Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA.
Touro College of Osteopathic Medicine, 230 W 125th St 3rd Floor, New York, NY, 10027, USA.
Eur J Orthop Surg Traumatol. 2024 May;34(4):2089-2098. doi: 10.1007/s00590-024-03896-9. Epub 2024 Mar 27.
Heterotopic ossification (HO) formation has been increasingly recognized as a complication of major orthopedic surgeries, particularly total hip arthroplasty (THA). Though, the overall incidence of HO following THA has been well-documented, it is often not reported by severity or by surgical approach.
QUESTIONS/PURPOSES: (1) What are the demographics of patients with HO? (2) What is the severity of HO following THA using the Brooker classification? (3) What is the incidence and class of HO following different THA approaches (anterior, posterior, posterolateral, anterolateral, superior, lateral, trans-gluteal)? (4) What are the number and training level of surgeons who performed each procedure?
The PubMed, Embase, and Web of Science databases were queried, and PRISMA guidelines were followed. Qualitative and quantitative analyses were performed using Microsoft Excel.
We isolated 26 studies evaluating 6512 total hip arthroplasties (THA). The mean HO percentage overall was 28.8%, mostly Class I (54.2%) or Class II (29.6%). The highest percentage of HO was associated with the modified direct lateral (57.2%) and the traditional lateral (34.6%) approaches. The lowest HO percentages were identified following posterolateral (12.8%) and direct superior approaches (1%). Most studies reported a singular senior surgeon operating within the same approach for all patients.
The traditional lateral and modified direct lateral approaches to THA resulted in the highest percentage of HO postoperatively. However, most ossification cases were not clinically significant and did not strongly affect overall patient morbidity. Further studies are warranted to identify an association between severity of ossification and different arthroplasty approaches.
异位骨化（HO）的形成已越来越被认为是重大骨科手术的并发症，尤其是全髋关节置换术（THA）。尽管全髋关节置换术后 HO 的总体发生率已有详细记录，但通常不按严重程度或手术入路报告。
问题/目的：（1）HO 患者的人口统计学特征是什么？（2）使用布鲁克分类法，THA 后 HO 的严重程度如何？（3）不同 THA 入路（前路、后路、后外侧、前外侧、上外侧、外侧、经臀肌）后 HO 的发生率和分类如何？（4）实施每种手术的外科医生数量和培训水平如何？
检索 PubMed、Embase 和 Web of Science 数据库，并遵循 PRISMA 指南。使用 Microsoft Excel 进行定性和定量分析。
我们共纳入了 26 项评估了 6512 例全髋关节置换术的研究。总体 HO 百分比为 28.8%，主要为 I 级（54.2%）或 II 级（29.6%）。HO 发生率最高的与改良直接外侧（57.2%）和传统外侧（34.6%）入路有关。后外侧（12.8%）和直接上外侧（1%）入路的 HO 百分比最低。大多数研究报告了一位高级外科医生在同一入路下为所有患者进行手术。
THA 的传统外侧和改良直接外侧入路术后导致 HO 的比例最高。然而，大多数骨化病例并不具有临床意义，并未对整体患者发病率产生强烈影响。需要进一步的研究来确定骨化严重程度与不同关节置换入路之间的关系。
