Abstract
Category:
Ankle Arthritis
Introduction/Purpose:
End-stage ankle osteoarthritis is a debilitating pathology and is most commonly preceded by trauma. Surgical intervention via ankle arthrodesis or ankle arthroplasty is the mainstay management option. Heterotopic ossification (HO) is a common finding following joint arthroplasty. However, no consensus regarding the impact of heterotopic ossification on clinical outcomes following total ankle arthroplasty has been reached to date. The purpose of this systematic review and meta- analysis was to evaluate the prevalence and clinical outcomes of heterotopic ossification following total ankle arthroplasty.
Methods:
During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting heterotopic ossification following TAA. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed.
Results:
Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9 months were included. The pooled prevalence rate was 45% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (120 patients, 33.9%). Random effects models of standardized mean differences found no difference in AOFAS, VAS and ROM between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 10.5%.
Conclusion:
This systematic review and meta-analysis found that HO is a common finding following TAA that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-severe, symptomatic HO following TAA. This study is limited by the significant heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAA.
