Heterotopic Ossification Following Arthroplasty for Femoral Neck Fracture

Does drainage affect development of heterotopic ossification after total hip arthroplasty?

OBJECTIVE

To investigate the effect of drainage on heterotopic ossification (HO) after total hip arthroplasty (THA) and to evaluate other postoperative complications and joint dysfunction between patients with and without drainage.

METHODS

In this retrospective cohort study, the medical records of patients who underwent THA from 2017 to 2019 were reviewed. The patients were divided into a drainage group and non-drainage group. Standard preoperative anteroposterior and lateral radiographs were assessed by senior radiologists for HO analysis. Clinical indicators included the hemoglobin concentration, superficial infection, blood transfusion, hematoma formation, hip range of motion (ROM), erythrocyte sedimentation rate, C-reactive protein concentration, dressing changes, visual analogue scale score, and Harris Hip Score (HHS).

RESULTS

The incidence of HO was significantly higher in the drainage than non-drainage group (32.0% vs. 16.3%). The presence of severe HO (Brooker grade III or IV) was also different between the groups. Patients in the non-drainage group had smaller ROM early after surgery, but the final ROM and HHS did not differ significantly between the groups.

CONCLUSIONS

The rate and degree of HO after THA were significantly different between patients with and without drainage. There is no added advantage of closed suction drainage over no drainage in primary THA.

Are there really specific risk factors for heterotopic ossifications? A case report of 'non-risk factor' after total hip replacement

Femoral neck fractures are one of the most common fractures in the elderly population. Due to frequent complications of the fixation of these fractures, patients are more and more often eligible for hip replacement surgery. One of the most frequently mentioned postoperative complication is the formation of heterotopic ossification. This case report describes as a 70-year-old male patient that presented with an old hip fracture accompanied by a mild craniocerebral trauma. The patient underwent total cementless hip arthroplasty followed by rehabilitation. At 8 months after surgery, the patient was diagnosed with Brooker IV° heterotopic ossification in the area of the operated hip joint. Due to the persistent pain and complete loss of mobility in the operated joint, computed tomography imaging was performed and the patient was recommended for a revision surgery. The procedure was performed 14 months after the original surgical treatment, resulting in a significant improvement in the range of motion and reduction of pain.

Total hip arthroplasty or hemiarthroplasty for femoral neck fractures in elderly patients with neuromuscular imbalance

AIM

This study aimed at comparing clinical outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in elderly patients with neuromuscular imbalance (stroke, Parkinsonism, etc.).

METHODS

A total of 226 elderly patients with neuromuscular imbalance and femoral neck fractures treated with THA or HA were recruited at a single center, and their clinical data retrospectively reviewed. Mean follow-up time was 40.5 months (range 24-78), the primary outcome was secondary hip procedure while secondary outcomes included function, pain, health-related quality of life, complications, and death. Kaplan-Meier survival curves were used to determine the estimated survivorship, with re-operation as the end point. Logistic regression analyses were performed to assess the effects of different surgical procedures on mortality while linear regression analysis was used to evaluate the function, pain and quality of life.

RESULTS

Kaplan-Meier survivorship, with an end point of re-operation for any reason in the THA group, was 90.3% (95% CI 82.3-98.3), which was not significantly different from 95.9% (95% CI 93.0-98.8) for the HA group (p = 0.137). The most common cause of re-operation in both groups was dislocation. There were no significant differences with regards to postoperative complications (including dislocation). Compared to HA, THA exhibited better functional outcomes, quality of life and low pain intensity. Notably, there was no difference in 2 year mortality rates between the groups, however, HA was associated with a higher mortality rate beyond 2 years (OR 0.137; 95% CI 0.030-0.630; p = 0.011).

CONCLUSION

THA is an effective therapeutic procedure for femoral neck fractures in elderly patients with neuromuscular imbalance.