Rate Of Heterotopic Ossification Research Articles

Emphasizing the Importance of Naproxen Prophylaxis May Decrease the Rate of Heterotopic Ossification After Hip Arthroscopy

Emphasizing the Importance of Naproxen Prophylaxis May Decrease the Rate of Heterotopic Ossification After Hip Arthroscopy

The significance of heterotopic ossification following total ankle arthroplasty: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to evaluate the prevalence and clinical significance of heterotopic ossification (HO) following total ankle replacement (TAR). During August 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting HO following TAR. Data regarding surgical characteristics, pathological characteristics, subjective clinical outcomes, ankle range of motion, radiographic outcomes, reoperation rates were extracted and analysed. Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9months were included. The pooled prevalence rate was 44.6% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (132 patients, 27.0%). Random effects models of standardized mean differences found no difference in American orthopedic foot and ankle society (AOFAS) scores, visual analog scale scores (VAS) and ankle range of motion (ROM) between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 4.2%. This systematic review and meta-analysis found that HO is a common finding following TAR that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-to-severe, symptomatic HO following TAR. This study is limited by the marked heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAR.

Heterotopic Ossification around the Elbow Revisited.

Heterotopic ossification (HO) is the process of ectopic bone formation in the periarticular soft tissues and is usually formed in the elbow, hip and knee joint as a complication of trauma, burns, brain injury or surgical procedures. The development of HO around the elbow joint can cause a severe limitation of range of motion (ROM) and may affect daily activities of the patient. Treatment of ectopic bone formation around the elbow is a challenge for many surgeons. Non-operative treatment usually fails to restore the ROM of the elbow joint; thus, surgery is necessary to restore the function of the joint. In the past, many surgeons suggested that a delayed excision of HO, until maturation of the ectopic bone, is the best option in order to avoid any possible recurrence. However, many authors now suggest that this delay may lead to complications such as muscular atrophy and formation of soft tissue contractures that can cause a greater impairment of elbow function; thus, early excision is a better option and can better restore the elbow ROM. We performed a literature research of articles that investigated which is the best time of HO excision and we also evaluated if the tethering effect of HO can lead to a greater impairment of the elbow function. We found numerous studies suggesting that a limitation in ROM of the elbow can appear from the tethering of the ectopic bone formation and not only from primary HO. Concerning the HO excision, there were no significant differences between patients who underwent delayed and early excision, concerning the recurrence rate of HO around the elbow. Patients who underwent early excision had better restoration of elbow ROM; thus, early excision, combined with a rehabilitation program, is reported to be the best option for these patients.

A Systematic Review of Heterotopic Ossification Following Shoulder Arthroplasty: Is There a Clinical Value?

This systematic review aims to assess the contemporary literature on the incidence rate, functional scores, and clinical outcomes of heterotopic ossification (HO) following shoulder arthroplasty. We conducted a thorough literature search on EMBASE, MEDLINE, and Ortho Search to identify studies that directly compared patients with and without HO following hemiarthroplasty, anatomic total shoulder arthroplasty (aTSA), or reverse total shoulder arthroplasty (rTSA). We included studies with a minimum follow-up period of one year published from January 2000 to March 2023. We excluded case reports, editorials, and reviews. We performed the systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of the 297 studies initially identified, seven met our inclusion criteria. These studies evaluated a total of 1,134 arthroplasties (212 hemiarthroplasties, 376 aTSAs, and 546 rTSAs). Themean follow-up period was 30.52 (12-120) months and the mean age was 68.69 (20-92). The overall incidence rate of HO was 26.8% (304/1,134). Male gender was associated with a higher incidence rate of HO in three studies. No statistically significant difference was noted in symptoms at follow-up or in Constant-Murley score at two years of follow-up (HO vs. non-HO: 70 vs. 75, p = 0.081). Only one study reported a significant difference in the post-arthroplasty range of motion, specifically in forward elevation (121° vs. 133°, p = 0.0087) and external rotation (19° vs. 25°, p-value = 0.0266). We conclude that HO after shoulder arthroplasty does not display a significant impact on postoperative symptoms or functional outcomes in the majority of patients. To fully comprehend its effect, further research and consensus among experts is necessary.

Complication Rates and Functional Outcomes after Total Ankle Arthroplasty in Patients with Rheumatoid Arthritis

Category: Ankle Arthritis; Other Introduction/Purpose: Utilization rates of total ankle arthroplasty (TAA) have greatly increased in recent years. For patients with rheumatoid arthritis (RA) undergoing TAA, conflicting data have been reported regarding risk of complications and patient reported outcome (PRO) improvement when compared to patients with osteoarthritis. The purpose of this study is to compare complication rates and PROs of patients with RA to patients with osteoarthritis and posttraumatic arthritis. Methods: This was a retrospective study of 1,071 primary TAA performed at a single institution between 2001 and 2020. Minimum follow-up was two years. Patients were stratified by indication for TAA (osteoarthritis, n=372; posttraumatic arthritis, n=642; RA, n=57). Patient demographics, intraoperative variables, postoperative complications, and PRO measures were compared between groups using univariable statistics. Multivariable Cox regression was performed to assess risk for implant failure. Mean follow-up was 5.6 years (SD: 3.1). Results: Compared to the osteoarthritis and posttraumatic arthritis groups, the RA cohort had the lowest mean age (p < 0.001), lowest percentage of males (p < 0.001), and highest ASA score (p < 0.001). Univariate analysis showed no statistically significant difference for infection rates among groups (p=1.0). The RA cohort had the highest rate of heterotopic ossification postoperatively (2/57, 3.5%, p< 0.001). Multivariable regression analysis showed no increased risk of implant failure for the RA cohort (p=0.23). For the SMFA, SF-36, AOFAS-hindfoot, FAOS-symptoms, and FAOS-ADL the RA group reported the worst scores at final follow-up (p < 0.001). However, the RA cohort demonstrated the largest improvements from preoperative to postoperative scores on the FADI, SF-36, and the symptoms and ADL subscales of the FAOS (p=0.04, 0.01, 0.03, 0.03). Conclusion: In the largest single institution study to date, patients with RA had the worst PRO scores compared to the osteoarthritis and posttraumatic arthritis groups. However, they experienced significantly higher improvements in functional outcomes from their preoperative baseline. Large patient samples with mid- to long-term follow up such as a presented in this series are imperative to fully understand the risk-benefit of TAA in various patient cohorts.

Prevalence of Heterotopic Ossification following Total Ankle Arthroplasty: A Systematic Review

Category: Ankle Arthritis Introduction/Purpose: End-stage ankle osteoarthritis is a debilitating pathology and is most commonly preceded by trauma. Surgical intervention via ankle arthrodesis or ankle arthroplasty is the mainstay management option. Heterotopic ossification (HO) is a common finding following joint arthroplasty. However, no consensus regarding the impact of heterotopic ossification on clinical outcomes following total ankle arthroplasty has been reached to date. The purpose of this systematic review and meta- analysis was to evaluate the prevalence and clinical outcomes of heterotopic ossification following total ankle arthroplasty. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting heterotopic ossification following TAA. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. Results: Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9 months were included. The pooled prevalence rate was 45% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (120 patients, 33.9%). Random effects models of standardized mean differences found no difference in AOFAS, VAS and ROM between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 10.5%. Conclusion: This systematic review and meta-analysis found that HO is a common finding following TAA that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-severe, symptomatic HO following TAA. This study is limited by the significant heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAA.

Is External Beam Radiation Therapy Really Associated With Low Rates of Heterotopic Ossification After Acetabular Surgery?

Describe rate of postoperative heterotopic ossification (HO) after acetabular surgery in patients who received external beam radiation (XRT) as HO prophylaxis. Retrospective. Level I trauma center. Consecutive series of patients who presented to a single, level I, academic trauma center over a 10-year period (2008-2018) for surgical fixation of an acetabular fracture. Patients eligible for inclusion were those who underwent surgical fixation of an acetabular fracture through a posterior (Kocher-Langenbeck), combined anterior and posterior, or extensile exposure. Patients were excluded if an isolated anterior approach was performed or if an acute total hip arthroplasty was performed at the time of index surgery. XRT. Severe HO (Brooker class III or IV). The severe HO (Brooker class III or IV) rate for entire cohort was 12% (44 of 361 patients). Of these 44 patients, 30 patients were classified as Brooker III and 14 patients were classified as Brooker IV. The Brooker IV rate for the entire cohort was 4% (14 of 361 patients). Severe HO rates showed a declining trend over the period examined, with a risk reduction of -1.0% per year (95% confidence interval -2.1% to 0.2%; P = 0.10). To our knowledge, this is the largest single consecutive series on acetabular fracture patients who received XRT as HO prophylaxis. The overall severe HO rate was 12%, which is similar to other comparably large series data on patients who did not receive XRT after surgical fixation acetabular fractures. Although these data suggest that XRT may not be beneficial when used universally for all patients, comparative studies are required to rule out the benefits of XRT for preventing HO in this population. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparison of primary total hip arthroplasty with limited open reduction and internal fixation vs open reduction and internal fixation for geriatric acetabular fractures: a systematic review and meta-analysis.

Comminuted fractures with poor bone quality in the elderly are associated with poor outcomes. An alternative to open reduction and internal fixation (ORIF) alone, primary or acute total hip arthroplasty (aTHA), allows early mobilization with full weight bearing. In this study, we aim to analyze whether treatment of aTHA with/withtout ORIF (limited ORIF) vs ORIF alone yields better intra-operative results, functional outcomes, and less complications. PubMed, Cochrane, Embase, and Scopus databases were searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Random-effects model and 95% confidence intervals were used. The outcomes of interest were surgery time, blood loss, length of hospital stay, Harris hip score (HHS), 36-Item Short Form Survey (SF-36), complication rate, surgical site infection rate, heterotopic ossification rate, reoperation rate, and mortality rate. Ten observational studies with a total of 642 patients (415 ORIF alone and 227 aTHA with/without ORIF) were included in the systematic review. Compared to ORIF alone, aTHA with limited ORIF provided higher HHS (P = 0.029), better physical function (P = 0.008), better physical component summary (P = 0.001), better mental component summary (P = 0.043) in postoperative 1-year SF-36, lesser complication rate (P = 0.001), and lesser reoperation rate (P = 0.000), but however greater bodily pain (P = 0.001) in acetabular fractured elderlies. Acute THA with limited ORIF is favorable alternative to ORIF technique alone. It provided better HHS, physical, and mental component summary in SF-36 and yielded lower complication and reoperation rate compare to ORIF alone.

Role of aspirin in the prevention of heterotopic ossification following total hip replacement: a systematic review and meta-analysis.

To systematically investigate if aspirin (ASA), used as venous thromboembolism (VTE) prophylaxis, plays a role in the prevention of heterotopic ossification (HO) following total hip arthroplasty (THA) and if ASA dosage impacted the rate of HO. Eligible studies published from January 2000 to July 2022 were identified from the computerized searching of PubMed, Scopus and Web of Science. HO was defined according to Brooker Classification. Pooled risk ratios (OR) and 95% confidence interval (CI) were estimated under a random-effect model. Additionally, combined HO incidences were compared according to ASA dosage (a regular dose of 325 bid vs. a low dose of 81 mg bid/162 mg qd). Thirteen studies were included. ASA administered for VTE prophylaxis was significantly associated with a reduced risk of all-grade HO following THA (univariate, OR: 0.50, 95% CI: 0.34-0.74, P < 0.001; multivariate, OR: 0.60, 95% CI: 0.49-0.73, P < 0.001). Similar results could be observed for high-grade HO (univariate, OR: 0.57, 95% CI: 0.36-0.89, P = 0.015; multivariate, OR: 0.50, 95% CI: 0.27-0.92, P = 0.026). There was a non-significant trend towards a higher incidence of HO formation for low-dose ASA (31%, 95% CI: 29-34%), compared with regular-dose ASA (21%, 95% CI: 11-33%) (P = 0.069 under test of interaction). ASA can be an effective option for HO prophylaxis. More well-designed trials with long-term follow-ups are encouraged to confirm the current findings and to investigate the effect of ASA dosage on HO reduction.

The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes

BackgroundHeterotopic ossification (HO) is a common complication after surgical fixation of acetabular fractures. Numerous strategies have been employed to prevent HO formation, but results are mixed and optimal treatment strategy remains controversial. The purpose of the study was to describe current national heterotopic ossification (HO) prophylaxis patterns among academic trauma centers, determine the association between prophylaxis type and radiographic HO, and identify if heterogeneity in treatment effects exist based on outcome risk strata. MethodsWe used data from a subset of participants enrolled in the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. We included only patients with closed AO-type 62 acetabular fractures that were surgically treated via a posterior (Kocher-Langenbeck), combined anterior and posterior, or extensile exposure. PREPARE Clinical Trial Registration Number: NCT03523962 Patient population This cohort study was nested within the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. The PREPARE trial is a multicenter cluster-randomized crossover trial evaluating the effectiveness of two alcohol-based pre-operative antiseptic skin solutions. All PREPARE trial clinical centers that enrolled at least one patient with a closed AO-type 62 acetabular fracture were invited to participate in the nested study. Results277 patients from 20 level 1 and level 2 trauma centers in the U.S. and Canada were included in this study. 32 patients (12%) received indomethacin prophylaxis, 100 patients (36%) received XRT prophylaxis, and 145 patients (52%) received no prophylaxis. Administration of XRT was associated with a 68% reduction in the adjusted odds of overall HO (OR 0.32, 95% CI, 0.14 – 0.69, p = 0.005). The overall severe HO (Brooker classes III or IV) rate was 8% for the entire cohort; XRT reduced the rate of severe HO in high-risk patients only (p=0.03). ConclusionHO prophylaxis patterns after surgical fixation of acetabular fractures have changed dramatically over the last two decades. Most centers included in this study did not administer HO prophylaxis. XRT was associated with a marked reduction in the rate of overall HO and the rate of severe HO in high-risk patients. Randomized trials are needed to fully elucidate the potential benefit of XRT. PREPARE Clinical Trial Registration Number: NCT03523962.

Distal Biceps Tendon Repair Using a Single Incision, Dual Anchor Technique

Background: Distal biceps tendon ruptures commonly present in the middle-aged population resulting in deficits of strength and endurance. Operative management has shown improved functional outcome; however, there is not a clear consensus on an ideal surgical method. Indications: Distal biceps tendon repair is indicated for patients with clinical evidence and supporting magnetic resonance imaging confirmation of complete or partial rupture of the biceps tendon. Ideally, surgery is performed within 1 to 2 weeks of the injury to minimize the amount of scar tissue that is formed and the severity of the tendon retraction. Technique Description: A single incision is created on the volar surface of the forearm approximately 15 mm distal to the main flexor crease. After dissection to and retrieval of the biceps tendon, a #2 FiberTag stitch is placed distally and secured in a standard looped, locking fashion. An anchor is then placed in the most proximal aspect of the radial tuberosity and preliminarily placed around the tendon. An all-suture intramedullary cortical button is then placed in the distal aspect of the radial tuberosity. The FiberTag sutures are then shuttled through the button and tightened to anatomically reduce the distal biceps. The sutures on the proximal anchor are then used as supplemental fixation. Results: An anterior, single incision technique provides exposure necessary for dual anchor fixation and anatomic restoration of the distal biceps tendon. Utilizing this approach, patients are found to have improved flexion and pronation at 1 year, lower rates of heterotopic ossification, and lower rates of reoperation. Conclusion: Distal biceps tendon repair through an anterior, single incision provides excellent exposure for surgical repair. Utilizing a dual anchor technique, the distal button allows for anatomic fixation while the proximal suture anchor provides secondary fixation and increases the bone-tendon interface. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Primary repair of acute versus chronic ruptures of the distal biceps tendon. Comparison of functional results in a case-control study

BackgroundIn the event of a rupture of the distal tendon of the biceps brachii, most authors recommend early reinsertion to recover optimal elbow function. However, these ruptures are not always diagnosed or promptly referred to surgeons, thus creating a delay in treatment. Studies reporting functional results in cases of chronic repair (greater than 21 days) of the distal biceps brachii tendon show an increased rate of complications. HypothesisPrimary repairs of chronic ruptures (treatment delayed for more than 21 days) and acute ruptures of the distal biceps give the same functional results and the same rate of complications. Material and methodsWe conducted a retrospective study between January 2017 and December 2021 comparing chronic primary repair of the distal biceps at the elbow (experimental group, comprising 75 patients) and acute (control group, comprising 135 patients) by endobutton. We analyzed the time between trauma and surgery, and assessed short- and long-term functional recovery by measuring residual pain (VAS), a collection of the following functional scores: Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Patient-Rated Elbow Evaluation (PREE), as well as a measure of strength (as a percentage of the healthy side). We evaluated the rate of complications and radiographically analyzed the rate of heterotopic ossification. ResultsThe mean time between trauma and surgery was 73±66 days (experimental group) versus 11.2±5 days (control group). In the short-term (4.79±2.09 months), there was no significant difference in the MEPS, Q-DASH and PREE functional scores between the two groups (p=0.354, p=0.412 and p=0.958, respectively). In the long-term (28.9±17.9 months), the functional evolution remained similar. The recovery of strength in flexion and supination was 89.19±13.43% and 77.48±16.68%, respectively, and similar in the two cohorts (p=0.476 and p=0.395). There was no difference in the rate of complications; however, the rate of heterotopic ossification was higher in the control group (p=0.006). DiscussionThe functional results and the recovery of strength did not change according to the time until surgery. Although the overall complication rate was similar, repairs of the biceps in less than 21 days led to more heterotopic ossification. Level of evidenceIII; retrospective case-control study.

Complications of Early Versus Delayed Total Elbow Arthroplasty for the Treatment of Distal Humerus Fractures

The purpose of this study was to compare the rates of wound complications and heterotopic ossification (HO) between patients who underwent acute total elbow arthroplasty (TEA) and those who underwent delayed TEA performed for the treatment of distal humerus fractures. Our hypothesis was that delayed surgery will have fewer wound complications but a higher rate of HO. We retrospectively reviewed 104 patients who had undergone TEA performed at 1 of 3 institutions following a distal humerus fracture. The acute cohort, comprising 69 patients, underwent TEA within 2 weeks; the delayed cohort, comprising 35 patients, received treatment between 2 weeks and 6 months. The rates of wound complications, HO, clinically relevant HO (requiring excision or resulting in loss of functional range of motion), and reoperation were recorded. These patients were followed up for an average of 52 (interquartile range, 18.5-117) weeks. Wound complications occurred in 10 patients (14.5%) in the early group and 7 (20.0%) in the delayed group. The overall rate of HO was 56.7% (59 patients). The rate of clinically relevant HO was 26.0% (27 patients), which was similar between the groups. Reoperation occurred in 20 patients (19.2%), which was similar between the groups. In the early group, 3 reoperations were performed for wound complications and 4 for HO. No patients required reoperation for these indications in the delayed group. The mean flexion-extension and supination-pronation arcs were 20°-130° and 80°-80°, respectively, which were similar between the groups. Rheumatoid arthritis and younger age were associated with increased odds of wound complications and reoperation. The rates of reoperation, wound complications, and HO were overall higher than those previously reported; however, the study was underpowered to determine a difference between early and delayed treatment. Therapeutic IV.

ДИАГНОСТИКА И ЛЕЧЕНИЕ СВЕЖИХ РАЗРЫВОВ ДИСТАЛЬ-НОГО СУХОЖИЛИЯ ДВУГЛАВОЙ МЫШЦЫ ПЛЕЧА

Distal biceps ruptures occur mostly in 40–60 y. o. men during rapid elbow flexion against significant external force. Clinical examination remains the mainstay of the diagnostics of the distal biceps tendon rupture (“Popeye” deformity, ecchymosis, and hook-test), ultra-sound and MR investigations may be used in doubtful cases. Non-operative treatment leads to the decrease of flexion and external rota-tion forces, thus surgical treatment is preferable in most cases. The choice of surgical approach depends on the fixation method. Transos-seous fixation with bone tunnels and two-incision technique is valid and pro-vides low level of re-ruptures with more anatomic restoration of the insertion point, but is associated with higher rate of heterotopic ossification. Newer methods of fixation (buttons, anchors, interferential screws) may allow the sin-gle approach, but not always provide anatomic reinsertion and may lead to higher rate of complications at the site of surgical approach in the elbow crease. Functional post-operative care in majority of cases leads to the restoration of range of movements at 6 weeks, and muscle forces at 12 weeks. This usually allows full restoration of the physical activity at 3 to 6 months after the sur-gery.

Radiological and Clinical Follow-up of Alpha-D Cervical Disk Prosthesis.

Fusion surgery is applied to prevent segmental instability after surgery for cervical disk herniation. Motion-sparing surgeries have been developed to prevent adjacent segment disease after fusion surgery. Total disk replacement, one of these methods, has been applied in the cervical region for more than 20years. We aimed to investigate the medium-term radiological and clinical outcomes of patients who had received Alpha-D disk prosthesis after cervical disk surgery, in terms of incidence of heterotopic ossification (HO) and other complications. We included 33 patients (17 women and 16 men) diagnosed with single-level cervical disk herniation and who had received prosthesis after anterior discectomy. The average follow-up period was 36 (18-78) months. The patients were followed up postoperatively at month 4, year 1, and annually thereafter. Patients, who had Alpha-D cervical disk prosthesis (CDP) (Medikon, Turkey), were monitored via radiological (standard and dynamic X-ray) and clinical (visual analog scale [VAS] and neck disability index [NDI]) modalities. Dynamic X-ray images were evaluated by an independent radiologist for HO and prosthesis movement. Mean patient age was 40 ± 6.88years. HO was observed in 7 (21.21%) patients, 6 of which were men. Significant intersex differences were noted for HO and movement rates (p = 0.039). Clinically, the mean preoperative and post-operative NDI levels were 35.4 ± 3.9 and 4 ± 2, respectively, whereas the mean pre- and post-operative VAS levels were 7 ± 1 and 1 ± 1, respectively. There was a clinically significant postoperative improvement in all the patients. However, there was no significant difference between the patients with and without HO in terms of age, operation level, and mean pre- and postoperative VAS, and postoperative NDI levels (p > 0.05). Despite the fact that there was a significant difference (p = 0.038) in favor of patients without HO in terms of mean preoperative NDI levels, this was not considered clinically significant. In the present study, all the patients demonstrated clinically significant improvement following CDP surgery. HO rate after CDP surgery was 21.21% in the medium term, and movement was preserved in 5 of the 7 patients with partial HO. The fact that the CDP design was based on the one-to-one reproduction of the movement segment in the cervical spine, might account for the underlying cause of success. However, these good results in the medium term may change in cases with long-term clinical follow-up.

Does drainage affect development of heterotopic ossification after total hip arthroplasty?

ObjectiveTo investigate the effect of drainage on heterotopic ossification (HO) after total hip arthroplasty (THA) and to evaluate other postoperative complications and joint dysfunction between patients with and without drainage.MethodsIn this retrospective cohort study, the medical records of patients who underwent THA from 2017 to 2019 were reviewed. The patients were divided into a drainage group and non-drainage group. Standard preoperative anteroposterior and lateral radiographs were assessed by senior radiologists for HO analysis. Clinical indicators included the hemoglobin concentration, superficial infection, blood transfusion, hematoma formation, hip range of motion (ROM), erythrocyte sedimentation rate, C-reactive protein concentration, dressing changes, visual analogue scale score, and Harris Hip Score (HHS).ResultsThe incidence of HO was significantly higher in the drainage than non-drainage group (32.0% vs. 16.3%). The presence of severe HO (Brooker grade III or IV) was also different between the groups. Patients in the non-drainage group had smaller ROM early after surgery, but the final ROM and HHS did not differ significantly between the groups.ConclusionsThe rate and degree of HO after THA were significantly different between patients with and without drainage. There is no added advantage of closed suction drainage over no drainage in primary THA.

Stress Shielding and Aseptic Loosening in Fully Porous-Coated vs Smooth Stemmed Tibial Implants in Total Ankle Arthroplasty

Category: Ankle Arthritis; Ankle Introduction/Purpose: Porous coating on the osseous interface of implants has gained increased popularity in total ankle replacement surgery. With the integration of porous coating into the newer generation of implants, this theoretically increases the chances of osseous ingrowth and survivorship in total ankle replacements. Alternatively, literature in hip replacement surgery has shown increased rates of stress shielding, aseptic loosening, thigh pain, and cystic formation around stemmed femoral implants extensively coated with porous surfaces. While some ankle prostheses have integrated porous coating technology with stemmed tibial implants, there is little to no research investigating the potential negative effects this may have on longevity or aseptic loosening secondary to a stress shielding effect. Methods: Our study identified 9 patients who underwent total ankle arthroplasty via a smooth-stemmed tibial prosthesis and matched these patients based on implant age with patients who received fully porous-coated tibial implants. We reviewed radiographs and compared postoperative rates of backside loosening and cystic formation secondary to stress shielding between the two groups. We also compared rates of heterotopic ossification between the two groups. A homoscedastic t-test was used to identify any statistical significance, which was defined as P &lt; 0.05. Results: While the smooth-stem group showed no rates of backside cystic formation or stress shielding, the follow-up matched porous-coated group showed a rate of 55% of cystic formation and potential loosening secondary to stress shielding observed on final radiographic follow up (P &lt; 0.01). There was no statistical difference between the two groups in their rates of heterotopic bone formation (P = 0.37). Conclusion: Despite having a relatively small sample size, this data shows that there is some consistency with the hip arthroplasty literature suggesting an increased risk for stress shielding in fully porous-coated stemmed tibial implants compared to smooth- stemmed tibial implants in total ankle arthroplasty.

Outcomes of Posterior Monteggia Variant Fractures Repaired Through a Trans-Olecranon Approach

To evaluate the clinical and radiographic outcomes and complications following surgical treatment of adult posterior Monteggia fracture variants in which coexisting radial head and coronoid fractures were addressed through a single extensile posterior trans-olecranon approach. We performed a retrospective review from January 1, 2010, to January 1, 2021, of all adult patients who underwent fixation of posterior Monteggia variant fractures with coexisting radial head and/or coronoid fractures through a trans-olecranon approach by a single surgeon. Patient records were reviewed for postoperative complications and radiographic outcomes. All patients were contacted to participate in a repeat clinical examination and functional assessment. Thirteen patients met the inclusion criteria, of which 7 agreed to participate. Final follow-up was conducted at an average of 49 months postoperatively. Six patients had a coexisting radial head fracture, 1 had a radial neck fracture, and all 7 patients had a coronoid fracture. All 7 coronoid fractures were repaired, 2 patients had internal fixation of the radial head, and 5 had radial head replacement. Four patients underwent reoperation. There were no cases of infection or heterotopic ossification, and all patients achieved radiographic bony union. The average final range of motion was 13°-133° flexion-extension (range: 0°-30° extension to 125°-145° flexion), 76° pronation (range: 70°-90°) and 72° supination (range: 60°-90°). The average Mayo Elbow Performance Score was 86 (range: 70-100), average Visual Analog Scale score was 1.4 (range: 0-3), and average Disabilities of the Arm, Shoulder, and Hand score was 9.8 (range: 0.83-35.83). Use of a single extensile trans-olecranon exposure offers reliable visualization and access to all bony structures requiring repair while minimizing soft tissue disruption. Patients treated with this trans-olecranon surgical approach demonstrate satisfactory clinical and radiographic outcomes with low rates of heterotopic ossification, nonunion, and infection. Therapeutic IV.

29. Imaging outcome at 24-month follow-up in a prospective, multicenter study of two-level cervical arthroplasty with a PEEK on ceramic artificial disc

<h3>BACKGROUND CONTEXT</h3> The use of cervical total disc replacement (cTDR) continues to increase. The implants continually evolve with respect to design and materials. Imaging studies of these devices provides insight to their ability to provide and maintain range of motion (ROM), disc height, and depending on the implant materials, facet joint assessment. <h3>PURPOSE</h3> The purpose of this study was to evaluate the imaging outcome of a PEEK-on-ceramic artificial disc for the treatment of two-level cervical disc disease. <h3>STUDY DESIGN/SETTING</h3> Data for this study came from a prospective, multicenter, non-randomized, historically controlled FDA Investigational Device Exemption (IDE) trial evaluating the Simplify®Cervical Artificial Disc for use at two levels. <h3>PATIENT SAMPLE</h3> Two-level cTDR was performed in 182 patients treated for symptomatic cervical disc degeneration with radiculopathy/myelopathy. <h3>OUTCOME MEASURES</h3> The primary outcome measures were ROM, disc height, and heterotopic ossification (HO) of the treated levels. MRI was used to assess the facet joints. <h3>METHODS</h3> The cTDR is composed of PEEK endplates with a mobile ceramic core. Radiographic evaluations were performed preoperatively, at hospital discharge, and 6 weeks, and 3, 6, 12, and 24 months postoperatively. MRI was performed pre- and 24 months postoperatively. All images were evaluated by an independent core lab. HO was evaluated based on a 0 (normal) to 4 (bridging bone) scale. Facets joints were scored on a 4-point scale ranging from 0 (normal) to 3 (severe degeneration) based on the MRI performed pre- and 24 months postoperatively. <h3>RESULTS</h3> At the superior cTDR level, the mean ROM improved from 8.0° prior to surgery to 9.5° at 24-month follow-up. At the inferior level, the values were 6.6° and 8.9°, respectively. At both operated levels, mean disc height increased postoperatively and the increase was maintained through 24-month follow-up. At the superior index level, the preoperative mean height was 3.1 mm and at 24 months it was 4.3 mm. At the inferior index level, the preoperative height was 3.1 mm and was 4.0 at 24 months. HO rates at 24-month follow-up were, the superior index level, severe HO (Grade 3) occurred in 8 patients (5%). Bridging HO (Grade 4) was also seen in 8 patients (5%). At the inferior index level, severe and bridging HO was seen in 17 (10%) and 5 (3%) patients, respectively. There was a lack of facet degeneration progression assessed on MRI between pre- and 24-month follow-up. No patient had severe facet degeneration at either operated level at either time point. The percentage of patients with a grade of moderate facet degeneration did not change at either level 8% at the superior index level and 5% at the inferior index level. At both levels, there appeared to be patients changing from the "none" category to the "mild" category. At the superior level prior to surgery, the figures for "none" and "mild" were 62% and 30% respectively. At 24-month follow-up, the figures were 52% and 39%, respectively. A similar pattern was seen at the inferior index level. <h3>CONCLUSIONS</h3> This study adds to the expanding evidence that two-level cTDR increases and maintains ROM and disc height and through 24-month follow-up. The majority of cTDR patients did not experience bridging HO. This PEEK-on-ceramic cTDR produces minimal artifact, allowing for reliable MRI visualization. This was used to evaluate the facet joints and a lack of facet degeneration progression was found. <h3>FDA DEVICE/DRUG STATUS</h3> Simplify Cervical Artificial Disc 2-level (Approved for this indication).

Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using the INBONE II Prosthesis.

The literature on the outcome of revision total ankle arthroplasty (TAA) remains limited. In this study, we aimed to report the clinical and radiographic outcomes of revision TAA at a high-volume center in the United Kingdom. This study was a retrospective review of 28 patients who underwent 29 revision TAAs using the INBONE II Total Ankle System (Wright Medical Technology/Stryker). Demographic, radiographic, and patient-reported outcome measure data were analyzed. The mean duration from primary TAA to revision was 87.5 months (range, 16 to 223 months). The main indication for the revision was aseptic loosening after the primary TAA (83%). Additional procedures were required in 76% of ankles. At a mean follow-up of 40 months (range, 24 to 60 months), the infection rate was 7%, the reoperation rate was 7%, and the implant survival rate was 97%. A significant postoperative improvement in the radiographic component alignment measures was observed. The subsidence, loosening, and heterotopic ossification rates in this study were comparable with those in other reports and did not influence the clinical outcome. A significant improvement was observed in the Manchester-Oxford Foot Questionnaire (MOXFQ) in all domains and the EuroQol-5 Dimensions (EQ-5D) in 3 domains at 24 months postoperatively. Revision TAA using the INBONE II prosthesis was associated with good short-term survival and improvement in postoperative scores at 2 years. Maintenance of the postoperatively improved alignment was documented at the follow-up. The results of this study support the notion that revision TAA is a satisfactory option for failed primary TAA. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.