Clinical Orthopaedics and Related Research®

, Volume 471, Issue 8, pp 2548–2555

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

Abstract

Background

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.

Questions/purposes

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?

Methods

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.

Results

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.

Conclusions

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.

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

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