Troublesome Heterotopic Ossification after Central Nervous System Damage: A Survey of 570 Surgeries

BACKGROUND: Heterotopic ossification (HO) is a frequent complication after central nervous system (CNS) damage but has seldom been studied. We aimed to investigate features of HO for the first time in a large sample and the rate of early recurrence of HO in terms of the time of surgery. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively analyzed data from an anonymous prospective survey of patients undergoing surgery between May 1993 and November 2009 in our institution for troublesome HO related to acquired neurological disease. Demographic and HO characteristics and neurological etiologies were recorded. For 357 consecutive patients, we collected data on 539 first surgeries for HO (129 surgeries for multiple sites). During the follow-up, recurrences requiring another surgery appeared in 31 cases (5.8% [31/539]; 95% confidence interval [CI]: 3.8%-7.8%; 27 patients). Most HO requiring surgery occurred after traumatic brain injury (199 patients [55.7%]), then spinal cord injury (86 [24.0%]), stroke (42 [11.8%]) and cerebral anoxia (30 [8.6%]). The hip was the primary site of HO (328 [60.9%]), then the elbow (115 [21.3%]), knee (77 [14.3%]) and shoulder (19 [3.5%]). For all patients, 181 of the surgeries were performed within the first year after the CNS damage, without recurrence of HO. Recurrence was not associated with etiology (p = 0.46), sex (p = 1.00), age at CNS damage (p = 0.2), multisite localization (p = 0.34), or delay to surgery (p = 0.7). CONCLUSIONS/SIGNIFICANCE: In patients with CNS damage, troublesome HO and recurrence occurs most frequently after traumatic brain injury and appears frequently in the hip and elbow. Early surgery for HO is not a factor of recurrence

Etude de la survie a 15 ans des prothèses de genou HLS1 et HLS2 (résultats d une série de 269 prothèses à 15 ans de recul)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Pseudarthrose du col du fémur (proposition de traitement par greffe pédiculée antérieure)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Total ankle arthroplasty in France

Objectives: After more than 10 years' experience in France, the French Foot Surgery Association (Association francaise de chirurgie du pied [AFCP]) presents an update on mobile-bearing ankle prostheses, based on a multicenter study. Meta-analysis - Biomechanics - Assessment and indications: A preliminary comparative metaanalysis of the literature studies on ankle and prosthesis biomechanics, reviews validated indications and contra-indications, and details clinical and radiological outcomes assessment protocols. Professional survey: Sixty-three surgeons (95% AFCP members) answered a professional online survey, by email or regular post: 70% performed total ankle replacement (TAR), 39% of them at least two per year and 16% more than 10 per year, resulting in 317 TARs per year or 50% of the French activity and 312 arthrodeses per year or 17% of the French activity - which gave the survey considerable power. In 2004-2005, 46% of the TARs implanted were AES®, 38% Salto® and 9% Hintegra®. Gait analysis following TAR: This study included two series of patients (15 in Brussels and six in Paris) with laboratory gait analysis preoperatively and at 6 months' and 1 year's FU. Following TAR, speed, cadence and strides increased and mean total work approximated normal values. These two independent studies quantified the advantages of TAR over arthrodesis. Conclusion: This multioperator, multi-implant series of 592 patients confirmed literature data. Prospective follow-up of the cohorts managed in these expert centers is essential, in order to make available long-term data

Sites of Heterotopic Ossification (HO) in Patients Undergoing Surgery After Central Nervous System Damage.

<p>Data are for Number of First Surgeries Performed.</p><p>TBI: traumatic brain injury; SCI: spinal cord injury; CA: cerebral anoxia; CNS: central nervous system.</p

Demographic Data for Patients Undergoing Surgery for Heterotopic Ossification After Central Nervous System (CNS) Damage.

<p>HO: Heterotopic Ossification; TBI: traumatic Brain Injury; SCI: Spinal Cord Injury; CA: Cerebral Anoxia; CNS: Central Nervous System.</p

Sites of Heterotopic Ossification of Patients Undergoing Surgery for Central Nervous System Damage. Data are for Number of First Surgeries Performed.

<p>Sites of Heterotopic Ossification of Patients Undergoing Surgery for Central Nervous System Damage. Data are for Number of First Surgeries Performed.</p

Univariate Analysis of Time from Central Nervous System Damage Related to Heterotropic Ossification Recurrence.

<p>Univariate Analysis of Time from Central Nervous System Damage Related to Heterotropic Ossification Recurrence.</p