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Risk Factors for the Development of Heterotopic Ossification After Knee Dislocation

  • Symposium: Management of the Dislocated Knee
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Results of treatment for acute knee dislocations and multiligament knee injuries may be influenced by a multitude of patient- and injury-related factors, including neurologic function, vascular status, ipsilateral fractures, and joint stability. The development of heterotopic ossification (HO) may nullify any benefits of reconstruction, because it can cause stiffness and discomfort. Identifying factors associated with HO after knee dislocation may help identify patients who might benefit from prophylaxis.

Questions/purposes

The purposes of this study were (1) to identify specific risk factors for the development of HO in patients with knee dislocation; and (2) to elucidate the relationship between the presence of absence of HO and postoperative range of motion.

Methods

Between 2005 and 2010, we performed 101 multiligament reconstructions for patients with knee dislocations, of which 91 (90%) in 91 patients were available for followup at a minimum of 6 months (mean, 18 months; range, 6–44 months), and were reviewed here. AP and lateral radiographs were reviewed for all patients and HO was classified according to the Mills and Tejwani classification system. This knee dislocation cohort was separated into two groups based on the presence or absence of HO for comparison. Using a significance level of p < 0.05 for factors in the univariate analyses, we identified potential variables for a multivariate logistic regression model to identify risk factors predicting development of HO in patients with multiligament knee injuries; multivariate analysis then was performed to mitigate the influence of potentially confounding variables. Thirty patients (34%) developed HO after multiligament knee injury in our series.

Results

Posterior cruciate ligament reconstruction was the only independent predictor of HO that we identified (odds ratio, 6.3; 95% confidence interval, 1.2–34.6). Patients who developed HO were more likely to develop stiff knees and undergo surgery (50%; 15 of 30 patients) versus those without HO (12%; seven of 58 patients) to attempt to restore functional range of motion (p < 0.001).

Conclusions

HO is a common complication after knee dislocation and can diminish range of motion and cause patients to undergo further surgery. Posterior cruciate ligament reconstruction is an independent risk factor for the development of HO. Strategies to identify risk factors for, and safe prevention of, HO after multiple ligament injury and surgery should be investigated going forward.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Surgery, University of Toronto, c/o St Michael’s Orthopaedic Associates, 55 Queen Street E, Suite 800, Toronto, ON, M5C 1R6, Canada

    Daniel B. Whelan MD

  2. Division of Orthopaedic Surgery, University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada

    Andrew P. Dold MD & Tomce Trajkovski MD

  3. Toronto Western Hospital, University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada

    Jas Chahal MD

Authors
  1. Daniel B. Whelan MD
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  2. Andrew P. Dold MD
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  3. Tomce Trajkovski MD
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  4. Jas Chahal MD
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Corresponding author

Correspondence to Daniel B. Whelan MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Whelan, D.B., Dold, A.P., Trajkovski, T. et al. Risk Factors for the Development of Heterotopic Ossification After Knee Dislocation. Clin Orthop Relat Res 472, 2698–2704 (2014). https://doi.org/10.1007/s11999-014-3730-7

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  • DOI: https://doi.org/10.1007/s11999-014-3730-7

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