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HinsdaleOrthopaedics
LOYOLAUNIVERSITY CHICAGO
LOYOLAUNIVERSITY CHICAGO
Heterotopic Ossification Excision Following Hip Arthroscopy
Molly A. Keegan, M.D.3
John M. Redmond, M.D.1,3
Asheesh Gupta, M.D.1
Jon E. Hammarstedt, BA1
Christine E. Stake, M.A.1
Benjamin G. Domb, M.D.1,2
1.American Hip Institute, 2. Hinsdale OrthopaedicsHinsdale, IL, 3. Mayo Clinic, Rochester, MN, 4. University of Illinois at Chicago
HinsdaleOrthopaedics
LOYOLAUNIVERSITY CHICAGO
Disclosures – Dr. Benjamin Domb
• American Hip Institute Research support: o American Hip Instituteo Arthrex, Inc.o Mako Surgical Corp.o Brego ATIo Pacira
• Consulting:o Arthrex, Inc.o Mako Surgical Corp.o Pacira
• Stock:o Stryker
• Royalties:o Arthrex, Inc.o Orthomericao DJO Global
• AANA Learning Center Committee
HinsdaleOrthopaedics
LOYOLAUNIVERSITY CHICAGO
BackgroundHeterotopic Ossification (HO)• Common after hip
arthroscopy• Incidence around 44%
for pts. not receiving prophylaxis
• Can still occur with preventative measures
HinsdaleOrthopaedics
LOYOLAUNIVERSITY CHICAGO
Purpose
• The purpose of this study was to evaluate patient-reported outcome (PRO) scores for patients undergoing revision surgery for HO excision.
HinsdaleOrthopaedics
LOYOLAUNIVERSITY CHICAGO
Methods• Study period: 2008 – 2014
o 2379 arthroscopic surgeries68 (3%) patients had revision surgery for HO excision
– Inclusion criteria was ossification of 1 cm, which eliminated 45 patients
– Final study group was 23 patientsTwo reviewers assessed radiographs for inclusion Retrospective chart review completedPatients with previous hip conditions were excluded
HinsdaleOrthopaedics
LOYOLAUNIVERSITY CHICAGO
Patient-Reported Outcome Tools• The protocol included
pre- and post-operative administration of:o Modified Harris Hip Score
(mHHS)o Non-Arthritic Hip Score
(NAHS)o Hip Outcome Score
Activities of Daily Living (HOS-ADL)
Sport Specific Subscale
o Visual Analog Scale (VAS)o Satisfaction
HinsdaleOrthopaedics
LOYOLAUNIVERSITY CHICAGO
Results - DemographicsParameter Measure
Follow-up Percentage 82.6%Average Follow-up Time 1.5 monthsGender
Male 10Female 13
Average Age 38.7 Laterality
Left 12Right 11
Primary Surgery Procedures
Procedure N=Femoral Osteoplasty 17Acetabuloplasty 16Iliopsoas Release 4Removal of Loose Body 3Trochanteric Bursectomy 2Labral Treatment
Base refixation 4Debridement 6Reconstruction 8Simple stitch 8
HO Excision Surgical Procedures
Procedure N
Femoroplasty 6
Chondroplasty 5
Acetabuloplasty 4
Iliopsoas Release 3
Osteoplasty (Peripheral) 2
Debridement of Trochanteric Bursitis 1
Iliotibial Band Release 1
Microfracture – Acetabulum 1
Labral Treatment
Base Refixation, Reconstruction & Simple Stitch 0
Debridement 13
Results
HinsdaleOrthopaedics
LOYOLAUNIVERSITY CHICAGO
Conclusion• Improved outcome scores
and decreased pain in patients undergoing revision surgery for HO excision
• Few patients achieved good or excellent results (defined as >80 mHHS)
• Revision surgery for HO removal should be approached cautiously
• Further research warranted
HinsdaleOrthopaedics
LOYOLAUNIVERSITY CHICAGO
References• Beckmann, J. T., J. D. Wylie, et al. (2014). "The Effect of NSAID Prophylaxis and Operative Variables on Heterotopic Ossification After Hip
Arthroscopy." Am J Sports Med. • Bedi, A., R. M. Zbeda, et al. (2012). "The incidence of heterotopic ossification after hip arthroscopy." Am J Sports Med 40(4): 854-863. • Cohn, R. M., R. Schwarzkopf, et al. (2011). "Heterotopic ossification after total hip arthroplasty." Am J Orthop (Belle Mead NJ) 40(11):
E232-235. • Domb, B. G., C. E. Stake, et al. (2014). "Revision hip preservation surgery with hip arthroscopy: clinical outcomes." Arthroscopy 30(5):
581-587. • Kaplan, F. S., D. L. Glaser, et al. (2004). "Heterotopic ossification." J Am Acad Orthop Surg 12(2): 116-125. • Lee, E. K., S. Namdari, et al. (2013). "Clinical results of the excision of heterotopic bone around the elbow: a systematic review." J
Shoulder Elbow Surg 22(5): 716-722. • Neal, B., H. Gray, et al. (2002). "Incidence of heterotopic bone formation after major hip surgery." ANZ J Surg 72(11): 808-821. • Ong, C., M. Hall, et al. (2013). "Surgical technique: arthroscopic treatment of heterotopic ossification of the hip after prior hip
arthroscopy." Clin Orthop Relat Res 471(4): 1277-1282. • Ozturk, B. Y. and B. T. Kelly (2013). "Heterotopic ossification in portal sites following hip arthroscopy." Arch Orthop Trauma Surg 133(7):
979-984. • Randelli, F., L. Pierannunzii, et al. (2010). "Heterotopic ossifications after arthroscopic management of femoroacetabular impingement:
the role of NSAID prophylaxis." J Orthop Traumatol 11(4): 245-250. • Rath, E., H. Sherman, et al. (2013). "The incidence of heterotopic ossification in hip arthroscopy." Arthroscopy 29(3): 427-433. • Reichel, L. M., E. Salisbury, et al. (2014). "Molecular mechanisms of heterotopic ossification." J Hand Surg Am 39(3): 563-566. • Salisbury, E., E. Rodenberg, et al. (2011). "Sensory nerve induced inflammation contributes to heterotopic ossification." J Cell Biochem
112(10): 2748-2758.
