Incidence and location of heterotopic ossification following hip arthroscopy

Zheng, Long; Hwang, Jung-Mo; Hwang, Deuk-Soo; Kang, Chan; Lee, Jeong-Kil; Park, Young-Cheol

doi:10.1186/s12891-020-3150-7

Cited by 10 publications

(12 citation statements)

References 24 publications

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“…42,81 Although widely studied, the exact mechanism by which HO develops has not yet been well established. 3,27,81,88 A suggested model is that the interaction between the injured periosteum and necrotic or damaged muscle may induce periosteal bone production. 2 Additionally, direct trauma to the soft tissue causes the release of bone morphogenic protein 2, which upregulates the release of inflammatory markers; this results in the recruitment of immune cells and the initiation of processes essential for nerve remodeling, fibroproliferation, and angiogenesis, which are necessary for HO formation.…”

Section: Resultsmentioning

confidence: 99%

“…69 In a series of 327 patients, a recent study found 14 cases (4.28%) of radiographically confirmed HO after hip arthroscopy, with 12 patients asymptomatic at the last follow-up. 88 In most cases, HO was in the central area of the arthroscopic portals or capsulotomy. Two patients with Brooker grade 2 disease required revision hip arthroscopy to excise symptomatic HO.…”

Section: Clinical Findingsmentioning

confidence: 99%

“…13 These formations of bone are radiographically evident by 6 weeks and typically cease to progress in development after 12 to 24 weeks. 3,4,47,88…”

Section: Pathophysiologymentioning

confidence: 99%

“…Intrinsic factors are male sex, a history of HO, and hypertrophic osteoarthritis. 3,[6][7][8]27,42,64,88 Other postulated factors include hips with markedly diminished range of motion, age >60 years, and coexisting bony pathologies, such as ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, and Paget disease. 22,32,52,63 Relative tissue hypoxia has been associated with periosteal bone formation, placing smokers and patients with chronic obstructive pulmonary disease at an inherently higher risk profile.…”

Section: Risk Factorsmentioning

confidence: 99%

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Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature

Zhou

Gee

Hansen

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Heterotopic ossification (HO) is the formation of bone in soft tissue resultant from inflammatory processes. Lesion formation after arthroscopic procedures is an uncommon but challenging complication. Optimal prophylaxis and management strategies have not been clearly defined. Purpose: To present a scoping review of the pathophysiology, risk factors, diagnostic modalities, prophylaxis recommendations, and current treatment practices concerning HO after arthroscopic management of orthopaedic injuries. Study Design: Scoping review; Level of evidence, 4. Methods: A scoping review via a PubMed search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The search strategy was based on the terms “heterotopic ossification” AND “arthroscopy.” The clinical outcomes review included studies on the arthroscopic management of orthopaedic injuries in which the primary subject matter or a secondary outcome was the development of HO. An analysis of the pathophysiology, diagnostic modalities, and management options was reported. Results: A total of 43 studies (33,065 patients) reported on HO after hip arthroscopy, while 21 (83 patients) collectively reported on HO after arthroscopic procedures to the shoulder, elbow, knee, or ankle; however, management techniques were not standardized. Identified risk factors for HO included male sex and mixed impingement pathology, while intraoperative capsular management was not suggested as a contributing factor. Diagnosis of ossification foci was performed using radiography and computed tomography. The rate of HO after hip arthroscopy procedures approached 46% without prophylaxis, and administration of nonsteroidal anti-inflammatory drugs (NSAIDs) decreased occurrence rates to 4% but carries associated risks. External beam radiation has not been exclusively studied for use after arthroscopic procedures. Conclusion: HO is a known complication after arthroscopic management of orthopaedic injuries. NSAID prophylaxis has been demonstrated to be effective after hip arthroscopy procedures. Patients with persistent symptoms and mature lesions may be indicated for surgical excision, although variability is present in patient-reported outcome scores postoperatively.

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Section: Resultsmentioning

confidence: 99%

Section: Clinical Findingsmentioning

confidence: 99%

“…13 These formations of bone are radiographically evident by 6 weeks and typically cease to progress in development after 12 to 24 weeks. 3,4,47,88…”

Section: Pathophysiologymentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature

Zhou

Gee

Hansen

et al. 2022

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…51 These complications are uncommon in arthroscopy. 52 Maqungo et al reported a prospective case series of ten patients treated with surgical hip dislocation for removal of retained intraarticular bullets in the hip. 53 In this series, average blood loss was noted to be 255 ml, wound infection in one patient was noted following surgery, and average length of stay was noted to be 12.8 days for these 10 patients.…”

Section: Discussionmentioning

confidence: 99%