Abstract
BackgroundThe preoperative Heterotopic Ossification (HO) extent is usually one of the main used criteria to predict the recurrence before excision. Brooker et al built a radiologic scale to assess this pre operative extent around the hip. The aim of this study is to investigate the relationship between the recurrence risk after hip HO excision in Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) patients and the preoperative extent of HO.Methodology/Principal FindingsA case control study including TBI or SCI patients following surgery for troublesome hip HO with (case, n = 19) or without (control, n = 76) recurrence. Matching criteria were: sex, pathology (SCI or TBI) and age at the time of surgery (+/−4.5 years). For each etiology (TBI and SCI), the residual cognitive and functional status (Garland classification), the preoperative extent (Brooker status), the modified radiological and functional status (GCG-BD classification), HO localization, side, mean age at the CNS damage, mean delay for the first HO surgery, and for the case series, the mean operative delay for recurrence after the first surgical intervention were noted.Conclusions/SignificanceThe median delay for first HO surgery was 38.6 months (range 4.5 to 414.5;) for the case subgroup and 17.6 months (range 5.7 to 339.6) for the control group. No significant link was found between recurrence and operative delay (p = 0.51); the location around the joint (0.07); the Brooker (p = 0.52) or GCG-BD status (p = 0.79). Including all the matching factors, no significant relationship was found between the recurrence HO risk and the preoperative extent of troublesome hip HO using Brooker status (OR = 1.56(95% CI: 0.47–5.19)) or GCG-BD status (OR class 3 versus 2 = 0.67(95% CI: 0.11–4.24) and OR class 4 versus 2 = 0.79(95%CI: 0.09–6.91)). Until the pathophysiology of HO development is understood, it will be difficult to create tools which can predict HO recurrence.
Highlights
Secondary orthopaedic complications after central nervous system lesion are common, mainly after Traumatic Brain Injury (TBI), and after Spinal Cord Injury (SCI) and in a smaller proportion after stroke or cerebral anoxia [1]
Including all the matching factors, no significant relationship was found between the recurrence Heterotopic Ossification (HO) risk and the preoperative extent of troublesome hip HO using Brooker status (OR = 1.56(95% CI: 0.47–5.19)) or GCG-BD status (OR class 3 versus 2 = 0.67(95% CI: 0.11–4.24) and OR class 4 versus 2 = 0.79(95%CI: 0.09–6.91))
The residual cognitive and functional status, the Brooker status [33], the modified radiological and functional GCG-BD classification of HO [14], the HO localization, the side, the age at the time of CNS damage, the delay for the first HO surgery, the diagnosis delay for recurrence from the first surgery) and the operative delay for recurrence from the first surgery were recorded for each patient
Summary
Secondary orthopaedic complications after central nervous system lesion are common, mainly after Traumatic Brain Injury (TBI), and after Spinal Cord Injury (SCI) and in a smaller proportion after stroke or cerebral anoxia [1]. The only effective treatment is still surgery for excision [1,2, 3,13] Complications of these interventions are obviously hematoma, fractures and sepsis which depend on surgical and perioperative procedures. This patient group is complex, often with several co-morbid factors. The preoperative Heterotopic Ossification (HO) extent is usually one of the main used criteria to predict the recurrence before excision. The aim of this study is to investigate the relationship between the recurrence risk after hip HO excision in Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) patients and the preoperative extent of HO
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