Abstract
This study reviewed pain and outcome scores of patients undergoing revision surgery with heterotopic ossification (HO) excision following previous hip arthroscopy. The aim was to determine if performing the excision arthroscopically improved clinical outcomes. Data were prospectively collected and retrospectively reviewed in patients who had HO removed arthroscopically between February 2008 and 2014. Four patient-reported outcome (PRO) measures were collected: Modified Harris Hip Score (mHHS), Non-Arthritis Hip Score (NAHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL) and Sport-Specific (HOS-SS) subscales. Minimum 1.5 year follow-up from index procedure was available for 23 patients (mean age = 38.6 years). Of the 23 patients who had revision surgery and HO removal, 19 (83%) were available for follow-up. Prior to revision, the average mHHS was 53.4, HOS-ADL 51.4, HOS-SS 24.5, NAHS 50.3 and VAS 6.7. Following revision with HO excision, each score had improved with an average mHHS of 73.62, HOS-ADL of 68.88, HOS SS of 58.51, NAHS of 70.83 and VAS of 4.33. Overall, mHHS increased by 20.26 points (P < 0.001), HOS-ADL increased by 17.48 points (P = 0.023), HOS-SS increased by 34.03 points (P < 0.001), NAHS increased by 20.55 points (P = 0.001) and VAS decreased by 2.38 points (P < 0.001). Patients undergoing revision hip surgery with HO excision demonstrated improved outcome scores and pain resolution; however, few patients achieved a good or excellent result. Revision hip surgery with HO excision should be approached cautiously because of the modest results in this patient group.
Highlights
Heterotopic ossification (HO) is a known complication after hip arthroscopy, and its incidence has been reported in up to 44% of individuals who were not prescribed prophylactic therapy [1]
Following revision with heterotopic ossification (HO) excision, each score had improved with an average Modified Harris Hip Score (mHHS) of 73.62, Hip Outcome Score-Activity of Daily Living (HOS-ADL) of 68.88, HOS SS of 58.51, Non-Arthritis Hip Score (NAHS) of 70.83 and visual analogue scale (VAS) of 4.33
MHHS increased by 20.26 points (P < 0.001), HOS-ADL increased by 17.48 points (P 1⁄4 0.023), HOS-SS increased by 34.03 points (P < 0.001), NAHS increased by 20.55 points (P 1⁄4 0.001) and VAS decreased by 2.38 points (P < 0.001)
Summary
Heterotopic ossification (HO) is a known complication after hip arthroscopy, and its incidence has been reported in up to 44% of individuals who were not prescribed prophylactic therapy [1] This osteogenic response is not unique to hip arthroscopy; HO can be caused by soft tissue trauma, traumatic nervous system injury, or a genetic disorder, but it is a common complication following major hip surgery [2, 3]. Beckmann et al [7] found that giving patients chemoprophylaxis therapy in the form of naproxen twice daily for 3 weeks reduced the incidence of HO from 25 to 5.6% This group noted the highest rates of HO were seen in patients who had undergone combined acetabuloplasty and femoral osteochondroplasty arthroscopically. This study reviewed pain and outcome scores of patients undergoing revision surgery with HO excision and aimed to determine if surgical intervention improved clinical outcomes
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