Heterotopic ossification following internal fixation or arthroplasty for displaced femoral neck fractures: a prospective randomized study

Abstract

One hundred hips in 99 patients of 75 years or older, with a displaced femoral neck fracture, were studied for heterotopic ossification (HO). The patients were randomized to either internal fixation or total hip arthroplasty (THA). In the THA group HO was found in 32 of 45 hips compared with 1 of 39 in the internal fixation group (P<0.0012). The frequency of HO after THA corresponds well with findings in other studies on patients receiving THA for osteoarthrosis. In cervical fractures the surgical procedure of total hip replacement seems to be a prerequisite for HO, indicating that the procedure itself is more important than the patient's age and the diagnosis. Severe symptoms due to HO were found in only one patient. HO following THA for a femoral neck fracture is of little clinical importance and prophylaxis is unnecessary.Résumé Nous avons étudié la fréquence des ossification hétérotopiques (OH) dans 100 hanches chez 99 patients âgés de 75 ans ou plus, avec une fracture déplacée du col du fémur. Les patients ont été randomisés pour un traitement soit par fixation interne soit par arthroplastie totale de la hanche. Dans le groupe des arthroplasties on a trouvé 32/45 hanches avec des ossifications et 1/39 dans le groupe fixation interne (P<0.0012). La fréquence des ossifications après arthroplastie correspond à celle retrouvée dans les cas de coxarthrose. Dans les fractures cervicales la procédure de remplacement prothétique paraît être une condition préalable à la survenue d'ossifications, en indiquant que la procédure elle-même est plus importante que l'âge et le diagnostic. Des symptômes graves dus aux ossifications ont été retrouvés seulement chez un patient. Les ossifications hétérotopiques après une prothèse totale de la hanche pour fracture du col du fémur ont peu d'importance et la prophylaxie est inutile.

Heterotopic Ossification Following Arthroplasty for Femoral Neck Fracture

“…U sing prospectively collected data from the HEALTH trial, we investigated the prevalence of HO following arthroplasty for hip fractures as well as the risk of revision surgery and the functional outcomes associated with this condition. Our findings confirm that the development of HO following THA or HA for a femoral neck fracture is fairly common, although the prevalence of 19.9% for any grade of HO at 24 months postoperatively in our study is lower than that in previous reports, in which the prevalence has usually ranged from 27.9% to 86.9% [27][28][29][30][31][32][33][34][35][36][37][38] . The prevalence of severe HO (grade III or IV) was 4.4% (63 of 1,441) in our study, in which only 5 patients (0.35%) had hip ankylosis (grade IV), which is similar to the previously reported prevalence of 3.6% to 7% for grades-III and IV HO following THA or HA 3,[39][40][41] .…”

“…In contrast, there are considerable conflicting data regarding the clinical relevance of Brooker grade-III or IV HO. Several authors have found reduced walking ability, function, and range of motion (especially flexion) 5,20,33,38,44,45 in patients with grade-III or IV HO, without an effect on pain scores 5,8,20,33,38 . A meta-analysis by Neal 5 showed Brooker grade-III and IV HO to have a negative correlation with range of motion and functional outcomes, whereas some authors concluded that only very severe HO (Brooker grade IV) is clinically relevant 6,7,9 .…”

Internal Fixation Compared with Total Hip Replacement for Displaced Femoral Neck Fractures

“…Previous studies concerning this cohort of patients have presented results for only up to two years postoperatively in four papers as well as in a dissertation 4,12,15,16 . The aim of the present study was to evaluate long-term results from a previous study comparing internal fixation and total hip replacement.…”

Unilateral Complete Ossification of Sacrotuberous Ligament

“…[7][8][9][10][11][12] Pathologic ossifications are also reported after total hip arthroplasty, anterior cruciate ligament reconstruction, and hip fracture. [13][14][15] There are very few reports about clinical and radiologic aspects of the ossification of STL. 4,5 Haller et al 16 suggested association between ossification of pelvic ligaments and spinal diffuse idiopathic skeletal hyperostosis.…”