Clinical Significance of the Heterotopic Ossification After Total Hip Arthroplasty

Abstract

Heterotopic ossification represents one of the most frequent complications following any type of hip arthroplasty. However, disagreement exists regarding the clinical significance of heterotopic ossification after total hip arthroplasty (THA). This study evaluated the effect of different grades of heterotopic ossification on range of hip motion, pain, and the clinical outcome in patients after THA. The study included 198 patients with primary THA because of unilateral hip osteoarthritis, followed for a minimum of 1 year after THA. Diagnosis and classification of heterotopic ossification according to Brooker was achieved on anteroposterior radiograph of the hips 1 year postoperatively. The clinical outcome was assessed at 1-year follow-up with the use of the Harris hip score. Pain was assessed as the pain component of the Harris hip score. Hip range of motion was measured passively in the lying position with a goniometer and recorded in degrees according to the method suggested by the American Academy of Orthopaedic Surgeons 1988. The incidence of heterotopic ossification was 47% and the incidence of severe ossification was 11%. The severe heterotopic ossification significantly reduced clinical outcome, overall range of hip motion and certain components such as flexion, abduction and external rotation, but had no significant effect on pain, while the lower degree of ossification did not significantly influence the clinical outcome, hip motion and pain. This study has shown that only severe heterotopic ossification is of clinical significance.

Dislocation Rate Fallowing Posterior Total Hip Arthroplasty with Intra-Osseous Soft Tissue Repair

“…Other reported post operative complications were comparable to international figure & include; 0% for sciatic nerve injury [58,60,61], & DVT [60,62,63]. While is 3.73% for; infection [62], intra-operative fracture [62][63][64][65] & hetero-topic ossification [4,[66][67]. One patient was died with cardiac shock & represent 3.73% which is also comparable to international figure [14,67].…”

Incidence and risk factors for heterotopic ossification after total hip arthroplasty: a meta-analysis

“…However, some limitations such as a small sample size and the inclusion of a single or very few potential risk factors in individual study have to be mentioned. In addition, some of the results obtained from individual studies were inconclusive, inconsistent and even conflicting, such as when using cemented implants [17][18][19]. Therefore, it remains uncertain how much capacity these identified factors from individual studies have in predicting clinical HO after THA.…”

In Brief: Classifications in Brief: Brooker Classification of Heterotopic Ossification After Total Hip Arthroplasty

“…Heterotopic ossification (HO) is a common complication after THA with a frequency of 26% to 41% reported in recent studies [2,20,21]. The majority of HO is not clinically important, but severe HO may lead to decreased hip ROM [12] and increased pain [7].…”

“…A limitation of the Brooker classification is that it correlates poorly with outcome measures such as the HHS. This is likely the result of the observation that HO is rarely clinically important until it severely impedes patient ROM [12]. Furthermore, the extent to which the Brooker classification is able to predict propensity toward future HO in individual patients undergoing subsequent surgical procedures has not been studied.…”