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BMC Musculoskeletal Disorders May 2024This review aims to study the clinical characteristics, diagnostic results, treatments, and outcomes in patients with heterotopic ossification following COVID-19...
BACKGROUND
This review aims to study the clinical characteristics, diagnostic results, treatments, and outcomes in patients with heterotopic ossification following COVID-19 infection.
METHODS
A literature search for eligible articles was conducted using MEDLINE/Pubmed, Global Health, and Scopus databases (January 12th, 2023), including all case reports and case series from any country and language. The criteria for inclusion in this review were cases of COVID-19 infection subsequently developing heterotopic ossification.
RESULTS
This systematic review analysed 15 reports (n = 20 patients) documenting cases of heterotopic ossification following COVID-19 infection. 80% of the patients were male, with a median age of 59 years. All patients required intensive care unit stay with an average duration of 48.5 days. Mechanical ventilation was necessary for all patients and 30% of them underwent tracheostomy. Common symptoms included stiffness and pain, most frequently affecting multiple locations (70%), with the hips and shoulders being predominantly involved. X-rays were the most commonly used imaging modality, followed by computed tomography. Although treatment was given, some of the patients continued to experience symptoms, particularly stiffness.
CONCLUSION
20 patients who developed heterotopic ossification after COVID-19 have been reported, the majority of which had at least two independent risk factors for this condition. The link between those two clinical entities is therefore uncertain, requiring further investigation. It is nonetheless important to suspect heterotopic ossification in patients with severe COVID-19 infection, prolonged immobilisation, mechanical ventilation, who develop joint pain and stiffness, as this condition can significantly impact patients' quality of life.
PROTOCOL REGISTRATION
CRD42023393516.
Topics: Humans; Ossification, Heterotopic; COVID-19; Male; Middle Aged; Female; Respiration, Artificial; Aged; SARS-CoV-2; Adult
PubMed: 38811925
DOI: 10.1186/s12891-024-07537-4 -
The Journal of Arthroplasty May 2024Developmental dysplasia of the hip (DDH) is one of the principal causes of secondary hip osteoarthritis, giving rise to considerable pain, impaired mobility, and a...
BACKGROUND
Developmental dysplasia of the hip (DDH) is one of the principal causes of secondary hip osteoarthritis, giving rise to considerable pain, impaired mobility, and a reduced quality of life. The optimal approach to managing individuals who have Crowe type IV DDH remains controversial. This study aimed to review the existing literature on the application of total hip arthroplasty (THA) as a treatment modality for Crowe type IV DDH, assessing its efficacy in addressing this severe hip deformity.
METHODS
A comprehensive search across the PubMed, Scopus, and Web of Science databases identified relevant studies. Inclusion criteria encompassed investigations reporting outcomes of THA in Crowe type IV DDH patients. Data extraction and quality assessment were performed independently by 2 reviewers. Utilizing R software, the prevalence of THA complications was analyzed through proportion analysis, employing the inverse variance method.
RESULTS
In this systematic review, a total of 74 studies were included, comprising a collective sample size of 2,829 patients (3,356 hips) diagnosed with Crowe type IV DDH. The posterior or posterolateral approach was the most commonly utilized surgical approach, followed by the lateral Hardinge and direct lateral approaches. The majority of studies have employed subtrochanteric osteotomies. Notably, post-THA, leg length discrepancy decreased, Trendelenburg sign resolved, and back pain was reduced. Patient-reported outcome measures like the Harris Hip Score improved significantly. The pooled prevalence rates of major postoperative complications were also assessed, including dislocation (7.2%), revision (8.7%), intraoperative fractures (10.5%), loosening (5.7%), nerve paralysis (5.6%), deep vein thrombosis (3.6%), infection (3.8%), heterotopic ossification grade 2 and above (6.1%), and a complicated patient rate of 11.0%.
CONCLUSIONS
Synthesizing diverse study data, an overview of THAs performance emerges, demonstrating significant enhancements in function, pain reduction, quality of life, and the correction of substantial leg length discrepancy. While THA has shown positive outcomes, instances of complications have been reported. The decision to undergo THA should involve a collaborative assessment between the surgeon and the patient, considering potential benefits and complications.
PubMed: 38759817
DOI: 10.1016/j.arth.2024.05.031 -
World Journal of Orthopedics Mar 2024Knee and hip osteoarthritis affects millions of people around the world and is expected to rise even more in frequency as the population ages. Joint arthroplasty is the...
BACKGROUND
Knee and hip osteoarthritis affects millions of people around the world and is expected to rise even more in frequency as the population ages. Joint arthroplasty is the surgical management of choice in these articulations. Heterotopic ossification and radiolucent lines formation are two frequent problems faced in hip and knee replacements respectively. Some studies show that the usage of pulsed lavage may prevent their formation.
AIM
To compare pulsed lavage to standard lavage in joint arthroplasty.
METHODS
PubMed, Cochrane, and Google Scholar (page 1-20) were searched till December 2023. Only comparative studies were included. The clinical outcomes evaluated were the heterotopic ossification formation in hip replacements, radiolucent lines formation, and functional knee scores in knee replacements.
RESULTS
Four studies met the inclusion criteria and were included in this meta-analysis. Pulsed lavage was shown to reduce the formation of radiolucent lines ( = 0.001). However, no difference was seen in the remaining outcomes.
CONCLUSION
Pulsed lavage reduced the formation of radiolucent lines in knee replacements. No difference was seen in the remaining outcomes. Furthermore, the clinical significance of these radiolucent lines is poorly understood. Better conducted randomized controlled studies and cost-effectivity studies are needed to reinforce these findings.
PubMed: 38596185
DOI: 10.5312/wjo.v15.i3.293 -
European Journal of Orthopaedic Surgery... May 2024Heterotopic ossification (HO) formation has been increasingly recognized as a complication of major orthopedic surgeries, particularly total hip arthroplasty (THA)....
BACKGROUND
Heterotopic ossification (HO) formation has been increasingly recognized as a complication of major orthopedic surgeries, particularly total hip arthroplasty (THA). Though, the overall incidence of HO following THA has been well-documented, it is often not reported by severity or by surgical approach.
QUESTIONS/PURPOSES
(1) What are the demographics of patients with HO? (2) What is the severity of HO following THA using the Brooker classification? (3) What is the incidence and class of HO following different THA approaches (anterior, posterior, posterolateral, anterolateral, superior, lateral, trans-gluteal)? (4) What are the number and training level of surgeons who performed each procedure?
METHODS
The PubMed, Embase, and Web of Science databases were queried, and PRISMA guidelines were followed. Qualitative and quantitative analyses were performed using Microsoft Excel.
RESULTS
We isolated 26 studies evaluating 6512 total hip arthroplasties (THA). The mean HO percentage overall was 28.8%, mostly Class I (54.2%) or Class II (29.6%). The highest percentage of HO was associated with the modified direct lateral (57.2%) and the traditional lateral (34.6%) approaches. The lowest HO percentages were identified following posterolateral (12.8%) and direct superior approaches (1%). Most studies reported a singular senior surgeon operating within the same approach for all patients.
CONCLUSIONS
The traditional lateral and modified direct lateral approaches to THA resulted in the highest percentage of HO postoperatively. However, most ossification cases were not clinically significant and did not strongly affect overall patient morbidity. Further studies are warranted to identify an association between severity of ossification and different arthroplasty approaches.
Topics: Ossification, Heterotopic; Arthroplasty, Replacement, Hip; Humans; Incidence; Postoperative Complications; Female; Male
PubMed: 38536499
DOI: 10.1007/s00590-024-03896-9 -
European Journal of Orthopaedic Surgery... May 2024The purpose of this systematic review and meta-analysis was to evaluate the prevalence and clinical significance of heterotopic ossification (HO) following total ankle... (Meta-Analysis)
Meta-Analysis
PURPOSE
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).
METHODS
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.
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 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%.
CONCLUSION
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.
Topics: Ossification, Heterotopic; Humans; Arthroplasty, Replacement, Ankle; Range of Motion, Articular; Postoperative Complications; Ankle Joint; Reoperation; Prevalence
PubMed: 38472436
DOI: 10.1007/s00590-024-03866-1 -
Indian Journal of Orthopaedics Mar 2024Open debridement remains the gold standard for the clinical treatment of post-traumatic elbow stiffness. However, postoperative complications, such as re-contraction and...
BACKGROUND
Open debridement remains the gold standard for the clinical treatment of post-traumatic elbow stiffness. However, postoperative complications, such as re-contraction and heterotopic ossification of the elbow joint, are highly prevalent. Hinged external fixation appears to offer the potential for greater improvement of joint function and reduction of complications. The purpose of this article is to provide the latest evidence on the effectiveness and safety of hinged external fixation combined with open debridement for the treatment of post-traumatic elbow stiffness.
METHODS
We searched for randomized controlled trials (RCTs) from the China National Knowledge Infrastructure, MEDLINE, PubMed, Web of Science, EMBASE, and Cochrane Library databases until December 31, 2022. STATA 15.1 software was used to analyze all the data for this article. The quality of the included articles was evaluated using the Cochrane Reviewer's Handbook 5.3.
RESULTS
Finally, we selected 8 high-quality RCTs for our meta-analysis, which included 555 patients. The meta-analysis demonstrated that hinged external fixation combined with open debridement for post-traumatic elbow stiffness (treatment group) showed a significant increase in elbow flexion and extension mobility (WMD = 5.16, 95% CI 4.39-5.49, = 13.02, = 0.000), Mayo elbow function scores (WMD = 5.25, 95% CI 4.33-6.17, = 11.15, = 0.000), and Mayo excellent rate (RR = 1.25, 95% CI 1.14-1.37, = 4.87, = 0.000). Additionally, there was a significant decrease in the complication rate (RR = 1.11, 95% CI 1.02-1.20, = 2.54, = 0.011) compared to open debridement alone (control group). Furthermore, the results of the publication bias test showed no significant bias.
CONCLUSIONS
With the assistance of hinged external fixation, open debridement for post-traumatic elbow stiffness can lead to increased elbow mobility and a reduced complication rate. However, due to the small sample size, a multicenter randomized controlled trial with a larger sample size is still necessary to further confirm the effectiveness and safety of hinged external fixation combined with open debridement for post-traumatic elbow stiffness.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s43465-023-01087-y.
PubMed: 38425820
DOI: 10.1007/s43465-023-01087-y -
Hip & Pelvis Mar 2024Protrusio acetabuli, or abnormal protrusion of the femoral head into the acetabulum, requires performance of a total hip arthroplasty (THA) for which various... (Review)
Review
Protrusio acetabuli, or abnormal protrusion of the femoral head into the acetabulum, requires performance of a total hip arthroplasty (THA) for which various reconstruction techniques and outcomes have been described. The aim of this systematic review is to provide a comprehensive analysis of the current evidence, evaluate treatment efficacy, compare surgical techniques, and identify topics for future research along with improving evidence-based decision-making, improving patient outcomes in the management of this condition. A thorough systematic review of the PubMed, Embase, Cochrane Library databases, and Scopus library was conducted, and articles describing techniques of THA for treatment of protrusion acetabuli were extracted. The initial search generated 751 results. After exclusion, 18 articles were included. Of these, eight were prospective studies and 10 were retrospective. Surgery was performed on 783 hips with a mean age of 60 years; 80% of females who mostly had inflammatory arthritis were followed up for 8.86 years (range, 2-15.4 years). Good outcomes have been achieved with THA using uncemented cups with bone graft; however, no conclusion could be drawn with regard to the femoral side. It can be concluded that the concept of restoration of the anatomical hip center of rotation is paramount for good outcome and better survival of the implant is important when using uncemented cups with a bone graft. In addition, screw augmentation for fixation is not recommended unless absolutely necessary. The most common complications were aseptic loosening and heterotopic ossification. While the former required revision, conservative management was administered for the latter.
PubMed: 38420735
DOI: 10.5371/hp.2024.36.1.12 -
The Journal of Arthroplasty Feb 2024Severe heterotopic ossification (HO) (grades III and IV) after total hip arthroplasty (THA) over the last 25 years requiring excision is very uncommon. We performed a...
BACKGROUND
Severe heterotopic ossification (HO) (grades III and IV) after total hip arthroplasty (THA) over the last 25 years requiring excision is very uncommon. We performed a systematic review of the literature and reported a new case series with operative treatment after primary uncemented THA.
METHODS
A systematic review identified papers describing patients who had excision of HO after THA performed after 1988. Concepts of hip arthroplasty, HO, and surgical excision were searched in MEDLINE, Embase, and Scopus from database inception to November 2022. The inclusion criteria were articles that included specific patient data on the grade of HO, operative procedure, and prophylaxis. Studies were screened for inclusion by 2 independent reviewers. The extracted data included demographic data, the interval from index surgery to excision, clinical results, and complications. There was one surgeon who performed reoperation for ankylosis of primary THA in 3 men who had severe pain and hip deformity.
RESULTS
Data from 7 studies were included. There were 41 patients who had grade III or IV HO who had excision, and in 5 patients, revision of a component was also performed. Perioperative prophylaxis was irradiation alone in 10 patients, irradiation and indomethacin in 10 patients, and indomethacin alone in 21 patients. At a mean follow-up time of 14.8 months, the definition of the results was not uniform, and range of motion was improved, but relief of pain was inconsistent. There was one dislocation after resection without revision, one gastrointestinal complication, and 2 recurrences. Treatment of the 3 new patients, with wide excision of periarticular bone, selective exchange of components, and perioperative irradiation prophylaxis, was successful in improving pain, motion, and deformity.
CONCLUSIONS
There is insufficient good-quality data on the operative treatment of severe symptomatic HO after THA performed over the last 25 years. Prophylaxis with low-dose irradiation prevented a recurrence. Multicenter studies are needed to determine the optimum timing and prognosis for treatment.
PubMed: 38360283
DOI: 10.1016/j.arth.2024.02.017 -
Clinical Otolaryngology : Official... May 2024The aim of the study is to conduct a systematic review of the existing literature on styloidectomy performed through transoral robotic surgery (TORS) in Eagle syndrome... (Review)
Review
OBJECTIVES
The aim of the study is to conduct a systematic review of the existing literature on styloidectomy performed through transoral robotic surgery (TORS) in Eagle syndrome (ES).
DESIGN AND SETTING
Two independent reviewers (RC and AC) conducted a systematic review of PubMed and Embase databases, seeking articles on TORS performed for ES treatment. The search was conducted in July 2023. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
PARTICIPANTS
The review included a total of 17 adult patients, comprising 12 females and 5 males, with an average age of 52.2 years, all diagnosed with ES.
MAIN OUTCOME MEASURES
For each patient, we assessed the overall length of the styloid process, the affected side, total intervention duration, hospitalization duration, pre and postoperative Visual Analogue Scale (VAS) scores, and the presence of minor and major complications.
RESULTS
We identified 4 articles describing 17 instances of TORS as a surgical treatment for ES in the literature, totaling 18 styloidectomies. The mean age of the patients was 52.2 years, with 12 females and 5 males. The average operation time, inclusive of the docking phase, was 68.8 minutes. Sixteen patients (94.1% of the total) experienced complete symptom disappearance or near-complete resolution after surgery. One patient (5.9%) showed improvement categorized as 'non-meaningful.' Only one case of minor complication was reported among the 17 procedures (5.9%).
Topics: Adult; Male; Female; Humans; Middle Aged; Robotic Surgical Procedures; Ossification, Heterotopic; Temporal Bone; Hospitalization
PubMed: 38290994
DOI: 10.1111/coa.14145 -
Journal of Orthopaedic Surgery and... Jan 2024Conversion total hip arthroplasty (THA) is considered the main treatment plan for patients with first-line treatment failure of acetabulum fracture. This meta-analysis... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Conversion total hip arthroplasty (THA) is considered the main treatment plan for patients with first-line treatment failure of acetabulum fracture. This meta-analysis aims to assess the effect of the type of initial treatment and timing of surgery on the outcomes of conversion THA.
METHODS
Using PRISMA guidelines, MEDLINE/PubMed, Scopus, Web of Science, and CENTRAL Cochrane were searched for articles published before October 14, 2022. Comparative studies investigating the outcome of THA following treatment failure of acetabular fracture were included. These articles were categorized into three groups, and the outcomes of treatment plans in each group were compared: (A) primary THA vs. conversion THA, (B) THA following conservative treatment vs. THA following ORIF, and (C) acute THA vs. delayed THA following prior treatment failure. Review Manager (RevMan, version 5.3) software was utilized to perform the statistical analysis.
RESULTS
Twenty-four comparative studies met the inclusion criteria (reported the data of 13,373 patients). Concerning group (A), the following complications were significantly higher in conversion THA: Infection (OR [95% CI] 3.19 [2.12, 4.79]; p value < 0.00001), dislocation (OR [95% CI] 4.58 [1.56, 13.45]; p value = 0.006), heterotopic ossification (OR [95% CI] 5.68 [3.46, 9.32]; p value < 0.00001), and Revision (OR [95% CI] 2.57 [1.65, 4.01]; p value < 0.00001). Postoperative HHS (SMD [95% CI] - 0.66 [- 1.24, - 0.08]; p value = 0.03) was significantly lower and operation time (SMD [95% CI] 0.88 [0.61, 1.15]; p value < 0.00001), blood loss (SMD [95% CI] 0.83 [0.56, 1.11]; p value < 0.00001), and bone graft need (OR [95% CI] 27.84 [11.80, 65.65]; p value < 0.00001) were significantly higher in conversion THA. Regarding group (B), bone graft need (OR [95% CI] 0.48 [0.27, 0.86]; p value = 0.01) was considerably higher in patients with prior acetabular fracture conservative treatment, while other outcomes were comparable. Respecting group (C), there were no significant differences in analyzed outcomes. However, systematically reviewing existing literature suggested a higher incidence rate of DVT following acute THA.
CONCLUSION
There were significantly higher postoperative complications and lower functional outcomes in conversion THA compared to primary THA. While complications and functional outcomes were comparable between ORIF and the conservative groups, the bone graft need was significantly higher in the conservative group. There were no significant differences between aTHA and dTHA. These results can assist surgeons in designing treatment plans based on each patient's clinical situation. Prospero registration code: CRD42022385508.
LEVEL OF EVIDENCE
III/IV.
Topics: Humans; Acetabulum; Arthroplasty, Replacement, Hip; Postoperative Complications; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 38245744
DOI: 10.1186/s13018-024-04561-x