Abstract
Heterotopic ossification (HO) is a known complication following total hip arthroplasty (THA). The anterior based muscle sparing (ABMS) approach is a variation of a direct anterior approach through the Watson–Jones interval. To date, few studies have evaluated HO formation following this surgery. We examine the incidence of HO in a consecutive series of THAs using this approach by three different surgeons at a single center. Standard preoperative radiographs were examined to determine the type of degenerative arthritis, and follow-up radiographs a minimum of 9 months after surgery were evaluated for the presence and classification of HO. The overall incidence of HO after ABMS THA in this study was 86/233, or 36.9%, which is comparable to recent studies of direct anterior and traditional approaches. Class III and IV HO is uncommon in ABMS surgery (3.9% and 1.3%, respectively) and appears to decrease with increased surgical experience with this technique.
Highlights
The anterior based muscle sparing (ABMS) approach to total hip replacement is a minimally invasive intermuscular approach without muscle transection which was reported initially by Bertin and Rottinger [1], and has been recently shown to have comparable outcomes to the direct anterior (Heuter) approach (DAA) [2]
Eight-eight hips were excluded for lack of appropriate follow-up radiographs, and 1 because the patient had simultaneous bilateral total hip arthroplasty (THA)
There is growing evidence that an anatomic dissection and approach, with a minimum of soft tissue trauma and muscle retraction, may contribute to the achievement of such a result [1,14,15]. These are factors that contribute to Heterotopic ossification (HO), so HO
Summary
The anterior based muscle sparing (ABMS) (modified Watson–Jones) approach to total hip replacement is a minimally invasive intermuscular approach without muscle transection which was reported initially by Bertin and Rottinger [1], and has been recently shown to have comparable outcomes to the direct anterior (Heuter) approach (DAA) [2]. Heterotopic ossification (HO) is a frequent radiographic finding following total hip arthroplasty (THA) using traditional approaches, with an incidence of as high as 61% overall and 8.2% high grade [4]. This finding is thought to be the result of osteoinductive growth factors released with the trauma of injury or surgery [5,6] and, the degree of HO formation is multifactorial, soft tissue trauma during surgery may be an important causative factor. A small percentage of patients with the most extensive HO report clinical effects such as significant pain, stiffness, and dysfunction [9]
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