Heterotopic Ossification Negatively Influences Range of Motion After Revision Total Knee Arthroplasty. 2021

Ioannis Gkiatas, and William Xiang, and Allina A Nocon, and Mark P Youssef, and T David Tarity, and Peter K Sculco
Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York.

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. Eighty-seven patients were prospectively enrolled and separated into 2 cohorts to evaluate ROM after revision TKA (2017-2019). Group 1 (N = 40) patients were revised for stiffness, while group 2 (N = 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. 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 = .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). 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.

UI MeSH Term Description Entries
D007719 Knee Joint A synovial hinge connection formed between the bones of the FEMUR; TIBIA; and PATELLA. Superior Tibiofibular Joint,Joint, Knee,Joint, Superior Tibiofibular,Knee Joints,Superior Tibiofibular Joints,Tibiofibular Joint, Superior
D009999 Ossification, Heterotopic The development of bony substance in normally soft structures. Ossification, Pathologic,Ectopic Ossification,Heterotopic Ossification,Ossification, Ectopic,Ossification, Pathological,Pathologic Ossification,Pathological Ossification
D011859 Radiography Examination of any part of the body for diagnostic purposes by means of X-RAYS or GAMMA RAYS, recording the image on a sensitized surface (such as photographic film). Radiology, Diagnostic X-Ray,Roentgenography,X-Ray, Diagnostic,Diagnostic X-Ray,Diagnostic X-Ray Radiology,X-Ray Radiology, Diagnostic,Diagnostic X Ray,Diagnostic X Ray Radiology,Diagnostic X-Rays,Radiology, Diagnostic X Ray,X Ray Radiology, Diagnostic,X Ray, Diagnostic,X-Rays, Diagnostic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D016059 Range of Motion, Articular The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate MUSCLE STRETCHING EXERCISES. Passive Range of Motion,Joint Flexibility,Joint Range of Motion,Range of Motion,Flexibility, Joint
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D019645 Arthroplasty, Replacement, Knee Replacement of the knee joint. Knee Replacement, Total,Arthroplasties, Knee Replacement,Arthroplasties, Replacement, Knee,Arthroplasty, Knee Replacement,Arthroplasty, Replacement, Partial Knee,Knee Arthroplasty,Knee Arthroplasty, Total,Knee Replacement Arthroplasties,Knee Replacement Arthroplasty,Partial Knee Arthroplasty,Partial Knee Replacement,Replacement Arthroplasties, Knee,Replacement Arthroplasty, Knee,Replacement, Total Knee,Total Knee Replacement,Unicompartmental Knee Arthroplasty,Unicompartmental Knee Replacement,Unicondylar Knee Arthroplasty,Unicondylar Knee Replacement,Arthroplasty, Knee,Arthroplasty, Partial Knee,Arthroplasty, Total Knee,Arthroplasty, Unicompartmental Knee,Arthroplasty, Unicondylar Knee,Knee Arthroplasty, Partial,Knee Arthroplasty, Unicompartmental,Knee Arthroplasty, Unicondylar,Knee Replacement, Partial,Knee Replacement, Unicompartmental,Knee Replacement, Unicondylar,Total Knee Arthroplasty

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