Heterotopic ossification after arthroscopy for hip impingement syndrome

• Published in: Chinese medical journal 2019-04, Vol.132 (7), p.827-833
• Main Authors: Gao, Guan-Ying, Zhang, Xin, Dai, Ling-Hui, Huang, Hong-Jie, Wu, Rui-Qi, Ju, Xiao-Dong, Mei, Yu, Niu, Xing-Yue, Wang, Jian-Quan, Xu, Yan
• Format: Article
• Language: English
• Subjects: Adult; Age; Arthroscopy - adverse effects; Cartilage; Female; Femoracetabular Impingement - surgery; Hip joint; Hip Joint - pathology; Hip Joint - surgery; Humans; Joint surgery; Male; Middle Aged; Original; Ossification, Heterotopic - diagnosis; Ossification, Heterotopic - etiology; Pain; Patient satisfaction; Pelvis; Radiography; Range of motion; Retrospective Studies; Treatment Outcome; Ultrasonic imaging
• ISSN: 0366-6999; 2542-5641
• 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