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. 2024 Mar 11;14(1):5882.
doi: 10.1038/s41598-024-56300-1.

Arthroscopic debridement improves range of motion for heterotopic ossification after total knee replacement: a retrospective cohort study

Dong-Liang Zhang #  1 , Wei Zhang #  2 , Yi-Ming Ren #  1 , Wen-Jun Zhao  1 , He-Jun Sun  1 , Zheng-Wei Tian  1 , Meng-Qiang Tian  3
Affiliations

Arthroscopic debridement improves range of motion for heterotopic ossification after total knee replacement: a retrospective cohort study

Dong-Liang Zhang et al. Sci Rep. .

Abstract

The presence of heterotopic ossification (HO) after primary total knee replacement (TKR) is rare and associated with limited mobility and stiffness of the knee. This study aimed to identify if the arthroscopic debridement after TKR could decrease HO and improve the function and range of motion. Thirty HO patients after TKR were retrospectively separated into 2 cohorts. 15 patients of group A accepted the arthroscopic debridement, while 15 patients of group B only had non-operative treatment, mainly including oral nonsteroidal anti-inflammatory drugs (NSAIDs) and rehabilitative treatment. Visual analog scale (VAS) scores, knee society knee scores (KSS), range of motion (knee flexion and knee extension) were obtained before treatment and at 1 month, 3 months, and 6 months after treatment. Radiography of after-treatment was also evaluated to assess the changes in HO. There were 3 males and 27 females with a mean age of 67.4 ± 0.8 years in group A and 68.2 ± 1.3 in group B. The onset time of HO was 3-6 months. The maximum size of the ossification was < 2 cm in 23 knees, 2 cm < heterotopic bone < 5 cm in 6 knees and > 5 cm in 1 knee. The size of HO decreased gradually in all knees by X-ray film at the last follow-up. There were no significant differences in VAS scores after replacement between two groups (p > 0.05). The average range of motion preoperatively in group A was - 15.2-90.6°, which postoperatively increased to - 4.2-110.0°. Meanwhile, the KSS scores and average range of motion of the group A were better than those of the group B at each follow-up time after treatment. Arthroscopic debridement can decrease HO seen from postoperative X-rays, improve the function and range of motion, as well as the pain remission between two groups are comparable. Consequently, arthroscopic resection of HO after TKR is recommended as soon as there is aggravating joint stiffness.

Keywords: Arthroscopy; Heterotopic ossification; Range of motion; Revision; Total knee replacement.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow chart of HO patient screening.
Figure 2
Figure 2
Postoperative TKR AP view (A) and lateral view (B) radiograph of patient showing type I HO (less than 2 cm of new bone formation).
Figure 3
Figure 3
Postoperative TKR AP view (A) and lateral view (B) radiograph of the patient, showing type II HO (more than 2 cm of new bone formation). Postoperative TKR AP view (C) and lateral view (D) radiograph of patient accepted the arthroscopic debridement at the 3 months follow-up.
Figure 4
Figure 4
Postoperative TKR AP view (A) and lateral view (B) radiograph of patient, showing type III HO (more than 5 cm of new bone formation).
Figure 5
Figure 5
Visual analog scale (VAS) pain score for patients receiving between the arthroscopic debridement (group A) and non-operative treatment (group B). *p < 0.05 for the difference between the groups.
Figure 6
Figure 6
Knee society knee score (KSS) function score for patients receiving between the arthroscopic debridement (group A) and non-operative treatment (group B). *p < 0.05 for the difference between the groups.
Figure 7
Figure 7
Comparison of knee flexion for patients receiving between the arthroscopic debridement (group A) and non-operative treatment (group B). *p < 0.05 for the difference between the groups.
Figure 8
Figure 8
Comparison of knee extension for patients receiving between the arthroscopic debridement (group A) and non-operative treatment (group B). *p < 0.05 for the difference between the groups.
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