Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, China.
Chin Med J (Engl). 2019 Apr 5;132(7):827-833. doi: 10.1097/CM9.0000000000000153.
Heterotopic ossification (HO) is a known complication of hip arthroscopy. We investigated incidence of HO after hip arthroscopy and determined whether revision for HO improved outcome.
A retrospective study was conducted on 242 patients (140 men and 102 women, mean age: 36.2 ± 9.5 years) who underwent hip arthroscopy for femoroacetabular impingement (FAI) between January 2016 and January 2018. The average follow-up period was 22.88 ± 11.74 months (range: 11-34 months). Thirteen (5.37%) cases of HO (six men and seven women, five left hips and eight right hips; mean age: 37.5 ± 4.7 years) were observed. Among them, four cases with HO with obvious pain symptoms and persistent non-remission underwent revision surgery to remove HO. Monthly follow-up was conducted. Visual analog scale (VAS), modified Harris Hip Score (mHHS), and non-Arthritis Hip Score (NAHS) were evaluated and compared between HO and non-HO patients. Independent sample t test, Mann-Whitney U test and the Chi-square test were used for inter-group comparisons. HO degree was evaluated using Brooker classification. Symptoms and function were evaluated before and after revision.
A total of 242 patients were involved in this study. Thirteen cases (5.4%) had imaging evidence of HO. Nine (9/13) were classified as Brooker stage I, three (3/13) Brooker stage II, and one (1/13) Brooker stage III. HO was detected by ultrasonography as early as 3 weeks after operation. After primary surgery, the mHHS of the HO group and non-HO group increased by 13.00 (8.50, 25.50) and 24.00 (14.00, 34.50) points (Z = -1.80, P = 0.08), NAHS increased by 18.00 (9.50, 31.50) and 26.00 (13.50, 36.00) points (Z = -1.34, P = 0.18), and VAS decreased by 3.00 (2.00, 4.00) and 4.00 (3.00, 4.50) points (Z = -1.55, P = 0.12). Average follow-up time after revision was 9.00 ± 2.94 months; mHHS increased by 34.75 points (t = -55.23, P < 0.01) and NAHS by 28.75 points (t = -6.03, P < 0.01), and VAS decreased by 4 points (t = 9.80, P < 0.01). HO and non-HO patients were similar for demographic and surgical data, and clinical and functional scores.
HO incidence after arthroscopic treatment of FAI is similar to that found in previous studies. Most HO have no effect on clinical symptoms. Patients who undergo revision HO resection show improvement in pain and joint function.
异位骨化（HO）是髋关节镜检查的已知并发症。我们研究了髋关节镜检查后 HO 的发生率，并确定了 HO 的翻修是否改善了结果。
对 242 例（男 140 例，女 102 例，平均年龄：36.2±9.5 岁）因股骨髋臼撞击症（FAI）接受髋关节镜检查的患者进行回顾性研究，时间为 2016 年 1 月至 2018 年 1 月。平均随访时间为 22.88±11.74 个月（范围：11-34 个月）。观察到 13 例（5.37%）HO（6 例男性和 7 例女性，5 例左侧髋关节和 8 例右侧髋关节；平均年龄：37.5±4.7 岁）。其中，4 例 HO 有明显疼痛症状且持续未缓解的患者接受了 HO 切除翻修手术。每月进行随访。评估并比较 HO 患者和非 HO 患者的视觉模拟评分（VAS）、改良 Harris 髋关节评分（mHHS）和非关节炎髋关节评分（NAHS）。采用独立样本 t 检验、Mann-Whitney U 检验和卡方检验进行组间比较。采用 Brooker 分级评估 HO 程度。评估术前和术后的症状和功能。
共纳入 242 例患者。13 例（5.4%）有 HO 的影像学证据。9 例（9/13）为 Brooker Ⅰ期，3 例（3/13）为 Brooker Ⅱ期，1 例（1/13）为 Brooker Ⅲ期。HO 在术后 3 周即可通过超声检查发现。初次手术后，HO 组和非 HO 组的 mHHS 分别增加了 13.00（8.50，25.50）和 24.00（14.00，34.50）分（Z=-1.80，P=0.08），NAHS 分别增加了 18.00（9.50，31.50）和 26.00（13.50，36.00）分（Z=-1.34，P=0.18），VAS 分别减少了 3.00（2.00，4.00）和 4.00（3.00，4.50）分（Z=-1.55，P=0.12）。翻修后平均随访时间为 9.00±2.94 个月；mHHS 增加了 34.75 分（t=-55.23，P<0.01），NAHS 增加了 28.75 分（t=-6.03，P<0.01），VAS 减少了 4 分（t=-9.80，P<0.01）。HO 患者和非 HO 患者在人口统计学和手术数据以及临床和功能评分方面相似。
髋关节镜治疗 FAI 后 HO 的发生率与既往研究相似。大多数 HO 对临床症状无影响。接受 HO 切除翻修的患者疼痛和关节功能改善。
