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A new classification for heterotopic ossifications in total hip arthroplasty considering the surgical approach

  • Clinical and Experimental Forum
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Abstract

We would like to introduce a new classification for heterotopic ossifications (HO) after total hip arthroplasty which also considers ossifications within the region of the surgical approach. Furthermore, we will point out the influence of the surgical approach on the rate of HO. We analyzed 75 cementless hip arthroplasties with consecutive HO in a prospective study. The operations were performed by three experienced orthopaedic surgeons using an identical stem and a standardized lateral approach. All patients followed an identical rehabilitation procedure. Clinical and radiological data were documented in a standardized way. We found a total of 40 HO. Only 24 could be exactly classified by the known methods. Our classification considers 3 regions and 4 grades and is relevant for all 40 HO. Electrocauterisation to dissect the muscles in the lateral approach reduced the rate of HO: overall 64.3% to 39.4%; clinically relevant ossifications were reduced to 3.0% from 16.7%. Our new classification considers all HO concerned with total hip arthroplasty, especially those localized in the intertrochanteric region. The rate of HO can be reduced by using electrocauterisation for muscle dissection in the lateral approach.

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References

  1. Ahrengart L, Lindgren U (1993) Heterotopic bone after hip arthroplasty. Clin Orthop 293:153–159

    Google Scholar 

  2. Arcq M (1988) Zur Problematik der periartikulären Verknöcherungen nach Hüftendoprothese. In: Maaz B, Gierse H (eds) Aktueller Stand der zementfreien Hüftendoprothetik. 2. Kaiserwerther Symposium. Thieme, Stuttgart, pp 71–84

    Google Scholar 

  3. Ayers DC, Pellegrini VD, McCollister Evarts C (1991) Prevention of heterotopic ossification in high-risk patients by radiation therapy. Clin Orthop 263:87–93

    Google Scholar 

  4. Bauer R, Kerschbaumer F, Poisel S (1994) Orthopädische Operationslehre, Vol II/1. Becken und untere Extremität. Thieme, Stuttgart, pp 6–8

    Google Scholar 

  5. Brooker AF, Bowerman JW, Robinson RA, Lee LH (1973) Ectopic ossification following total hip replacement. J Bone Joint Surg [Am] 55:1629–1632

    Google Scholar 

  6. Deflitch CJ, Stryker JA (1993) Postoperative hip irradiation in prevention of heterotopic ossification: causes of treatment failure. Radiology 188:265–270

    Google Scholar 

  7. Delee J, Ferrari A, Charnley J (1976) Ectopic bone formation following low friction arthroplasty of the hip. Clin Orthop 121:53–59

    Google Scholar 

  8. Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg [Br] 64:17–19

    Google Scholar 

  9. Horwitz BR, Rockowitz NL, Goll SR et al (1993) A prospective randomized comparison of two surgical approaches to total hip arthroplasty. Clin Orthop 281:154–163

    Google Scholar 

  10. Kjærsgaard-Andersen P, Sletgård J, Gjerløff C, Lund F (1990) Heterotopic bone formation after noncemented total hip arthroplasty. Clin Orthop 252:156–162

    Google Scholar 

  11. McFarland B, Osborne G (1954) Approach to the hip. A suggested improvement on Kocher's method. J Bone Joint Surg [Br] 36:364–367

    Google Scholar 

  12. McMahon JS, Wadall JP, Morton J (1991) Effect of short course indomethacin on heterotopic bone formation after uncemented total hip arthroplasty. J Arthroplasty 6:259–264

    Google Scholar 

  13. Müller JP, Koch P (1989) Die periartikulären Ossifikationen bei Hüfttotalprothesen. Orthopäde 18:511–516

    Google Scholar 

  14. Nollen AJG, Slooff TJJH (1973) Para-articular ossifications after total hip replacement. Acta Orthop Scand 44:230–241

    Google Scholar 

  15. Parkinson JR, Evarts CM, Hubbard LF (1982) Radiation therapy in the prevention of heterotopic ossification after total hip arthroplasty. In: Nelson JP (ed) The hip: proceedings of the tenth open scientific meeting of the Hip Society. Mosby, St. Louis, pp 211–227

    Google Scholar 

  16. Rosendahl S, Krogh Christoffersen J, Norgaard M (1977) Paraarticular ossification following hip replacement. Acta Orthop Scand 48:400–404

    Google Scholar 

  17. Schmidt J, Hackenbroch MH (1994) The Cenos hollow stem in total hip arthroplasty: first experiences in a prospective study. Arch Orthop Trauma Surg 113:117–120

    Google Scholar 

  18. Seegenschmidt MH, Goldmann AR, Martus P, Wölfel R, Hohmann D, Sauer R (1993) Prophylactic radiation therapy for prevention of heterotopic ossification after hip arthroplasty: results in 141 high-risk hips. Radiology 188:257–264

    Google Scholar 

  19. Søballe K, Christensen F, Skydt Kristensen S (1988) Ectopic bone formation after total hip arthroplasty. Clin Orthop 228:57–62

    Google Scholar 

  20. Sodemann B, Persson PE, Nilsson OS (1988) Periarticular heterotopic ossification after total hip arthroplasty for primary coxarthrosis. Clin Orthop 237:150–157

    Google Scholar 

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  1. Klinik und Poliklinik für Orthopädie der Universität zu Köln, Joseph-Stelzmann-Strasse 24, D-50931, Köln, Germany

    J. Schmidt & M. H. Hackenbroch

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  1. J. Schmidt
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  2. M. H. Hackenbroch
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Schmidt, J., Hackenbroch, M.H. A new classification for heterotopic ossifications in total hip arthroplasty considering the surgical approach. Arch Orthop Trauma Surg 115, 339–343 (1996). https://doi.org/10.1007/BF00420328

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  • DOI: https://doi.org/10.1007/BF00420328

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