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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

Case of severe heterotopic ossifications. HOs developed in a patient who had been moved to the emergency room after ceramic-ceramic THR because of her critical condition. The patient remained motionless for 1 month after hip replacement, and 1 year later, heterotopic ossifications were removed (a, b)
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Fig3: Case of severe heterotopic ossifications. HOs developed in a patient who had been moved to the emergency room after ceramic-ceramic THR because of her critical condition. The patient remained motionless for 1 month after hip replacement, and 1 year later, heterotopic ossifications were removed (a, b)

Mentions: Periarticular HO formed in 59.9 % (390/651) of the patients (Fig. 2). Among these, 135 (34.6 %) had mild HO (grade 1, Brooker classification); 107 (27.4 %) had moderate HO (grade 2, Brooker classification); 120 (30.8 %) had severe HO (grade 3, Brooker classification); and 28 (7.2 %) showed very severe HO (grade 4, Brooker classification). The pictures taken at the operating table show grade 4 HOs that developed in a patient of our cohort who was moved to the emergency room because of her critical condition after the operation (Fig. 3).Fig. 2


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)

Case of severe heterotopic ossifications. HOs developed in a patient who had been moved to the emergency room after ceramic-ceramic THR because of her critical condition. The patient remained motionless for 1 month after hip replacement, and 1 year later, heterotopic ossifications were removed (a, b)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Case of severe heterotopic ossifications. HOs developed in a patient who had been moved to the emergency room after ceramic-ceramic THR because of her critical condition. The patient remained motionless for 1 month after hip replacement, and 1 year later, heterotopic ossifications were removed (a, b)
Mentions: Periarticular HO formed in 59.9 % (390/651) of the patients (Fig. 2). Among these, 135 (34.6 %) had mild HO (grade 1, Brooker classification); 107 (27.4 %) had moderate HO (grade 2, Brooker classification); 120 (30.8 %) had severe HO (grade 3, Brooker classification); and 28 (7.2 %) showed very severe HO (grade 4, Brooker classification). The pictures taken at the operating table show grade 4 HOs that developed in a patient of our cohort who was moved to the emergency room because of her critical condition after the operation (Fig. 3).Fig. 2

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