Abstract
PurposeTotal hip arthroplasty (THA) is a successful procedure. However, in time, heterotopic ossification (HO) can form due to, amongst others, soft tissue damage. This can lead to pain and impairment. This study compares the formations of HO between patients who underwent either THA with the posterolateral approach (PA) or with the direct lateral approach (DLA). Our hypothesis is that patients who underwent THA with a PA form less HO compared to THA patients who underwent DLA.MethodsIn this prospective cohort study, 296 consecutive patients were included who underwent THA. A total of 127 patients underwent THA with the PA and 169 with the DLA. This was dependent on the surgeon’s preference and experience. More than 95% of patients had primary osteoarthritis as the primary diagnosis. Clinical outcomes were scored using the Numeric Rating Scale (NRS) and Harris Hip Score (HHS), radiological HO were scored using the Brooker classification. Follow-up was performed at 1 and 6 years postoperatively.ResultsTwo hundred and fifty-eight patients (87%) completed the 6-year follow-up. HO formation occurred more in patients who underwent DLA, compared to PA (43(30%) vs. 21(18%), p = 0.024) after 6 years. However, the presence of severe HO (Brooker 3–4) was equal between the DLA and PA (7 vs. 5,p = 0.551). After 6 years the HHS and NRS for patient satisfaction were statistically significant higher after the PA (95.2 and 8.9, respectively) compared to the DLA (91.6 and 8.5, respectively) (p < 0.001 and p = 0.003, respectively). The NRS for load pain was statistically significant lower in the PA group (0.5) compared to the DLA group (1.2) (p = 0.004). The NRS for rest pain was equal: 0.3 in the PA group and 0.5 in the DLA group.ConclusionTHA with the PA causes less HO formation than the DLA.Trial registrationRegistrated as HipVit trial, NL 32832.100.10, R-10.17D/HIPVIT 1. Central Commission Human-Related research (CCMO) Registry.
Highlights
Total hip arthroplasty (THA) is a successful treatment for patients with hip osteoarthritis, resulting in less pain, a greater range of motion (ROM) and a considerably higher quality of life [1, 2]
After 6 years of follow-up, statistically significant more radiological heterotopic ossifications (HO) formation was found after the direct lateral approach (DLA) compared to the posterolateral approach (PA) (30% vs. 18%)
The finding that patients undergoing DLA for THA form more HO can be explained by the fact that DLA presumably causes more tissue damage [19]
Summary
Total hip arthroplasty (THA) is a successful treatment for patients with hip osteoarthritis, resulting in less pain, a greater range of motion (ROM) and a considerably higher quality of life [1, 2]. In a minority of patients, peri-articular heterotopic ossifications (HO) develop postoperatively. These bony formations in the soft tissues of the operated hip can lead to pain and impairment of ROM [3, 4]. Soft tissue damage caused by the surgery provides an environment that causes osteoblasts to arrive from mesenchymal cells, resulting in HO [3, 4]. It is thought that increased soft tissue damage during surgery result in more HO [6]. Known risk factors for the formation of HO include male sex, smoking, a chronic infection, high number
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