Heterotopic Ossification Negatively Influences Range of Motion After Revision Total Knee Arthroplasty

Abstract

Background: The incidence of heterotopic ossification (HO) after total knee arthroplasty (TKA) varies and is of unclear clinical significance. This study aimed to identify the incidence of HO in patients undergoing revision TKA for either stiffness or aseptic loosening/instability and determine if the presence of HO is associated with inferior absolute range of motion (ROM) and ROM gains. Methods: Eighty-seven patients were prospectively enrolled and separated into 2 cohorts to evaluate ROM after revision TKA (2017-2019). Group 1 (N ¼ 40) patients were revised for stiffness, while group 2 (N ¼ 47) patients were revised for either aseptic loosening or instability. Goniometer-measured ROM values were obtained preoperatively and at 6 weeks, 6 months, and 1 year postoperatively. Statistical analysis included a Fisher's exact test to assess for an association between preoperative HO and final ROM at 1 year after revision TKA. Results: HO was identified on preoperative radiographs in 17 patients (20%). There was a significantly higher rate of preoperative HO in patients revised for stiffness compared to patients revised for instability or loosening (30% vs 11%; P ¼ .03). Five cases of HO qualitatively identified as most clinically severe were associated with lower ROM at each time point compared to the remainder of HO cases in this study cohort (P < .02). Conclusion:The presence of HO is greater in patients undergoing revision TKA for stiffness. Additionally, HO severity appears to have a major effect on preoperative and postoperative ROM trajectory. This information should help guide patient expectations and highlight the need for a comprehensive, standardized classification system for HO.

Severe Heterotopic Ossification After Revision Total Knee Arthroplasty: A Case Report and Review of the Literature

“…Patients with HO were also found to have decreased preoperative range of motion (52°c ompared with 63°), which improved at the final 1-year follow-up (81°vs 86°). 7 Immunologic and inflammatory conditions may contribute to heterotopic ossification. The patient's comorbidities including diabetes and psoriasis may have contributed to heterotopic ossification.…”

“…At 1-year follow-up, the range of motion was from full extension to 100° of flexion. 3 A prospective cohort study by Gkiatas et al 7 found that patients with more severe HO had decreased range of motion postoperatively, but there was no difference in postoperative range of motion patterns in patients with HO compared with those without HO. The present case is an example of severe HO with complete loss of range of motion.…”

“…Patients with HO were also found to have decreased preoperative range of motion (52° compared with 63°), which improved at the final 1-year follow-up (81° vs 86°). 7 …”

Relatively Low Rate of Heterotopic Ossification Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-analysis

“…In addition, the most qualitatively severe HO cases were associated with a lower range of motion preoperatively and at every postoperative follow-up timepoint up to 1-year, indicating that severe HO formation is not fully mitigated even after revision TKA. 26 Furthermore, when notable levels of functional debilitation are reached, revision surgery for HO excision may be required for symptom relief. For example, a recent systematic review of HO after total elbow arthroplasty found that 25% of patients who developed HO were symptomatic and, of those, 22% required subsequent revision surgery.…”

Heterotopic ossification after alloplastic temporomandibular joint replacement: a case cohort study

“…HO is the appearance of mature bone tissue in soft tissues including muscles, tendons, or articular capsules [ 7 ]. The incidence of HO in total hip/knee arthroplasty (THA/TKA) ranges from 15 to 90% [ 8 , 9 ]. However, there are few reports on the occurrence of the HO after TMJ TJR, as well as its affection on patients.…”