Pulsed Lavage in Cementless Total Hip Arthroplasty Reduces the Incidence ofBrooker Grade 3 and 4 Heterotopic Ossifications

Joris Mellema, Wierd Zijlstra, Tom van Raaij, Bas ten Have, Jos van Raay

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DOI: 10.4236/ojo.2011.12003                

Abstract

Heterotopic ossification (HO) may cause pain, and can lead to loss of hip motion after total hip arthroplasty (THA). There is evidence that pulsed lavage may lower the incidence of HO formation. We assessed the effect of pulsed lavage on the incidence of HO in 87 male patients after THA. All patients received an uncemented THA through a posterolateral approach. 39 patients were treated with pulsed lavage (index group) and 48 males were treated without pulsed lavage (historical control group, matched on aetiology, gender, surgical approach and type of prosthesis). Both groups followed the same postoperative treatment regimen. HO severity was scored in both groups according to the Brooker classification by three blinded orthopaedic surgeons one year postoperatively. Good inter-observer agreement (Kappa 0.7) for scoring HO was found. The incidence of HO (51%) in the index group did not differ significantly (p = 0.53) from the control group (58%). However, the incidence of clinically relevant HO (Brooker grades 3 and 4) was significantly lower (p = 0.04) in the index group (3%) as compared to the control group (17%). These results suggest a beneficial effect of pulsed lavage on the incidence of severe heterotopic ossification after cementless THA in male patients.

Keywords

Heterotopic Ossification, Pulsed Lavage, Total Hip Arthroplasty, Uncemented

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Sneath RJ, Bindi FD, Davies J, Parnell EJ. The effect of pulsed irrigation on the incidence of heterotopic ossifica-tion after total hip arthroplasty. J Arthroplasty 2001 Aug;16(5):547-51.
[2]	Toom A, Haviko T, Rips L. Heterotopic ossification after total hip arthroplasty. Int Orthop 2001;24(6):323-6.
[3]	Neal BC, Rodgers A, Clark T, Gray H, Reid IR, Dunn L, et al. A systematic survey of 13 randomized trials of non-steroidal anti-inflammatory drugs for the prevention of heterotopic bone formation after major hip surgery. Acta Orthop Scand 2000 Apr;71(2):122-8.
[4]	Buvanendran A, Kroin JS, Berger RA. Preoperative cyc-looxygenase-2 inhibitor treatment reduces the incidence of heterotopic ossification after hip arthroplasty: six-month follow-up. Anesthesiology 2007 Aug;107(2):358-9.
[5]	Della Valle AG, Ruzo PS, Pavone V, Tolo E, Mintz DN, Salvati EA. Heterotopic ossification after total hip arthro-plasty: a critical analysis of the Brooker classification and proposal of a simplified rating system. J Arthroplasty 2002 Oct;17(7):870-5.
[6]	Kjaersgaard-Andersen P, Ritter MA. Prevention of for-mation of heterotopic bone after total hip arthroplasty. J Bone Joint Surg Am 1991 Jul;73(6):942-7.
[7]	Kolbl O, Knelles D, Barthel T, Kraus U, Flentje M, Eul-ert J. Randomized trial comparing early postoperative ir-radiation vs. the use of nonsteroidal antiinflammatory drugs for prevention of heterotopic ossification following prosthetic total hip replacement. Int J Radiat Oncol Biol Phys 1997 Dec 1;39(5):961-6.
[8]	McCarthy EF, Sundaram M. Heterotopic ossification: a review. Skeletal Radiol 2005 Oct;34(10):609-19.
[9]	Lo TC, Healy WL. Re-irradiation for prophylaxis of het-erotopic ossification after hip surgery. Br J Radiol 2001 Jun;74(882):503-6.
[10]	Horwitz BR, Rockowitz NL, Goll SR, Booth RE, Jr., Balderston RA, Rothman RH, et al. A prospective ran-domized comparison of two surgical approaches to total hip arthroplasty. Clin Orthop Relat Res 1993 Jun;(291):154-63.
[11]	Nollen JG, van Douveren FQ. Ectopic ossification in hip arthroplasty. A retrospective study of predisposing factors in 637 cases. Acta Orthop Scand 1993 Apr;64(2):185-7.
[12]	Knahr K, Salzer M, Eyb R, Frank P, Blauensteiner W. Heterotopic ossification with total hip endoprostheses in various models of thrombosis prophylaxis. J Arthroplasty 1988;3(1):1-8.
[13]	Ayers DC, Evarts CM, Parkinson JR. The prevention of heterotopic ossification in high-risk patients by low-dose radiation therapy after total hip arthroplasty. J Bone Joint Surg Am 1986 Dec;68(9):1423-30.
[14]	Brooker AF, Bowerman JW, Robinson RA, Riley LH, Jr. Ectopic ossification following total hip replacement. In-cidence and a method of classification. J Bone Joint Surg Am 1973 Dec;55(8):1629-32.
[15]	Kjaersgaard-Andersen P, Sletgard J, Gjerloff C, Lund F. Heterotopic bone formation after noncemented total hip arthroplasty. Location of ectopic bone and the influence of postoperative antiinflammatory treatment. Clin Orthop Relat Res 1990 Mar;(252):156-62.
[16]	Ritter MA, Vaughan RB. Ectopic ossification after total hip arthroplasty. Predisposing factors, frequency, and ef-fect on results. J Bone Joint Surg Am 1977 Apr;59(3):345-51.
[17]	Toom A, Fischer K, Martson A, Rips L, Haviko T. In-ter-observer reliability in the assessment of heterotopic ossification: proposal of a combined classification. Int Orthop 2005 Jun;29(3):156-9.
[18]	Arcq M. Die paraartikul?ren Ossifikationen- eine Komplikation der Totalhüftendoprothese des Hüftgelenks. Arch Orthop Unfall Chir 1973;77:108-31.
[19]	DeLee J, Ferrari A, Charnley J. Ectopic bone formation following low friction arthroplasty of the hip. Clin Orthop Relat Res 1976 Nov;(121):53-9.
[20]	Neal B, Gray H, MacMahon S, Dunn L. Incidence of heterotopic bone formation after major hip surgery. ANZ J Surg 2002 Nov;72(11):808-21.
[21]	Kasetti RJ, Shetty AA, Rand C. Heterotopic ossification after uncemented hydroxyapatite-coated primary total hip arthroplasty. J Arthroplasty 2001 Dec;16(8):1038-42.
[22]	Rama KR, Vendittoli PA, Ganapathi M, Borgmann R, Roy A, Lavigne M. Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty 2009 Feb;24(2):256-62.
[23]	Puzas JE, Evarts CM, Brand JS. The stimulus for bone formation. Hip 1987;25-38.
[24]	Thomas BJ. Heterotopic bone formation after total hip arthroplasty. Orthop Clin North Am 1992 Apr;23(2):347-58.
[25]	Higo T, Mawatari M, Shigematsu M, Hotokebuchi T. The incidence of heterotopic ossification after cementless to-tal hip arthroplasty. J Arthroplasty 2006 Sep;21(6):852-6.