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Aprato A, Cambursano S, Artiaco S, Fusini F, Bevilacqua S, Catalani P, Massè A. Severe heterotopic ossification after total hip arthroplasty in male patients under 70 years of age: effectiveness of prophylactic protocol. Musculoskelet Surg 2024:10.1007/s12306-024-00868-4. [PMID: 39382615 DOI: 10.1007/s12306-024-00868-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/02/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND This study aims to evaluate the incidence of clinically significant heterotopic ossification (HO) in primary total hip arthroplasty (THA), comparing outcomes with and without the adoption of an HO prophylactic protocol in male patients under 70 years of age. METHODS The prophylactic protocol involved the administration of 50 mg of Indomethacin twice daily for 3 weeks. HO presence was classified according to the Brooker classification system, considering "severe" clinically significant HO (Brooker grade 3 and 4). RESULTS Two hundred and seventy-nine patients were included in our study, and an overall HO rate of 68.2% versus a rate of 61.5% was found respectively in patients not subjected and subjected to prophylactic protocol, without significant difference (PR 0.062). However, patients not subjected to the HO prophylactic protocol exhibited a severe HO rate of 22.4% compared to 7.7% in the prophylactic group, with a statistically significant difference (P = 0.008). CONCLUSIONS Our study demonstrated that prophylactic protocol adoption is significantly associated with lower rate of severe HO in male patients under 70 years of age. Currently, there are no orthopedic guidelines for the prevention and management of HO after THA, but in the absence of contraindications, the adoption of a prophylactic protocol for HO should always be considered in high-risk patients.
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Affiliation(s)
| | | | - Stefano Artiaco
- University of Turin, Corso Dogliotti, 14, 10100, Turin, Italy
| | - Federico Fusini
- University of Turin, Corso Dogliotti, 14, 10100, Turin, Italy
| | | | - Paolo Catalani
- University of Turin, Corso Dogliotti, 14, 10100, Turin, Italy
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Migliorini F, Maffulli N. Prevention of heterotopic ossification in primary total hip arthroplasty: a bone in the dark. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04087-2. [PMID: 39320409 DOI: 10.1007/s00590-024-04087-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 08/25/2024] [Indexed: 09/26/2024]
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy.
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, 00185, Rome, Italy
- Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
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Olivero M, Garg AK, Cañones M, San Francisco FO, Adarraga JM, Chawla A, Lopez-Subias J, Garijo RL, Marín-Peña O. Heterotopic ossification following total hip arthroplasty. Which is the predominant risk factor: surgical approach or post-operative prophylaxis? INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06298-y. [PMID: 39254721 DOI: 10.1007/s00264-024-06298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/20/2024] [Indexed: 09/11/2024]
Abstract
PURPOSE To investigate the impact of surgical approach and post-operative prophylaxis on heterotopic ossification (HO) development after total hip arthroplasty (THA). METHODS A retrospective analysis of 312 patients who underwent THA between January 2009 and April 2016. Patients were categorized by surgical approach (direct lateral or posterolateral), prosthesis type, and post-operative prophylaxis (Etoricoxib 60 mg daily for two weeks). Two orthopaedic surgeons independently assessed radiographs at serial intervals, and HO was graded as per Brooker classification. Bivariate analysis and regression modelling were performed to assess the associations and confounding effects of different variables, RESULTS: Bivariate analysis identified factors correlated with higher HO incidence: absence of prophylaxis, older age, longer symptom evolution, and lower pre-surgery physical activity. Regression modelling showed a correlation between the direct-lateral approach, post-operative prophylaxis, symptom evolution, and higher HO incidence. CONCLUSION Patients with longer symptom evolution before surgery and without post-operative prophylaxis are at higher risk of developing HO. While the direct lateral approach showed higher HO rates, the difference was insignificant. A two-week prophylactic regimen of Etoricoxib 60 mg daily after THA effectively reduced HO formation. Pharmacological prophylaxis should be evaluated case-by-case, considering patient characteristics and risk factors.
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Affiliation(s)
| | - Ankit Kumar Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, India.
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Dai GC, Wang H, Ming Z, Lu PP, Li YJ, Gao YC, Shi L, Cheng Z, Liu XY, Rui YF. Heterotopic mineralization (ossification or calcification) in aged musculoskeletal soft tissues: A new candidate marker for aging. Ageing Res Rev 2024; 95:102215. [PMID: 38325754 DOI: 10.1016/j.arr.2024.102215] [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: 11/19/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
Aging can lead to various disorders in organisms and with the escalating impact of population aging, the incidence of age-related diseases is steadily increasing. As a major risk factor for chronic illnesses in humans, the prevention and postponement of aging have become focal points of research among numerous scientists. Aging biomarkers, which mirror molecular alterations at diverse levels in organs, tissues, and cells, can be used to monitor and evaluate biological changes associated with aging. Currently, aging biomarkers are primarily categorized into physiological traits, imaging characteristics, histological features, cellular-level alterations, and molecular-level changes that encompass the secretion of aging-related factors. However, in the context of the musculoskeletal soft tissue system, aging-related biological indicators primarily involve microscopic parameters at the cellular and molecular levels, resulting in inconvenience and uncertainty in the assessment of musculoskeletal soft tissue aging. To identify convenient and effective indicators, we conducted a comprehensive literature review to investigate the correlation between ectopic mineralization and age-related changes in the musculoskeletal soft tissue system. Here, we introduce the concept of ectopic mineralization as a macroscopic, reliable, and convenient biomarker for musculoskeletal soft tissue aging and present novel targets and strategies for the future management of age-related musculoskeletal soft tissue disorders.
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Affiliation(s)
- Guang-Chun Dai
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Hao Wang
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Zhang Ming
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Pan-Pan Lu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Ying-Juan Li
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Yu-Cheng Gao
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Zhang Cheng
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Xiao-Yu Liu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China.
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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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Wang Z, Mao Z, Yu M, Li H, Chen G, Wang Y, Yao Q. Role of aspirin in the prevention of heterotopic ossification following total hip replacement: a systematic review and meta-analysis. ANZ J Surg 2023; 93:1907-1916. [PMID: 37043691 DOI: 10.1111/ans.18447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/03/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND To systematically investigate if aspirin (ASA), used as venous thromboembolism (VTE) prophylaxis, plays a role in the prevention of heterotopic ossification (HO) following total hip arthroplasty (THA) and if ASA dosage impacted the rate of HO. METHODS Eligible studies published from January 2000 to July 2022 were identified from the computerized searching of PubMed, Scopus and Web of Science. HO was defined according to Brooker Classification. Pooled risk ratios (OR) and 95% confidence interval (CI) were estimated under a random-effect model. Additionally, combined HO incidences were compared according to ASA dosage (a regular dose of 325 bid vs. a low dose of 81 mg bid/162 mg qd). RESULTS Thirteen studies were included. ASA administered for VTE prophylaxis was significantly associated with a reduced risk of all-grade HO following THA (univariate, OR: 0.50, 95% CI: 0.34-0.74, P < 0.001; multivariate, OR: 0.60, 95% CI: 0.49-0.73, P < 0.001). Similar results could be observed for high-grade HO (univariate, OR: 0.57, 95% CI: 0.36-0.89, P = 0.015; multivariate, OR: 0.50, 95% CI: 0.27-0.92, P = 0.026). There was a non-significant trend towards a higher incidence of HO formation for low-dose ASA (31%, 95% CI: 29-34%), compared with regular-dose ASA (21%, 95% CI: 11-33%) (P = 0.069 under test of interaction). CONCLUSIONS ASA can be an effective option for HO prophylaxis. More well-designed trials with long-term follow-ups are encouraged to confirm the current findings and to investigate the effect of ASA dosage on HO reduction.
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Affiliation(s)
- Zhenwei Wang
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Zimu Mao
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Meng Yu
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Hongchuan Li
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Guoqiang Chen
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yang Wang
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Qi Yao
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
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7
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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 & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 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] [MESH Headings] [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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Badi HA, Tanzer M, Nooh A, Hall B, Hart A. A Short Course of Celecoxib Prevents Heterotopic Ossification Following Cementless Total Hip Arthroplasty. Life (Basel) 2023; 13:life13040944. [PMID: 37109473 PMCID: PMC10142707 DOI: 10.3390/life13040944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/19/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Heterotopic ossification (HO) is a common complication after total hip arthroplasty (THA) and can result in pain and loss of motion of the hip. This is the first study in the literature to determine if a short course of Celecoxib is effective in the prevention of HO in patients undergoing cementless THA. In this retrospective study of prospectively collected data, consecutive patients undergoing a primary cementless THA were reviewed at a 2-year follow-up. The Control group consisted of 104 hips that did not receive Celecoxib (Control group), while the 208 hips in the Celecoxib group received 100 mg twice daily for 10 days. Radiographs, patient-recorded outcome measures and range of motion (ROM) were evaluated. Overall, there was a significantly decreased incidence of HO in the Celecoxib group (18.7%) than in the Control group (31.7%) (p = 0.01). The odds that a patient developed HO using Celecoxib were 0.4965 times the odds that a patient developed HO without treatment. Clinically, the Celecoxib group demonstrated significantly greater improvement in their mean WOMAC stiffness (0.35 vs. 0.17, p = 0.02) and physical function scores (3.26 vs. 1.83, p = 0.03) compared to those in the Control group, but there was no difference in the ROM between the two groups. This study is the first to demonstrate that the lowest dose of Celecoxib for a short course of only 10 days is a simple and effective prophylactic treatment option that can significantly reduce the incidence of HO following cementless THA.
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Affiliation(s)
- Hamid Al Badi
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Michael Tanzer
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Anas Nooh
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Brandon Hall
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Adam Hart
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, QC H3G 1A4, Canada
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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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10
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Yeung P, Zarnett O, Lefaivre KA, Guy P. Risk Factors for the Development of Heterotopic Ossification Following Acetabular Fractures: A Systematic Review. JBJS Rev 2022; 10:01874474-202209000-00005. [PMID: 36137013 DOI: 10.2106/jbjs.rvw.20.00263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Heterotopic ossification (HO) following acetabular fractures is a common complication that may affect clinical outcomes. However, the effects of prophylactic treatment with nonsteroidal anti-inflammatory drugs or radiation therapy remain controversial. While several factors have been related to the development of HO, there is considerable uncertainty regarding their importance or effect size in the setting of acetabular surgery. Therefore, this systematic review aims to summarize the risk factors for HO following the operative fixation of acetabular fractures and clarify their interrelationships. METHODS In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, MEDLINE, Embase, and CINAHL databases were searched from inception to February 2021. Studies that assessed factors related to HO development among patients with operatively repaired acetabular fractures were included. Outcomes were risk factors and their effect size (p values, odds ratios, and 95% confidence intervals). RESULTS Twenty-five studies and 1 conference abstract with a total of 3,940 patients were included. The following risk factors for HO were identified. Patient factors were increased body mass index, male sex, and increased age. Injury factors were intensive care unit (ICU) admission and length of stay, non-ICU hospitalization for >10 days, the need for mechanical ventilation for ≥2 days, abdominal and/or chest injuries, the number and type of associated fractures, traumatic brain injuries, T-type acetabular fractures, pelvic ring injuries, and hip dislocation. Care factors were a delay to surgery, extensile and posterior surgical approaches to the hip, trochanteric osteotomy, postoperative step-off of >3 mm, and a delay to prophylaxis following injury or surgery. Ethnicity, Injury Severity Score, cause of the fracture, femoral head injuries, degloving injuries, comminution, intra-articular debris, the type of bone void filler, gluteus minimus muscle preservation, prolonged operative time, and intraoperative patient position were not risk factors for developing HO. CONCLUSIONS HO following operative fixation of acetabular fractures is not uncommon, with severe-grade HO associated with substantial disability. Careful consideration of the risk factor effect sizes and interdependencies could aid physicians in identifying patients at risk for developing HO and guide their prophylactic management. The results of this study could establish a framework for future studies. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Phillip Yeung
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oren Zarnett
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly A Lefaivre
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
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Singh S, Morshed S, Motamedi D, Kidane J, Paul A, Hsiao EC, Wentworth KL. Identification of Risk Factors in the Development of Heterotopic Ossification After Primary Total Hip Arthroplasty. J Clin Endocrinol Metab 2022; 107:e3944-e3952. [PMID: 35451005 PMCID: PMC9387692 DOI: 10.1210/clinem/dgac249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Heterotopic ossification (HO) is a process by which bone forms abnormally in soft tissues. Known risk factors for developing HO include male sex, spinal cord injury, trauma, and surgery. We investigated additional risk factors in the development of HO after hip arthroplasty. METHODS We performed a retrospective review of electronic medical records of 4070 individuals who underwent hip arthroplasty from September 2010 to October 2019 at the University of California, San Francisco Hospital. Demographics, anthropometrics, medications, and comorbid conditions were used in logistic regression analysis to identify factors associated with the development of HO. RESULTS A total of 2541 patients underwent primary hip arthroplasty in the analyzed timeframe (46.04% men, mean age at procedure: 62.13 ± 13.29 years). The incidence of postsurgical HO was 3% (n = 80). A larger proportion of individuals who developed HO had underlying osteoporosis (P < 0.001), vitamin D deficiency (P < 0.001), spine disease (P < 0.001), type 1 or 2 diabetes (P < 0.001), amenorrhea (P = 0.037), postmenopausal status (P < 0.001), parathyroid disorders (P = 0.011), and history of pathologic fracture (P = 0.005). Significant predictors for HO development were Black/African American race [odds ratio (OR) 2.97, P = 0.005], preexisting osteoporosis (OR 2.72, P = 0.001), spine disease (OR 2.04, P = 0.036), and low estrogen states (OR 1.99, P = 0.025). In the overall group, 75.64% received perioperative nonsteroidal anti-inflammatory drugs (NSAIDs), which negatively correlated with HO formation (OR 0.39, P = 0.001). CONCLUSIONS We identified new factors potentially associated with an increased risk of developing HO after primary hip arthroplasty, including African American race, osteoporosis, and low estrogen states. These patients may benefit from HO prophylaxis, such as perioperative NSAIDs.
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Affiliation(s)
- Sukhmani Singh
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Saam Morshed
- Departments of Orthopedic Surgery, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Daria Motamedi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph Kidane
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Alexandra Paul
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Edward C Hsiao
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- The Institute for Human Genetics, The Program in Craniofacial Biology, and the Robert L. Kroc Chair in Rheumatic and Connective Tissue Diseases III, University of California-San Francisco, San Francisco, CA, USA
| | - Kelly L Wentworth
- Correspondence: Kelly Wentworth, MD, University of California, San Francisco, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, Room 3501A, UCSF Box 0874, San Francisco, CA 94110, USA.
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Nóbrega JPG, Jordão P, Arcângelo J. Bilateral hip heterotopic ossification with sciatic nerve compression on a paediatric patient–An individualized surgical approach: A case report. World J Orthop 2022; 13:768-774. [PMID: 36159619 PMCID: PMC9453277 DOI: 10.5312/wjo.v13.i8.768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/15/2021] [Accepted: 07/18/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neurogenic heterotopic ossification is an acquired serious complication described in patients with central nervous system disorders and defined by bone formation in non-osseous tissue.
CASE SUMMARY We present an unusual case of a 13-yr-old boy presenting with hip pain and severe gait impairment 5 mo after the diagnosis of hemiplegia following a spontaneous intracerebral haemorrhage. Computed tomography revealed bilateral heterotopic ossification of both the paretic and the non-paretic limbs, with entrapment of the sciatic nerve. The choice of surgical or nonsurgical management of such patients depends on the timing of diagnosis, the symptoms, and the extent of maturation of the ossified lesions. Surgical resection remains the only treatment with proven, evidence-based effectiveness. The choice of surgical approach largely depends on the location of the ossified lesions.
CONCLUSION We believe the plane of dissection presented is a satisfactory option for resection of a posteromedial mass and sciatic nerve release.
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Affiliation(s)
| | - Pedro Jordão
- Department of Orthopaedics, Hospital Dona Estefânia, Lisboa 1169-045, Portugal
| | - Joana Arcângelo
- Department of Orthopaedics, Hospital Dona Estefânia, Lisboa 1169-045, Portugal
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13
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Willburger RE, Brinkhoff F, Nottenkämper J, Krapp J, Oberberg S. Heterotopic ossification after total hip arthroplasty: When is development completed? J Orthop Surg Res 2022; 17:147. [PMID: 35248082 PMCID: PMC8898402 DOI: 10.1186/s13018-022-02959-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Heterotopic ossifications (HO) are a common complication after total hip arthroplasty (THA). Nonsteroidal anti-inflammatory drugs have proven to reduce the occurrence of HO. It is still unclear when the formation of HO is finished. Aim of our study was to answer this question. Methods In a prospective study, the occurrence of periarticular HO was checked during the follow-up (FU) examinations. In total, 75 consecutive patients who underwent THA were included. To ensure a high follow-up rate, only patients with a life expectancy of at least 10 years were included. A medical ossification prophylaxis with mostly etoricoxib (90 mg once daily) was administered. Follow-up examinations were performed at 3 months, 1 year, 3, 5, and 10 years postoperatively. Each time, a clinical and radiological examination was carried out. The HO was graded according to Brooker’s method.
Results Low-grade HO classified by Brooker grade I and II occurred significantly more frequent than HO grade III. In patients with present HO, a possible increase in Brooker stage could further be observed within 3 years postoperatively. After 3 years, the formation of HO was completed in all patients. Conclusion Three years after THA, the formation of HO is complete. After more than 3 years postoperatively, if HO occurs or increases, other triggering causes such as new trauma, periarticular infection, or implant loosening should be considered.
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Yim CR, Uhrich RM, Perez L. Treatment of Temporomandibular Joint Heterotopic Ossificans: A Novel Protocol With Multimodal Therapy Based on Literature Review and Presentation of a Unique Case Reportc. J Oral Maxillofac Surg 2021; 80:869-888. [PMID: 35032438 DOI: 10.1016/j.joms.2021.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to create a treatment protocol for cases of heterotopic ossification (HO) of the temporomandibular joint (TMJ), particularly those refractory to current TMJ HO protocols. In addition, we demonstrate the success of this protocol on a unique case of recurrent HO that failed multiple TMJ HO protocols in the setting of an improvised explosive device (IED) blast in a wounded warrior. METHODS An electronic literature review was conducted via PubMed and Web of Science. Twenty-five studies were identified to provide supporting evidence for a proposed, up-to-date protocol for the treatment of refractory TMJ HO. The authors present a case report of a wounded warrior with HO ankylosis of bilateral TMJs in the setting of IED blast and demonstrate successful use of our surgical and pharmacotherapeutic protocol. RESULTS Based on the literature review, our proposed protocol consists of pharmacotherapy with celecoxib and etidronate, with weekly forced dilation (brisement) and home physical therapy with the TheraBite Jaw Motion Rehab System. Surgically, the TMJ should be treated with two-stage reconstruction using initial polymethyl methacrylate spacers and subsequent total joint reconstruction with custom prostheses, fat grafting, and 3-dimensional-navigated total resection of HO. This protocol was successfully utilized in our patient's refractory HO ankylosed TMJ secondary to IED blast, and the patient's maximal incisal opening was regained and has remained stable 2 years after surgery without recurrent HO. CONCLUSIONS Our method for treatment in this case deviated from the standard TMJ Concepts HO protocol in that it included multimodal pharmacotherapy with celecoxib and etidronate. Based on our literature review and experience, we advise that clinicians utilize our protocol for the management of all craniofacial HO cases, particularly in cases of recurrent HO that fail conventional therapies and/or involving high-order blast trauma.
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Affiliation(s)
- Changmin Richard Yim
- Attending Surgeon, Department Oral & Maxillofacial Surgery, Walter Reed National Military Medical Center.
| | - Ross M Uhrich
- Attending Surgeon, Department Oral & Maxillofacial Surgery, Walter Reed National Military Medical Center & Washington Navy Yard Branch Health Clinic
| | - Leonel Perez
- Program Director and Attending Surgeon, Department of Oral & Maxillofacial Surgery, Walter Reed National Military Medical Center
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Migliorini F, Trivellas A, Eschweiler J, Driessen A, Tingart M, Maffulli N. NSAIDs for Prophylaxis for Heterotopic Ossification After Total Hip Arthroplasty: A Bayesian Network Meta-analysis. Calcif Tissue Int 2021; 108:196-206. [PMID: 33044630 PMCID: PMC7819944 DOI: 10.1007/s00223-020-00763-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
Non-steroidal anti-inflammatory drugs (NSAID) have been recommended to prevent of heterotopic ossification (HO) after total hip arthroplasty (THA), but debates are still ongoing. The present Bayesian network meta-analysis of randomized clinical trials (RCTs) compared all available pathways of NSAID treatment as prophylaxis for HO after THA. The present Bayesian network meta-analysis was conducted according to The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions guidelines. All randomized clinical trials comparing two or more interventions to prevent HO after THA were considered for analysis. HO was classified according to Brooker. The quality of the methodological assessment was performed through the risk of bias summary tool of the Review Manager Software 5.3 (The Cochrane Collaboration, Copenhagen). The network meta-analysis was performed through a STATA routine for Bayesian hierarchical random-effects model analysis, with log odd ratio (LOR) effect measure. Data from 26 studies (6396 THAs; 58% females) were collected. The mean follow-up was 10.50 ± 5.7 months. ANOVA showed good comparability among mean age and gender (P > 0.5). Celecoxib demonstrated the highest rate of Brooker class 0 (LOR 6.96), followed by diclofenac (LOR 6.94). Naproxen demonstrated the lowest rate of Brooker I HO (LOR 2.82), followed by celecoxib (LOR 3.52). Celecoxib demonstrated lowest rate of Brooker class II HO (LOR 1.66), class III (LOR), and class IV (LOR 0.25). The equation for global linearity detected no statistically significant inconsistency (P > 0.5) in all the comparisons. The present Bayesian network meta-analysis encourages the use of celecoxib as a prophylaxis for HO. These conclusions must be interpreted in light of the limitations of the present study. Future investigations are required to establish more definitely the role of celecoxib.Level of Evidence: I, Bayesian network analysis of RCTs.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelstr. 31, 52074, Aachen, Germany
| | - Andromahi Trivellas
- Department of Orthopaedics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Jörg Eschweiler
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelstr. 31, 52074, Aachen, Germany
| | - Arne Driessen
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelstr. 31, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelstr. 31, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England.
- Barts and the London School of Medicine and Dentistry, Mile End Hospital, Centre for Sports and Exercise Medicine, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England.
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Hu ZH, Chen W, Sun JN, Zhang Y, Zhang Y, Chen XY, Feng S. Radiotherapy for the prophylaxis of heterotopic ossification after total hip arthroplasty: A systematic review and meta-analysis of randomized controlled trails. Med Dosim 2020; 46:65-73. [PMID: 32928622 DOI: 10.1016/j.meddos.2020.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 01/14/2023]
Abstract
Heterotopic ossification (HO) refers to the formation of lamellar bone in soft tissues and is a significant complication after total hip arthroplasty (THA). Radiotherapy has been proven as an effective prophylaxis especially for those patients with high risk of HO after THA. However the dose, timing, and frequency of radiation have yet to be determined. To compare HO progressions with different radiotherapy strategies and explore an optimal radiation option. We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trails (through December 1, 2019; no language restrictions) collecting patients who accepted prophylaxis radiation for whom HO progression outcomes were reported. Of 87 identified studies, 10 randomized controlled trails including 1203 patients and 1268 hips were taken to this analysis. Compared with the low biologically effective radiation dose group (biologically effective dose [BED] < 20 Gy), the medium biologically effective radiation dose group (20 Gy ≤ BED ≤ 24 Gy) had statistically significant difference on the prophylaxis of HO (p = 0.003). But for overall incidence of HO, there was no statistically significant difference between low BED group and high BED group (BED > 24, p = 0.21). There was statistically significant reduction in the prophylaxis of HO progression with multiple fractions as opposed to single fraction radiotherapy (p = 0.04). Hips with preoperative radiation were no more likely to observe HO progression than those with postoperative radiotherapy (p = 0.43). Radiotherapy with medium dose (20 Gy ≤ BED ≤ 24 Gy) after THA is an effective dose for preventing HO. In the prophylaxis of HO, multiple fractions seem to be more effective than single fraction radiation. Preoperative radiotherapy could prevent HO progression with the same efficacy postoperative.
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Affiliation(s)
- Zheng-Hao Hu
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China
| | - Wang Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China
| | - Jian-Ning Sun
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China
| | - Ye Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China
| | - Yu Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China
| | - Xiang-Yang Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China.
| | - Shuo Feng
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China.
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Georhakopoulos I, Kouloulias V, Kougiountzopoulou A, Platoni K, Antypas C, Liakouli Z, Nikoloudi S, Kelekis N, Moulopoulou LE, Zygogianni A. Radiation therapy for the prevention of heterotopic ossification: Efficacy and toxicity of single fraction radiotherapy. Orthop Rev (Pavia) 2020; 12:8577. [PMID: 32922703 PMCID: PMC7461644 DOI: 10.4081/or.2020.8577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/01/2020] [Indexed: 01/05/2023] Open
Abstract
Numerous nonmalignant diseases can be treated with radiation therapy (RT). Among them, Heterotopic Ossification (HO) is a benign condition resulting from several causes that can be successfully managed with ionizing radiation. More often seen in the hip area after major surgical procedures, HO is of major concern as it can lead to functional disorders, pain and even to joint ankylosis. We retrospectively analyzed the outcome of therapeutic irradiation for the prevention of HO in 14 patients treated in our hospital between 2005 and 2011. All patients were irradiated with a dose ranging from 7 to10 Gy in a single fraction for prevention of HO after surgery. After a median follow up of 126 months (range 96 – 156 months) none of our patients developed HO. Impaired wound healing or other post surgery complications like trochanteric nonunion were not observed. A single fraction of RT seems to be a sufficient, cost effective and safe treatment regimen. In our study we report excellent results as none of our patients developed HO.
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Affiliation(s)
- Ioannis Georhakopoulos
- National and Kapodistrian University of Athens, Medical School, 2 Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, Athens
| | - Vasilios Kouloulias
- National and Kapodistrian University of Athens, Medical School, 2 Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, Athens
| | - Andromachi Kougiountzopoulou
- National and Kapodistrian University of Athens, Medical School, 2 Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, Athens
| | - Kalliopi Platoni
- National and Kapodistrian University of Athens, Medical School, 2 Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, Athens
| | - Christos Antypas
- National and Kapodistrian University of Athens, Medical School, 1 Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Athens, Greece
| | - Zoi Liakouli
- National and Kapodistrian University of Athens, Medical School, 1 Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Athens, Greece
| | - Stiliani Nikoloudi
- National and Kapodistrian University of Athens, Medical School, 1 Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Athens, Greece
| | - Nikolaos Kelekis
- National and Kapodistrian University of Athens, Medical School, 2 Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, Athens
| | - Lia Evangelia Moulopoulou
- National and Kapodistrian University of Athens, Medical School, 1 Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Athens, Greece
| | - Anna Zygogianni
- National and Kapodistrian University of Athens, Medical School, 1 Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Athens, Greece
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Resection of hip heterotrophic ossification leads to resolution of autonomic nervous system dysfunction in a patient with spinal Charcot arthropathy: a case report. Spinal Cord Ser Cases 2020; 6:41. [PMID: 32404876 DOI: 10.1038/s41394-020-0286-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Patients with complete spinal cord injury (SCI) may develop concurrent sequalae that interact and share symptoms; thus, a careful approach to diagnosis and management of new symptoms is crucial. CASE PRESENTATION A patient with prior T4 complete SCI presented with progressive autonomic nervous system (ANS) dysfunction. The initial differential diagnosis included syringomyelia and lumbar Charcot arthropathy. He had comorbid heterotopic ossification (HO) of the left hip. Surprisingly, his autonomic symptoms resolved following resection of the HO. In hindsight, loss of motion through the hip caused by HO may have led to hinging through a previously asymptomatic lumbar Charcot joint, causing dysautonomia. DISCUSSION ANS dysfunction is a disabling sequela of complete SCI and has a broad differential diagnosis. Hip immobility may be an indirect and overlooked cause due to the mechanical relationship between the hip and the lumbar spine.
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Schwarze M, Merle C, Glanzmann P, Schiltenwolf M. [Omitted prophylaxis of heterotopic ossification]. DER ORTHOPADE 2020; 49:815-817. [PMID: 32372225 DOI: 10.1007/s00132-020-03919-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Schwarze
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - C Merle
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - P Glanzmann
- Gutachterkommission Bezirksärztekammer Nordbaden, Karlsruhe, Deutschland
| | - M Schiltenwolf
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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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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