Clinical Orthopaedics and Related Research®

, Volume 471, Issue 8, pp 2548–2555 | Cite as

Weber Osteotomy for Large Hill-Sachs Defects: Clinical and CT Assessments

  • Alexandra L. Brooks-Hill
  • Bruce B. Forster
  • Case van Wyngaarden
  • Robert Hawkins
  • William D. Regan
Clinical Research



The Weber derotation osteotomy is an uncommon procedure that typically is reserved for patients with engaging Hill-Sachs defects who have had other surgical treatments for shoulder instability fail. It is unknown whether the desired humeral derotation actually is achieved with the Weber osteotomy.


The purposes of this study were to answer the following questions: (1) What are the complication (including redislocation) and reoperation rates of the Weber osteotomy? (2) What are the American Shoulder and Elbow Surgeons (ASES) and functional (ROM in internal rotation, self care) results? (3) What fraction of the patients had humeral derotation within 10° of the desired rotation?


A chart review of 19 Weber osteotomies and clinical assessment of 10 Weber osteotomies were performed by independent clinicians. The chart review, at a mean followup of 51 months (range, 13–148 months), focused on the complication rate and the frequency of redislocation. The clinical and CT assessments, at a mean followup of 54 months (range, 26–151 months), focused on ASES scores, ability of patients to perform self care with the affected arm, and CT scans to measure change in humeral retroversion.


There were 25 complications and nine reoperations in 17 patients (19 shoulders), including pain (six patients, of whom one had complex regional pain syndrome), hematoma, infection, nonunion, delayed union, reoperations related to hardware and other noninstability-related causes (five patients), and internal rotation deficit. Redislocation occurred in one patient, who underwent repeat surgery, and subjective instability developed in two others. The mean ASES score was 78 points (of 100 points); six of the 10 patients (11 procedures) evaluated in person found it difficult or were unable to wash their backs with the affected arm. Humeral derotation varied from 7° to 77°; only three of the nine patients for whom CT scans were available had derotation within 10° of the desired rotation.


Complication rates with the Weber osteotomy were much higher than previously reported. Because seven of 17 patients were lost to followup, the redislocation rate may be higher than we observed here. Given the unpredictable variability in humeral derotation achieved with a Weber osteotomy, an improved surgical technique is critical to avoid osteoarthritis and loss of internal rotation associated with overrotation.

Level of Evidence

Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.


Internal Rotation Reoperation Rate Complex Regional Pain Syndrome Osteochondral Allograft Redislocation Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Jordan Leith MD, MHSc, FRCSC for his contribution to the scientific process, Cheryl Davies MSc, for her contribution to data coalition, and Dean Malpas for his contribution to the CT scan methodology.


  1. 1.
    Bigliani L, Flatow E, Pollock R. Fractures of the proximal humerus. In: Rockwood C, Green D, Bucholz R, Heckman J, eds. Fractures in Adults. 4th ed. Philadelphia, PA: Lippincott-Raven; 1996:1055–1107.Google Scholar
  2. 2.
    Boileau P, O’Shea K, Vargas P, Pinedo M, Old J, Zumstein M. Anatomical and functional results after arthroscopic Hill-Sachs remplissage. Jf Bone Joint Surg Am. 2012;94:618–626.CrossRefGoogle Scholar
  3. 3.
    Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of Arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16:677–694.PubMedCrossRefGoogle Scholar
  4. 4.
    Calandra JJ, Baker CL, Uribe J. The incidence of Sill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy. 1989;5:254–257.PubMedCrossRefGoogle Scholar
  5. 5.
    Cetik O, Uslu M, Ozsar B. The relationship between Hill-Sachs lesion and recurrent anterior shoulder dislocation. Acta Orthop Belg. 2007;73:175–178.PubMedGoogle Scholar
  6. 6.
    Chapovsky F, Kelly JD 4th. Osteochondral allograft transplantation for treatment of glenohumeral instability. Arthroscopy. 2005;21:1007.PubMedGoogle Scholar
  7. 7.
    Dahmen G, Gartner J. [Results of rotation osteotomy using the Weber method in the treatment of habitual shoulder dislocation] [in German]. Z OrthopIihre Grenzgeb. 1983;121:541–546.CrossRefGoogle Scholar
  8. 8.
    Flury MP, Goldhahn J, Holzmann P, Simmen BR. Does Weber’s rotation osteotomy induce degenerative joint disease at the shoulder in the long term? J Shoulder Elbow Surg. 2007;16:735–741.PubMedCrossRefGoogle Scholar
  9. 9.
    Grondin P, Leith J. Case series: Combined large Hill–Sachs and bony Bankart lesions treated by Latarjet and partial humeral head resurfacing: a report of 2 cases. Can J Surg. 2009;52:249–254.PubMedGoogle Scholar
  10. 10.
    Hardegger F. [Technique and results of subcapital humeral derotation osteotomy in the setting of habitual shoulder dislocation] [in German]. Orthopade. 1978;77:147–153.Google Scholar
  11. 11.
    Hardegger F, Kappeler U. [Taumatic subluxation of the shoulder joint] [in German]. Zeitschr Orthop. 1980;118:553–554.Google Scholar
  12. 12.
    Hart R, Okal F, Komzak M. [Transhumeral head plasty and massive osteocartilaginous allograft transplantation for the management of large hill-sachs lesions] [abstract]. Acta Chir Orthop Traumatol Cech. 2010;77:402–410.PubMedGoogle Scholar
  13. 13.
    Haviv B, Mayo L, Biggs D. Outcomes of arthroscopic “remplissage”: capsulotenodesis of the engaging large Hill-Sachs lesion. J OrthopSurg Res. 2011;6:29.Google Scholar
  14. 14.
    Hawkins RH. Glenoid osteotomy for recurrent posterior subluxation of the shoulder: assessment by computed axial tomography. J Shoulder Elbow Surg. 1996;5:393–400.PubMedCrossRefGoogle Scholar
  15. 15.
    Hernigou P, Duparc F, Hernigou A. Determining humeral retroversion with computed tomography. J Bone Joint SurgAm. 2002;84:1753–1762.Google Scholar
  16. 16.
    Hill H, Sachs M. The grooved defect of the humeral head: a frequently unrecognized complication of dislocations of the shoulder joint. Radiology. 1940;35:690–700.Google Scholar
  17. 17.
    Kazel MD, Sekiya JK, Greene JA, Bruker CT. Percutaneous correction (humeroplasty) of humeral head defects (Hill-Sachs) associated with anterior shoulder instability: a cadaveric study. Arthroscopy. 2005;21:1473–1478.PubMedCrossRefGoogle Scholar
  18. 18.
    Kominiak P, Gusta A, Ferenc M, Pawlowski Z. [Reconstruction of humeral head retroversion in the treatment of anterior shoulder instability] [in Polish]. Chir Narzadow Ruchu Ortop Pol. 2004;69:301–303.PubMedGoogle Scholar
  19. 19.
    Kralinger FS, Golser K, Wischatta R, Wambacher M, Sperner G. Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med. 2002;30:116–120.PubMedGoogle Scholar
  20. 20.
    Kronberg M, Brostrom LA. Proximal humeral osteotomy to correct the anatomy in patients with recurrent shoulder dislocations. J Orthop Trauma. 1991;5:129–133.PubMedCrossRefGoogle Scholar
  21. 21.
    Kronberg M, Brostrom LA. Rotation osteotomy of the proximal humerus to stabilise the shoulder: five years’ experience. J Bone Joint Surg Br. 1995;77:924–927.PubMedGoogle Scholar
  22. 22.
    Kumar A, Dhawan R, Maqsood M. Hill-Sachs reconstruction and repair using a synthetic scaffold. Acta Orthop Belg. 2012;78:117–120.PubMedGoogle Scholar
  23. 23.
    Marti R, Weber B, Afchampour P. [Technique and results of humeral osteotomy in habitual shoulder dislocation] [in German]. Z Unfallmed Berufskr. 1973;66:130–136.PubMedGoogle Scholar
  24. 24.
    Miniaci A, Gish M. Management of anterior glenohumeral instability associated with large Hill-Sachs defects. Tech Shoulder Elbow Surg. 2004;5:170–175.CrossRefGoogle Scholar
  25. 25.
    Muller-Farber J, Muller KH, Scheuer I. [Specific treatment of recurrent dislocation of the shoulder] [in German]. Unfallheilkunde. 1983;86:87–95.PubMedGoogle Scholar
  26. 26.
    Nourissat G, Kilinc AS, Werther JR, Doursounian L. A prospective, comparative, radiological, and clinical study of the influence of the “remplissage” procedure on shoulder range of motion after stabilization by arthroscopic Bankart repair. Am J Sports Med. 2011;39:2147–2152.PubMedCrossRefGoogle Scholar
  27. 27.
    Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-Sachs “remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy. 2008;24:723–726.PubMedCrossRefGoogle Scholar
  28. 28.
    Re P, Gallo R, Richmond J. Transhumeral head plasty for large Hill-Sachs lesions. Arthroscopy. 2006;22:798.e1–4.Google Scholar
  29. 29.
    Richter J, Lacher B, Stratmann B, Ekkernkamp A, Muhr G. [Sports and work capacity after stabilization of recurrent shoulder jointdislocations] [in German]. Unfallchirurg. 1997;100:198–204.PubMedCrossRefGoogle Scholar
  30. 30.
    Rowe CR, Zarins B, Ciullo JV. Recurrent anterior dislocation of the shoulder after surgical repair: apparent causes of failure and treatment. J Bone Joint Surg Am. 1984;66:159–168.PubMedGoogle Scholar
  31. 31.
    Schmidt M, Drews H, Havemann D. [Results of treatment of multiple ventral shoulder dislocations and surgical stabilization by Weber rotational osteotomy] [un German]. Z Unfallchir Versicherungsmed. 1993;86:18–21.PubMedGoogle Scholar
  32. 32.
    Wang VM, Sugalski MT, Levine WN, Pawluk RJ, Mow VC, Bigliani LU. Comparison of glenohumeral mechanics following a capsular shift and anterior tightening. J Bone Joint Surg Am. 2005;87:1312–1322.PubMedCrossRefGoogle Scholar
  33. 33.
    Weber BG, Simpson LA, Hardegger F. Rotational humeral osteotomy for recurrent anterior shoulder dislocation of the shoulder associated with a large Hill-Sachs lesion. J Bone Joint Surg Am. 1984;66:1443–1450.PubMedGoogle Scholar
  34. 34.
    Yagishita K, Thomas BH. Use of allograft for large Hill-Sachs lesion associated with anterior glenohumeral dislocation: a case report. Injury. 2002;33:791–794.PubMedCrossRefGoogle Scholar
  35. 35.
    Zhu YM, Lu Y, Zhang J, Shen JW, Jiang CY. Arthroscopic Bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging Hill-Sachs lesion: a report of 49 cases with a minimum 2-year follow-up. Am J Sports Med. 2011;39:1640–1647.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Alexandra L. Brooks-Hill
    • 1
  • Bruce B. Forster
    • 2
  • Case van Wyngaarden
    • 2
  • Robert Hawkins
    • 3
  • William D. Regan
    • 4
  1. 1.Department of Orthopaedics, Faculty of MedicineUniversity of British Columbia, Sea to Sky Orthopaedics, Squamish General Hospital & Whistler Health Care CentreWhistlerCanada
  2. 2.Department of Radiology, Faculty of MedicineUniversity of British ColumbiaWhistlerCanada
  3. 3.Department of Orthopaedics, Faculty of MedicineUniversity of British Columbia, UBC HospitalWhistlerCanada
  4. 4.Department of Orthopaedics, Faculty of MedicineUniversity of British Columbia, Joint Preservation Centre of BC, UBC HospitalWhistlerCanada

Personalised recommendations