Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2015 | Research article

Incidence and clinical relevance of heterotopic ossification after internal fixation of acetabular fractures: retrospective cohort and case control study

Authors: Dominik Baschera, Hooman Rad, Dermot Collopy, René Zellweger

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2015

Abstract

Objective

The aim of the study was to evaluate predictors and clinical relevance of heterotopic ossification (HO) in patients treated for acetabular fractures in a tertiary referral centre.

Patients and methods

The study is a retrospective cohort study with a nested case–control study. All patients treated with internal fixation of acetabular fractures from January 2004 to October 2013. Ninety patients had postoperative imaging available at 6 and 12 months postoperatively and received no prophylaxis. Plain radiographs were used to grade HO. The Hip disability and Osteoarthritis Outcome Score (HOOS) was used to compare outcomes between patients suffering from HO with patients who did not.

Results

Sixteen patients (17.7%) suffered from HO. According to the Brooker classification, 5 had class I, 4 class II, 3 class III and 4 class IV HO. Traumatic brain injury (TBI) was the only significant risk factor for developing HO (odds ratio (OR) 8.6, 95% confidence interval (CI) (1.693–43.753), p = 0.014). The HO rate in patients with an anterior (ilioinguinal) or posterior (Kocher-Langenbeck) surgical approach was 20% and 21% respectively, and the HO rate in patients with a combined approach was much lower at 11%. Neither fracture type nor gender nor age increased the risk of HO significantly. The outcome measured by HOOS was not significantly different between patients with HO and patients in the control group. Patients with HO Brooker class II–IV had slightly lower (effect estimate +4.25, 95% CI (−10.2 to +12.10), p = 0.220) HOOS compared to the majority of the control group.

Conclusion

A very low rate of HO was found compared to the HO rates described in other studies with similar patient cohorts who received prophylaxis. Based on our findings and the current literature, we do not recommend giving prophylaxis against HO to patients after internal fixation of acetabular fractures.

Kaempffe FA, Bone LB, Border JR. Open reduction and internal fixation of acetabular fractures: heterotopic ossification and other complications of treatment. J Orthop Trauma. 1991;5(4):439–45.CrossRefPubMed

Matta JM, Siebenrock KA. Does indomethacin reduce heterotopic bone formation after operations for acetabular fractures? A prospective randomised study. J Bone Joint Surg. 1997;79(6):959–63.CrossRef

Tonna EA, Cronkite EP. Autoradiographic studies of cell proliferation in the periosteum of intact and fractured femora of mice utilizing DNA labeling with H3-thymidine. Proc Soc Exp Biol Med. 1961;107:719–21.CrossRefPubMed

Firoozabadi R, O’Mara TJ, Swenson A, Agel J, Beck JD, Routt M. Risk factors for the development of heterotopic ossification after acetabular fracture fixation. Clin Orthop Relat Res. 2014;472(11):3383–8.CrossRefPubMed

Brooker AF, Bowerman JW, Robinson RA, Riley Jr LH. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55(8):1629–32.PubMed

Thomas BJ. Heterotopic bone formation after total hip arthroplasty. Orthop Clin North Am. 1992;23(2):347–58.PubMed

Macfarlane RJ, Ng BH, Gamie Z, El Masry MA, Velonis S, Schizas C, et al. Pharmacological treatment of heterotopic ossification following hip and acetabular surgery. Expert Opin Pharmacother. 2008;9(5):767–86.CrossRefPubMed

Sagi HC, Jordan CJ, Barei DP, Serrano-Riera R, Steverson B. Indomethacin prophylaxis for heterotopic ossification after acetabular fracture surgery increases the risk for nonunion of the posterior wall. J Orthop Trauma. 2014;28(7):377–83.CrossRefPubMed

Burd TA, Hughes MS, Anglen JO. Heterotopic ossification prophylaxis with indomethacin increases the risk of long-bone nonunion. J Bone Joint Surg (Br). 2003;85(5):700–5.

10.

Clive DM, Stoff JS. Renal syndromes associated with nonsteroidal antiinflammatory drugs. N Engl J Med. 1984;310(9):563–72.CrossRefPubMed

11.

Oates JA, FitzGerald GA, Branch RA, Jackson EK, Knapp HR, Roberts 2nd LJ. Clinical implications of prostaglandin and thromboxane A2 formation (1). N Engl J Med. 1988;319(11):689–98.CrossRefPubMed

12.

Oertel S, Schneider U, Keel M, Lutolf UM, Bosshard G. Prophylaxis of heterotopic ossification in patients sedated after polytrauma: medical and ethical considerations. Strahlenther Onkol. 2008;184(4):212–7.CrossRefPubMed

13.

Schneider V, Levesque LE, Zhang B, Hutchinson T, Brophy JM. Association of selective and conventional nonsteroidal antiinflammatory drugs with acute renal failure: a population-based, nested case–control analysis. Am J Epidemiol. 2006;164(9):881–9.CrossRefPubMed

14.

Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med. 1999;340(24):1888–99.CrossRefPubMed

15.

Vuolteenaho K, Moilanen T, Moilanen E. Non-steroidal anti-inflammatory drugs, cyclooxygenase-2 and the bone healing process. Basic Clin Pharmacol Toxicol. 2008;102(1):10–4.PubMed

16.

Klassbo M, Larsson E, Mannevik E. Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol. 2003;32(1):46–51.CrossRefPubMed

17.

Nilsdotter AK, Lohmander LS, Klassbo M, Roos EM. Hip disability and osteoarthritis outcome score (HOOS)—validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003;4:10.CrossRefPubMedCentralPubMed

18.

Bosse MJ, Poka A, Reinert CM, Ellwanger F, Slawson R, McDevitt ER. Heterotopic ossification as a complication of acetabular fracture. Prophylaxis with low-dose irradiation. J Bone Joint Surg Am. 1988;70(8):1231–7.PubMed

19.

Karunakar MA, Sen A, Bosse MJ, Sims SH, Goulet JA, Kellam JF. Indometacin as prophylaxis for heterotopic ossification after the operative treatment of fractures of the acetabulum. J Bone Joint Surg. 2006;88(12):1613–7.CrossRef

20.

Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg. 2005;87(1):2–9.

21.

Griffin SM, Sims SH, Karunakar MA, Seymour R, Haines N. Heterotopic ossification rates after acetabular fracture surgery are unchanged without indomethacin prophylaxis. Clin Orthop Relat Res. 2013;471(9):2776–82.CrossRefPubMedCentralPubMed

22.

Gautschi OP, Cadosch D, Frey SP, Skirving AP, Filgueira L, Zellweger R. Serum-mediated osteogenic effect in traumatic brain-injured patients. ANZ J Surg. 2009;79(6):449–55.CrossRefPubMed

23.

Gautschi OP, Toffoli AM, Joesbury KA, Skirving AP, Filgueira L, Zellweger R. Osteoinductive effect of cerebrospinal fluid from brain-injured patients. J Neurotrauma. 2007;24(1):154–62.CrossRefPubMed

24.

Simonsen LL, Sonne-Holm S, Krasheninnikoff M, Engberg AW. Symptomatic heterotopic ossification after very severe traumatic brain injury in 114 patients: incidence and risk factors. Injury. 2007;38(10):1146–50.CrossRefPubMed

25.

Toffoli AM, Gautschi OP, Frey SP, Filgueira L, Zellweger R. From brain to bone: evidence for the release of osteogenic humoral factors after traumatic brain injury. Brain Inj. 2008;22(7–8):511–8.CrossRefPubMed

26.

Ghalambor N, Matta JM, Bernstein L. Heterotopic ossification following operative treatment of acetabular fracture. An analysis of risk factors. Clin Orthop Relat Res. 1994;305:96–105.CrossRefPubMed

27.

Daum WJ, Scarborough MT, Gordon Jr W, Uchida T. Heterotopic ossification and other perioperative complications of acetabular fractures. J Orthop Trauma. 1992;6(4):427–32.CrossRefPubMed

28.

Mears DC, Velyvis JH, Chang CP. Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res. 2003;407:173–86.CrossRefPubMed

29.

McLaren AC. Prophylaxis with indomethacin for heterotopic bone. After open reduction of fractures of the acetabulum. J Bone Joint Surg Am. 1990;72(2):245–7.PubMed

Title: Incidence and clinical relevance of heterotopic ossification after internal fixation of acetabular fractures: retrospective cohort and case control study
Authors: Dominik Baschera
Hooman Rad
Dermot Collopy
René Zellweger
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2015
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-015-0202-z

At a glance: The STEP trials

Springer Medicine

Incidence and clinical relevance of heterotopic ossification after internal fixation of acetabular fractures: retrospective cohort and case control study

Abstract

Objective

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2015

A biomechanical comparison between cortical bone trajectory fixation and pedicle screw fixation

Comparison of four different reduction methods for anterior dislocation of the shoulder

Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: a systematic review and meta-analysis of randomized controlled trials

Effects of knee position on blood loss following total knee arthroplasty: a randomized, controlled study

Development of a cartilage composite utilizing porous tantalum, fibrin, and rabbit chondrocytes for treatment of cartilage defect

Modified minimally invasive transforaminal lumbar interbody fusion using a trans-multifidus approach: a safe and effective alternative to open-TLIF