The significance of heterotopic ossification following total ankle arthroplasty: a systematic review and meta-analysis
Purpose The purpose of this systematic review and meta-analysis was to evaluate the prevalence and clinical significance of heterotopic ossification (HO) following total ankle replacement (TAR). Methods During August 2023, the PubMed, Embase and Cochrane library databases were systematically reviewe...
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| Veröffentlicht in: | European journal of orthopaedic surgery & traumatology 2024-05, Vol.34 (4), p.1945-1956 |
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| container_title | European journal of orthopaedic surgery & traumatology |
| container_volume | 34 |
| creator | Butler, James J. Healy, Hazel Anil, Utkarsh Habibi, Akram Azam, Mohammad T. Walls, Raymond J. Kennedy, John G. |
| description | Purpose
The purpose of this systematic review and meta-analysis was to evaluate the prevalence and clinical significance of heterotopic ossification (HO) following total ankle replacement (TAR).
Methods
During August 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting HO following TAR. Data regarding surgical characteristics, pathological characteristics, subjective clinical outcomes, ankle range of motion, radiographic outcomes, reoperation rates were extracted and analysed.
Results
Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9 months were included. The pooled prevalence rate was 44.6% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (132 patients, 27.0%). Random effects models of standardized mean differences found no difference in American orthopedic foot and ankle society (AOFAS) scores, visual analog scale scores (VAS) and ankle range of motion (ROM) between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 4.2%.
Conclusion
This systematic review and meta-analysis found that HO is a common finding following TAR that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-to-severe, symptomatic HO following TAR. This study is limited by the marked heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAR.
Level of evidence III. |
| doi_str_mv | 10.1007/s00590-024-03866-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2956681532</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2956681532</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-c9efc806aa16efd4f4346b4ce693254330e897e1bcb1812d86fd621e58163de53</originalsourceid><addsrcrecordid>eNp9kUuPFCEURonROA_9Ay4MiRs3pZdnU-7MRB2TSdyMa0JTl25GqmiBnkn_e3F6fMSFK0ju-T5uOIS8YPCGAazeVgA1wgBcDiCM1gN7RE6ZFHxgoM3jv-4n5KzWGwCmRqaekhNh5IpLoU_J7fUWaY2bJYbo3eKR5kC32LDklnfR01zr_ajFvNCQU8p3cdnQlptL1C3fElJX2rbkXXK1Hd5RR-uhNpx7wtOCtxHvOjfRGZsb3OLSocb6jDwJLlV8_nCek68fP1xfXA5XXz59vnh_NXjBdRv8iMEb0M4xjWGSQQqp19KjHgVXUghAM66Qrf2aGcYno8OkOUNlmBYTKnFOXh97dyV_32Ntdo7VY0puwbyvlo9Ka8OU4B199Q96k_el71utAKVhxWCETvEj5Uv_mYLB7kqcXTlYBvanFXu0YrsVe2_Fsh56-VC9X884_Y780tABcQRqHy0bLH_e_k_tD3N9mYc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3056071090</pqid></control><display><type>article</type><title>The significance of heterotopic ossification following total ankle arthroplasty: a systematic review and meta-analysis</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Butler, James J. ; Healy, Hazel ; Anil, Utkarsh ; Habibi, Akram ; Azam, Mohammad T. ; Walls, Raymond J. ; Kennedy, John G.</creator><creatorcontrib>Butler, James J. ; Healy, Hazel ; Anil, Utkarsh ; Habibi, Akram ; Azam, Mohammad T. ; Walls, Raymond J. ; Kennedy, John G.</creatorcontrib><description>Purpose
The purpose of this systematic review and meta-analysis was to evaluate the prevalence and clinical significance of heterotopic ossification (HO) following total ankle replacement (TAR).
Methods
During August 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting HO following TAR. Data regarding surgical characteristics, pathological characteristics, subjective clinical outcomes, ankle range of motion, radiographic outcomes, reoperation rates were extracted and analysed.
Results
Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9 months were included. The pooled prevalence rate was 44.6% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (132 patients, 27.0%). Random effects models of standardized mean differences found no difference in American orthopedic foot and ankle society (AOFAS) scores, visual analog scale scores (VAS) and ankle range of motion (ROM) between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 4.2%.
Conclusion
This systematic review and meta-analysis found that HO is a common finding following TAR that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-to-severe, symptomatic HO following TAR. This study is limited by the marked heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAR.
Level of evidence III.</description><identifier>ISSN: 1432-1068</identifier><identifier>ISSN: 1633-8065</identifier><identifier>EISSN: 1432-1068</identifier><identifier>DOI: 10.1007/s00590-024-03866-1</identifier><identifier>PMID: 38472436</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Ankle ; Ankle Joint - physiopathology ; Ankle Joint - surgery ; Arthroplasty, Replacement, Ankle - adverse effects ; Clinical outcomes ; Humans ; Medicine ; Medicine & Public Health ; Original Article ; Ossification, Heterotopic - epidemiology ; Ossification, Heterotopic - etiology ; Ossification, Heterotopic - physiopathology ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - physiopathology ; Prevalence ; Range of motion ; Range of Motion, Articular ; Reoperation - statistics & numerical data ; Surgical Orthopedics ; Systematic review ; Transplants & implants ; Traumatic Surgery</subject><ispartof>European journal of orthopaedic surgery & traumatology, 2024-05, Vol.34 (4), p.1945-1956</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-c9efc806aa16efd4f4346b4ce693254330e897e1bcb1812d86fd621e58163de53</cites><orcidid>0009-0005-6223-4544</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00590-024-03866-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00590-024-03866-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38472436$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Butler, James J.</creatorcontrib><creatorcontrib>Healy, Hazel</creatorcontrib><creatorcontrib>Anil, Utkarsh</creatorcontrib><creatorcontrib>Habibi, Akram</creatorcontrib><creatorcontrib>Azam, Mohammad T.</creatorcontrib><creatorcontrib>Walls, Raymond J.</creatorcontrib><creatorcontrib>Kennedy, John G.</creatorcontrib><title>The significance of heterotopic ossification following total ankle arthroplasty: a systematic review and meta-analysis</title><title>European journal of orthopaedic surgery & traumatology</title><addtitle>Eur J Orthop Surg Traumatol</addtitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><description>Purpose
The purpose of this systematic review and meta-analysis was to evaluate the prevalence and clinical significance of heterotopic ossification (HO) following total ankle replacement (TAR).
Methods
During August 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting HO following TAR. Data regarding surgical characteristics, pathological characteristics, subjective clinical outcomes, ankle range of motion, radiographic outcomes, reoperation rates were extracted and analysed.
Results
Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9 months were included. The pooled prevalence rate was 44.6% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (132 patients, 27.0%). Random effects models of standardized mean differences found no difference in American orthopedic foot and ankle society (AOFAS) scores, visual analog scale scores (VAS) and ankle range of motion (ROM) between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 4.2%.
Conclusion
This systematic review and meta-analysis found that HO is a common finding following TAR that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-to-severe, symptomatic HO following TAR. This study is limited by the marked heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAR.
Level of evidence III.</description><subject>Ankle</subject><subject>Ankle Joint - physiopathology</subject><subject>Ankle Joint - surgery</subject><subject>Arthroplasty, Replacement, Ankle - adverse effects</subject><subject>Clinical outcomes</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Ossification, Heterotopic - epidemiology</subject><subject>Ossification, Heterotopic - etiology</subject><subject>Ossification, Heterotopic - physiopathology</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - physiopathology</subject><subject>Prevalence</subject><subject>Range of motion</subject><subject>Range of Motion, Articular</subject><subject>Reoperation - statistics & numerical data</subject><subject>Surgical Orthopedics</subject><subject>Systematic review</subject><subject>Transplants & implants</subject><subject>Traumatic Surgery</subject><issn>1432-1068</issn><issn>1633-8065</issn><issn>1432-1068</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUuPFCEURonROA_9Ay4MiRs3pZdnU-7MRB2TSdyMa0JTl25GqmiBnkn_e3F6fMSFK0ju-T5uOIS8YPCGAazeVgA1wgBcDiCM1gN7RE6ZFHxgoM3jv-4n5KzWGwCmRqaekhNh5IpLoU_J7fUWaY2bJYbo3eKR5kC32LDklnfR01zr_ajFvNCQU8p3cdnQlptL1C3fElJX2rbkXXK1Hd5RR-uhNpx7wtOCtxHvOjfRGZsb3OLSocb6jDwJLlV8_nCek68fP1xfXA5XXz59vnh_NXjBdRv8iMEb0M4xjWGSQQqp19KjHgVXUghAM66Qrf2aGcYno8OkOUNlmBYTKnFOXh97dyV_32Ntdo7VY0puwbyvlo9Ka8OU4B199Q96k_el71utAKVhxWCETvEj5Uv_mYLB7kqcXTlYBvanFXu0YrsVe2_Fsh56-VC9X884_Y780tABcQRqHy0bLH_e_k_tD3N9mYc</recordid><startdate>20240501</startdate><enddate>20240501</enddate><creator>Butler, James J.</creator><creator>Healy, Hazel</creator><creator>Anil, Utkarsh</creator><creator>Habibi, Akram</creator><creator>Azam, Mohammad T.</creator><creator>Walls, Raymond J.</creator><creator>Kennedy, John G.</creator><general>Springer Paris</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0009-0005-6223-4544</orcidid></search><sort><creationdate>20240501</creationdate><title>The significance of heterotopic ossification following total ankle arthroplasty: a systematic review and meta-analysis</title><author>Butler, James J. ; Healy, Hazel ; Anil, Utkarsh ; Habibi, Akram ; Azam, Mohammad T. ; Walls, Raymond J. ; Kennedy, John G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-c9efc806aa16efd4f4346b4ce693254330e897e1bcb1812d86fd621e58163de53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Ankle</topic><topic>Ankle Joint - physiopathology</topic><topic>Ankle Joint - surgery</topic><topic>Arthroplasty, Replacement, Ankle - adverse effects</topic><topic>Clinical outcomes</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Ossification, Heterotopic - epidemiology</topic><topic>Ossification, Heterotopic - etiology</topic><topic>Ossification, Heterotopic - physiopathology</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - physiopathology</topic><topic>Prevalence</topic><topic>Range of motion</topic><topic>Range of Motion, Articular</topic><topic>Reoperation - statistics & numerical data</topic><topic>Surgical Orthopedics</topic><topic>Systematic review</topic><topic>Transplants & implants</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Butler, James J.</creatorcontrib><creatorcontrib>Healy, Hazel</creatorcontrib><creatorcontrib>Anil, Utkarsh</creatorcontrib><creatorcontrib>Habibi, Akram</creatorcontrib><creatorcontrib>Azam, Mohammad T.</creatorcontrib><creatorcontrib>Walls, Raymond J.</creatorcontrib><creatorcontrib>Kennedy, John G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of orthopaedic surgery & traumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Butler, James J.</au><au>Healy, Hazel</au><au>Anil, Utkarsh</au><au>Habibi, Akram</au><au>Azam, Mohammad T.</au><au>Walls, Raymond J.</au><au>Kennedy, John G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The significance of heterotopic ossification following total ankle arthroplasty: a systematic review and meta-analysis</atitle><jtitle>European journal of orthopaedic surgery & traumatology</jtitle><stitle>Eur J Orthop Surg Traumatol</stitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><date>2024-05-01</date><risdate>2024</risdate><volume>34</volume><issue>4</issue><spage>1945</spage><epage>1956</epage><pages>1945-1956</pages><issn>1432-1068</issn><issn>1633-8065</issn><eissn>1432-1068</eissn><abstract>Purpose
The purpose of this systematic review and meta-analysis was to evaluate the prevalence and clinical significance of heterotopic ossification (HO) following total ankle replacement (TAR).
Methods
During August 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting HO following TAR. Data regarding surgical characteristics, pathological characteristics, subjective clinical outcomes, ankle range of motion, radiographic outcomes, reoperation rates were extracted and analysed.
Results
Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9 months were included. The pooled prevalence rate was 44.6% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (132 patients, 27.0%). Random effects models of standardized mean differences found no difference in American orthopedic foot and ankle society (AOFAS) scores, visual analog scale scores (VAS) and ankle range of motion (ROM) between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 4.2%.
Conclusion
This systematic review and meta-analysis found that HO is a common finding following TAR that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-to-severe, symptomatic HO following TAR. This study is limited by the marked heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAR.
Level of evidence III.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>38472436</pmid><doi>10.1007/s00590-024-03866-1</doi><tpages>12</tpages><orcidid>https://orcid.org/0009-0005-6223-4544</orcidid></addata></record> |
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| subjects | Ankle Ankle Joint - physiopathology Ankle Joint - surgery Arthroplasty, Replacement, Ankle - adverse effects Clinical outcomes Humans Medicine Medicine & Public Health Original Article Ossification, Heterotopic - epidemiology Ossification, Heterotopic - etiology Ossification, Heterotopic - physiopathology Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - physiopathology Prevalence Range of motion Range of Motion, Articular Reoperation - statistics & numerical data Surgical Orthopedics Systematic review Transplants & implants Traumatic Surgery |
| title | The significance of heterotopic ossification following total ankle arthroplasty: a systematic review and meta-analysis |
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