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Heterotopic ossification following hip arthroplasty: a comparative radiographic study about its development with the use of three different kinds of implants.

Biz C, Pavan D, Frizziero A, Baban A, Iacobellis C - J Orthop Surg Res (2015)

Bottom Line: Within the population that developed HO, data were assessed for correlation with severity of ossification graded according to Brooker classification.The overall incidence of HOs was 59.91 %.The factors increasing their incidence in the univariate analysis were as follows: lower age of the patients with HO (mean 77.6 years, p = 0.0018) than those subjects who did not develop HO (mean 80.2 years); male gender (64.4 %, p = 0.1011); diagnosis of coxarthrosis (72.7 %, p = 0.0001) compared to femur neck fracture (55.9 %, p = 0.0001); presence of previous HO (76.2 %, p = 0.0260); lateral approach (65.5 %) as opposed to anterior-lateral approach (55.6 %, p = 0.0163); and ceramic-ceramic THR (68.1 %) and TriboFit(®) (67.0 %) compared to endoprosthesis (51.3 %, p = 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy. carlo.biz@unipd.it.

ABSTRACT

Background: Our purpose was to record the incidence of heterotopic ossification (HO) following hip replacement by different variables to identify patient groups that are likely to develop HO in the absence of a prophylactic protocol.

Methods: Radiographically, we studied 651 patients having undergone hip joint replacement, evaluating three kinds of implants: ceramic-ceramic-coupled total hip replacement (THR), TriboFit (®) with polycarbonate urethane-ceramic coupling and endoprosthesis. Each patient was analysed for HO development by age, gender, diagnosis, presence of previous ossifications, surgical approach and kind of implant. Within the population that developed HO, data were assessed for correlation with severity of ossification graded according to Brooker classification.

Results: The overall incidence of HOs was 59.91 %. The factors increasing their incidence in the univariate analysis were as follows: lower age of the patients with HO (mean 77.6 years, p = 0.0018) than those subjects who did not develop HO (mean 80.2 years); male gender (64.4 %, p = 0.1011); diagnosis of coxarthrosis (72.7 %, p = 0.0001) compared to femur neck fracture (55.9 %, p = 0.0001); presence of previous HO (76.2 %, p = 0.0260); lateral approach (65.5 %) as opposed to anterior-lateral approach (55.6 %, p = 0.0163); and ceramic-ceramic THR (68.1 %) and TriboFit(®) (67.0 %) compared to endoprosthesis (51.3 %, p = 0.0001). During multivariate analysis, the presence of HO after previous hip surgery (p = 0.0324) and the kind of implant (p = 0.0004) showed to be independent risk factors for the development of HO. Analysing the population that developed HO, we found that the severity of ossification by Brooker classification was influenced by gender (p = 0.0478) and kind of implant (p = 0.0093).

Conclusions: In agreement with the literature, our radiographic study confirms the following risk factors of HO development in absence of any prophylactic treatment: male gender, diagnosis of coxarthrosis compared to femur neck fracture, previous HO, surgical approach and kind of implant. In particular, Hardinge-Bauer and Watson-Jones surgical approaches, characterized by a wide exposure of the coxofemoral joint, and ceramic-ceramic THR and TriboFit(®) implants significantly increase the development of HO.

No MeSH data available.


Related in: MedlinePlus

Distribution of the diagnoses of a diseased hip. a Main diagnoses. b Diagnoses included under “others”
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Fig1: Distribution of the diagnoses of a diseased hip. a Main diagnoses. b Diagnoses included under “others”

Mentions: The analysed cohort consisted of 440 women (67.59 %) and 211 men (32.41 %) with a mean patient age of 78.7 years (range 19–98 years) at the time of surgery. Diagnosis of diseased hip included traumatic femoral neck fracture in 517 patients (79.42 %), coxarthrosis in 99 patients (15.21 %) and other diagnoses in 35 patients (5.37 %). The latter included 11 femoral head necrosis, 1 hip instability, 2 painful THRs, 6 hip surgical revisions for prosthesis mobilization, 3 surgeries after spacer positioning, 2 pathological fractures, 1 revision for intolerance to metal, 1 hip dysplasia, 2 acetabular fractures, 1 posttraumatic stiffness of the hip, 1 pseudoarthrosis after femoral neck surgery with percutaneous screws, 1 hip arthritis, 2 previous femoral neck surgeries with percutaneous screws and 1 pertrochanteric fracture with severe coxarthrosis (Fig. 1). Forty-two patients (6.45 %) had already developed HO after previous surgery of the ipsilateral and/or contralateral hip. With regard to the population which underwent ceramic-ceramic THR, 20 (8.73 %) patients had already undergone a previous surgical intervention of the ipsilateral coxofemoral joint. All operations were carried out adopting one of the following two surgical approaches to the hip:Fig. 1


Heterotopic ossification following hip arthroplasty: a comparative radiographic study about its development with the use of three different kinds of implants.

Biz C, Pavan D, Frizziero A, Baban A, Iacobellis C - J Orthop Surg Res (2015)

Distribution of the diagnoses of a diseased hip. a Main diagnoses. b Diagnoses included under “others”
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4644335&req=5

Fig1: Distribution of the diagnoses of a diseased hip. a Main diagnoses. b Diagnoses included under “others”
Mentions: The analysed cohort consisted of 440 women (67.59 %) and 211 men (32.41 %) with a mean patient age of 78.7 years (range 19–98 years) at the time of surgery. Diagnosis of diseased hip included traumatic femoral neck fracture in 517 patients (79.42 %), coxarthrosis in 99 patients (15.21 %) and other diagnoses in 35 patients (5.37 %). The latter included 11 femoral head necrosis, 1 hip instability, 2 painful THRs, 6 hip surgical revisions for prosthesis mobilization, 3 surgeries after spacer positioning, 2 pathological fractures, 1 revision for intolerance to metal, 1 hip dysplasia, 2 acetabular fractures, 1 posttraumatic stiffness of the hip, 1 pseudoarthrosis after femoral neck surgery with percutaneous screws, 1 hip arthritis, 2 previous femoral neck surgeries with percutaneous screws and 1 pertrochanteric fracture with severe coxarthrosis (Fig. 1). Forty-two patients (6.45 %) had already developed HO after previous surgery of the ipsilateral and/or contralateral hip. With regard to the population which underwent ceramic-ceramic THR, 20 (8.73 %) patients had already undergone a previous surgical intervention of the ipsilateral coxofemoral joint. All operations were carried out adopting one of the following two surgical approaches to the hip:Fig. 1

Bottom Line: Within the population that developed HO, data were assessed for correlation with severity of ossification graded according to Brooker classification.The overall incidence of HOs was 59.91 %.The factors increasing their incidence in the univariate analysis were as follows: lower age of the patients with HO (mean 77.6 years, p = 0.0018) than those subjects who did not develop HO (mean 80.2 years); male gender (64.4 %, p = 0.1011); diagnosis of coxarthrosis (72.7 %, p = 0.0001) compared to femur neck fracture (55.9 %, p = 0.0001); presence of previous HO (76.2 %, p = 0.0260); lateral approach (65.5 %) as opposed to anterior-lateral approach (55.6 %, p = 0.0163); and ceramic-ceramic THR (68.1 %) and TriboFit(®) (67.0 %) compared to endoprosthesis (51.3 %, p = 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy. carlo.biz@unipd.it.

ABSTRACT

Background: Our purpose was to record the incidence of heterotopic ossification (HO) following hip replacement by different variables to identify patient groups that are likely to develop HO in the absence of a prophylactic protocol.

Methods: Radiographically, we studied 651 patients having undergone hip joint replacement, evaluating three kinds of implants: ceramic-ceramic-coupled total hip replacement (THR), TriboFit (®) with polycarbonate urethane-ceramic coupling and endoprosthesis. Each patient was analysed for HO development by age, gender, diagnosis, presence of previous ossifications, surgical approach and kind of implant. Within the population that developed HO, data were assessed for correlation with severity of ossification graded according to Brooker classification.

Results: The overall incidence of HOs was 59.91 %. The factors increasing their incidence in the univariate analysis were as follows: lower age of the patients with HO (mean 77.6 years, p = 0.0018) than those subjects who did not develop HO (mean 80.2 years); male gender (64.4 %, p = 0.1011); diagnosis of coxarthrosis (72.7 %, p = 0.0001) compared to femur neck fracture (55.9 %, p = 0.0001); presence of previous HO (76.2 %, p = 0.0260); lateral approach (65.5 %) as opposed to anterior-lateral approach (55.6 %, p = 0.0163); and ceramic-ceramic THR (68.1 %) and TriboFit(®) (67.0 %) compared to endoprosthesis (51.3 %, p = 0.0001). During multivariate analysis, the presence of HO after previous hip surgery (p = 0.0324) and the kind of implant (p = 0.0004) showed to be independent risk factors for the development of HO. Analysing the population that developed HO, we found that the severity of ossification by Brooker classification was influenced by gender (p = 0.0478) and kind of implant (p = 0.0093).

Conclusions: In agreement with the literature, our radiographic study confirms the following risk factors of HO development in absence of any prophylactic treatment: male gender, diagnosis of coxarthrosis compared to femur neck fracture, previous HO, surgical approach and kind of implant. In particular, Hardinge-Bauer and Watson-Jones surgical approaches, characterized by a wide exposure of the coxofemoral joint, and ceramic-ceramic THR and TriboFit(®) implants significantly increase the development of HO.

No MeSH data available.


Related in: MedlinePlus