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Review
. 2012 Apr;21(4):674-80.
doi: 10.1007/s00586-011-2094-x. Epub 2011 Dec 2.

Prevalence of heterotopic ossification after cervical total disc arthroplasty: a meta-analysis

Jian Chen  1 , Xinwei Wang, Wanshan Bai, Xiaolong Shen, Wen Yuan
Affiliations
Review

Prevalence of heterotopic ossification after cervical total disc arthroplasty: a meta-analysis

Jian Chen et al. Eur Spine J. 2012 Apr.

Abstract

Background: Heterotopic ossification (HO) is a well-known complication after total hip and knee arthroplasty. But limited studies have focused on prevalence of HO following cervical total disc arthroplasty (CTDA) and the published data show controversial results.

Objective: The purpose of this review is to investigate the prevalence of HO following CTDA by meta-analysis.

Methods: The literatures were collected from PubMed, Embase and Cochrane library by using keywords as ([disc or disk] and [arthroplasty or replacement]) and (HO or delayed fusion or spontaneous fusion). The original studies were eligible only if the prevalence of HO and of advanced HO (Grade 3-4 according to McAfee) were investigated. A meta-analysis was then performed on collected data. Statistical heterogeneity across the various trials was tested using Cochran's Q, statistic and in the case of heterogeneity a random effect model was used. Tests of publication bias and sensitivity analysis were also performed.

Results: Our data showed that the pooled prevalence of HO was 44.6% (95% confidence interval (CI), 37.2-45.6%) 12 months after CTDA and 58.2% (95% CI, 29.7-86.8%) 24 months after CTDA, while the advanced HO was 11.1% (95% CI, 5.5-16.7%) and 16.7% (95% CI, 4.6-28.9%), respectively. A significant heterogeneity was obtained. There was no publication bias and individual study had no significant effect on the pooled prevalence estimate.

Conclusion: Higher prevalence of HO was observed following CTDA, although HO was reported to be unrelated to the clinical improvement. It suggests that cervical disc replacement should be performed cautiously before obtaining long-term supporting evidence.

Level of evidence: Prognostic level III.

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Figures

Fig. 1
Fig. 1
The procedure and criteria to collect the data
Fig. 2
Fig. 2
The prevalence of heterotopic ossification (HO) with 95% confidence intervals (CIs). The prevalence of total HO (a, b) and advanced HO (c, d) was depicted by Forest plots on 12 months group (a, c) and 24 months group (b, d). The vertical line of each plot represented the pooled prevalence. Each study symbol is proportional to the size of the study
Fig. 3
Fig. 3
The publication bias of the analysis. The publication bias of analysis on total (a, b) and advanced (c, d) heterotopic ossification (HO) were expressed by Funnel plots as 12 months group (a, c) and 24 months group (b, d) after CTDA, respectively. No evidence of publication bias was observed
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