Management of Bone Loss in Glenohumeral Instability

With anterior dislocations, bony defects of the anterior glenoid and posterosuperior aspect of the humeral head occur with relative frequency. In shoulders sustaining a Hill-Sachs lesion at the initial dislocation, there exists a statistically significant association with recurrent dislocation. When a patient has symptomatic anterior instability associated with an engaging Hill-Sachs lesion with an articular arc deficit, treatment must be directed at both repairing the Bankart lesion, if present, and preventing the Hill-Sachs lesion from engaging the anterior glenoid. Glenoid bone loss often requires bone-block transfers using the coracoid (Bristow/Latarjet) or iliac crest autograft. Humeral bone loss can be addressed through a variety of surgical options, including humeroplasty, remplissage, partial resurfacing, allograft transfers, and total shoulder arthroplasty.