Abstract
In contrast to the well-known association with total hip arthroplasty, heterotopic ossification (HO) following total knee replacement has largely been regarded as a coincidental radiographic curiosity of little clinical importance. While rarely impuned as responsible for any compromise in the functional result of prosthetic knee arthroplasty, there have been isolated case reports of such dramatic magnitude as to attract the attention of the knee surgeon. In its most florid form bony ankylosis may result; inflammation and ossification within the suprapatellar extensor mechanism is a more frequent sequela of lesser degrees of involvement. Notwithstanding these noteworthy reports, the true clinical significance of ectopic bone formation about the knee following prosthetic arthroplasty remains to be defined.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Freeman PA. Walldius arthroplasty. A review of 80 cases. Clin Orthop Rel Res 1973; 94: 85–91.
Engelbrecht E, Siegel A, Rottger J, Buchholz HW. Statistics of total knee replacement: partial and total knee replacement, design St. Georg: a review of a 4-year observation. Clin Orthop Rel Res 1976; 00 (120): 54–64.
Booth CM, King JB. Myositis ossificans following porous-ingrowth total knee replacement. Orthop Rey 1979; 25: 223–227.
McClelland SJ, Rudolf LM. Myositis ossificans following porous-ingrowth TK replacement. Orthop Rey 1986; 15: 223–227.
Scott WN, Rubinstein M, Scuderi G. Results after knee replacement with a posterior cruciate-substituting prosthesis. J Bone Joint Surg 1988; 70A: 1163–1173.
Lovelock JE, Griffiths HJ, Silverstein AM, Anson PS. Complications of total knee replacement. AJR 1984; 142: 985–992.
Figgie HE III, Goldberg VM, Heiple KG, Moller HS III. The incidence and significance of heterotopic ossification following total knee arthroplasty. Adu Orthop Surg 1986; 10: 12–17.
Harwin SF, Stein AJ, Stern RE, Kulick RG. Heterotopic ossification following primary total knee arthroplasty. J Arthroplasty 1993; 8: 113–116.
Furia JP, Pellegrini VD Jr. Heterotopic ossification following primary total knee arthroplasty [see comments]. J Arthroplasty 1995; 10: 413–419.
Rader CP, Barthel T, Haase M, Scheidler M, Eulert J. Heterotopic ossification after total knee arthroplasty: 54/ 615 cases after 1–6 years’ follow-up. Acta Orthop Scand 1997; 68: 46–50.
Anapolle DM, Stuchin SA. Heterotopic ossification following total knee arthroplasty. Am J Knee Surg 1994; 7: 82–86.
Puzas JE, Brand JS, Evarts CM. Endogenous factors regulate bone formation: a possible cause of heterotopic bone growth after surgery. Surg Forum 1981; 32: 529–531.
Pellegrini VD Jr, Evarts CM. Radiation prophylaxis of heterotopic bone formation following total hip arthroplasty: current status. Semin Arthroplasty 1992; 3: 156–166.
Chalmers J, Gray DH, Rush J. Observations on the induction of bone in soft tissues. J Bone Joint Surg 1975; 57B: 36–45.
Geshickter CF, Maseritz IH. Myositis ossificans progressiva. J Bone Joint Surg 1929; 11A: 157.
Hall BK. Histogenesis and morphogenesis of bone. Clin Orthop Rel Res 1971; 74: 249–268.
Jowsey J, Coventry MB, Robins PR. Heterotopic ossification: theoretical considerations, possible etiologic factors, and a clinical review of total hip arthroplasty patients exhibiting this phenomenon. In: Murray WR (ed). The Hip: Proceedings of the Fifth Open Scientific Meeting of the Hip Society. St. Louis: CV Mosby, 1977: 210–221.
Ostrowski K, Wlodarski K. Induction of heterotopic bone formation. In: Bourne GH (ed). The Biochemistry and Physiology of Bone, vol 3. New York: Academic Press, 1971: 299.
Tonna EA, Cronkite EP. Autoradiographic studies of cell proliferation in the periosteum of intact and fractured femora of mice utilizing DNA labelling with 3H thymidine. Proc Soc Exp Biol Med 1961; 107: 719.
Tornkvist H, Nilsson OS, Bauer FC, Lindholm TS. Experimentally induced heterotopic ossification in rats influenced by anti-inflammatory drugs. Scand J Rheumatol 1983; 12: 177–180.
Craven PL, Urist MR. Osteogenesis by radioisotope labelled cell populations in implants of bone matrix under the influence of ionizing radiation. Clin Orthop Rel Res 1971; 76: 231–233.
Urist MR, Silverman BF, Suring K, Dubuc FL, Rosenberg JM. The bone induction principle. Clin Orthop Rel Res 1967; 53: 243–283.
Urist MR, Hay PH, Dubuc F, Buring K. Osteogenetic competence. Clin Orthop Rel Res 1969; 64: 194–220.
Urist MR, Strates BS. Bone formation in implants of partially and wholly demineralized bone matrix, including observations on acetone-fixed intra- and extracellular proteins. Clin Orthop Rel Res 1970; 71: 271–278.
Puzas JE, Brand JS, Howard GA, Liu CC, Evarts CM. Heterotopic bone formation after operation: a quantitative histologic and biochemical study. Surg Forum 1984; 35: 521–523.
Puzas JE, Evarts CM, Brand JS. The stimulus for bone formation. In: Brand RA (ed). The Hip: Proceedings of the 14th Open Scientific Meeting of the Hip Society. St. Louis: CV Mosby, 1986: 25–38.
Bonarigo BC, Rubin P. Nonunion of pathologic fracture after radiation therapy. Radiology 1967; 88: 889–898.
Friedlander GE. The influence of various physical modalities and drugs on bone regeneration and ingrowth. In: Fitzgerald R (ed). Noncemented Total Hip Arthroplasty. New York: Raven Press, 1988: 135–141.
Ahrengart L, Lindgren U. Functional significance of heterotopic bone formation after total hip arthroplasty. J Arthroplasty 1989; 4: 125–131.
Bergstrom B, Lindberg L, Persson BM, Onnerfalt R. Complications after total hip arthroplasty according to Charnley in a Swedish series of cases. Clin Orthop Rel Res 1973; 95: 91–95.
Bisla RS, Ranawat CS, Inglis AE. Total hip replacement in patients with ankylosing spondylitis with involvement of the hip. J Bone Joint Surg 1976; 58A: 233–238.
Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg 1973; 55A: 1629–1632.
Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg 1972; 54B: 61–76.
DeLee J, Ferrari A, Charnley J. Ectopic bone formation following low friction arthroplasty of the hip. Clin Orthop Rel Res 1976; 121: 53–59.
Fahrer H, Koch P, Balimer P, Enzler P, Gerber N. Ectopic ossification following total hip arthroplasty: is diffuse idiopathic skeletal hyperostosis a risk factor? Br J Rheumatol 1988; 27: 187–190.
Foster DE, Hunter JR. The direct lateral approach to the hip for arthroplasty. Advantages and complications. Orthopedics 1987; 10: 274–280.
Hierton C, Blomgren G, Lindgren U. Factors associated with heterotopic bone formation in cemented total hip prostheses. Acta Orthop Scand 1983; 54: 698–702.
Johnston RC. Clinical follow-up of total hip replacement. Clin Orthop Rel Res 1973; 95: 118–126.
Kromann-Andersen C, Sorensen TS, Hougaard K, Zdravkovic D, Frigaard E. Ectopic bone formation following Charnley hip arthroplasty. Acta Orthop Scand 1980; 51: 633–638.
Lazansky MG. Complications revisited. The debit side of total hip replacement. Clin Orthop Rel Res 1973; 95: 96103.
Nolan DR, Fitzgerald RH Jr, Beckenbaugh RD, Coventry MB. Complications of total hip arthroplasty treated by reoperation. J Bone Joint Surg 1975; 57A: 977–981.
Pedersen NW, Kristensen SS, Schmidt SA, Pedersen P, Kjaersgaard-Andersen P. Factors associated with hetero-topic bone formation following total hip replacement. Arch Orthop Trauma Surg 1989; 108: 92–95.
Pellegrini VD Jr, Konski AA, Gastel JA, Rubin P, Evarts CM. Prevention of heterotopic ossification with irradiation after total hip arthroplasty. Radiation therapy with a single dose of eight hundred centigray administered to a limited field. J Bone Joint Surg 1992; 74A: 186–200.
Riegler HF, Harris CM. Heterotopic bone formation after total hip arthroplasty. Clin Orthop Rel Res 1976; 117: 209–216.
Ritter MA, Vaughan RB. Ectopic ossification after total hip arthroplasty. Predisposing factors, frequency, and effect on results. J Bone Joint Surg 1977; 59A: 345–351.
Shaffer B. A critical review. Heterotopic ossification in total hip replacement. Bull Hosp Joint Dis Orthop Inst 1989; 49: 55–74.
Soballe K, Christensen F, Kristensen SS. Ectopic bone formation after total hip arthroplasty. Clin Orthop Rel Res 1988; 228: 57–62.
Sundaram NA, Murphy JC. Heterotopic bone formation following total hip arthroplasty in ankylosing spondylitis. Clin Orthop Rel Res 1986; 207: 223–226.
Williams E, Taylor AR, Arden GP, Edwards DH. Arthroplasty of the hip in ankylosing spondylitis. J Bone Joint Surg 1977; 59B: 393–397.
Wilson PD Jr, Amstutz HC, Czerniecki A, Salvati EA, Mendes DG. Total hip replacement with fixation by acrylic cement. A preliminary study of 100 consecutive McKee-Farrar prosthetic replacements. J Bone Joint Surg 1972; 54A: 207–236.
Garland DE. Clinical observations on fractures and heterotopic ossification in the spinal cord and traumatic brain injured populations. Clin Orthop Rel Res 1988; 233: 86–101.
Lal S, Hamilton BB, Heinemann A, Betts HB. Risk factors for heterotopic ossification in spinal cord injury. Arch Phys Med Rehabil 1989; 70: 387–390.
Peterson SL, Mani MM, Crawford CM, Neff JR, Hiebert JM. Postburn heterotopic ossification: insights for management decision making. J Trauma 1989; 29: 365–369.
V.D. Pellegrini, Jr.
Garland DE, Blum CE, Waters RL. Periarticular hetero-topic ossification in head-injured adults. Incidence and location. J Bone Joint Surg 1980; 62A: 1143–1146.
Bosse MJ, Poka A, Reinert CM, Ellwanger F, Slawson R, McDevitt ER. Heterotopic ossification as a complication of acetabular fracture. Prophylaxis with low-dose irradiation. J Bone Joint Surg 1988; 70A: 1231–1237.
Brumback RJ, Wells JD, Lakatos R, Poka A, Bathon GH, Burgess AR. Heterotopic ossification about the hip after intramedullary nailing for fractures of the femur [see comments]. J Bone Joint Surg 1990; 72A: 1067–1073.
Edwards E, Miller J, Chan KH. The effect of postoperative collateral ligament laxity in total knee arthroplasty. Clin Orthop Rel Res 1988; 236: 44–51.
Kjaersgaard-Andersen P, Frich LH, Sojbjerg JO, Sneppen O. Heterotopic bone formation following total shoulder arthroplasty. J Arthroplasty 1989; 4: 99–104.
Evarts CM, Ayers DC, Puzas JE. Prevention of hetero-topic bone formation in high-risk patients by postoperative irradiation. In: Brand R (ed). The Hip: Proceedings of the 14th Open Scientific Meeting of the Hip Society. St. Louis: CV Mosby, 1986: 70–83.
Ilstrup DM, Nolan DR, Beckenbaugh RD, Coventry MB. Factors influencing the results in 2,012 total hip arthroplasties. Clin Orthop Rel Res 1973; 95: 250–262.
Kjaersgaard-Andersen P, Hougaard K, Linde F, Christiansen SE, Jensen J. Heterotopic bone formation after total hip arthroplasty in patients with primary or secondary coxarthrosis. Orthopedics 1990; 13: 1211–1217.
Nollen AJ, Slooff TJ. Para-articular ossifications after total hip replacement. Acta Orthop Scand 1973; 44: 230241.
Parkinson JR, Evarts CM, Hubbard LF. Radiation therapy in the prevention of heterotopic ossification after total hip arthroplasty. In: Nelson JP, ed. The Hip: Proceedings of the 10th Open Scientific Meeting of the Hip Society. St. Louis: CV Mosby, 1982: 211–227.
Sawyer JR, Myers MA, Rosier RN, Puzas JE. Heterotopic ossification: clinical and cellular aspects. Calcif Tissue Int 1991; 49: 208–215.
Resnick D, Linovitz RJ, Feingold ML. Postoperative heterotopic ossification in patients with ankylosing hyperostosis on the spine (Forestier’s disease). J Rheumatol 1976; 3: 313–320.
Freedman EL, Freedman DM. Heterotopic ossification following total knee arthroplasty requiring surgical excision. Am J Orthop 1996; 25: 559–561.
Austin KS, Siliski JM. Symptomatic heterotopic ossification following total knee arthroplasty. J Arthroplasty 1995; 10: 695–698.
Daluga D, Lombardi AV Jr, Mallory TH, Vaughn BK. Knee manipulation following total knee arthroplasty. Analysis of prognostic variables. J Arthroplasty 1991; 6: 119–128.
Pham J, Kumar R. Heterotopic ossification after total knee arthroplasty. Am J Orthop 1997; 26: 141–143.
Maloney WJ, Schurman DJ. The effects of implant design on range of motion after total knee arthroplasty. Total condylar versus posterior stabilized total condylar designs. Clin Orthop Rel Res 1992; 278: 147–152.
Ritter MA, Stringer EA. Predictive range of motion after total knee replacement. Clin Orthop Rel Res 1979; 143: 115–119.
Schurman DJ, Parker JN, Ornstein D. Total condylar knee replacement. A study of factors influencing range of motion as late as two years after arthroplasty. J Bone Joint Surg 1985; 67A: 1006–1014.
Walker PS, Garg A. Range of motion in total knee arthroplasty. A computer analysis. Clin Orthop Rel Res 1991; 262: 227–235.
Ryu J, Saito S, Yamamoto K, Sano S. Factors influencing the postoperative range of motion in total knee arthroplasty. Bull Hosp J Dis 1993; 53: 35–40.
Chiarello CM, Gundersen L, O’Halloran T. The effect of continuous passive motion duration and increment on range of motion in total knee arthroplasty patients. J Orthop Sports Phys Ther 1997; 25: 119–127.
Gotlin RS, Hershkowitz S, Juris PM, Gonzalez EG, Scott WN, Insall JN. Electrical stimulation effect on extensor lag and length of hospital stay after total knee arthroplasty. Arch Phys Med Rehabil 1994; 75: 957–959.
Stulberg SD. Extensor mechanism complications after total knee arthroplasty. Orthopedics 1995; 18: 919920.
Pellegrini VD Jr. Radiation prophylaxis of hetero-topic ossification [editorial] [see comments] [published erratum appears in Int J Radiat Oncol Biol Phys 1995; 32(1): 283]. Int J Radiat Oncol Biol Phys 1994; 30: 743–744.
Pellegrini VD Jr, Gregoritch SJ. Preoperative irradiation for prevention of heterotopic ossification following total hip arthroplasty. J Bone Joint Surg 1996; 78A: 870–881.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2001 Springer Science+Business Media New York
About this chapter
Cite this chapter
Pellegrini, V.D. (2001). Heterotopic Ossification Following Total Knee Arthroplasty. In: Malek, M.M. (eds) Knee Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-87202-0_24
Download citation
DOI: https://doi.org/10.1007/978-3-642-87202-0_24
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-87204-4
Online ISBN: 978-3-642-87202-0
eBook Packages: Springer Book Archive