Heterotopic Ossification in Hip Arthroscopy: an Updated Review

Background: Recent studies have shown that assessment of the lateral center-edge angle (LCEA) between 18° and 25° is not sufficient to adequately classify mildly dysplastic hips and that further radiological features should be considered. However, no correlation between different morphologic features and clinical outcomes has been investigated so far. Purpose: To analyze the clinical outcomes of patients with different subtypes of borderline dysplastic hips who underwent arthroscopic surgery. Study Design: Cohort study; Level of evidence, 3. Methods: We examined patients with an LCEA between 18° and 25° who underwent arthroscopic treatment for femoroacetabular impingement syndrome between January 2015 and December 2016. A hierarchical cluster analysis was performed to identify hip morphologic subtypes according to radiographic parameters, including the LCEA, femoro-epiphyseal acetabular roof (FEAR) index, anterior and posterior wall indices (AWI and PWI), Tönnis angle, alpha angle, and femoral neck-shaft angle. In addition, the International Hip Outcome Tool 12 (iHOT-12) and a visual analog scale (VAS) for pain were applied preoperatively and at follow-up, and the results were compared among the different clusters. Previously reported minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) values were used to determine clinically significant improvements. Results: A total of 40 patients were identified. Of these, 36 patients were available for evaluation at a mean follow-up of 43.8 months. In total, 4 sex-independent clusters with different morphologic patterns of the hip were identified: cluster 1, unstable anterolateral deficiency (FEAR index >2°, AWI <0.35); cluster 2, stable anterolateral deficiency (FEAR index <2°, AWI <0.35); cluster 3, stable lateral deficiency (FEAR index >2°, normal AWI and PWI); and cluster 4, stable posterolateral deficiency (FEAR index <2°, PWI <0.85). At follow-up, clusters 1, 2, and 3 showed significantly improved iHOT-12 ( P < .0001) and VAS pain ( P < .0001) scores, and cluster 4 showed no significant improvements. The MCID of 15.2 points was achieved by all patients in clusters 2 and 3, by 63% of patients in cluster 1, and by 23% of patients in cluster 4. Clusters 2 and 3 differed significantly from clusters 1 and 4 ( P = .02). A postoperative PASS score of 60 was achieved by all patients in cluster 3, by 86% of patients in cluster 2, by 63% of patients in cluster 1, and by 20% of patients in cluster 4. The differences between the groups were statistically significant ( P = .01). Conclusion: Arthroscopic surgery yielded good results in the treatment of stable borderline hip dysplasia with anterolateral and lateral deficiency. In contrast, borderline hip dysplasia with acetabular retroversion showed no improvements after arthroscopic therapy. This study underlines the need for an accurate analysis of all possible radiological signs to adequately classify borderline dysplastic hips.

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“…Heterotopic ossification prophylaxis with nonsteroidal anti-inflammatory drugs was recommended for 2 to 3 weeks. 24,50…”

Section: Methodsmentioning

confidence: 99%

Is Hip Arthroscopy an Adequate Therapy for the Borderline Dysplastic Hip? Correlation Between Radiologic Findings and Clinical Outcomes

Zimmerer

Schneider

Nietschke

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Most HO is asymptomatic and only requires excision in rare settings. 3 In addition, although the PRECISION (Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen or Naproxen) trial showed noninferiority of celecoxib to naproxen, 4 Celecoxib has fewer gastrointestinal effects than naproxen, and is (probably) just as safe from a cardiovascular standpoint, 4 but that is different than saying celecoxib is a benign drug. 6 Does prophylactic treatment justify the risks?…”

Section: See Related Article On Page 453mentioning

confidence: 99%

Editorial Commentary: The Curious Incident of the Bone in the Soft Tissue: Is Heterotopic Ossification After Hip Arthroscopy an Interesting Finding or Is It a Complication?

Ochiai

Adib

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Heterotopic ossification (HO) following hip arthroscopy is a common finding. Naproxen and celecoxib have both been found to decrease the incidence of HO. Whether this makes a clinical difference to outcomes is unclear at this time. A critical weighing of risks and benefits with regard to HO prophylaxis is warranted. Although the authors will personally continue to use nonsteroidal anti-inflammatory drugs for HO prophylaxis, it is up to the discerning reader to draw her/his own conclusion.

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“…Heterotopic ossification (HO) is a common complication following hip arthroscopy with an incidence of up to 44% [1,2]. Reported risk factors include male gender, femoral neck osteochondroplasty, and unrepaired capsulotomy [1][2][3][4]. Current treatments range from nonoperative management of asymptomatic lesions, ultrasound guided lavage for a small symptomatic HO lesion, and revision surgery for excision of painful lesions [5].…”

Section: Introductionmentioning

confidence: 99%

A Novel Radiographic Finding of Intracapsular Heterotopic Ossification: A Report of Two Cases

Wilson

Goodell

Kollmorgen

2020

Cureus

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Symptomatic heterotopic ossification (HO) is a complication of hip arthroscopy that occurs in less than 1% of cases. To our knowledge, there are no reported cases of symptomatic intracapsular HO. We present 2 patients with a radiographic finding associated with intracapsular HO. Both patients underwent revision hip arthroscopy and required capsular reconstruction due to void of the iliofemoral ligament following excision of HO. We believe this radiographic finding may be useful to hip preservationists as it may be associated with capsular deficiency necessitating capsular reconstruction upon revision hip arthroscopy.

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Heterotopic Ossification in Hip Arthroscopy: an Updated Review

Cited by 22 publications

References 29 publications

Is Hip Arthroscopy an Adequate Therapy for the Borderline Dysplastic Hip? Correlation Between Radiologic Findings and Clinical Outcomes

Is Hip Arthroscopy an Adequate Therapy for the Borderline Dysplastic Hip? Correlation Between Radiologic Findings and Clinical Outcomes

Editorial Commentary: The Curious Incident of the Bone in the Soft Tissue: Is Heterotopic Ossification After Hip Arthroscopy an Interesting Finding or Is It a Complication?

A Novel Radiographic Finding of Intracapsular Heterotopic Ossification: A Report of Two Cases

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