Heterotopic ossification after total shoulder arthroplasty

doi:10.1016/S0883-5403(00)90154-2

The Journal of Arthroplasty

Volume 15, Issue 2, February 2000, Pages 179-182

https://doi.org/10.1016/S0883-5403(00)90154-2 Get rights and content

Abstract

Fifty-eight primary ingrowth total shoulder arthroplasties, performed between 1989 and 1992, with a minimum of 2 years' radiographic and clinical follow-up (mean, 4.7 years), were reviewed to determine the frequency and clinical significance of heterotopic ossification after total shoulder arthroplasty. Fourteen of the 58 shoulders had radiographic evidence of heterotopic ossification: grade I (12 shoulders) and grade II (2 shoulders). Heterotopic ossification was present on the early postoperative radiographs (1–2 months) in 12 of the 14 shoulders. Amont these 12 shoulders, there was no increase in the grade of ossification comparing the early postoperative radiographs with those obtained at a minimum of 2 years. There were no identifiable preoperative patient characteristics associated with the development of heterotopic ossification (P > .05). Range of motion, pain, and result rating were not statistically different comparing patients with and without heterotopic ossification (P > .05). The data from this study suggest that when heterotopic ossification develops after elective total shoulder arthroplasty, it is usually low grade, is present in the early postoperative period, is nonprogressive, and does not adversely affect the clinical results.

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2023, Journal of Orthopaedic Science
To assess how tuberosity treatment affects the short-term clinical outcome of patients with complex proximal humeral fractures (PHFs) treated with reverse shoulder arthroplasty (RSA).
This is a multicentre study on 90 patients affected by acute PHFs (Neer type-4/11C3.2 in 80% of patients, and a Neer type 3/11B3.2 in 20%) treated with RSA and followed at an average of 34 months. Patients were divided into two groups (reconstructed and non-reconstructed tuberosity) according to the surgical fixation of the tuberosities. Then, the “reconstructed tuberosity” was divided into “healed” and “non-healed” groups. All patients were clinically evaluated in terms of ROM and strength in elevation, as well as with 0–10 numerical rating scale (NRS), Constant and Murley Score (CMS), DASH Score, and EQ-VAS. X-rays in anteroposterior and Neer views were performed.
Based on the status of the tuberosities, 18.9% were non-reconstructed (17 patients) and 81.1% were reconstructed (73 patients): out of these, 11 were correctly healed, 42 healed with malposition, and 20 were reabsorbed. Instability was found in 2/73 patients in the reconstructed group, and in 4/17 patients in the non-reconstructed group. NRS (1.4 vs 0.5), DASH (23.1 vs 13.9), and EQ-VAS (78.1 vs 83.7) scores had better final values in the non-reconstructed group (p < 0.05). However, the non-correctly healed tuberosity group (excision + resorption + malposition/migration) showed worse strength, as well as clinical scores when compared to the correctly healed tuberosity group.
RSA ensures satisfactory functional results for PHFs. Patients with a successfully reconstructed tuberosity have an overall better outcome. However, in this series most of the reconstructed cases presented tuberosity reabsorption, malposition, or migration, which led to lower results. Thus, tuberosity reconstruction must be carefully considered and tuberosity reabsorption or migration factors should be investigated, to optimize tuberosity reconstruction and provide to a higher number of patients a better outcome of RSA for the treatment of PHFs.
Surgical Management of Shoulder Heterotopic Ossification
2019, Arthroscopy Techniques
The formation of heterotopic ossification around the shoulder is a rare but potentially debilitating condition. It is found most commonly around the hip and is usually associated with an inciting event such as trauma, burn, previous surgery, or traumatic brain/spinal cord injury. The formation of shoulder heterotopic ossification following arthroscopic surgery is very uncommon, with few data pertaining to it in the current literature. Formation of heterotopic ossification in the shoulder after arthroscopic surgery typically occurs around the acromioclavicular joint and in the subacromial space. This location may lead to chronic pain and decreased mobility. The purpose of this article is to describe an arthroscopic technique for excision of heterotopic ossification.
Heterotopic ossification after superior capsular reconstruction
2018, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
HO around the shoulder was described in the literature as far back as 1835.34 Neer26 described HO after surgical management of proximal humeral fractures in 1970, and numerous accounts of HO after hemi, total, or reverse shoulder arthroplasty have been published since.2,7,10,20,29,36,38 Verhofste et al38 described a modified Brooker3 classification of HO of the shoulder with a range from 1 to 3, with 3 being complete ankylosis.
Heterotopic ossification of the long head of the triceps after reverse total shoulder arthroplasty
2016, Journal of Shoulder and Elbow Surgery
Heterotopic ossification (HO) around shoulder arthroplasty is a frequent finding with unclear clinical relevance. This study evaluated the incidence, relevance, and predisposing factors of HO in the long head of the triceps tendon after reverse shoulder arthroplasty.
Retrospective chart review was conducted to identify patients who had a reverse shoulder arthroplasty performed between 2008 and 2012. Patient demographics, implant types, and diagnoses were noted. Three fellowship-trained shoulder/elbow surgeons independently evaluated postoperative Grashey radiographs using a novel classification system.
Within a 164-patient cohort, the overall HO rate in the long head of the triceps tendon was 61.6%; 23.2% of osteophytes were considered impinging, 14.6% had notching, 14.0% were free-floating, and 3.0% appeared ankylosed. Although not statistically significant, revision surgery had a higher rate of HO (68.3%) compared with primary surgery (59.4%). There was no difference in HO rates between diagnoses or implant types. Male and female HO rates were 74.0% and 56.1%, respectively (P = .0304). Between patients with and without HO, forward elevation was 121° compared with 133° (P = .0087) and external rotation was 19° compared with 25° (P = .0266); however, HO size did not significantly affect motion.
Using our novel classification scheme, HO was a common finding in this series. Men had a higher rate of HO formation, and HO formation was associated with worse postoperative motion. Further study is needed to fully characterize the clinical implications of HO involving the long head of the triceps tendon and to explore potential preventive measures.
The evaluation of the failed shoulder arthroplasty
2014, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
Neer's74 original classification of HO in 1970 was later modified to the widely used classification by Brooker et al14 in 1973. The overall incidence of HO in the shoulder is much less common than it is in the hip, knee, and elbow, but is reported to be 12% to 54%.8,40,52,66,74,94,102 Symptomatic shoulder HO with loss of range of motion is even less common, with an incidence of <10%.8,40,52,66,94,102
As the incidence of shoulder arthroplasty continues to rise, the orthopedic shoulder surgeon will be increasingly faced with the difficult problem of evaluating a failed shoulder arthroplasty. The patient is usually dissatisfied with the outcome of the previous arthroplasty as a result of pain, but may complain of poor function due to limited range of motion or instability. A thorough and systematic approach is necessary so that the most appropriate treatment pathway can be initiated. A comprehensive history and physical examination are the first steps in the evaluation. Diagnostic studies are numerous and include laboratory values, plain radiography, computed tomography, ultrasound imaging, joint aspiration, nuclear scans, and electromyography. Common causes of early pain after shoulder arthroplasty include technical issues related to the surgery, such as malposition or improper sizing of the prosthesis, periprosthetic infection, neurologic injury, and complex regional pain syndrome. Pain presenting after a symptom-free interval may be related to chronic periprosthetic infection, component wear and loosening, glenoid erosion, rotator cuff degeneration, and fracture. Poor range of motion may result from inadequate postoperative rehabilitation, implant-related factors, and heterotopic ossification. Instability is generally caused by rotator cuff deficiency and implant-related factors. Unfortunately, determining the cause of a failed shoulder arthroplasty can be difficult, and in many situations, the source of pain and disability is multifactorial.
Complications of unconstrained shoulder prostheses
2011, Journal of Shoulder and Elbow Surgery

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Heterotopic ossification after total shoulder arthroplasty

Abstract

J Arthroplasty

J Arthroplasty

J Shoulder Elbow Surg

J Arthroplasty

J Arthroplasty

J Arthroplasty

UCLA anatomic total shoulder arthroplasty

Clin Orthop

The Dana total shoulder arthroplasty

J Bone Joint Surg Am

Total shoulder arthroplasty

J Bone Joint Surg Am

Clinical experience with total arthroplasty and hemiarthroplasty of the shoulder using the Neer prosthesis

Int Orthop

Survivorship of unconstrained total shoulder arthroplasty

J Bone Joint Surg Am

Should the glenoid be replaced in shoulder arthroplasty with an unconstrained Dana or St. George prosthesis?

Ann Chir Gynaecol