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

Abstract

Background Heterotopic ossification (HO) is a relatively common complication following hip surgery treated with open reduction and internal fixation, total arthroplasty or hemiarthroplasty. Development of HO after hip surgery is an important clinical issue as it can affect functional status. We aimed to determine whether there was association between severity of heterotopic ossification about the hip and the interval between the time of hip fracture and surgery. Materials and methods Our retrospective study included 151 patients (age range 33–95 years) treated for hip fractures by hemiarthroplasty. Medical records were reviewed for time interval to surgery, laterality, surgical approach, and patient age. Patients who had any post-operative complications were excluded. Radiographs were semiquantitatively assessed for the degree of heterotopic ossification based on Brooker Classification (5-point scale). Statistical analysis was performed utilizing Chi-square, Kruskal-Wallis, and Score tests, and also a proportional odds model (significance level set at 0.05). Results Thirty eight patients had no heterotopic ossification, 43 had class 1, 55 had class 2, and 15 had class 3 or greater heterotopic ossification. The majority of patients (59.6%) had surgery within 2 days of acute injury. Severe heterotopic ossification (HO 3+) was associated with the longer interval between the time of acute hip fracture and surgery (median 6 days) vs. median 2 days in all other groups (HO classes 0–2) ( p = 0.0015). The odds ratio and 95% CI for one level higher HO class was 1.296 (1.152, 1.459), which meant that the odds of having HO class one level higher increased by about 29.6% for every one-day increase in the days to surgery. No significant association was found for other variables. Conclusion Class 3 or greater HO was associated with longer time interval between time of acute hip fracture and surgery compared to all other groups (HO class 0–2).

Primary Versus Secondary Radiotherapy for Heterotopic Ossification Prevention About the Elbow

“…Interestingly, although most of these patients had new evidence of radiographic HO after initial resection followed by XRT, none of these patients ultimately required an additional surgery for recurrence of HO, suggesting that XRT may be effective in preventing severe HO in this special population. [21][22][23][24] A 2011 study by Strauss et al used combination radiation and NSAID therapy in 52 patients to prevent elbow HO. They found a 48% incidence of radiographic HO but reported a symptomatic, clinically relevant rate of 0% and ultimately concluded that combination therapy is effective in preventing clinically significant elbow HO.…”

Are there really specific risk factors for heterotopic ossifications? A case report of ‘non-risk factor’ after total hip replacement

“…Numerous studies have shown their effectiveness in reducing ossification. 27 , 28 Considering the possible side-effects of NSAIDs, some authors recommend their reasonable use and the need for their use to be dependent upon the presence of risk factors. 29 Radiotherapy is also widely described as a prophylactic method, both as preoperative and postoperative therapy, with good efficacy in reducing the risk of ossification in various dose ranges.…”

“…In this current patient, the ossification resection and the release of the affected joint were performed 14 months after the initial surgery, without ordering additional tests to confirm the maturity and lack of metabolic activity of the ossicles. 26 , 27 …”

“…In this current patient, the ossification resection and the release of the affected joint were performed 14 months after the initial surgery, without ordering additional tests to confirm the maturity and lack of metabolic activity of the ossicles. 26,27 As one of the main risk factors for the occurrence of heterotopic ossification is their formation after previous operations it was decided to introduce preoperative radiotherapy as a preventive measure. In our opinion, radiotherapy in the preoperative period is easier for the patient than transporting him/her in the first days after the surgery.…”

Comparison of third generation long Gamma nail and femur intramedullary nail for the treatment of femoral subtrochanteric fractures

“…Heterotopic ossification (HO) is another complication mentioned in the literature [7]. While Hayashi et al [25] mention gender, surgical approach, ethnicity and fracture site as risk factors associated with HO, they found that severe HO was associated with longer time between time of acute hip fracture and surgery. In our study, two patients, one from each group, developed mild HO during follow up.…”