From the Mayo Clinic, Jacksonville, FL.
J Am Acad Orthop Surg. 2023 Apr 1;31(7):e385-e393. doi: 10.5435/JAAOS-D-22-00639. Epub 2023 Feb 6.
Although risk factors for heterotopic ossification (HO) have been defined, the effect from surgical approach is not fully understood. The primary objective of our study was to evaluate the effect that surgical approach has on the risk for developing severe HO after total hip arthroplasty (THA) and compare this with other known risk factors. We hypothesized that there would be no difference in HO formation based on the surgical approach.
We retrospectively reviewed all patients who underwent primary THA at our hospital between March 2011 and March 2021. Patients with HO documented in the radiology reports were cross-referenced with our THA data set and manually reviewed to determine Brooker classification. Patient demographics, medical comorbidities, surgical details, and medication information were collected from the electronic medical record and compared.
Of 3,427 patients who underwent THA, 677 (19.8%) developed HO postoperatively. A multivariable analysis confirmed that surgical approach was independently associated with increased odds for HO development. The anterolateral (odds ratio [OR], 3.43; P < 0.001) and posterior (OR, 2.24; P < 0.001) approaches had increased odds for developing HO compared with the direct anterior approach. However, only the anterolateral approach (OR, 1.85; P = 0.033) demonstrated an increased association with the development of severe HO (Brooker 3, 4) postoperatively.
Although the use of the direct anterior approach had the lowest overall OR for developing HO after THA, this is likely only clinically notable when compared with the anterolateral approach.
III.
虽然已经确定了异位骨化（HO）的危险因素，但手术入路的影响尚不完全清楚。我们研究的主要目的是评估手术入路对全髋关节置换术（THA）后发生严重 HO 的风险的影响，并将其与其他已知的危险因素进行比较。我们假设手术入路不会对 HO 的形成产生影响。
我们回顾性分析了 2011 年 3 月至 2021 年 3 月期间在我院接受初次 THA 的所有患者。将放射学报告中记录有 HO 的患者与我们的 THA 数据集进行交叉引用，并进行手动审查以确定 Brooker 分类。从电子病历中收集患者的人口统计学、合并症、手术细节和用药信息，并进行比较。
在 3427 例接受 THA 的患者中，有 677 例（19.8%）术后发生 HO。多变量分析证实，手术入路与 HO 发生的几率增加独立相关。与直接前入路相比，前外侧（比值比 [OR]，3.43；P < 0.001）和后入路（OR，2.24；P < 0.001）发生 HO 的几率增加。然而，只有前外侧入路（OR，1.85；P = 0.033）与术后严重 HO（Brooker 3、4）的发生有增加的相关性。
尽管直接前入路在 THA 后发生 HO 的总体 OR 最低，但与前外侧入路相比，这可能只是临床上有意义。
III 级。
