title: Heterotopic ossification after hemiarthroplasty of the hip - A comparison of three common approaches.
abstract: OBJECTIVE
  Heterotopic ossification (HO) about the hip after total hip arthroplasty and internal fixation of the hip, pelvis, and acetabulum has been linked to surgical approach. However, no study has investigated surgical approach and HO in patients undergoing hemiarthroplasty. We therefore aimed to explore the influence of operative approach in patients undergoing hemiarthroplasty.
  
  
  METHODS
  Through a retrospective case series at an Urban level I trauma center, we found 80 patients over the age of 60 undergoing hemiarthroplasty for femoral neck fractures from 2000 to 2009. Patient charts, operative notes, and radiographs were reviewed for demographics, operative approach (anterior: A, anterior-lateral: AL, posterior: P), and any development of HO. Fisher's exact test compared rates of HO among the three approaches. Student's t-tests compared Brooker Classification levels of HO among the approaches.
  
  
  RESULTS
  82 hemiarthroplasties (26 A, 32 AL, 24 P) were included for analysis. 22 patients (27%) had HO. There was no significant difference in the development of HO based upon surgical approach: A: 19% (n = 5); AL: 34% (n = 11); P: 25% (n = 6). There was a significant difference in the grade of HO based on Brooker Classification (BC) with the posterior approach resulting in significantly lower grade of HO: A (BC: 2.60); AL (BC: 2.64); P (BC: 1.50) (p = 0.012).
  
  
  CONCLUSIONS
  Our data is the first to evaluate surgical approach and HO in patients with hemiarthroplasty. Patients have a significant risk of developing higher grade HO based on surgical approach (A or AL). Orthopedists should be mindful of these risks when considering A or AL approaches.
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Corrigan
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Greenberg
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Vasanth
authors.initials: V
authors.lastname: Sathiyakumar
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Mitchell
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Arie
authors.initials: A
authors.lastname: Francis
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Adan
authors.initials: A
authors.lastname: Omar
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Rachel V
authors.initials: RV
authors.lastname: Thakore
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi
keywords: Hemiarthroplasty; Heterotropic ossification; Operative approach