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
Ahrengart L, Lindgren U (1993) Heterotopic bone after hip arthroplasty. Clin Orthop 293:153–159
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
Ayers DC, Pellegrini VD, McCollister Evarts C (1991) Prevention of heterotopic ossification in high-risk patients by radiation therapy. Clin Orthop 263:87–93
Bauer R, Kerschbaumer F, Poisel S (1994) Orthopädische Operationslehre, Vol II/1. Becken und untere Extremität. Thieme, Stuttgart, pp 6–8
Brooker AF, Bowerman JW, Robinson RA, Lee LH (1973) Ectopic ossification following total hip replacement. J Bone Joint Surg [Am] 55:1629–1632
Deflitch CJ, Stryker JA (1993) Postoperative hip irradiation in prevention of heterotopic ossification: causes of treatment failure. Radiology 188:265–270
Delee J, Ferrari A, Charnley J (1976) Ectopic bone formation following low friction arthroplasty of the hip. Clin Orthop 121:53–59
Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg [Br] 64:17–19
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
Kjærsgaard-Andersen P, Sletgård J, Gjerløff C, Lund F (1990) Heterotopic bone formation after noncemented total hip arthroplasty. Clin Orthop 252:156–162
McFarland B, Osborne G (1954) Approach to the hip. A suggested improvement on Kocher's method. J Bone Joint Surg [Br] 36:364–367
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
Müller JP, Koch P (1989) Die periartikulären Ossifikationen bei Hüfttotalprothesen. Orthopäde 18:511–516
Nollen AJG, Slooff TJJH (1973) Para-articular ossifications after total hip replacement. Acta Orthop Scand 44:230–241
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
Rosendahl S, Krogh Christoffersen J, Norgaard M (1977) Paraarticular ossification following hip replacement. Acta Orthop Scand 48:400–404
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
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
Søballe K, Christensen F, Skydt Kristensen S (1988) Ectopic bone formation after total hip arthroplasty. Clin Orthop 228:57–62
Sodemann B, Persson PE, Nilsson OS (1988) Periarticular heterotopic ossification after total hip arthroplasty for primary coxarthrosis. Clin Orthop 237:150–157
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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