Influence of surgical approach on heterotopic ossification after total hip arthroplasty – is minimal invasive better? A case control study

Abstract

BackgroundHeterotopic ossification (HO) is a well-known complication after total hip arthroplasty (THA).Recently, the trend is to operate THA minimally invasive being less traumatic than standard approaches and promising a faster return to activity. The purpose of the study was to investigate if minimal invasive surgery (MIS), leads also to less HO after THA.MethodsThis retrospective study included 134 consecutive patients undergoing THA. In 42 (31.3%) patients a standard modified anterolateral (STD-Watson-Jones), in 28 (20.9%) patients a standard transgluteal Bauer approach (STD-Bauer), in 39 (29.1%) a MIS direct anterior approach (AMIS) and in 25 (18.7%) patients a MIS anterolateral (MIS-AL) approach was used. Standard preoperative anterior-posterior and lateral radiographs were assessed for occurrence of HO. HO was classified according to Brooker. In addition, short- and long-term adverse events were noted. Data was statistically analyzed using Chi-square tests, analysis of variance, multivariate data analysis and Pearson’s correlation (p < 0.05).ResultsOverall, HO was found in 38 caucasian patients (28.4%) after THA. The STD-Watson-Jones group showed the highest HO rate (45.2% n = 19) with a significant difference to the AMIS (23.1% n = 9) and STD-Bauer approach (14.3% n = 4). No statistical difference was found to the MIS-AL approach (24.0% n = 6). Postoperative complications did not differ significantly except for a higher incidence of Trendelenburg`s sign in STD-Bauer.ConclusionsThe rate and degree of HO after THA were significantly different with regards to the surgical approach. The standard modified anterolateral approach resulted in the highest HO rate, however, MIS approaches showed higher HO rates than the STD-Bauer.

Incidence of Heterotopic Ossification in Anterior Based Muscle Sparing Total Hip Arthroplasty: A Retrospective Radiographic Review

“…HO development following ABMS THA surgery was 86/233, or 36.9%, which is comparable to studies of direct anterior [16] and posterior THA [17], and lower than the prevalence with a direct lateral approach with (Liverpool) [18] and without (Hardinge-Bauer) [19] bone attachment. Our results demonstrate higher rates of HO compared with two other reports of the ABMS technique [20,21], and we are unsure of the reason for these differences. It is fair to say, however, that there is significant variation in the reported incidence of HO in the literature; and this is likely related to small study sizes, variations in the methodology of measurement, differing implant geometries, and confounding patient risk factors, to name some examples.…”

Severity of heterotopic ossification in patients following surgery for hip fracture: a retrospective observational study

“…Means to prevent or reduce HO have been explored and include pre-operative [3] and post-operative irradiation [4] and the use of non-steroidal anti-inflammatory drugs [5, 6]. Rate and degree of HO after THA were shown to be affected by patient gender [7], surgical approach [8, 9] as well as type of surgery [10]. Moreover, African-American ethnicity has been shown to be an independent risk factor for HO formation after THA [11].…”

Heterotopic ossification and clinical results after total hip arthroplasty using the anterior minimally invasive and anterolateral approaches

“…The problem is particularly apparent in terms of HO. According to the studies comparing the most common approaches, the WJ approach seems to be strongly predisposing patients to ossification [15,19]. According to Newman et al [20], the HO rate after surgery using the anterior MIS approach is 24.3%.…”

“…Heterotopic ossification is believed to be a result of osteoinductive growth factors released due to the trauma of soft tissues [11]. The risk of ossification is estimated at 24% to as high as 32% [12]. Prophylaxis options include selective and non-selective non-steroid anti-inflammatory drugs (i.e.…”