Pulsed Lavage in Cementless Total Hip Arthroplasty Reduces the Incidence ofBrooker Grade 3 and 4 Heterotopic Ossifications

Abstract

Heterotopic ossification (HO) may cause pain, and can lead to loss of hip motion after total hip arthroplasty (THA). There is evidence that pulsed lavage may lower the incidence of HO formation. We assessed the effect of pulsed lavage on the incidence of HO in 87 male patients after THA. All patients received an uncemented THA through a posterolateral approach. 39 patients were treated with pulsed lavage (index group) and 48 males were treated without pulsed lavage (historical control group, matched on aetiology, gender, surgical approach and type of prosthesis). Both groups followed the same postoperative treatment regimen. HO severity was scored in both groups according to the Brooker classification by three blinded orthopaedic surgeons one year postoperatively. Good inter-observer agreement (Kappa 0.7) for scoring HO was found. The incidence of HO (51%) in the index group did not differ significantly (p = 0.53) from the control group (58%). However, the incidence of clinically relevant HO (Brooker grades 3 and 4) was significantly lower (p = 0.04) in the index group (3%) as compared to the control group (17%). These results suggest a beneficial effect of pulsed lavage on the incidence of severe heterotopic ossification after cementless THA in male patients.

Extensive Surgical Wound Lavage Reduces the Incidence and Severity of Heterotopic Ossification in Primary Total Hip Replacement: A Study of 175 Hip Replacements

“…Sneath et al 26) have shown no difference in incidence of HO in their patient groups, in a randomized trial, despite use of pulsed lavage. But on the contrary, another prospective case control study by Mellema et al 27) has suggested a significant reduction in the incidence of severe grade HO with use of pulsed lavage. Unlike in our study they did not notice any improvement in the overall incidence between the groups (51% and 58%) but did notice a significant improvement in the severe grades (3% and 17%).…”

“…But we believe that if the lavage is done in a sequential manner, the debris are washed away as they are generated hence minimizing the risk of dissemination. There are only a handful of studies in literature which report the relation between formation of HO and use of pulsed lavage 26 27) . Sneath et al 26) have shown no difference in incidence of HO in their patient groups, in a randomized trial, despite use of pulsed lavage.…”

Pulsed lavage in joint arthroplasty: A systematic review and meta-analysis

“…Four studies[ 24 , 28 , 30 , 31 ] met the inclusion criteria and were included in the meta-analysis with 2 randomized controlled trials and 1 prospective non-randomized study, and 1 retrospective comparative study. It involved 185 subjects in the PL group and 182 subjects in the SL group.…”

“…Our results showed no difference in HO formation between PL and SL. A study by Mellema et al [ 28 ] showed a beneficial effect of PL in preventing Brooker grade 3-4 HO however this may be limited by the low numbers in such high HO grades. The etiology of this pathology is still unclear.…”

“…Another problem in THA is the formation of heterotopic ossification (HO). PL may stop HO development by removing the nascent mesenchymal cells from the hip joint and gluteal muscles[ 28 ].…”