Heterotopic ossification after total hip arthroplasty: When is development completed?

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: All authors declare that they have no competing interests. 14. J Bone Joint Surg Am. 2021 Jul 21;103(14):1328-1334. doi: 10.2106/JBJS.20.01586. Heterotopic Ossification Following Arthroplasty for Femoral Neck Fracture. Comeau-Gauthier M(1), Zura RD(2), Bzovsky S(1), Schemitsch EH(3), Axelrod D(1), Avram V(1), Manjoo A(1), Poolman RW(4), Frihagen F(5)(6), Heels-Ansdell D(7), Bhandari M(1)(7), Sprague S(1)(7); the HEALTH Investigators. Author information: (1)Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. (2)Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana. (3)Department of Surgery, University of Western Ontario, London, Ontario, Canada. (4)Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, and OLVG (Onze Lieve Vrouwe Gasthuis), Amsterdam, the Netherlands. (5)Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway. (6)Institute of Clinical Medicine, University of Oslo, Oslo, Norway. (7)Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. BACKGROUND: Heterotopic ossification (HO) is a frequent complication following hip surgery. Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we aimed to (1) determine the prevalence of HO following total hip arthroplasty (THA) for femoral neck fracture in patients ≥50 years of age, (2) identify whether HO is associated with an increased risk of revision surgery within 24 months after the fracture, and (3) determine the impact of HO on functional outcomes. METHODS: We performed a multivariable Cox regression analysis using revision surgery as the dependent variable and HO as the independent variable. We compared Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between participants with and those without HO at 24 months. RESULTS: Of 1,441 participants in the study, 287 (19.9%) developed HO within 24 months. HO was not associated with subsequent revision surgery. Grade-III HO was associated with statistically significant and clinically relevant deterioration in the total WOMAC score, which was mainly related to the function component of the score, compared with grade I or II. CONCLUSIONS: The impact of grade-III HO on the functional outcomes and quality of life after THA for hip fracture is clinically important, and HO prophylaxis for selected high-risk patients may be appropriate. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated. DOI: 10.2106/JBJS.20.01586 PMCID: PMC8388546