University of Turin, Viale 25 aprile 137 int 6, 10133, Turin, Italy.
Eur J Orthop Surg Traumatol. 2023 May;33(4):1037-1041. doi: 10.1007/s00590-022-03244-9. Epub 2022 Mar 19.
Aim is to identify if age, sex, type of posterolateral approach (mini vs standard), surgical time and time from surgery to drainage removal were independent risk factors for heterotopic ossifications after total hip arthroplasty.
Patients who underwent a THA with posterolateral approach during a 15 years period were included. The exclusion criteria were absence of X-rays follow-up or HO prophylaxis protocol adoption. The following data were collected: age, sex, type of approach (classical/minimal-invasive), surgical time, time from surgery to drainage removal. Two orthopedic surgeons independently reviewed the 2 years follow-up X-rays and classified the HO according to Brooker classification. Severe HO was defined if HO were classified as major than grade 2. Correlation between severe HO and risk factor has been tested with multivariable analysis.
About 1225 patients were included: mean age of 63.8 years, 504 were men. HO were found in 67.6%. Men showed higher severe HO rate than woman (44.1% vs 29.1%, p = 0.001). Patients older than 65 years showed higher severe HO rate (30.3% vs 39.9%, p = 0.002). Standard posterolateral approach was performed in 75.4% and severe HO rate was 32.8% versus 27.1% in those treated with the minimally invasive approach (p = 0.067). In 75.6% of cases surgery lasted less than 90 min and this group showed a severe HO rate in 29.1%, while patient with longer surgical time showed a rate of 35.7% (p = 0.033). In 47.4% of patients, the drainage was removed in the first post-operative day, in this group severe HO rate was significantly lower than the others: 24.8 versus 36.2% (p = 0.001).
Male sex, age older than 65 years, surgical time longer than 90 min and delayed drainage removal are risk factors for severe HO. Patients with one or more of those risk factors should be identified as good candidates for HO prophylaxis.
目的是确定年龄、性别、后外侧入路类型（微创与标准）、手术时间以及从手术到引流管拔除的时间是否为全髋关节置换术后异位骨化的独立危险因素。
纳入了在 15 年内接受后外侧入路全髋关节置换术的患者。排除标准为缺乏 X 射线随访或未采用异位骨化预防方案。收集了以下数据：年龄、性别、入路类型（经典/微创）、手术时间、从手术到引流管拔除的时间。两名骨科医生独立回顾了 2 年的随访 X 射线，并根据布鲁克（Brooker）分类对异位骨化进行了分类。如果异位骨化被归类为大于 2 级，则定义为严重异位骨化。使用多变量分析检验严重异位骨化与危险因素之间的相关性。
共纳入了约 1225 名患者：平均年龄为 63.8 岁，504 名为男性。67.6%的患者出现了异位骨化。男性的严重异位骨化发生率高于女性（44.1%比 29.1%，p=0.001）。年龄大于 65 岁的患者严重异位骨化发生率更高（30.3%比 39.9%，p=0.002）。75.4%的患者采用标准后外侧入路，严重异位骨化发生率为 32.8%，而采用微创入路的患者严重异位骨化发生率为 27.1%（p=0.067）。在 75.6%的病例中，手术时间小于 90 分钟，该组严重异位骨化发生率为 29.1%，而手术时间较长的患者发生率为 35.7%（p=0.033）。在 47.4%的患者中，引流管在术后第 1 天拔除，该组严重异位骨化发生率明显低于其他组：24.8%比 36.2%（p=0.001）。
男性、年龄大于 65 岁、手术时间长于 90 分钟以及延迟引流管拔除是严重异位骨化的危险因素。有一个或多个这些危险因素的患者应被视为异位骨化预防的良好候选者。
