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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

Examples of radiographic high-graded heterotopic ossification for each kind of implant within our cohort. a Ceramic-ceramic-coupled total hip replacement. b TriboFit®. c Endoprosthesis
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Fig4: Examples of radiographic high-graded heterotopic ossification for each kind of implant within our cohort. a Ceramic-ceramic-coupled total hip replacement. b TriboFit®. c Endoprosthesis

Mentions: This study reports retrospective data from the radiographic analysis of a cohort of 651 patients who underwent hip replacement surgery with the aim of evaluating the incidence of HO on the basis of different risk factors in the absence of prophylaxis. Discussing our results together with those reported in literature, another purpose is to suggest possible features that make the patients suitable for preventive measures against HO following hip replacement surgery. Of examined patients, 59.9 % (390/651) developed periarticular HO following hip replacement surgery. This result, apparently negative, does not deviate from the mean value reported in similar studies [1] where patients did not undergo any prophylaxis. Instead, an aspect that seems relevant is the high percentage of cases that showed severe or very severe ossification by Brooker classification (38 %), with a variable incidence reported in the literature [7] between 3 and 55 % (Fig. 4). This result could be justified by the choice of surgical approaches that could have contributed negatively. In this study, only two surgical approaches were examined, anterolateral and lateral, both believed liable to cause a higher incidence of HO by several authors [9, 10].Fig. 4


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)

Examples of radiographic high-graded heterotopic ossification for each kind of implant within our cohort. a Ceramic-ceramic-coupled total hip replacement. b TriboFit®. c Endoprosthesis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Examples of radiographic high-graded heterotopic ossification for each kind of implant within our cohort. a Ceramic-ceramic-coupled total hip replacement. b TriboFit®. c Endoprosthesis
Mentions: This study reports retrospective data from the radiographic analysis of a cohort of 651 patients who underwent hip replacement surgery with the aim of evaluating the incidence of HO on the basis of different risk factors in the absence of prophylaxis. Discussing our results together with those reported in literature, another purpose is to suggest possible features that make the patients suitable for preventive measures against HO following hip replacement surgery. Of examined patients, 59.9 % (390/651) developed periarticular HO following hip replacement surgery. This result, apparently negative, does not deviate from the mean value reported in similar studies [1] where patients did not undergo any prophylaxis. Instead, an aspect that seems relevant is the high percentage of cases that showed severe or very severe ossification by Brooker classification (38 %), with a variable incidence reported in the literature [7] between 3 and 55 % (Fig. 4). This result could be justified by the choice of surgical approaches that could have contributed negatively. In this study, only two surgical approaches were examined, anterolateral and lateral, both believed liable to cause a higher incidence of HO by several authors [9, 10].Fig. 4

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