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MINERVA ORTOPEDICA E TRAUMATOLOGICA
Rivista di Ortopedia e Traumatologia
Minerva Ortopedica e Traumatologica 2015 Agosto;66(4):153-9
Is minimally invasive anterior approach to the hip related to high risk of heterotopic ossification? A clinical and radiographic assessment
Basso M. 1, Formica M. 1, Sanguineti F. 1, Concina C. 2, Alecci V. 2
1 Clinica Ortopedica, IRCCS Azienda Ospedaliero-Universitaria, San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italia;
2 Ospedale San Polo di Monfalcone, Monfalcone, Gorizia, Italia
AIM: Giving the increasing request for tissue-sparing surgery, which is the best surgical approach for total hip replacement, is object of debate. One of the main concerns is: are they really respectful of muscle tissues? Periprosthetic heterotopic ossification (HO) is considered as an indirect sign of muscle damage. The aim of this study is to evaluate the incidence of heterotopic ossification using the minimally invasive direct anterior approach (DAA) to the hip. We evaluated clinical and radiological outcomes as well as the relationship with the type of stem used.
METHODS: A total of 203 patients, who underwent to total hip arthroplasty using DAA, were evaluated at least after 10 months from the operation. A clinical and functional assessment was performed using pre and postoperative Visual Analogue Scale (VAS) and Harris Hip Score (HHS). A t-score statistics was used. The evaluation has been completed with the research of HO at the pelvis radiographs. HO was classified according to Brooker’s. Patients were also divided in three groups in relation to the type of stem: straight, anatomical and short stems.
RESULTS: HO was observed in 44/203 patients (21.6%). 13.6% was classified as “mild/moderate” and 86.4% as “severe”. There was no relationship between clinical results and severity of HO. As regards the type of stem, straight stems developed HO in 26.4% of cases, mini stems in 25.8% and anatomical stems in 17% (P>0.05).
CONCLUSION: Incidence of HO using DAA is slightly lower than traditional approaches. We have not noticed a statistically significant reduction in developing HO using short stems and no relationship between HO severity and clinical outcome was observed.