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Xie Y, Zhang J, Jin X, Liu S, Song W. Development and validation of a nomogram for predicting heterotopic ossification following spinal cord injury. Clin Neurol Neurosurg 2024; 243:108348. [PMID: 38833809 DOI: 10.1016/j.clineuro.2024.108348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE Heterotopic ossification (HO) following spinal cord injury (SCI) can severely compromise patient mobility and quality of life. Precise identification of SCI patients at an elevated risk for HO is crucial for implementing early clinical interventions. While the literature presents diverse correlations between HO onset and purported risk factors, the development of a predictive model to quantify these risks is likely to bolster preventive approaches. This study is designed to develop and validate a nomogram-based predictive model that estimates the likelihood of HO in SCI patients, utilizing recognized risk factors to expedite clinical decision-making processes. METHODS We recruited a total of 145 patients with SCI and presenting with HO who were hospitalized at the China Rehabilitation Research Center, Beijing Boai Hospital, from June 2016 to December 2022. Additionally, 337 patients with SCI without HO were included as controls. Comprehensive data were collected for all study participants, and subsequently, the dataset was randomly partitioned into training and validation groups. Using Least Absolute Shrinkage and Selection Operator regression, variables were meticulously screened during the pretreatment phase to formulate the predictive model. The efficacy of the model was then assessed using metrics including receiver-operating characteristic (ROC) analysis, calibration assessment, and decision curve analysis. RESULTS The final prediction model incorporated age, sex, complete spinal cord injury status, spasm occurrence, and presence of deep vein thrombosis (DVT). Notably, the model exhibited commendable performance in both the training and validation groups, as evidenced by areas under the ROC curve (AUCs) of 0.756 and 0.738, respectively. These values surpassed the AUCs obtained for single variables, namely age (0.636), sex (0.589), complete spinal cord injury (0.681), spasm occurrence (0.563), and DVT presence (0.590). Furthermore, the calibration curve illustrated a congruence between the predicted and actual outcomes, indicating the high accuracy of the model. The decision curve analysis indicated substantial net benefits associated with the application of the model, thereby underscoring its practical utility. CONCLUSIONS HO following SCI correlates with several identifiable risk factors, including male gender, youthful age, complete SCI, spasm occurrence and DVT. Our predictive model effectively estimates the likelihood of HO development by leveraging these factors, assisting physicians in identifying patients at high risk. Subsequently, correct positioning to prevent spasm-related deformities and educating healthcare providers on safe lower limb mobilization techniques are crucial to minimize muscle injury risks from rapid iliopsoas muscle extension. Additionally, the importance of early DVT prevention through routine screening and anticoagulation is emphasized to further reduce the incidence of HO.
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Affiliation(s)
- Yulei Xie
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Junwei Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China; Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, China; Department of Orthopedics Surgery, Capital Medical University, Beijing, China.
| | - Xiaoqin Jin
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shujia Liu
- School of Rehabilitation, Capital Medical University, Beijing, China; Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, China; Department of Orthopedics Surgery, Capital Medical University, Beijing, China
| | - Wei Song
- Department of Rehabilitation Engineering, China Rehabilitation Science Institute, Beijing, China.
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Zampogna B, Laudisio A, Papalia GF, Vorini F, Zampoli A, Righini R, Fiore M, Vadalà G, Angeletti S, Ramella S, Papalia R. Heterotopic hip ossification resection: monocentric experiences of associated factors, outcomes, and complications. INTERNATIONAL ORTHOPAEDICS 2024; 48:699-704. [PMID: 37776348 DOI: 10.1007/s00264-023-05993-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/15/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE The exponential increase in total hip arthroplasty (THA) has led to acute and chronic surgery-related complications. Common chronic and local complications are represented by hip ossification (HO). The aim of our study was to assess the clinical and radiological correlates of patients undergoing surgical removal of heterotopic ossifications after THA and the possible association between HO and prosthetic joint infection. METHODS Data of 26 patients who underwent surgical removal of periprosthetic calcifications after THA from 2000 to 2022 were analyzed and compared with characteristics of 156 subjects without HO. RESULTS The preoperative radiographs of patients showed a high-grade Brooker, 3 or 4, later reduced to 1 or 2 in the postoperative radiographs. Ten (38.5%) patients underwent radiotherapy prophylaxis, administered as a single dose 24 h before surgery. In 19 (73%) patients, pharmacological prophylaxis with indomethacin was added in the 30 postoperative days. Only one patient who underwent radiotherapy had a recurrence, while new ossifications were found in three patients without prophylaxis (11.5%). Intraoperative cultures were performed for suspected periprosthetic infection in 8 study group patients. In logistic regression, the presence of HO was significantly and inversely associated with the ASA score (OR = 0.27, 95% CI = 0.09-0.82; P = 0.021) after adjusting. CONCLUSION Surgical HO removal in symptomatic patients with high-grade disease produces good clinical and radiographic results. Radiotherapy was a good perioperative and preventive strategy for recurrence, also associated with NSAIDs and COX-2 inhibitors.
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Affiliation(s)
- B Zampogna
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - A Laudisio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy.
- Research Unit of Geriatrics, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - G F Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - F Vorini
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - A Zampoli
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - R Righini
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - M Fiore
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - G Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - S Angeletti
- Operative Research Unit of Clinical Laboratory Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
- Research Unit of Clinical Laboratory Science, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy
| | - S Ramella
- Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - R Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
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Purcell KF, Lachiewicz PF. Heterotopic Ossification After Modern Total Hip Arthroplasty: Predisposing Factors, Prophylaxis, and Surgical Treatment. J Am Acad Orthop Surg 2023; 31:490-496. [PMID: 36972521 DOI: 10.5435/jaaos-d-22-01070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Indexed: 03/29/2023] Open
Abstract
Heterotopic ossification (HO) is a common radiographic finding and potentially serious complication after modern total hip arthroplasty. Although historically associated with the posterolateral approach, HO has been noted in 10% to 40% of patients having direct anterior or anterior-based muscle sparing approaches. The available data are uncertain whether robotic arm-assisted procedures are associated with this complication. Current prophylaxis for patients considered high risk of this complication includes postoperative, nonsteroidal, anti-inflammatory medication for several weeks or low-dose perioperative irradiation. The surgical treatment of symptomatic HO associated with severely restricted motion or ankylosis of the hip should be individualized but may include wide excision of bone, acetabular revision to prevent instability, and prophylaxis to prevent recurrence.
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Affiliation(s)
- Kevin F Purcell
- From the Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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Zran N, Joseph E, Callamand G, Ohl X, Siboni R. Heterotopic ossification after total hip arthroplasty: radiological comparison between a direct anterior approach without an orthopaedic table and a posterior approach. Hip Int 2022; 32:604-609. [PMID: 33155848 DOI: 10.1177/1120700020970793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Heterotopic ossification (HO) occurs in almost ⅓ of total hip arthroplasties (THAs). A direct anterior approach (DAA) with an orthopaedic table is less likely to cause HO than a posterior approach. Without an orthopaedic table, the exposure of the femur requires additional soft tissue release. Soft tissue trauma leads to the production of HO inductors. Our study evaluated the incidence of HO 6 months after THA and compared the results between DAAs without an orthopaedic table and posterior approaches. METHODS Retrospectively, 164 consecutive, primary THAs were included: 76 through a posterior approach and 88 through a DAA. The main objective was to measure the presence of HO on pelvis radiography 6 months after surgery. RESULTS The incidence of HO was significantly higher in the DAA group than in the posterior approach group (47.7% vs. 27.6%, respectively; p < 0.01). The overall incidence of HO was 38.4%. No significant difference was found between the 2 approaches regarding the severity of HO. No significant risk factor for HO was identified other than the surgical approach. DISCUSSION In our study, the incidence of HO after THA in patients undergoing DAA without an orthopaedic table was higher than in patients undergoing a posterior approach after 6 months of follow-up. This result is closely related to the surgical trauma. It suggests that the minimally invasive feature of a surgical approach cannot be dissociated from the overall conditions in which it is performed.
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Affiliation(s)
- Naïm Zran
- Orthopaedic and Traumatolgy Department, Reims University Hospital (CHU Reims), Reims, France
| | - Etienne Joseph
- Orthopaedic and Traumatolgy Department, Reims University Hospital (CHU Reims), Reims, France
| | - Gabriel Callamand
- Orthopaedic and Traumatolgy Department, Reims University Hospital (CHU Reims), Reims, France
| | - Xavier Ohl
- Orthopaedic and Traumatolgy Department, Reims University Hospital (CHU Reims), Reims, France
| | - Renaud Siboni
- Orthopaedic and Traumatolgy Department, Reims University Hospital (CHU Reims), Reims, France
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Tellefsen RA, Ugland T, Bjørndal MM, Ugland S, Pripp AH, Nordsletten L. Increased risk of high-grade heterotopic ossification using direct lateral approach versus a muscle-sparing anterolateral approach to the hip: radiological results from a randomised trial in patients with a femoral neck fracture treated with hemiarthroplasty. Hip Int 2022:11207000221097639. [PMID: 35585787 DOI: 10.1177/11207000221097639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Hemiarthroplasty is a common treatment in patients with displaced femoral neck fracture. Due to positive claims of less pain, earlier mobilisation and favourable functional outcome, the anterior approaches to the joint are gaining in popularity. This randomised controlled trial investigated if component placement and heterotopic ossification differed between a muscle sparing anterior approach and a direct lateral approach. PATIENTS AND METHODS 150 patients operated with an uncemented hemiarthroplasty, were randomised to anterolateral or direct lateral approach and assessed postoperatively radiologically. Measurements included leg-length discrepancy, femoral offset, femoral stem position, canal fill ratio and the presence of heterotopic ossification after 12 months. RESULTS There was an increased risk of high-grade heterotopic ossification in the direct lateral approach (p < 0.05). We found no statistically significant differences in leg-length discrepancy, femoral stem position or femoral offset. CONCLUSIONS Hemiarthroplasty performed in the direct lateral approach resulted in a higher incidence of Brooker grade 3 heterotopic ossification. Our results support equal geometrical restoration and similar component placement with both approaches. CLINICAL TRIAL REGISTRY ClinicalTrials.gov Identifier: NCT03974698Uncemented Hemiarthroplasty, Radiological Features Comparing Lateral Versus Anterolateral Approach https://www.clinicaltrials.gov/ct2/show/NCT03974698?term=raymond+tellefsen…draw=2…rank=1.
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Affiliation(s)
- Raymond A Tellefsen
- Division of Orthopaedic Surgery, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Terje Ugland
- Division of Orthopaedic Surgery, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Maria M Bjørndal
- Division of Radiology, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Stein Ugland
- Division of Orthopaedic Surgery, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Are Hugo Pripp
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Lars Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Norway
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Aprato A, Cambursano S, Artiaco S, Bevilacqua S, Catalani P, Massè A. Heterotopic ossification in primary total hip arthroplasty: risk factor analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1037-1041. [PMID: 35377072 PMCID: PMC10126050 DOI: 10.1007/s00590-022-03244-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aim is to identify if age, sex, type of posterolateral approach (mini vs standard), surgical time and time from surgery to drainage removal were independent risk factors for heterotopic ossifications after total hip arthroplasty. MATERIALS AND METHODS Patients who underwent a THA with posterolateral approach during a 15 years period were included. The exclusion criteria were absence of X-rays follow-up or HO prophylaxis protocol adoption. The following data were collected: age, sex, type of approach (classical/minimal-invasive), surgical time, time from surgery to drainage removal. Two orthopedic surgeons independently reviewed the 2 years follow-up X-rays and classified the HO according to Brooker classification. Severe HO was defined if HO were classified as major than grade 2. Correlation between severe HO and risk factor has been tested with multivariable analysis. RESULTS About 1225 patients were included: mean age of 63.8 years, 504 were men. HO were found in 67.6%. Men showed higher severe HO rate than woman (44.1% vs 29.1%, p = 0.001). Patients older than 65 years showed higher severe HO rate (30.3% vs 39.9%, p = 0.002). Standard posterolateral approach was performed in 75.4% and severe HO rate was 32.8% versus 27.1% in those treated with the minimally invasive approach (p = 0.067). In 75.6% of cases surgery lasted less than 90 min and this group showed a severe HO rate in 29.1%, while patient with longer surgical time showed a rate of 35.7% (p = 0.033). In 47.4% of patients, the drainage was removed in the first post-operative day, in this group severe HO rate was significantly lower than the others: 24.8 versus 36.2% (p = 0.001). DISCUSSION Male sex, age older than 65 years, surgical time longer than 90 min and delayed drainage removal are risk factors for severe HO. Patients with one or more of those risk factors should be identified as good candidates for HO prophylaxis.
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Affiliation(s)
- Alessandro Aprato
- University of Turin, Viale 25 aprile 137 int 6, 10133, Turin, Italy.
| | | | - Stefano Artiaco
- University of Turin, Viale 25 aprile 137 int 6, 10133, Turin, Italy
| | | | - Paolo Catalani
- University of Turin, Viale 25 aprile 137 int 6, 10133, Turin, Italy
| | - Alessandro Massè
- University of Turin, Viale 25 aprile 137 int 6, 10133, Turin, Italy
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The Impact of Continuous Passive Motion on Heterotopic Ossification Maturation. Am J Phys Med Rehabil 2021; 100:e194-e197. [PMID: 34310347 DOI: 10.1097/phm.0000000000001852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Heterotopic ossification is the formation of pathological bone in soft tissues. It is postulated that continuous passive motion is a helpful adjuvant in the halt of the heterotopic ossification progression and the maintenance or increase of the joint mobility. The purpose of this clinical case study is to present the effectiveness of continuous passive motion. A 46-yr-old male patient experiencing right hemiparesis arrived in our rehabilitation department with limitation on passive flexion of the right hip. On x-ray of the pelvis, immature heterotopic bone formation was found. To halt this ongoing process of heterotopic bone formation, a program of continuous passive motion was implemented. In addition, risedronate was administrated. We started the continuous passive motion at 50 degrees of flexion for 30 mins that was increased to 100 degrees for 3 hrs daily. The final range of motion at the hip was: flexion 85 degrees, extension 0 degrees, internal rotation 10 degrees, external rotation 10 degrees, abduction 10 degrees, and adduction 10 degrees. Based on our results, continuous passive motion plays a role in heterotopic ossification maturation. The effectiveness of continuous passive motion implementation against HO should be further investigated for selected cases.
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A Rare Case of Extremely Severe Heterotopic Ossification after Primary Total Hip Arthroplasty due to Persistent Mild Periprosthetic Joint Infection. Case Rep Orthop 2021; 2021:8849929. [PMID: 34094609 PMCID: PMC8164530 DOI: 10.1155/2021/8849929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/18/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022] Open
Abstract
Periprosthetic joint infection (PJI) caused by coagulase-negative staphylococci (CNS) can be a mild, persisting infection. Although heterotopic ossification (HO) is common following total hip arthroplasty (THA), the etiology of severe HO remains unclear. Herein, we describe a rare case of extremely severe HO after a PJI associated with a Staphylococcus caprae infection in a 78-year-old male patient. The patient had poorly controlled diabetes mellitus with no diabetic complications. The patient had no previous history of hip surgery, hip injury, or systemic bacterial infection. Immediately after the initial THA, he developed intermittent low-grade fever (37°C), which persisted for 3 months; consequently, he also reported mild hip pain during walking. He experienced a gradual decrease in hip range of motion within 5 years after the surgery, with progressive gait impairment. Two revision surgeries were required for the successful treatment of this difficult case. The patient's hip function improved, and the PJI was controlled following the second revision surgery. Based on the clinical course, CNS-caused PJI may lead to severe HO. This possibility warrants verification from an accumulated number of cases.
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Turner EH, Goodspeed DC, Spiker AM. Excision of Heterotopic Ossification around the Hip: Arthroscopic and Open Techniques. Arthrosc Tech 2021; 10:e1179-e1186. [PMID: 33981568 PMCID: PMC8085537 DOI: 10.1016/j.eats.2021.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
Heterotopic ossification (HO) can occur as a complication of various pathologies affecting the hip including trauma, tendon avulsions, chronic injury, spinal cord injury, and soft-tissue disruption caused by surgery. When HO is present alongside intra-articular hip pathology such as femoroacetabular impingement syndrome (FAIS) or labral pathology, consideration should be made to combine the surgical excision of the HO with the FAIS decompression or labral repair if the location and size of the HO is appropriate for arthroscopic excision. Often times, the HO is located in such a position that any central compartment work can be completed before turning to the HO excision. If an open approach is required, the modified Gibson approach can be used for lateral hip access, whereas the Smith-Petersen approach provides anterior hip access. In this Technical Note we discuss arthroscopic techniques for excision of HO in the setting of concomitant FAIS, with discussion of when HO excision occurs in relation to cam decompression and labral repair, and mention tips on how to approach HO excision through an open approach.
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Affiliation(s)
| | | | - Andrea M. Spiker
- Address correspondence to Andrea M. Spiker, M.D., Department of Orthopedic Surgery, University of Wisconsin–Madison, UW Health at The American Center, 4602 Eastpark Blvd., Madison, WI 53718, U.S.A.
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Licini C, Farinelli L, Cerqueni G, Hosein A, Marchi S, Gigante A, Mattioli-Belmonte M. Heterotopic ossification in a patient with diffuse idiopathic skeletal hyperostosis: Input from histological findings. Eur J Histochem 2020; 64. [PMID: 33272008 PMCID: PMC7731577 DOI: 10.4081/ejh.2020.3176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
A high incidence of heterotopic ossification (HO) has been reported in patients with diffuse idiopathic skeletal hyperostosis (DISH), a metabolic disease characterized by calcifications of entheses at spine and peripheral sites. We performed histological and immunohistochemical analyses in five different HO sites in a patient with DISH to study a possible mutual interaction of bone morphogenetic protein 2 (BMP-2), transforming growth factor beta (TGF-β), and decorin, crucial for bone mass increasing, matrix calcification, and endochondral bone formation. We speculated that the surgical trauma triggered HO, inducing TGF-β release at the lesion site. TGF-β recruits osteoblast precursor cells and determines the overexpression of BMP-2 in the surrounding skeletal muscle, inducing a further osteogenic differentiation, contributing to HO onset.
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Affiliation(s)
- Caterina Licini
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Luca Farinelli
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Giorgia Cerqueni
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Andrell Hosein
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Saverio Marchi
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Antonio Gigante
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
| | - Monica Mattioli-Belmonte
- Department of Clinical and Molecular Sciences-DISCLIMO, Università Politecnica delle Marche, Ancona.
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Guo J, Dou D. Influence of prior hip arthroscopy on outcomes after hip arthroplasty: A meta-analysis of matched control studies. Medicine (Baltimore) 2020; 99:e21246. [PMID: 32702905 PMCID: PMC7373566 DOI: 10.1097/md.0000000000021246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND No meta-analysis exists elucidate the impact of prior hip arthroscopy on the outcomes of subsequent hip arthroplasty. The purpose of this study was to systematically review the current evidence in the literature to ascertain if prior hip arthroscopy leads to inferior outcomes after hip arthroplasty. METHODS PUBMED, Scopus, EMBASE, and Cochrane Library databases were searched on May 20, 2019. Only English publications were included. The primary outcomes were postoperative complication, revision, and reoperation. Secondary outcomes included Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), operative time, and estimated blood loss. RESULTS Eleven studies with a total of 1227 patients were included. The pooled data revealed that patients with prior hip arthroscopy were associated with higher risks for any postoperative complication (P < .00001), dislocation (P = .03), revision (P = .03), and reoperation (P = .02) following subsequent hip arthroplasty. However, there were no significant differences in infection rate (P = .22), HHS (P = .09), WOMAC (P = .19), operative time (P = .52), and estimated blood loss (P = .17) between the groups. CONCLUSIONS Patients with prior hip arthroscopy are at increased risks for any postoperative complication, dislocation, revision, and reoperation following subsequent hip arthroplasty. However, prior hip arthroscopy does not appear to have an impact on the functional outcomes and intraoperative outcomes.
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Affiliation(s)
- Jiankuo Guo
- Department of Orthopedics, Huaihe Hospital, Henan University
| | - Dongmei Dou
- Institute of Chronic Disease Risks Assessment, Henan University, Henan, China
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12
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Heterotopic Ossification: A Challenging Complication of Total Hip Arthroplasty: Risk Factors, Diagnosis, Prophylaxis, and Treatment. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3860142. [PMID: 31119167 PMCID: PMC6500709 DOI: 10.1155/2019/3860142] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 02/02/2019] [Accepted: 02/24/2019] [Indexed: 11/18/2022]
Abstract
Background This review is intended to summarize the risk factors, classification, diagnosis, and treatment of heterotopic ossification (HO) of previously published studies. Results Heterotopic ossification is a common complication of total hip arthroplasty. Its prevalence is not the same in all of the patient groups. Frequency of HO varies from 15 to 90%. Hip ankylosis, male gender, and previous history of HO are said to be risk factors with a significant level. Diagnosis is based on a single AP radiograph: the Brooker classification that divides HO into four grades is the most commonly used. The confirmation test that can be used is a bone scan. A great amount of bone metabolic turnover markers have been tested, but none of them seems to be relevant in case of prevention or diagnosis of HO. The most effective prophylactic treatment is radiotherapy or administration of nonsteroidal anti-inflammatory drugs. Over the years a lot of different RT protocols have been tested. Nowadays the most often used regimen is 7 Gy given postoperatively in a single dose. The most commonly prescribed drug in prophylaxis of HO is indomethacin. Also, the efficacy of ibuprofen and diclofenac was proven. Recently researchers focused on selective COX-2 inhibitors. They appear to be as effective as nonselective NSAIDs having less side effects. The one and only treatment of HO is a revision arthroplasty.
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Han PF, Chen CL, Zhang ZL, Han YC, Wei L, Li PC, Wei XC. Robotics-assisted versus conventional manual approaches for total hip arthroplasty: A systematic review and meta-analysis of comparative studies. Int J Med Robot 2019; 15:e1990. [PMID: 30746868 PMCID: PMC6594016 DOI: 10.1002/rcs.1990] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 12/13/2022]
Abstract
Background Several studies have compared robotics‐assisted (RA) and conventional manual (CM) approaches for total hip arthroplasty (THA), but their results are controversial. Methods A literature search was conducted for controlled clinical trials (CCTs) comparing the clinical efficacy of the RA and CM approaches for THA and published between August 1998 and August 2018. The obtained data were analyzed using the statistical software Review Manager 5.3. Results Fourteen articles were included in the meta‐analysis, which revealed that the RA group had less intraoperative complications, better cup angle, and more cases of cup placement in the safe zone than the CM group. However, the operation time required for the CM group was less than that required for the RA group. Moreover, postoperative complications (eg, dislocation and revision surgery) were less frequent in the CM group than in the RA group. However, the two groups had similar functional scores, total number of complications, and rate of occurrence of limb length discrepancy. Conclusion Compared with the CM approach, the RA approach yields better radiological outcomes and fewer intraoperative complications in THA, but similar functional scores.
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Affiliation(s)
- Peng-Fei Han
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Cheng-Long Chen
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Zhi-Liang Zhang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Yi-Chen Han
- Department of Upper School, Subsidiary High School of Taiyuan Normal University, Taiyuan, China
| | - Lei Wei
- Department of Orthopaedics, The Alpert Medical School of Brown University, Providence, Rhode Island
| | - Peng-Cui Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Xiao-Chun Wei
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
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Copay AG, Eyberg B, Chung AS, Zurcher KS, Chutkan N, Spangehl MJ. Minimum Clinically Important Difference: Current Trends in the Orthopaedic Literature, Part II: Lower Extremity. JBJS Rev 2018; 6:e2. [DOI: 10.2106/jbjs.rvw.17.00160] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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15
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Klasan A, Sen A, Dworschak P, El-Zayat BF, Ruchholtz S, Schuettler KF, Schmitt J, Heyse TJ. Ten-year follow-up of a cemented tapered stem. Arch Orthop Trauma Surg 2018; 138:1317-1322. [PMID: 30043147 DOI: 10.1007/s00402-018-3002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION This stem was cleared by the FDA in 2002 and has been implanted in cementless and cemented versions. Despite its long history, there are no long-term clinical results available for the cemented version of this implant. The aim of this study was to provide such data. It was hypothesized that this implant delivers clinical success comparable to other tapered cemented stems. MATERIALS AND METHODS A total of 113 hip replacements were performed in 106 patients between October 2007 and December 2009 using the cemented version of this stem. The mean age of the patients at operation was 74.8 years (range 50-91 years). The mean follow-up was 8.9 years with only two patients lost to follow-up. Implant survival was determined using the Kaplan-Meier analysis. RESULTS Stem survival with revision for any reason as the endpoint was 96.4% after 10 years. Survival for stem aseptic loosening was 100%. There were no cases of osteolysis. Clinical outcomes, as shown by Harris Hip Scores, were in line with previous investigations and the rate of adverse events was very low. CONCLUSIONS This is a modern cemented stem with an excellent survival rate and satisfactory functional outcomes. In this cohort, there were no failures related to the stem through the first decade.
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Affiliation(s)
- Antonio Klasan
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Ahmet Sen
- Department for Trauma, Clinic Jung-Stilling, Wichernstraße 40, 57074, Siegen, Germany
| | - Philipp Dworschak
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Bilal Farouk El-Zayat
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Karl F Schuettler
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Jan Schmitt
- Department for Orthopedics, Clinic Wetzlar, Forsthausstraße 1, 35578, Wetzlar, Germany
| | - Thomas J Heyse
- ORTHOmedic Frankfurt Offenbach, Herrnstr. 57, 63065, Offenbach, Germany
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16
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White PB, Ramkumar PN, Meftah M, Ghazi N, Ranawat AS, Ranawat CS. Incidence of Heterotopic Ossification Following a Multimodal Pain Protocol in Total Hip Arthroplasty With the Posterior Approach. Orthopedics 2018; 41:e92-e97. [PMID: 29120007 DOI: 10.3928/01477447-20171102-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 10/13/2017] [Indexed: 02/03/2023]
Abstract
Heterotopic ossification (HO) is prevalent after total hip arthroplasty (THA). Oral nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 (COX-2) inhibitors have reduced the incidence of HO; however, to the authors' knowledge, no studies have reported the incidence and severity of HO with a pain protocol highlighted by celecoxib in the pre- and postoperative period with a posterolateral approach. Between October 2014 and October 2015, a retrospective study was conducted of 687 consecutive primary THAs with minimum 1-year follow-up performed between January 2009 and December 2013. All patients underwent a posterolateral THA with a multimodal pain protocol consisting of preoperative celecoxib; local steroid infiltration intraoperatively; postoperative celecoxib, dexamethasone, and ketorolac; and aspirin or warfarin thromboprophylaxis. For all patients, pre- and postoperative radiographs were examined and classified for HO using the Brooker classification. Interobserver reliability was calculated for both incidence of HO and Brooker classification. Overall, HO was present around 98 (14.3%) THAs. The incidence of Brooker I, II, and III HO was 38 (5.5%), 47 (6.8%), and 12 (1.7%), respectively. No patients required surgical excision or had radiographic evidence of Brooker IV HO. Multivariate logistic regression identified male sex and hypertrophic osteoarthritis as significant risk factors. The use of aspirin for thromboprophylaxis significantly reduced the incidence of HO. This study found the overall incidence of HO when using celecoxib during a posterior THA to be 14.3%, which is similar to what others have reported with the direct lateral approach and with other COX-2 inhibitors for a posterior approach. Risk factors include male sex and preoperative hypertrophic osteoarthritis. [Orthopedics. 2018; 41(1):e92-e97.].
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Aspirin/therapeutic use
- Celecoxib/therapeutic use
- Cyclooxygenase 2 Inhibitors/therapeutic use
- Female
- Humans
- Incidence
- Male
- Middle Aged
- Ossification, Heterotopic/diagnostic imaging
- Ossification, Heterotopic/epidemiology
- Ossification, Heterotopic/etiology
- Ossification, Heterotopic/prevention & control
- Osteoarthritis, Hip/complications
- Osteoarthritis, Hip/epidemiology
- Pain, Postoperative/prevention & control
- Radiography
- Reproducibility of Results
- Retrospective Studies
- Risk Factors
- Sex Factors
- United States/epidemiology
- Young Adult
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17
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Mandell JC, Marshall RA, Weaver MJ, Harris MB, Sodickson AD, Khurana B. Traumatic Hip Dislocation: What the Orthopedic Surgeon Wants to Know. Radiographics 2017; 37:2181-2201. [DOI: 10.1148/rg.2017170012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Jacob C. Mandell
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Richard A. Marshall
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Michael J. Weaver
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Mitchel B. Harris
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Aaron D. Sodickson
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Bharti Khurana
- From the Department of Radiology (J.C.M., R.A.M., A.D.S., B.K.), Division of Musculoskeletal Imaging and Intervention (J.C.M.), Division of Emergency Radiology (A.D.S., B.K.), and Department of Orthopedic Surgery (M.J.W., M.B.H.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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18
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Redmond JM, Keegan MA, Gupta A, Worsham JR, Hammarstedt JE, Domb BG. Outcomes of heterotopic ossification excision following revision hip arthroscopy. J Hip Preserv Surg 2017. [PMID: 28630738 PMCID: PMC5467417 DOI: 10.1093/jhps/hnx010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study reviewed pain and outcome scores of patients undergoing revision surgery with heterotopic ossification (HO) excision following previous hip arthroscopy. The aim was to determine if performing the excision arthroscopically improved clinical outcomes. Data were prospectively collected and retrospectively reviewed in patients who had HO removed arthroscopically between February 2008 and 2014. Four patient-reported outcome (PRO) measures were collected: Modified Harris Hip Score (mHHS), Non-Arthritis Hip Score (NAHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL) and Sport-Specific (HOS-SS) subscales. Minimum 1.5 year follow-up from index procedure was available for 23 patients (mean age = 38.6 years). Of the 23 patients who had revision surgery and HO removal, 19 (83%) were available for follow-up. Prior to revision, the average mHHS was 53.4, HOS-ADL 51.4, HOS-SS 24.5, NAHS 50.3 and VAS 6.7. Following revision with HO excision, each score had improved with an average mHHS of 73.62, HOS-ADL of 68.88, HOS SS of 58.51, NAHS of 70.83 and VAS of 4.33. Overall, mHHS increased by 20.26 points (P < 0.001), HOS-ADL increased by 17.48 points (P = 0.023), HOS-SS increased by 34.03 points (P < 0.001), NAHS increased by 20.55 points (P = 0.001) and VAS decreased by 2.38 points (P < 0.001). Patients undergoing revision hip surgery with HO excision demonstrated improved outcome scores and pain resolution; however, few patients achieved a good or excellent result. Revision hip surgery with HO excision should be approached cautiously because of the modest results in this patient group.
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Affiliation(s)
- John M Redmond
- Southeast Orthopedic Specialists, 6500 Bowden Road, Suite 103, Jacksonville, FL 32216, USA
| | - Molly A Keegan
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Asheesh Gupta
- Hinsdale Orthopaedics, American Hip Institute, 1010 Executive Ct Suite 250, Westmont, IL 60559, USA
| | - Jacob R Worsham
- Department of Orthopaedic Surgery, UF Health Jacksonville, 655 West 8th Street, 2nd Floor ACC, Jacksonville, FL 32209, USA
| | - Jon E Hammarstedt
- Hinsdale Orthopaedics, American Hip Institute, 1010 Executive Ct Suite 250, Westmont, IL 60559, USA
| | - Benjamin G Domb
- Hinsdale Orthopaedics, American Hip Institute, 1010 Executive Ct Suite 250, Westmont, IL 60559, USA
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Alijanipour P, Patel RP, Naik TU, Parvizi J. Heterotopic Ossification in Primary Total Hip Arthroplasty Using the Direct Anterior vs Direct Lateral Approach. J Arthroplasty 2017; 32:1323-1327. [PMID: 28024885 DOI: 10.1016/j.arth.2016.11.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/19/2016] [Accepted: 11/12/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The formation and severity of heterotopic ossification (HO) may be influenced by type of surgical approach. Our hypothesis was that because of differences in soft tissue dissection, differences exist in HO formation in primary total hip arthroplasty using direct anterior (DA) vs direct lateral (DL) approach. METHODS A total of 1482 consecutive patients with DL (736) or DA (746) approach and similar perioperative care protocol during 2009-2011 were retrospectively studied. No patient received prophylactic radiotherapy. Preoperative and 6-month postoperative radiographs were reviewed based on Brooker classification. RESULTS The incidence of overall HO was higher in DL (36.1%) vs DA group (19.4%, P < .001) but high-grade HO (Brooker ≥3) was not significantly different among the groups (3.9% for DL and 3.0% for DA groups). No patient required further surgery for HO resection. CONCLUSION The type of approach (DA vs DL) did not seem to have a major influence on the short-term incidence of high-grade HO based on this radiographic analysis.
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Affiliation(s)
- Pouya Alijanipour
- Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ripal P Patel
- Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Tejal U Naik
- Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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20
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Spencer-Gardner LS, Camp CL, Martin JR, Sierra RJ, Trousdale RT, Krych AJ. Does Prior Surgery for Femoroacetabular Impingement Compromise Hip Arthroplasty Outcomes? J Arthroplasty 2016; 31:1899-903. [PMID: 27026643 DOI: 10.1016/j.arth.2016.02.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/13/2016] [Accepted: 02/16/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Open and arthroscopic approaches have been described to address femoroacetabular impingement (FAI). Despite good outcomes, there is a subset of patients who subsequently require total hip arthroplasty (THA). However, there is a paucity of data on the outcomes of THA after surgery for FAI. The purpose of this study was to determine whether clinical outcomes of THA are affected by prior open or arthroscopic treatment of FAI. METHODS This case-matched retrospective review included 23 patients (24 hips) that underwent THA after previous surgery for FAI (14 arthroscopic and 10 open) and compared them to 24 matched controls with no history of prior surgery on the operative hip. The controls were matched for age, sex, surgical approach, implants used, and preoperative modified Harris hip score (mHHS) did not differ between groups. The primary outcome measure was the mHHS. Operative time, blood loss, and the presence of heterotopic ossification after THA were also compared between groups. RESULTS There was no significant difference in mean mHHS between the FAI treatment group 92.9 ± 12.7 and controls 95.2 ± 6.6 (P = .43) at a mean follow-up after THA of 33 (24-70) months. Increased operative times were noted for THA after surgical hip dislocation (SHD; mean 109.3 ± 29.8) compared to controls (mean 88.0 ± 24.2; P < .05). There was no significant difference in blood loss between groups. The occurrence of heterotopic ossification was significantly higher after SHD compared to controls (P < .05). CONCLUSIONS Clinical outcomes after THA are not affected by prior open or arthroscopic procedures for FAI. However, increased operative times and an increased risk of heterotopic ossification were noted after SHD.
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Affiliation(s)
| | | | - J Ryan Martin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Zhang L, Ge S, Liu H, Wang Q, Wang L, Xian CJ. Contact damage failure analyses of fretting wear behavior of the metal stem titanium alloy–bone cement interface. J Mech Behav Biomed Mater 2015; 51:132-46. [DOI: 10.1016/j.jmbbm.2015.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/20/2015] [Accepted: 06/23/2015] [Indexed: 11/26/2022]
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