Heterotopic Ossification Excision Following Hip Arthroscopy
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1 Heterotopic Ossification Excision Following Hip Arthroscopy Molly A. Keegan, M.D. 3 John M. Redmond, M.D. 1,3 Asheesh Gupta, M.D. 1 Jon E. Hammarstedt, BA 1 Christine E. Stake, M.A. 1 Benjamin G. Domb, M.D. 1,2 1.American Hip Institute, 2., IL, 3. Mayo Clinic, Rochester, MN, 4. University of Illinois at Chicago
2 Disclosures Dr. Benjamin Domb American Hip Institute Research support: o American Hip Institute o Arthrex, Inc. o Mako Surgical Corp. o Breg o ATI o Pacira Consulting: o Arthrex, Inc. o Mako Surgical Corp. o Pacira Stock: o Stryker Royalties: o Arthrex, Inc. o Orthomerica o DJO Global AANA Learning Center Committee
3 Background Heterotopic Ossification (HO) Common after hip arthroscopy Incidence around 44% for pts. not receiving prophylaxis Can still occur with preventative measures
4 Purpose The purpose of this study was to evaluate patient-reported outcome (PRO) scores for patients undergoing revision surgery for HO excision.
5 Methods Study period: o 2379 arthroscopic surgeries 68 (3%) patients had revision surgery for HO excision Inclusion criteria was ossification of 1 cm, which eliminated 45 patients Final study group was 23 patients Two reviewers assessed radiographs for inclusion Retrospective chart review completed Patients with previous hip conditions were excluded
6 Patient-Reported Outcome Tools The protocol included pre- and post-operative administration of: o Modified Harris Hip Score (mhhs) o Non-Arthritic Hip Score (NAHS) o Hip Outcome Score Activities of Daily Living (HOS- ADL) Sport Specific Subscale o Visual Analog Scale (VAS) o Satisfaction
7 Results - Demographics Parameter Measure Follow-up Percentage 82.6% Average Follow-up Time 1.5 months Gender Male 10 Female 13 Average Age 38.7 Laterality Left 12 Right 11
8 Primary Surgery Procedures Procedure N= Femoral Osteoplasty 17 Acetabuloplasty 16 Iliopsoas Release 4 Removal of Loose Body 3 Trochanteric Bursectomy 2 Labral Treatment Base refixation 4 Debridement 6 Reconstruction 8 Simple stitch 8
9 HO Excision Surgical Procedures Procedure N Femoroplasty 6 Chondroplasty 5 Acetabuloplasty 4 Iliopsoas Release 3 Osteoplasty (Peripheral) 2 Debridement of Trochanteric Bursitis 1 Iliotibial Band Release 1 Microfracture Acetabulum 1 Labral Treatment Base Refixation, Reconstruction & Simple Stitch 0 Debridement 13
10 Results
11 Conclusion Improved outcome scores and decreased pain in patients undergoing revision surgery for HO excision Few patients achieved good or excellent results (defined as >80 mhhs) Revision surgery for HO removal should be approached cautiously Further research warranted
12 References Beckmann, J. T., J. D. Wylie, et al. (2014). "The Effect of NSAID Prophylaxis and Operative Variables on Heterotopic Ossification After Hip Arthroscopy." Am J Sports Med. Bedi, A., R. M. Zbeda, et al. (2012). "The incidence of heterotopic ossification after hip arthroscopy." Am J Sports Med 40(4): Cohn, R. M., R. Schwarzkopf, et al. (2011). "Heterotopic ossification after total hip arthroplasty." Am J Orthop (Belle Mead NJ) 40(11): E Domb, B. G., C. E. Stake, et al. (2014). "Revision hip preservation surgery with hip arthroscopy: clinical outcomes." Arthroscopy 30(5): Kaplan, F. S., D. L. Glaser, et al. (2004). "Heterotopic ossification." J Am Acad Orthop Surg 12(2): Lee, E. K., S. Namdari, et al. (2013). "Clinical results of the excision of heterotopic bone around the elbow: a systematic review." J Shoulder Elbow Surg 22(5): Neal, B., H. Gray, et al. (2002). "Incidence of heterotopic bone formation after major hip surgery." ANZ J Surg 72(11): Ong, C., M. Hall, et al. (2013). "Surgical technique: arthroscopic treatment of heterotopic ossification of the hip after prior hip arthroscopy." Clin Orthop Relat Res 471(4): Ozturk, B. Y. and B. T. Kelly (2013). "Heterotopic ossification in portal sites following hip arthroscopy." Arch Orthop Trauma Surg 133(7): Randelli, F., L. Pierannunzii, et al. (2010). "Heterotopic ossifications after arthroscopic management of femoroacetabular impingement: the role of NSAID prophylaxis." J Orthop Traumatol 11(4): Rath, E., H. Sherman, et al. (2013). "The incidence of heterotopic ossification in hip arthroscopy." Arthroscopy 29(3): Reichel, L. M., E. Salisbury, et al. (2014). "Molecular mechanisms of heterotopic ossification." J Hand Surg Am 39(3): Salisbury, E., E. Rodenberg, et al. (2011). "Sensory nerve induced inflammation contributes to heterotopic ossification." J Cell Biochem 112(10):
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