The impact of class III (morbid) obesity on heterotopic ossification outcomes

Mourad, W.F.; Packianathan, Satyaseelan; Shourbaji, R.A.; Zhang, Zhen; Khan, Majid; Graves, Matthew; Baird, Michael C.; Russell, George V.; Vijayakumar, Srinivasan

doi:10.1016/j.prro.2011.11.003

Cited by 8 publications

(10 citation statements)

References 15 publications

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“…Other specific perioperative complications seen more frequently in this population are increased intraoperative blood loss, higher rate of DVT occurrence, and increased hospital length of stay 11,12,24. Several studies have also noted increased incidence of post-traumatic osteoarthritis and HO in the obese population 10,29,30…”

Section: Resultsmentioning

confidence: 91%

“…Twenty-six out of 38 morbidly obese patients (68%) developed post-traumatic arthritis out of a series of 299 acetabular fixations 29. A retrospective study comparing the incidence of HO after operative treatment of acetabular fracture in morbidly obese patients (BMI >40) compared to those patients with a BMI ≤40 showed that only 18% (68/374) of nonobese patients developed HO, while 47% (21/45) of morbidly obese patients developed HO 30…”

Section: Resultsmentioning

confidence: 99%

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Operative management of acetabulum fractures in the obese patient: challenges and solutions

Sardesai

Miller

Jauregui

et al. 2017

ORR

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Abstract:In this review, we aim to increase our knowledge of the treatment of acetabular fractures in the obese patient population. The extremely high incidence of obesity in the USA is a looming health care concern that impacts aspects of health care in all medical specialties. There are specific concerns to the orthopedic surgeon when treating obese patients for acetabular fracture. Patients with body mass index ≥30 present particular challenges to the surgeon in terms of preexisting medical conditions, diagnostic imaging, and perioperative complications. Specifically, this patient population experiences worse functional outcomes and greater incidence of surgical site infection, intraoperative blood loss, deep venous thrombosis, post-traumatic osteoarthritis, heterotopic ossification, and increased hospital length of stay. These problems are further exacerbated in the morbidly obese, as a scaling effect exists between increasing body mass index and worsening complication profile. This is problematic given the current high incidence of morbid obesity in the USA and particularly worrisome in light of the projected increase in obesity rates for the future.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Operative management of acetabulum fractures in the obese patient: challenges and solutions

Sardesai

Miller

Jauregui

et al. 2017

ORR

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“…All surgical procedures were performed by fellowship trained, orthopedic trauma surgeons. All patients underwent ORIF via a posteriorly approached (Kocher-Langenbeck) surgical exposure with the patient in either lateral or prone position (15,16). Early postoperative patient mobilization, with toe-touch weight bearing as tolerated, was initiated for all patients.…”

Section: Methodsmentioning

confidence: 99%

“…Seven hundred cGy was delivered in a single fraction to the mid-plane, using 6-18 MV photons. Treatment fields included the soft tissues around the proximal femur and acetabulum without bone shielding (15)(16)(17). Five different treatment plans were generated after CT simulation (the process used to determine the exact location, shape and size of the targeted area to be treated) to investigate the testicular doses.…”

Section: Methodsmentioning

confidence: 99%

“…Additional treatment planning trials were created for each patient by utilizing a SBT medially and by using different photon energies (6,10 and 18 MV) to study the effects of these maneuvers on the delivered dose to the testicles. Results (10)(11)(12)(13)(14)(15)(16)(17)(18) Heterotopic ossification (HO) is the pathological process of bone formation in non-osseous tissues following trauma and/or surgical intervention. Following traumatic injury, cellular and hormonal signals from the site of injury, a supply of mesenchymal cells and the appropriate tissue microenvironment are all among the potential factors that could contribute to development of HO in injured tissues (1).…”

Section: Abstract Aim: a Single-institution Retrospective Study Wasmentioning

confidence: 99%

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Testicular Dose During Prophylaxis of Heterotopic Ossification with Radiation Therapy

Mourad

John

Packianathan

et al. 2017

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Heterotopic ossification (HO) is the pathological process of bone formation in non-osseous tissues following trauma and/or surgical intervention. Following traumatic injury, cellular and hormonal signals from the site of injury, a supply of mesenchymal cells and the appropriate tissue microenvironment are all among the potential factors that could contribute to development of HO in injured tissues (1). Prophylactic radiation therapy (RT) is commonly used to reduce the risk of HO after open reduction and internal fixation (ORIF) of traumatic acetabular fractures (TAFs); heterotopic ossification after operative treatment of the hip using a posterior surgical approach has been reported in up to 50% of such patients (2). Radiation therapy presumably decreases the risk of HO by inhibiting the proliferation of pluripotential mesenchymal cells that could potentially differentiate into osteoblastic stem cells and is usually administered postoperatively, within 72 h of surgery (3-5). However, preoperative RT has also been used in these situations (6)(7)(8). In a recent meta-analysis reporting the incidence of HO after TAF status post ORIF, it was reported that the incidence of HO formation after RT prophylaxis 461 This article is freely accessible online.

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Leptin accelerates the pathogenesis of heterotopic ossification in rat tendon tissues via mTORC1 signaling

Jiang¹,

Chen²,

Chen³

et al. 2017

Journal Cellular Physiology

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Leptin, an adipocyte-derived cytokine associated with bone metabolism, is believed to play a critical role in the pathogenesis of heterotopic ossification (HO). The effect and underlying action mechanism of leptin were investigated on osteogenic differentiation of tendon-derived stem cells (TDSCs) in vitro and the HO formation in rat tendons. Isolated rat TDSCs were treated with various concentrations of leptin in the presence or absence of mTORC1 signaling specific inhibitor rapamycin in vitro. A rat model with Achilles tenotomy was employed to evaluate the effect of leptin on HO formation together with or without rapamycin treatment. In vitro studies with TDSCs showed that leptin increased the expression of osteogenic biomarkers (alkaline phosphatase, runt-related transcription factor 2, osterix, osteocalcin) and enhanced mineralization of TDSCs via activating the mTORC1 signal pathway (as indicated by phosphorylation of p70 ribosomal S6 kinase 1 and p70 ribosomal S6). However, mTORC1 signaling blockade with rapamycin treatment suppressed leptin-induced osteogenic differentiation and mineralization. In vivo studies showed that leptin promoted HO formation in the Achilles tendon after tenotomy, and rapamycin treatment blocked leptin-induced HO formation. In conclusion, leptin can promote TDSC osteogenic differentiation and heterotopic bone formation via mTORC1 signaling in both vitro and vivo model, which provides a new potential therapeutic target for HO prevention.

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The impact of class III (morbid) obesity on heterotopic ossification outcomes

Cited by 8 publications

References 15 publications

Operative management of acetabulum fractures in the obese patient: challenges and solutions

Operative management of acetabulum fractures in the obese patient: challenges and solutions

Testicular Dose During Prophylaxis of Heterotopic Ossification with Radiation Therapy

Leptin accelerates the pathogenesis of heterotopic ossification in rat tendon tissues via mTORC1 signaling

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