Is Preoperative Radiation Therapy as Effective as Postoperative Radiation Therapy for Heterotopic Ossification Prevention in Acetabular Fractures?

Abstract

Background Prophylactic approaches to prevent heterotopic ossification after acetabular fracture surgery have included indomethacin and/or single-dose external beam radiation therapy administered after surgery. Although preoperative radiation has been used for heterotopic ossification prophylaxis in the THA population, to our knowledge, no studies have compared preoperative and postoperative radiation therapy in the acetabular fracture population. Questions/purposes We determined whether heterotopic ossification frequency and severity were different between patients with acetabular fracture treated with prophylactic radiation therapy preoperatively and postoperatively. Methods Between January 2002 and December 2009, we treated 320 patients with a Kocher-Langenbeck approach for acetabular fractures, of whom 50 (34%) were treated with radiation therapy preoperatively and 96 (66%) postoperatively. Thirty-four (68%) and 71 (74%), respectively, had 6-month radiographs available for review and were included. For hospital logistical reasons, patients who underwent operative treatment on a Friday or Saturday received radiation therapy preoperatively, and all others received it postoperatively. The treatment groups were comparable in terms of most demographic parameters, injury severity, and fracture patterns. Sixmonth postoperative radiographs were reviewed and graded according to Brooker. Followup ranged from 6 to 93 months and 6 to 97 months for the preoperative and postoperative groups, respectively. Post hoc power analysis showed our study was powered to detect a difference of 22% or more between patients with severe heterotopic ossification. Sample size calculations showed 915 subjects would be needed to detect a 5% relative difference in severe heterotopic ossification status between groups. Results We detected no difference in heterotopic ossification frequency between the preoperative (eight of 36, 22%) and postoperative (19 of 71, 27%) groups (p = 0.609). There was also no difference in heterotopic ossification severity between groups (p = 0.666). Two of 36 (6%) in the preoperative group and three of 71 (4%) in the postoperative group developed clinically significant

Does Postoperative Radiation Decrease Heterotopic Ossification After the Kocher-Langenbeck Approach for Acetabular Fracture?

“…In a similar study, when looking at extensile approaches only, Bosse et al [4] found a decrease in the risk of severe HO with the use of radiotherapy. In these two and another study comparing preoperative with postoperative radiotherapy, Brooker Classes III and IV were considered severe [2,4,23]. When comparing radiotherapy with indomethacin, the findings are been less clear.…”

A case of the management of Heterotopic ossification as the result of acetabular fracture in a patient with traumatic brain injury

“…From the morphostructural point of view, we witnessed the sedimentation of calcium salts in nodular or laminar formations, sometimes aggregated in small or large masses, in the context of connective fascial-fat, and periarticular, muscular, and subcutaneous tissues [1][2][3]. In the literature, there are no validated therapeutic algorithms or treatment guidelines clearly defined, which is why there is a heavy reliance on personalized choice for some cases [9][10][11].…”

“…Treatments such as indomethacin (25 mg 3 times a day), radiation therapy (700cGy) and shock waves, decrease the incidence of this complication by 10% [9][10][11][12].…”

“…Originally, bisphosphonates were expected to be of value after hip surgery. To date, there has been no convincing evidence of their benefit despite being used prophylactically [9][10][11]. Depending on the growth's location, orientation, and severity, surgical removal may be possible.…”

“…(a) SF36 preoperative(26,9); (b) SF36 postoperative (45, 1-52, 7). There was a great improvement of the score with satisfaction of the patient.…”