Anaesthesia
- The entire procedure can take 60 minutes to two hours.
- The procedure is performed and sent to the recovery room, for observation
- Pain medications are prescribed to help with pain during the recovery phase.
Post Surgery Care
- It is important to avoid high impact activities during the early phase of recovery to minimise the risk of further injury.
- If there are any postoperative concerns or pain, please do not hesitate in contacting our rooms.
The patient should keep a pillow under their elbow while lying in bed.
- The patient will not be allowed to lift anything greater than 1 litre of milk for the first 6 weeks.
- 10-14 days after surgery the doctor will see the patient, monitor their progress and remove the sutures.
- Pain Management - Oral pain relievers will be prescribed to help you manage your pain.
- Apply an ice bag to the affected area to reduce both swelling and pain.
- Use Bracing as directed
- Undertake physical therapy to aid recovery & mobility
- When appropriate you will be discharged from Hospital (1 day)
- Consume nutritious foods and plenty of water.
- Attend scheduled Follow Up Appointments

Reconstructive Shoulder Surgery Rehabilitation Program

1 Week - Post Op Rehab
Following surgery, your arm is kept in a sling for six weeks to facilitate healing.

Your physiotherapist will show you how to use the sling and instruct you on simple exercises.
You may have pain after surgery, which requires pain medications for 3-5 days.
- Apply ice packs on the shoulder to help reduce the swelling.
- You can use a pillow under your shoulder while lying in bed.
- Avoid heavy lifting and driving during the first 6 weeks.
- You will be given specific instructions regarding activity and a rehabilitation program of exercise and strengthening.
6 Weeks - Post Op Rehab
32 Weeks - Post Op Rehab

Risks & Complications Associated with Reconstructive Shoulder Surgery

Surgical Follow Ups

2 Weeks After Surgery
- Rehabilitation usually begins early on the first postoperative day with finger movements and passive assisted range of motion exercises.
- Progress to a full range of motion and exercises is allowed as tolerated
A physiotherapy program is recommended for 3 months after which you can return to your regular activities.
12 Weeks After Surgery
- Check-Up with Surgeon
- X Rays
- After 3 months, more physical activities, such as sports will be possible
1 Year After Surgery
- Check Up with Surgeon
- X Rays

6 Weeks After Surgery
- When you reach the six-week mark after your surgery, your doctor will determine whether you can resume physical activities and return to work.
- If your daily routine includes a lot of movement or a lot of strain, you may need more physical therapy sessions.
- It is recommended that the patient not drive during the first 6 weeks while wearing a sling due to safety reasons and the risk of injury to the surgical site.
- The patient will be given specific instructions regarding activity and a rehabilitation program of exercise and strengthening.
32 Weeks After Surgery
- Check Up with Surgeon
- X Rays
Ongoing Care

You should continue to see your surgeon for the rest of your life to check your shoulder and take X-rays.

You will be asked to return for annual visits thereafter to assess the status and function of your implant.

How Risks Are Minimised

Get Moving Quickly

Immobilization: Uses a sling to stabilize your shoulder for several weeks as your joint heals.
Passive exercise: Relies on assistance and support of your physical therapist or a specific machine to move your arm gently starting a few weeks after surgery.
Active exercise: Moves your shoulder and arm by using your muscles beginning up to three months following your surgery.

Don’t Resume Physical Activity Too Soon

Even if you are not in a lot of pain, you must still follow the doctor's instructions regarding when you can do certain things during your recovery period. Attempting to perform difficult exercises, activities, or sports that put strain on your shoulder may result in another injury. When you resume physical activities too soon, you may injure other parts of your body, such as your elbow or spine.

Receive Physical Therapy

On the day of your surgery, a physical therapist will see you a few hours after you arrive, and then twice a day for the next few days.

They will give you an exercise program to help you increase your range of motion. They will also teach you about safety through gait and transfer training as well as joint positioning.

Shoulder Surgery Exercises

To improve comfort and blood flow, the doctor will most likely instruct you to straighten and bend your elbow, perform gentle pendulum motions, and clench and unclench your fist on a regular basis.

How Can I Minimise Post Operative Complications

Blood clots (DVT or PE)

All patients receive a number of treatment measures to reduce the risk of blood clots. These include injections of heparin during and after surgery,

As a result of these measures, we have never had a patient develop a deep venous thrombosis. Any patient who is at high risk of a blood clot (such as a history of blood clots or clotting disorders) may be asked to continue heparin (Clexane) injections for 10 days after the surgery in addition to the other measures. This can be done at home, and we will show you how.