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Zavras AG, Federico VP, Butler AJ, Nolte MT, Dandu N, Phillips FM, Colman MW. Relative Efficacy of Cervical Total Disc Arthroplasty Devices and Anterior Cervical Discectomy and Fusion for Cervical Pathology: A Network Meta-Analysis. Global Spine J 2024; 14:322-346. [PMID: 37099726 PMCID: PMC10676167 DOI: 10.1177/21925682231172982] [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: 04/28/2023] Open
Abstract
STUDY DESIGN Systematic Review and Meta Analysis. OBJECTIVE This study sought to compare patient-reported outcomes, success, complications, and radiographic outcomes directly and indirectly between different cervical total disc arthroplasty (TDA) devices and anterior cervical discectomy and fusion (ACDF). METHODS Patients of prospective randomized controlled trials of 1-level cervical TDA with a minimum of 2 years follow up were identified in the literature. A frequentist network meta-analysis model was used to compare each outcome across the different TDA devices included and ACDF using the mixed effect sizes. RESULTS 15 studies were included for quantitative analysis, reporting the outcomes of 2643 patients with an average follow-up was 67.3 months (range: 24-120 months), 1417 of whom underwent TDA and 1226 of whom underwent ACDF. Nine TDA devices were compared to ACDF, including the Bryan, Discover, Kineflex, M6, Mobi-C, PCM, Prestige ST, ProDisc-C, and Secure-C cervical prostheses. Several devices outperformed ACDF for certain outcomes, including Visual Analog Scale (VAS) Arm, Physical Component Score of the Short-Form Health Survey (SF PCS), neurological success, satisfaction, index-level secondary surgical interventions (SSI), and adjacent level surgeries. Cumulative ranking of each intervention assessed demonstrated the highest performance with the M6 prosthesis (P = .70), followed by Secure-C (P = .67), PCM (P = .57), Prestige ST (P = .57), ProDisc-C (P = .54), Mobi-C (P = .53), Bryan (P = .49), Kineflex (P = .49), Discover (P = .39), and ACDF (P = .14). CONCLUSION Cervical TDA was found to be superior on most outcomes assessed in the literature of high-quality clinical trials. While most devices demonstrated similar outcomes, certain prostheses such as the M6 were found to outperform others across several outcomes assessed. These findings suggest that the restoration of near-normal cervical kinematics may lead to improved outcomes.
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Affiliation(s)
- Athan G. Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Vincent P. Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alexander J. Butler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael T. Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Navya Dandu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Frank M. Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W. Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Olivero M, Capurro B, Reis-Campos P, Aprato A, Ayeni O, Chawla A, Larrainzar Garijo R, Marín-Peña O. Low-dose prophylaxis protocol for heterotopic ossification after hip preservation surgery in a sport participants cohort. SICOT J 2023; 9:27. [PMID: 37668540 PMCID: PMC10478760 DOI: 10.1051/sicotj/2023024] [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] [Received: 04/17/2023] [Accepted: 07/30/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Heterotopic ossification (HO) is a well-known complication of arthroscopic and open surgical treatment of femoroacetabular impingement (FAI). Incidence of heterotopic ossification has been reported in the literature between 0% and 44% after hip arthroscopy and between 18.2% and 25% after anterior mini-open surgery. Currently, pharmacological prophylaxis with NSAIDs and selective COX-2 inhibitors are commonly used and their effectiveness is well documented in literature. HYPOTHESIS We hypothesized that the low-dose prophylaxis protocol with selective cox-2 inhibitors decreases the risk of heterotopic ossification in open or arthroscopic hip preservation surgery in athletes. METHODS This study is an analysis of prospectively gathered data on 98 sport participant patients who underwent arthroscopic or anterior mini-open treatment for FAI between April 2008 and April 2018. All the patients received postoperative oral prophylaxis with 60 mg etoricoxib once daily for two weeks. Post-operative X-rays were performed at 1, 3, and 12 months after surgery and reviewed by two orthopedic surgeons blinded to the type and side of surgery. HO were graded according to the Brooker classification. Descriptive statistics was used to analyze demographic data. Bivariate analysis was performed to analyze the association of HO with each of the following variables: type of surgery, physical activity, time of evolution of symptoms, age at surgery, and sex. Finally, a regression model analysis was performed to determine the presence of confounding effects between variables. RESULTS The study cohort was composed of 54 patients in the arthroscopic treatment group and 44 patients in the anterior mini-open group. HO was identified in 6 (13.6%) patients in the mini-open group. No HO was identified in the arthroscopic group. In the bivariate analysis, "type of surgery" was the only variable that showed a statistically significant association with HO (p = 0.007). CONCLUSION Results of this study suggest that anterior mini-open treatment was characterized by a higher risk of HO development compared to hip arthroscopy for femoroacetabular impingement treatment regardless of pharmacological prophylaxis. The treatment regimen of 60 mg etoricoxib daily for two weeks was an effective prophylaxis for HO formation in sport participant patients compared with data available in the literature.
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Affiliation(s)
- Matteo Olivero
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Centro Traumatológico Ortopédico, (CTO), University of Torino 10126 Torino Italy
| | - Bruno Capurro
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Department of Orthopaedic Surgery and Sport Traumatology, IMSKE Hospital 46024 Valencia Spain
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European Hip Preservation Associates, EHPA-ESSKA Section Europe
| | - Pedro Reis-Campos
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Orthopedic and Traumatology Department, Hospital Vila Franca de Xira 2600-009 Portugal
| | - Alessandro Aprato
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Centro Traumatológico Ortopédico, (CTO), University of Torino 10126 Torino Italy
| | - Olufemi Ayeni
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Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center L8S 4S4 Hamilton Canada
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European Hip Preservation Associates, EHPA-ESSKA Section Europe
| | - Anuj Chawla
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Department of Orthopaedic Surgery, Tan Tock Seng Hospital PC 308433 Novena Singapore
| | - Ricardo Larrainzar Garijo
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Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Infanta Leonor 28031 Madrid Spain
| | - Oliver Marín-Peña
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Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Infanta Leonor 28031 Madrid Spain
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European Hip Preservation Associates, EHPA-ESSKA Section Europe
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Idiopathic Spontaneous Occurrence of Heterotrophic Occurrence During Pregnancy. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202301000-00009. [PMID: 36701241 PMCID: PMC9851693 DOI: 10.5435/jaaosglobal-d-22-00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/23/2022] [Indexed: 01/27/2023]
Abstract
Heterotopic ossification (HO) typically presents in the hip, knee, and elbow joints in the setting of trauma or postsurgical intervention. Less commonly, it may occur secondary to neurologic dysfunction or underlying genetic conditions, but idiopathic HO is rare. Most cases of HO are managed nonoperatively with surgical resection remaining a controversy due to high recurrence rates. We describe a case of idiopathic HO of the shoulder that occurred in the absence of trauma, neurologic dysfunction, or underlying genetic disorder that was treated with surgical excision.
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Sun Z, Liu W, Liu H, Li J, Hu Y, Tu B, Wang W, Fan C. A new prognostic nomogram for heterotopic ossification formation after elbow trauma : the Shanghai post-Traumatic Elbow Heterotopic Ossification Prediction (STEHOP) model. Bone Joint J 2022; 104-B:963-971. [PMID: 35909382 DOI: 10.1302/0301-620x.104b8.bjj-2022-0206.r2] [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: 11/05/2022]
Abstract
AIMS Heterotopic ossification (HO) is a common complication after elbow trauma and can cause severe upper limb disability. Although multiple prognostic factors have been reported to be associated with the development of post-traumatic HO, no model has yet been able to combine these predictors more succinctly to convey prognostic information and medical measures to patients. Therefore, this study aimed to identify prognostic factors leading to the formation of HO after surgery for elbow trauma, and to establish and validate a nomogram to predict the probability of HO formation in such particular injuries. METHODS This multicentre case-control study comprised 200 patients with post-traumatic elbow HO and 229 patients who had elbow trauma but without HO formation between July 2019 and December 2020. Features possibly associated with HO formation were obtained. The least absolute shrinkage and selection operator regression model was used to optimize feature selection. Multivariable logistic regression analysis was applied to build the new nomogram: the Shanghai post-Traumatic Elbow Heterotopic Ossification Prediction model (STEHOP). STEHOP was validated by concordance index (C-index) and calibration plot. Internal validation was conducted using bootstrapping validation. RESULTS Male sex, obesity, open wound, dislocations, late definitive surgical treatment, and lack of use of non-steroidal anti-inflammatory drugs were identified as adverse predictors and incorporated to construct the STEHOP model. It displayed good discrimination with a C-index of 0.80 (95% confidence interval 0.75 to 0.84). A high C-index value of 0.77 could still be reached in the internal validation. The calibration plot showed good agreement between nomogram prediction and observed outcomes. CONCLUSION The newly developed STEHOP model is a valid and convenient instrument to predict HO formation after surgery for elbow trauma. It could assist clinicians in counselling patients regarding treatment expectations and therapeutic choices. Cite this article: Bone Joint J 2022;104-B(8):963-971.
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Affiliation(s)
- Ziyang Sun
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Weixuan Liu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Hang Liu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Juehong Li
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Yuehao Hu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Tu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Wei Wang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Cunyi Fan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, China
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Hwang CD, Pagani CA, Nunez JH, Cherief M, Qin Q, Gomez-Salazar M, Kadaikal B, Kang H, Chowdary AR, Patel N, James AW, Levi B. Contemporary perspectives on heterotopic ossification. JCI Insight 2022; 7:158996. [PMID: 35866484 PMCID: PMC9431693 DOI: 10.1172/jci.insight.158996] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Heterotopic ossification (HO) is the formation of ectopic bone that is primarily genetically driven (fibrodysplasia ossificans progressiva [FOP]) or acquired in the setting of trauma (tHO). HO has undergone intense investigation, especially over the last 50 years, as awareness has increased around improving clinical technologies and incidence, such as with ongoing wartime conflicts. Current treatments for tHO and FOP remain prophylactic and include NSAIDs and glucocorticoids, respectively, whereas other proposed therapeutic modalities exhibit prohibitive risk profiles. Contemporary studies have elucidated mechanisms behind tHO and FOP and have described new distinct niches independent of inflammation that regulate ectopic bone formation. These investigations have propagated a paradigm shift in the approach to treatment and management of a historically difficult surgical problem, with ongoing clinical trials and promising new targets.
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Affiliation(s)
- Charles D Hwang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Chase A Pagani
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Johanna H Nunez
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Masnsen Cherief
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Qizhi Qin
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Balram Kadaikal
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Heeseog Kang
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashish R Chowdary
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Safety and Efficacy of Postoperative Nonsteroidal Anti-inflammatory Drugs in Sports Medicine. J Am Acad Orthop Surg 2022; 30:535-542. [PMID: 35576538 DOI: 10.5435/jaaos-d-21-01228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for multimodal pain control after surgery. These medications work by selective or nonselective inhibition of cyclooxygenase, which has downstream effects on thromboxanes, prostaglandins, and prostacyclins. Clinical studies have shown beneficial effects for alleviating pain and reducing opioid consumption after surgery. Within hip arthroscopy, there is evidence that postoperative NSAIDs can also reduce the risk of symptomatic heterotopic bone formation. However, preclinical and animal studies have raised concern over the effect of NSAIDs on bone and soft-tissue healing. In addition, selective and nonselective cyclooxygenase 2 inhibitors may have different safety profiles regarding postoperative soft-tissue healing. The purpose of this review was to outline the mechanisms of action, efficacy, and effect on soft-tissue healing of postoperative NSAIDs and to provide evidence-based recommendations for appropriate use.
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7
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Incidence of heterotopic ossification following hip arthroscopy is low: considerations for routine prophylaxis. INTERNATIONAL ORTHOPAEDICS 2022; 46:1489-1500. [PMID: 35482060 PMCID: PMC9166824 DOI: 10.1007/s00264-022-05402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/04/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE This scoping review aims to map and summarise the available literature on heterotopic ossification (HO) following hip arthroscopy, with particular focus on incidence, distribution as per Brooker classification, efficacy of prophylactic measures and factors that may influence the likelihood of production of HO. METHODS A computer-based search was performed on PubMed, Embase, Emcare, Cinahl, ISI web of science and Scopus using the terms 'heterotopic ossification' and 'hip arthroscopy'. Articles reporting heterotopic ossification following hip arthroscopy for any condition were included after two-stage title/abstract and full-text screening. RESULTS Of the 663 articles retrieved, 45 studies were included. The proportion of patients with HO ranged from 0 to 44%. The majority of the cases were either Brooker grade I or II. Of the six studies investigating the effect of NSAID prophylaxis, five reported a significantly lower incidence of heterotopic ossification associated with its use. Weak evidence suggests that an outside-in arthroscopic approach, no capsular closure, male sex and mixed cam and pincer resection may be associated with an increased risk of HO. CONCLUSION Although there is a large variation in rates of HO following hip arthroscopy in the current literature, the majority of studies report a low incidence. Evidence exists advocating the administration of post-operative NSAIDs to reduce the incidence of HO following hip arthroscopy. This, combined with the low risk of complications, means there is a favourable risk-benefit ratio for prophylactic NSAID used in HA. Future research should work to identify patient clinical and demographic factors which may increase the risk of development of HO, allowing clinicians to risk stratify and select only specific patients who would benefit from receiving NSAID prophylaxis.
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8
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Feroe AG, Hassan MM, Flaugh RA, Maier SP, Cook DL, Yen YM, Kocher MS. Incidence and Risk Factors for Heterotopic Ossification in a Matched Cohort Adolescent Population Undergoing Hip Arthroscopy. J Pediatr Orthop 2022; 42:e331-e335. [PMID: 35132015 DOI: 10.1097/bpo.0000000000002072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) is a known complication after hip arthroscopy in adults, positively associated with larger cam resection, male sex, older age, and obesity, and negatively associated with nonsteroidal anti-inflammatory drug (NSAID) use and capsular closure. However, it has not been well-documented in adolescents. The purpose of this study was to determine the incidence and risk factors for the development of HO in adolescent patients undergoing hip arthroscopy. METHODS Clinical and operative records from a pediatric institution were queried to identify patients aged 21 years or younger who underwent hip arthroscopy between 2008 and 2018. The 27 cases that developed HO were matched 1:4 on age and sex with 107 controls. The bivariate analysis assessed the relationship between demographic and perioperative factors on the development of HO. Multivariable logistic regression evaluated the association between prophylactic NSAID use (indomethacin 75 mg, 3 wk) and HO, controlling for surgeon and extent of cam resection (change in alpha angle). RESULTS Twenty-seven of 595 (4.5%) hips that underwent hip arthroscopy developed HO within 2 years of surgery. Prophylactic indomethacin was not significantly associated with developing HO [30% (8/27), P=0.83], after controlling for surgeon and extent of cam resection-nor were age, sex, and body mass index percentile. Of patients who developed HO, a smaller proportion underwent reoperation for HO excision among those who received prophylactic indomethacin than those who did not [13% (1/8) vs. 63% (12/19), P=0.03]. CONCLUSIONS The incidence of HO within 2 years of hip arthroscopy in this adolescent population was 4.5%. Although studies in the adult hip arthroscopy population have pointed to a protective role of NSAIDs (eg, indomethacin) in radiographic HO, the effect was less certain in this adolescent sample. Larger studies are important to further evaluate the role of prophylactic NSAIDs and variations in arthroscopic technique in developing HO. LEVEL OF EVIDENCE Level III-therapeutic, case-control study.
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Affiliation(s)
- Aliya G Feroe
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Mahad M Hassan
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Rachel A Flaugh
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Stephen P Maier
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Danielle L Cook
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital
| | - Yi-Meng Yen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Mininder S Kocher
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital
- Harvard Medical School, Boston, MA
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Zhou L, Gee SM, Hansen JA, Posner MA. Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature. Orthop J Sports Med 2022; 10:23259671211060040. [PMID: 35071654 PMCID: PMC8777353 DOI: 10.1177/23259671211060040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Heterotopic ossification (HO) is the formation of bone in soft tissue
resultant from inflammatory processes. Lesion formation after arthroscopic
procedures is an uncommon but challenging complication. Optimal prophylaxis
and management strategies have not been clearly defined. Purpose: To present a scoping review of the pathophysiology, risk factors, diagnostic
modalities, prophylaxis recommendations, and current treatment practices
concerning HO after arthroscopic management of orthopaedic injuries. Study Design: Scoping review; Level of evidence, 4. Methods: A scoping review via a PubMed search was performed according to the PRISMA
(Preferred Reporting Items for Systematic Reviews and Meta-analyses)
guidelines. The search strategy was based on the terms “heterotopic
ossification” AND “arthroscopy.” The clinical outcomes review included
studies on the arthroscopic management of orthopaedic injuries in which the
primary subject matter or a secondary outcome was the development of HO. An
analysis of the pathophysiology, diagnostic modalities, and management
options was reported. Results: A total of 43 studies (33,065 patients) reported on HO after hip arthroscopy,
while 21 (83 patients) collectively reported on HO after arthroscopic
procedures to the shoulder, elbow, knee, or ankle; however, management
techniques were not standardized. Identified risk factors for HO included
male sex and mixed impingement pathology, while intraoperative capsular
management was not suggested as a contributing factor. Diagnosis of
ossification foci was performed using radiography and computed tomography.
The rate of HO after hip arthroscopy procedures approached 46% without
prophylaxis, and administration of nonsteroidal anti-inflammatory drugs
(NSAIDs) decreased occurrence rates to 4% but carries associated risks.
External beam radiation has not been exclusively studied for use after
arthroscopic procedures. Conclusion: HO is a known complication after arthroscopic management of orthopaedic
injuries. NSAID prophylaxis has been demonstrated to be effective after hip
arthroscopy procedures. Patients with persistent symptoms and mature lesions
may be indicated for surgical excision, although variability is present in
patient-reported outcome scores postoperatively.
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Affiliation(s)
- Liang Zhou
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Shawn M. Gee
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Orthopaedic Surgery, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Joshua A. Hansen
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Matthew A. Posner
- Department of Orthopaedic Surgery, Keller Army Hospital, West Point, New York, USA
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Schaver AL, Willey MC, Westermann RW. Incidence of Heterotopic Ossification with NSAID Prophylaxis Is Low After Open and Arthroscopic Hip Preservation Surgery. Arthrosc Sports Med Rehabil 2021; 3:e1309-e1314. [PMID: 34712968 PMCID: PMC8527257 DOI: 10.1016/j.asmr.2021.06.001] [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: 12/29/2020] [Accepted: 06/07/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose We evaluate the incidence of heterotopic ossification (HO) development with nonsteroidal anti-inflammatory drug (NSAID) prophylaxis in patients after open and arthroscopic hip preservation surgery. Methods A retrospective review identified patients who underwent hip preservation surgery at a single institution within the past 3 years. Patients who underwent hip arthroscopy with or without periacetabular osteotomy (PAO) or femoral osteotomy (FO) were included. Those who did not receive 3-month postoperative radiographs were excluded. The incidence and Brooker classification (BC) of HO in patients taking Naproxen or another NSAID (meloxicam, celecoxib, indomethacin, or aspirin alone) was assessed using AP radiographs available from 3-, 6-, and 12-month follow-up appointments. Univariate analysis was conducted to compare numerical means and categorical data (significance level P = .05). Results A total of 328 hips (284 patients) were included. All patients received hip arthroscopy, while 71 patients (21.6%) received concurrent periacetabular osteotomy (PAO; n = 65) or femoral osteotomy (FO; n = 6). Overall, 276 hips (84.4%) received Naproxen for HO prophylaxis. In total, 5 of 328 hips (1.5%) developed HO (4, BC I; 1, BC III). The rate of HO development was significantly higher in males versus females (4 of 121 (3.31%) vs 1 of 207 (.48%), P = .0441). All 5 patients received arthroscopic cam resection and labral repair, and 1 patient also received PAO. Three patients in the Naproxen group (.91%) developed HO, which was not statistically different from those taking a different NSAID (.61%, P = .1797). Conclusion The incidence of HO development was low with NSAID prophylaxis after hip preservation surgery.
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Affiliation(s)
- Andrew L Schaver
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Michael C Willey
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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Abstract
Patients undergoing hip arthroscopy often have postoperative pain that is managed in part with opioids. The hypothesis of this study was that administration of ketorolac at the conclusion of the case may improve postoperative pain control and reduce opioid use. This investigation was a retrospective, observational study of opioid use, pain, and time spent in the postanesthesia care unit (PACU) among opioid-naïve patients undergoing primary hip arthroscopy (Current Procedural Terminology code 29914 or 29916) for femoroacetabular impingement syndrome before and after the institution of a surgeon-driven policy to administer ketorolac at the end of the case. Baseline characteristics and perioperative ketorolac administration were recorded. Outcomes included opioids used in the PACU through discharge measured in oral morphine equivalents, time spent in the PACU, and pain reported by the patient in the PACU. Comparative statistics, including multivariable main effects linear regression modeling, were performed to determine the effect of ketorolac administration on outcomes. Patients who did not receive ketorolac consumed a median of 22.5 oral morphine equivalents in the PACU through discharge, whereas patients who received ketorolac consumed a median of 17.5 oral morphine equivalents. No significant difference was found in pain reported or time spent in the PACU through discharge, although the results favored ketorolac administration. This study showed a modest but statistically significant reduction in early postoperative opioid use among patients receiving ketorolac at closure. Ketorolac could be part of a multimodal preemptive pain management strategy to help to reduce postoperative opioid use. [Orthopedics. 2021;44(3):e417-e421.].
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Zimmerer A, Ramoser A, Streit M, Janz V, Sobau C, Wassilew GI, Miehlke W. Osteoarthrosis, Advanced Age, and Female Sex Are Risk Factors for Inferior Outcomes After Hip Arthroscopy and Labral Debridement for Femoroacetabular Impingement Syndrome: Case Series With Minimum 10-Year Follow-Up. Arthroscopy 2021; 37:1822-1828.e1. [PMID: 33515737 DOI: 10.1016/j.arthro.2021.01.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To determine the cumulative survivorship using the endpoint of total hip arthroplasty (THA) correlated with osteoarthrosis (Tönnis grade ≤ 1 vs Tönnis grade > 1) at a minimum 10-year follow-up and (2) to identify risk factors for THA conversion. METHODS This study examined 112 patients who underwent hip arthroscopy for femoroacetabular impingement syndrome (FAIS) between 2007 and 2009. The inclusion criterion was primary hip arthroscopy to treat FAIS with corresponding chondrolabral pathologies. The exclusion criteria were secondary hip pathologies, revision hip arthroscopy, or dysplasia. The mean follow-up period was 11 years. Cumulative survival was estimated by Kaplan-Meier analysis using the endpoint of THA. Risk factors for THA conversion were identified using a multivariate Cox proportional hazards model. RESULTS Forty patients underwent THA. The cumulative survivorship rate at 11 years was 86% for patients with a Tönnis grade of 1 or less and 46% for those with a Tönnis grade greater than 1. Osteoarthrosis, advanced age, and female sex were associated with lower hip survival rates. In particular, the risk of THA conversion was 24% higher for patients with an advanced age at the time of surgery, 97% higher for female patients, and 133% higher for hips with a Tönnis grade greater than 1. CONCLUSIONS The survivorship rate at a mean 11-year follow-up after arthroscopic FAIS therapy was 86.3% in the group with a Tönnis grade of 1 or less and 46.4% in the group with a Tönnis grade greater than 1. The presence of osteoarthrosis, advanced age, and female sex adversely affected the outcome. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Alexander Zimmerer
- ARCUS Sportklinik Pforzheim, Pforzheim, Germany; Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany.
| | | | | | - Viktor Janz
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | | | - Georgi I Wassilew
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
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Tassinari E, Castagnini F, Mariotti F, Biondi F, Montalti M, Bordini B, Traina F. Arthroscopic tendon release for iliopsoas impingement after primary total hip arthroplasty: a retrospective, consecutive series. Hip Int 2021; 31:125-132. [PMID: 31830823 DOI: 10.1177/1120700019893341] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Aim of this study was to describe the clinical outcomes of 16 patients with iliopsoas (IP) impingement after primary total hip arthroplasty (THA), treated with an arthroscopic tendon release. METHODS 16 patients (11 females/5 males), with a mean age of 57.8 ± 11.1 years (age at THA: 54.4 ± 11 years) and a diagnosis of IP impingement after primary THA, were treated with the Wettstein tenotomy. Preoperatively, every patient underwent a diagnostic ultrasonography guided peritendinous injection and a computed tomography (CT) scan. Every patient was clinically evaluated using WOMAC score. Subjective pain relief and active hip flexion strength were measured. RESULTS No complications related to arthroscopy were detected. Every cup was prominent with a mean axial overhang of 13 ± 4.8 mm (range 5-20 mm). At a mean follow-up of 27 ± 20.1 months (range 6-48 months), the WOMAC score was 83.7 ± 10.1 points. 13 patients out of 16 (81.3%) had a complete pain relief. 14 patients out of 16 (88%) regained full active hip flexion strength at the final follow-up. 1 patient was scheduled for cup revision after 6 months, due to persistent symptomatology. No demographic data or CT measurements about cup position statistically influenced the outcome. CONCLUSIONS When preceded by an appropriate diagnosis, arthroscopic tenotomy proved safe and effective for IP impingement, regardless the magnitude of cup protrusion.
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Affiliation(s)
- Enrico Tassinari
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- University of Bologna, Bologna, Italy
| | - Federica Mariotti
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Biondi
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Montalti
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- University of Messina, Messina, Italy
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Cunningham DJ, Mather RC, Olson SA, Lewis BD. The Association of Prescriber Awareness of Opioid Consumption Trends with Postoperative Opioid Prescription Volume in Hip Arthroscopy: Prescriber Awareness of Opioid Consumption. Arthrosc Sports Med Rehabil 2020; 2:e481-e487. [PMID: 33134984 PMCID: PMC7588603 DOI: 10.1016/j.asmr.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/08/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To evaluate the impact of prescriber knowledge of 6-week postoperative opioid usage trends on postoperative opioid prescribing in hip arthroscopy for femoroacetabular impingement syndrome. Methods Two groups of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome with the same 2 surgeons were defined. One group preceded study design and implementation and 1 group was after study completion termed the preawareness group (n = 129) and awareness group (n = 130). Baseline clinical and operative characteristics and cumulative 6-week postoperative opioid prescription amount in oral morphine equivalents (OMEs), initial discharge OMEs, and cumulative 6-week postoperative opioid refills were recorded. Multivariable models were constructed to evaluate the impact of provider awareness of opioid usage along with the other baseline characteristics previously mentioned on the outcomes of postoperative opioid prescribing. Results Preawareness group (365.8 additional OMEs; 95% confidence interval [CI], 132.6-599; P = .002), preoperative opioid usage (506.2 additional OMEs; 95% CI, 268.0-744.3; P < .001), postoperative nonsteroidal anti-inflammatory drugs (-664.6 additional OMEs; -1002.6 to -326.6; P < .001), and Caucasian race (-597.5 additional OMEs; 95% CI, -914.8 to -280.2; P < .001) were significantly associated with 6-week postoperative opioid prescribing. Caucasian race (odds ratio, 0.4; 95% CI, 0.18-0.86; P = .02) was associated with lower odds of additional postoperative opioid prescriptions whereas preoperative opioid usage (odds ratio, 2.47; 95% CI, 1.4-4.36; P = .002) was associated with increased odds of additional postoperative opioid prescriptions. Conclusions Patients in the awareness group received significantly lower opioid volume without an increase in overall prescription numbers. Level of Evidence III, prognostic, retrospective comparative study.
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Affiliation(s)
- Daniel J Cunningham
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Richard C Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Steven A Olson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Brian D Lewis
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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A 2-Week Course of Naproxen for Heterotopic Ossification Prophylaxis Is Effective Following Hip Arthroscopy for Femoroacetabular Impingement. Arthrosc Sports Med Rehabil 2020; 2:e789-e794. [PMID: 33376993 PMCID: PMC7754608 DOI: 10.1016/j.asmr.2020.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/10/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the effectiveness of 2 weeks of naproxen prophylaxis for heterotopic ossification (HO) after primary hip arthroscopy for femoroacetabular impingement (FAI). Methods All consecutive hip arthroscopy cases by a single surgeon from January 1, 2015, to December 31, 2016, were retrospectively reviewed. Cases were included if they met the following criteria: (1) Primary hip arthroscopy, including femoral neck osteoplasty, for FAI; (2) naproxen prophylaxis for 2 weeks’ duration; and (3) radiographic follow-up at a minimum of 3 months postoperatively. Radiographic imaging for each patient was evaluated for the presence of HO, and independent radiology reports were used to confirm patients with HO. Maximal size of HO was measured and classified according to the Brooker criteria. Demographic and operative variables of the patients included in this study who received naproxen prophylaxis for 2 weeks were formally compared with a cohort of patients who received naproxen prophylaxis for 3 weeks in a previous randomized controlled trial. Results A total of 185 patients who received naproxen prophylaxis for 2 weeks were included in the study, 5 of whom developed HO (3%). A total of 48 patients who received naproxen prophylaxis for 3 weeks were included for comparison, 2 of whom developed HO (4%). There was no significant difference in the rate of HO formation between 2 weeks and 3 weeks of naproxen prophylaxis (P = .597). All 7 cases of HO were classified as Brooker class 1. Conclusions The observed rate of postoperative heterotopic ossification after 2 weeks of naproxen prophylaxis in this study was equivalent to that observed after 3 weeks’ prophylaxis in a previously published study. Two weeks of naproxen prophylaxis may be a sufficient treatment course for the prevention of heterotopic ossification after primary hip arthroscopy for FAI. Level of Evidence Level III – Retrospective Comparative Study.
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16
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Nieuwenhuizen CJ, van Veldhoven PLJ, van Oosterom RF. Rare case of a traumatic myositis ossificans in the tibialis anterior muscle. BMJ Case Rep 2020; 13:13/8/e233210. [PMID: 32816878 DOI: 10.1136/bcr-2019-233210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Athletes involved in contact sports can be diagnosed with traumatic myositis ossificans. Myositis ossificans is characterised by a benign ossifying lesion in soft tissue mass, most commonly preceded by a muscle contusion in the thigh. Despite the fact that it is often a self-limiting disease, treatment modalities are anti-inflammatory drugs, physiotherapy, shockwave therapy, radiation therapy or surgical resection. We report a 22-year-old competitive football player with severe ongoing pain in the lower leg after a direct trauma. An X-ray showed calcification between the tibia and fibula. An additional ultrasound confirmed the diagnosis: myositis ossificans of the tibialis anterior muscle. After treating him with anti-inflammatory drugs and physiotherapy, he was able to return to sports. Myositis ossificans of the lower leg is an uncommon, though if present, troublesome condition, occurring after a contusion.
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Affiliation(s)
| | | | - Robert F van Oosterom
- Sports Medicine, Medisch Centrum Haaglanden, Den Haag, Zuid-Holland, The Netherlands
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17
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Zimmerer A, Schneider MM, Nietschke R, Miehlke W, Sobau C. Is Hip Arthroscopy an Adequate Therapy for the Borderline Dysplastic Hip? Correlation Between Radiologic Findings and Clinical Outcomes. Orthop J Sports Med 2020; 8:2325967120920851. [PMID: 32548181 PMCID: PMC7249583 DOI: 10.1177/2325967120920851] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/10/2020] [Indexed: 12/24/2022] Open
Abstract
Background Recent studies have shown that assessment of the lateral center-edge angle (LCEA) between 18° and 25° is not sufficient to adequately classify mildly dysplastic hips and that further radiological features should be considered. However, no correlation between different morphologic features and clinical outcomes has been investigated so far. Purpose To analyze the clinical outcomes of patients with different subtypes of borderline dysplastic hips who underwent arthroscopic surgery. Study Design Cohort study; Level of evidence, 3. Methods We examined patients with an LCEA between 18° and 25° who underwent arthroscopic treatment for femoroacetabular impingement syndrome between January 2015 and December 2016. A hierarchical cluster analysis was performed to identify hip morphologic subtypes according to radiographic parameters, including the LCEA, femoro-epiphyseal acetabular roof (FEAR) index, anterior and posterior wall indices (AWI and PWI), Tönnis angle, alpha angle, and femoral neck-shaft angle. In addition, the International Hip Outcome Tool 12 (iHOT-12) and a visual analog scale (VAS) for pain were applied preoperatively and at follow-up, and the results were compared among the different clusters. Previously reported minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) values were used to determine clinically significant improvements. Results A total of 40 patients were identified. Of these, 36 patients were available for evaluation at a mean follow-up of 43.8 months. In total, 4 sex-independent clusters with different morphologic patterns of the hip were identified: cluster 1, unstable anterolateral deficiency (FEAR index >2°, AWI <0.35); cluster 2, stable anterolateral deficiency (FEAR index <2°, AWI <0.35); cluster 3, stable lateral deficiency (FEAR index >2°, normal AWI and PWI); and cluster 4, stable posterolateral deficiency (FEAR index <2°, PWI <0.85). At follow-up, clusters 1, 2, and 3 showed significantly improved iHOT-12 (P < .0001) and VAS pain (P < .0001) scores, and cluster 4 showed no significant improvements. The MCID of 15.2 points was achieved by all patients in clusters 2 and 3, by 63% of patients in cluster 1, and by 23% of patients in cluster 4. Clusters 2 and 3 differed significantly from clusters 1 and 4 (P = .02). A postoperative PASS score of 60 was achieved by all patients in cluster 3, by 86% of patients in cluster 2, by 63% of patients in cluster 1, and by 20% of patients in cluster 4. The differences between the groups were statistically significant (P = .01). Conclusion Arthroscopic surgery yielded good results in the treatment of stable borderline hip dysplasia with anterolateral and lateral deficiency. In contrast, borderline hip dysplasia with acetabular retroversion showed no improvements after arthroscopic therapy. This study underlines the need for an accurate analysis of all possible radiological signs to adequately classify borderline dysplastic hips.
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Affiliation(s)
- Alexander Zimmerer
- ARCUS Sportklinik, Pforzheim, Germany.,University of Greifswald, Greifswald, Germany
| | - Marco M Schneider
- ARCUS Sportklinik, Pforzheim, Germany.,University of Witten/Herdecke, Witten, Germany
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18
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Dow T, King JP, Wong IHB. The Reduction of Heterotopic Ossification Incidence After Hip Arthroscopy in Patients Treated With Selective Cyclooxygenase 2 Inhibitor (Celecoxib). Arthroscopy 2020; 36:453-461. [PMID: 31734042 DOI: 10.1016/j.arthro.2019.08.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effectiveness of celecoxib, a selective cyclooxygenase 2 inhibitor, in reducing heterotopic ossification (HO) after hip arthroscopic surgery and to evaluate celecoxib's impact on clinical outcomes. METHODS We performed a retrospective review of patients who received hip arthroscopy performed by the same surgeon between January 1, 2012, and December 31, 2016. Patients who had an allergy to sulfa drugs, had pre-existing HO or previous surgery on the operative side, or failed to complete radiographic follow-up at 6 months postoperatively were excluded. Patients in the treatment group received 400 mg of celecoxib postoperatively for 6 weeks, whereas the control group received no postoperative celecoxib. The incidence of HO was assessed using anteroposterior radiographs obtained at 6 months, 1 year, and 2 years postoperatively. Patients completed the International Hip Outcome Tool 33 survey, and the proportion of patients who met the minimal clinically important difference, substantial clinical benefit (SCB), and absolute SCB was calculated. RESULTS A total of 559 patients were identified. After application of the exclusion criteria, 454 patients were included in the study (211 in control group and 243 in treatment group). The overall incidence of HO was 20.3% (n = 92). The treatment group had a significantly lower incidence of HO at 6 months (P = .006), 1 year (P < .001), and 2 years (P = .008) postoperatively. At 2 years postoperatively, the treatment group had a significantly higher International Hip Outcome Tool 33 score on average: 64.2 versus 57.3 (P = .023). No significant difference in the proportion of patients reaching the minimal clinically important difference, SCB, or absolute SCB was found at any of the postoperative time points. CONCLUSION The findings of this study suggest that a prophylactic treatment regimen of 400 mg of celecoxib once daily for 6 weeks significantly reduces the incidence of HO formation after hip arthroscopic surgery; however, it did not impact clinical outcomes. LEVEL OF EVIDENCE Level III, retrospective, comparative case-control study.
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Affiliation(s)
- Todd Dow
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John-Paul King
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Ho-Bun Wong
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
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19
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Zhang AH, Chen X, Zhao QX, Wang KL. A systematic review and meta-analysis of naproxen for prevention heterotopic ossification after hip surgery. Medicine (Baltimore) 2019; 98:e14607. [PMID: 30946309 PMCID: PMC6455982 DOI: 10.1097/md.0000000000014607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the efficacy of naproxen in preventing heterotopic ossification (HO) after hip surgery (total hip arthroplasty [THA] and hip arthroscopy). METHODS Using databases (PubMed, EMBASE, and Web of Science), we conducted an electronic, systematic search of randomized controlled trials (RCTs) comparing naproxen versus placebo on HO after hip surgery. The risk ratio (RR) of the dichotomous data, weighted mean difference (WMD) of continuous data, and 95% confidence intervals (CIs) were calculated to assess the effects of naproxen in patients with hip surgery. RESULTS A total of 4 studies including 269 patients were analyzed. Risk of bias was relatively high in allocation concealment and blinding. Compared with control group, administration naproxen was associated with a significantly reduction of the occurrence of HO at final follow-up after hip surgery (P < .05). What's more, naproxen was associated with a reduction of the Brooker I and II HO (P < .05). However, there was no significant difference between the Brooker III HO between naproxen and control groups (P > .05). Furthermore, there was no significant difference between the complications (P > .05) between naproxen and control groups. CONCLUSION Naproxen has a beneficial role in reducing the total occurrence of HO, Brooker I and II HO after hip surgery. However, conclusions are limited due to the lack of high-quality studies. More high quality studies may help in a more reliable therapy for HO.
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Affiliation(s)
- Ai-Hua Zhang
- Department of Animal Laboratory of Scientific Research
| | | | | | - Ke-Lai Wang
- Department of Pediatric Orthopaedic Surgery, Qi1u Hospital, Shandong University, People's Republic of China
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21
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Kurz AZ, LeRoux E, Riediger M, Coughlin R, Simunovic N, Duong A, Laskovski JR, Ayeni OR. Heterotopic Ossification in Hip Arthroscopy: an Updated Review. Curr Rev Musculoskelet Med 2019; 12:147-155. [PMID: 30810970 DOI: 10.1007/s12178-019-09543-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Heterotopic ossification (HO) in hip arthroscopy is a common post-operative complication. This review was undertaken to provide an update (2014 present) on the current literature regarding HO in hip arthroscopy. RECENT FINDINGS Risk factors for HO post-hip arthroscopy include male gender, mixed impingement, picture, and the size of CAM resection. HO prophylaxis with NSAIDs has been proven to decrease the rate of HO post-hip arthroscopy; however, there is inherent risk to long-standing NSAIDs therapy. HO post-hip arthroscopy is not uncommon as a radiological finding, but symptomatic HO post-hip arthroscopy requiring revision surgery is a rare event, at < 1%. The outcomes for revision surgery for HO excision have fair outcomes. The hip arthroscopist should stratify their patients based on known risk factors, and determine whether NSAIDs prophylaxis is warranted.
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Affiliation(s)
- Adrian Z Kurz
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Eugenie LeRoux
- School of Medicine, St. George's University, St. George's, Grenada
| | - Michael Riediger
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Ryan Coughlin
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Jovan R Laskovski
- Crystal Clinic Orthopedic Center, 1622 East Turkeyfoot Lake Road, Akron, OH, 44312, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
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de Sa D, Lian J, Sheean AJ, Inman K, Drain N, Ayeni O, Mauro C. A Systematic Summary of Systematic Reviews on the Topic of Hip Arthroscopic Surgery. Orthop J Sports Med 2018; 6:2325967118796222. [PMID: 30320142 PMCID: PMC6154262 DOI: 10.1177/2325967118796222] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a rapidly growing body of literature on the topic of hip arthroscopic surgery. PURPOSE To provide an overall summary of systematic reviews published on the indications, complications, techniques, outcomes, and information related to hip arthroscopic surgery. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of all hip arthroscopic surgery-related systematic reviews published between January 2000 and May 2018 was performed using PubMed, MEDLINE, and the Cochrane Library. Narrative reviews and non-English articles were excluded. RESULTS A total of 837 articles were found, of which 85 met the inclusion criteria. Included articles were summarized and divided into 6 major categories based on the subject of the review: femoroacetabular impingement (FAI), non-FAI indications, surgical technique, outcomes, complications, and miscellaneous. CONCLUSION A summary of systematic reviews on hip arthroscopic surgery can provide surgeons with a single source for the most current synopsis of the available literature. As the prevalence of orthopaedic surgeons performing hip arthroscopic surgery increases, updated evidence-based guidelines must likewise be advanced and understood to ensure optimal patient management.
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Affiliation(s)
- Darren de Sa
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jayson Lian
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Albert Einstein College of Medicine, New York, New York, USA
| | - Andrew J Sheean
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathleen Inman
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas Drain
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Olufemi Ayeni
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Craig Mauro
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Loder SJ, Agarwal S, Chung MT, Cholok D, Hwang C, Visser N, Vasquez K, Sorkin M, Habbouche J, Sung HH, Peterson J, Fireman D, Ranganathan K, Breuler C, Priest C, Li J, Bai X, Li S, Cederna PS, Levi B. Characterizing the Circulating Cell Populations in Traumatic Heterotopic Ossification. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 188:2464-2473. [PMID: 30142335 DOI: 10.1016/j.ajpath.2018.07.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/08/2018] [Accepted: 07/26/2018] [Indexed: 12/23/2022]
Abstract
Heterotopic ossification (HO) occurs secondary to trauma, causing pain and functional limitations. Identification of the cells that contribute to HO is critical to the development of therapies. Given that innate immune cells and mesenchymal stem cells are known contributors to HO, we sought to define the contribution of these populations to HO and to identify what, if any, contribution circulating populations have to HO. A shared circulation was obtained using a parabiosis model, established between an enhanced green fluorescent protein-positive/luciferase+ donor and a same-strain nonreporter recipient mouse. The nonreporter mouse received Achilles tendon transection and dorsal burn injury to induce HO formation. Bioluminescence imaging and immunostaining were performed to define the circulatory contribution of immune and mesenchymal cell populations. Histologic analysis showed circulating cells present throughout each stage of the developing HO anlagen. Circulating cells were present at the injury site during the inflammatory phase and proliferative period, with diminished contribution in mature HO. Immunostaining demonstrated that most early circulatory cells were from the innate immune system; only a small population of mesenchymal cells were present in the HO. We demonstrate the time course of the participation of circulatory cells in trauma-induced HO and identify populations of circulating cells present in different stages of HO. These findings further elucidate the relative contribution of local and systemic cell populations to HO.
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Affiliation(s)
- Shawn J Loder
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Shailesh Agarwal
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael T Chung
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - David Cholok
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Charles Hwang
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Noelle Visser
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kaetlin Vasquez
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Sorkin
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Joe Habbouche
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hsiao H Sung
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Joshua Peterson
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - David Fireman
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kavitha Ranganathan
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Christopher Breuler
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Caitlin Priest
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - John Li
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Xue Bai
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Shuli Li
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paul S Cederna
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Benjamin Levi
- Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Are Controversial Issues in Cervical Total Disc Replacement Resolved or Unresolved?: A Review of Literature and Recent Updates. Asian Spine J 2018; 12:178-192. [PMID: 29503699 PMCID: PMC5821925 DOI: 10.4184/asj.2018.12.1.178] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/17/2017] [Accepted: 08/12/2017] [Indexed: 12/17/2022] Open
Abstract
Since the launch of cervical total disc replacement (CTDR) in the early 2000s, many clinical studies have reported better outcomes of CTDR compared to those of anterior cervical discectomy and fusion. However, CTDR is still a new and innovative procedure with limited indications for clinical application in spinal surgery, particularly, for young patients presenting with soft disc herniation with radiculopathy and/or myelopathy. In addition, some controversial issues related to the assessment of clinical outcomes of CTDR remain unresolved. These issues, including surgical outcomes, adjacent segment degeneration (ASD), heterotopic ossification (HO), wear debris and tissue reaction, and multilevel total disc replacement (TDR) and hybrid surgeries are a common concern of spine surgeons and need to be resolved. Among them, the effect of CTDR on patient outcomes and ASD is theoretically and clinically important; however, this issue remains disputable. Additionally, HO, wear debris, multilevel TDR, and hybrid surgery tend to favor CTDR in terms of their effects on outcomes, but the potential of these factors for jeopardizing patients' safety postoperatively and/or to exert harmful effects on surgical outcomes in longer-term follow-up cannot be ignored. Consequently, it is too early to determine the therapeutic efficacy and cost-effectiveness of CTDR and will require considerable time and studies to provide appropriate answers regarding the same. For these reasons, CTDR requires longer-term follow-up data.
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Zeng LR, Zhu FB, Wang JY, Hou Q, Yue ZS, Yan SG, Quan RF, Zhang YL. Local influence of high molecular polyethylene particles on heterotopic ossification. Exp Ther Med 2017; 13:2934-2938. [PMID: 28587363 PMCID: PMC5450723 DOI: 10.3892/etm.2017.4327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/06/2017] [Indexed: 11/06/2022] Open
Abstract
We studied the effect of molecular polyethylene particles on local heterotopic ossification. A total of 36 healthy Sprague-Dawley rats were randomly divided into the control group (n=18) and the observation group (n=18). High molecular polyethylene particles were injected to rupture Achilles tendon position in the observation group, and normal saline was injected in the control group. X-ray examinations were conducted on Achilles tendon in the 4th, 8th and 12th week after operation. The incidence rate of heterotopic ossification was evaluated, and bone trabecula morphological structure was studied under optical microscope after hematoxylin and eosin staining. Bone morphogenetic protein 2 (BMP-2), transforming growth factor-β (TGF-β), interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α), runt-related transcription factor 2 (Runx2) and matrix metalloproteinase-9 (MMP-9) expression levels were also measured. Our results showed that heterotopic ossification incidence in the observation group was significantly lower than that in the control group. Achilles tendon structure in the control group increased in volume, and its texture was harder and cartilage-like. In the observation group, trabecular bone volume, thickness and quantity were more than those observed in the control group. BMP-2, TGF-β, IL-1, TNF-α, Runx2 and MMP-9 levels in the observation group were significantly lower than those in the control group. We concluded that, high molecular polyethylene particles had a significant inhibiting effect on local heterotopic ossification.
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Affiliation(s)
- Lin-Ru Zeng
- Department of Orthopaedic Surgery, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang 311200, P.R. China
| | - Fang-Bing Zhu
- Department of Orthopaedic Surgery, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang 311200, P.R. China
| | - Jian-Yue Wang
- Department of Orthopaedic Surgery, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang 311200, P.R. China
| | - Qiao Hou
- Department of Orthopaedic Surgery, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang 311200, P.R. China
| | - Zhen-Shuang Yue
- Department of Orthopaedic Surgery, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang 311200, P.R. China
| | - Shi-Gui Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Ren-Fu Quan
- Department of Orthopaedic Surgery, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang 311200, P.R. China
| | - Ying-Liang Zhang
- Department of Orthopaedic Surgery, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang 311200, P.R. China
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Mohtadi NG, Johnston K, Gaudelli C, Chan DS, Barber RS, Walker R, Patel C, Mackay E, Oddone Paolucci E. The incidence of proximal deep vein thrombosis after elective hip arthroscopy: a prospective cohort study in low risk patients. J Hip Preserv Surg 2016; 3:295-303. [PMID: 29632689 PMCID: PMC5883170 DOI: 10.1093/jhps/hnw027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/03/2016] [Indexed: 11/13/2022] Open
Abstract
Prospectively assess the incidence of deep venous thrombosis (DVT) using Doppler Ultrasound, in patients receiving elective hip arthroscopy without pharmacologic/mechanical prophylaxis. One hundred and fifteen consecutive patients (mean 35.4 years, SD = 10.3) underwent elective hip arthroscopy. Patients with previous major risk factors for DVT were excluded. Signs/symptoms of DVT/pulmonary embolism were assessed at 2-week post-operatively. A bilateral whole leg Duplex color (Doppler) Ultrasonography was scheduled between 10- and 22-day post-op. The primary outcome was frequency of DVT. Secondary outcomes assessed surgical risk factors. One hundred and ten patients (mean = 34.3 years, SD = 10.1) did not get a DVT. Five patients (mean = 43.8 years, SD = 12.1) were diagnosed with a DVT, 2- to 22-day post-operatively. All DVT patients received arthroscopy in the supine position (n = 76), versus no patients in the lateral position (n = 39). Average traction time was 38 (SD = 4) and 61 (SD = 4) minutes for patients with and without a DVT, respectively. All other a priori defined risk factors were similar. Four out of five patients presented with symptoms of a DVT, confirmed by ultrasound. One patient was without symptoms/clinical findings. Four patients had a DVT restricted to the calf veins; one patient had involvement of the popliteal vein. No patients had proximal extension into the thigh or pelvis. No pulmonary emboli were suspected or occurred. The incidence of deep venous thromboembolism is 4.3%. The majority of patients had symptomatic and distal venous thromboembolic events. This study provides supportive evidence that routine prophylaxis and/or screening may not be necessary in low risk patients undergoing elective hip arthroscopy.
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Affiliation(s)
- Nicholas G Mohtadi
- University of Calgary Sport Medicine Centre, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Kelly Johnston
- Alberta Hip & Knee Clinic - Calgary, Suite 335, 401 9th Ave SW, Calgary, AB T2P 3C5, Canada
| | - Cinzia Gaudelli
- Department of Surgery, University of Calgary Cumming School of Medicine, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Denise S Chan
- University of Calgary Sport Medicine Centre, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Rhamona S Barber
- University of Calgary Sport Medicine Centre, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Richard Walker
- Department of Radiology, University of Calgary Cumming School of Medicine, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Chirag Patel
- Department of Radiology, University of Calgary Cumming School of Medicine, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Elizabeth Mackay
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine and, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Elizabeth Oddone Paolucci
- Department of Surgery, University of Calgary Cumming School of Medicine, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.,Department of Community Health Sciences, University of Calgary Cumming School of Medicine and, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
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27
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Miller GK. Editorial Commentary: The Efficacy of Nonsteroidal Anti-inflammatory Drugs for Prophylaxis of Heterotopic Ossification in Hip Arthroscopy--Do We Treat Patients or X-rays? Arthroscopy 2016; 32:526-7. [PMID: 26945959 DOI: 10.1016/j.arthro.2015.12.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 02/02/2023]
Abstract
A systematic review of 5 series comparing the incidence of heterotopic ossification after hip arthroscopy with and without nonsteroidal anti-inflammatory drug prophylaxis showed a statistically significant improvement with the use of prophylaxis.
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