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

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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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References

  1. Bohlman HH, Emery SE, Goodfellow DB, Jones PK (1993) Robinson anterior cervical discetcomy and arthrodesis for cervical radiculopathy: long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 75(9):1298–1307

    PubMed  CAS  Google Scholar 

  2. Yue WM, Brodner W, Highland TR (2005) Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine (Phila Pa 1976) 30(19):2138–2144

    Article  Google Scholar 

  3. Robertson JT, Papadopoulos SM, Traynelis VC (2005) Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine 3(6):417–423

    Article  PubMed  Google Scholar 

  4. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81(4):519–528

    PubMed  CAS  Google Scholar 

  5. Reitan CA, Hipp JA, Nguyen L, Esses SI (2004) Changes in segmental intervertebral motion adjacent to cervical arthrodesis: a prospective study. Spine (Phila Pa 1976) 29(11):E221–E226

    Article  Google Scholar 

  6. Eck JC, Humphreys SC, Lim TH, Jeong ST, Kim JG, Hodges SD, An HS (2002) Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976) 27(22):2431–2434

    Article  Google Scholar 

  7. Goffin J, Van Calenbergh F, van Loon J, Casey A, Kehr P, Liebig K, Lind B, Logroscino C, Sgrambiglia R, Pointillart V (2003) Intermediate follow-up after treatment of degenerative disc disease with the Bryan cervical disc prosthesis: single-level and bi-level. Spine (Phila Pa 1976) 28(24):2673–2678

    Article  Google Scholar 

  8. Dmitriev AE, Cunningham BW, Hu N, Sell G, Vigna F, McAfee PC (2005) Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine (Phila Pa 1976) 30(10):1165–1172

    Article  Google Scholar 

  9. Pimenta L, McAfee PC, Cappuccino A, Bellera FP, Link HD (2004) Clinical experience with the new artificial cervical PCM (Cervitech) disc. Spine J 4(6 Suppl):315–321

    Article  Google Scholar 

  10. Nayak KN, Mulliken B, Rorabeck CH, Bourne RB, Woolfrey MR (1997) Prevalence of heterotopic ossification in cemented versus noncemented total hip joint replacement in patients with osteoarthrosis: a randomized clinical trial. Can J Surg 40(5):368–374

    PubMed  CAS  Google Scholar 

  11. Rama KR, Vendittoli PA, Ganapathi M, Borgmann R, Roy A, Lavigne M (2009) Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty 24(2):256–262

    Article  PubMed  Google Scholar 

  12. Dalury DF, Jiranek WA (2004) The incidence of heterotopic ossification after total knee arthroplasty. J Arthroplasty 19(4):447–452

    Article  PubMed  Google Scholar 

  13. McAfee PC, Cunningham BW, Devine J, Williams E, Yu-Yahiro J (2003) Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech 16(4):384–389

    Article  PubMed  Google Scholar 

  14. Mehren C, Suchomel P, Grochulla F, Barsa P, Sourkova P, Hradil J, Korge A, Mayer HM (2006) Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976) 31(24):2802–2806

    Article  Google Scholar 

  15. Leung C, Casey AT, Goffin J, Kehr P, Liebig K, Lind B, Logroscino C, Pointillart V (2005) Clinical significance of heterotopic ossification in cervical disc replacement: a prospective multicenter clinical trial. Neurosurgery. 57(4):759–763

    Article  PubMed  Google Scholar 

  16. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283(15):2008–2012

    Article  PubMed  CAS  Google Scholar 

  17. Richardson WS, Polashenski WA, Robbins BW (2003) Could our pretest probabilities become evidence based? A prospective survey of hospital practice. J Gen Intern Med 18(3):203–208

    Article  PubMed  Google Scholar 

  18. Jüni P, Witschi A, Bloch R, Egger M (1999) The hazards of scoring the quality of clinical trials for meta-analysis. JAMA 282(11):1054–1060

    Article  PubMed  Google Scholar 

  19. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  Google Scholar 

  20. Lee JH, Jung TG, Kim HS, Jang JS, Lee SH (2010) Analysis of the incidence and clinical effect of the heterotopic ossification in a single-level cervical artificial disc replacement. Spine J 10(8):676–682

    Article  PubMed  Google Scholar 

  21. Yi S, Kim KN, Yang MS, Yang JW, Kim H, Ha Y, Yoon do H, Shin HC (2010) Difference in occurrence of heterotopic ossification according to prosthesis type in the cervical artificial disc replacement. Spine (Phila Pa 1976). 35(16):1556–1561

    Article  Google Scholar 

  22. Reyes-Sanchez A, Miramontes V, Olivarez LMR, Aquirre AA, Quiroz AO, Zarate-Kalfopulos B (2010) Initial clinical experience with a next-generation artificial disc for the treatment of symptomatic degenerative cervical radiculopathy. SAS J 4(1):9–15

    Article  Google Scholar 

  23. Suchomel P, Jurak L, Benes V III, Brabec R, Bradac O, Elgawhary S (2010) Clinical results and development of heterotopic ossification in total cervical disc replacement during a 4-year follow-up. Eur Spine J 19(2):307–315

    Article  PubMed  Google Scholar 

  24. Beaurain J, Bernard P, Dufour T, Fuentes JM, Hovorka I, Huppert J, Steib JP, Vital JM, Aubourg L, Vila T (2009) Intermediate clinical and radiological results of cervical TDR (Mobi-C) with up to 2 years of follow-up. Eur Spine J 18(6):841–850

    Article  PubMed  CAS  Google Scholar 

  25. Heidecke V, Burkert W, Brucke M, Rainov NG (2008) Intervertebral disc replacement for cervical degenerative disease: clinical results and functional outcome at two years in patients implanted with the Bryan cervical disc prosthesis. Acta Neurochir 150(5):453–459

    Article  CAS  Google Scholar 

  26. Bertagnoli R (2008) Heterotopic ossification at the index level after Prodisc-C surgery: what is the clinical relevance? Spine J. 8(5 Suppl):123S

    Article  Google Scholar 

  27. Janssen M, Goldstein J, Murrey D, Delamarter R (2007) Heterotopic ossifiction at the index level after Prodisc-C: What is the clinical significance? Spine J 7(5 Suppl):48S–49S

    Article  Google Scholar 

  28. Nollen JG, van Douveren FQ (1993) Ectopic ossification in hip arthroplasty. A retrospective study of predisposing factors in 637 cases. Acta Orthop Scand 64(2):185–187

    Article  PubMed  CAS  Google Scholar 

  29. Tortolani PJ, Cunningham BW, Eng M, McAfee PC, Holsapple GA, Adams KA (2007) Prevalence of heterotopic ossification following total disc replacement: a prospective, randomized study of two hundred and seventy-six patients. J Bone Joint Surg Am 82(1):82–88

    Article  Google Scholar 

  30. Pointillart V (2001) Cervical disc prosthesis in humans: first failure. Spine (Phila Pa 1976) 26(5):E90–E92

    Article  CAS  Google Scholar 

  31. Fijn R, Koorevaar RT, Brouwers JR (2003) Prevention of heterotopic ossification after total hip replacement with NSAIDs. Pharm World Sci 25(4):138–145

    Article  PubMed  CAS  Google Scholar 

  32. Sodemann B, Persson PE, Nilsson OS (1988) Prevention of heterotopic ossification by nonsteroid antiinflammatory drugs after total hip arthroplasty. Clin Orthop Relat Res. 237:158–163

    PubMed  Google Scholar 

  33. Bartels RH, Donk R, Verbeek AL (2010) No justification for cervical disk prostheses in clinical practice: a meta-analysis of randomized controlled trials. Neurosurgery 66(6):1153–1160

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedics, Second Military Medical University Affiliated Changzheng Hosipital, 415 Fengyang Road, Shanghai, 200003, People’s Republic of China

    Jian Chen, Xinwei Wang, Wanshan Bai, Xiaolong Shen & Wen Yuan

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  1. Jian Chen
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  2. Xinwei Wang
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  3. Wanshan Bai
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  4. Xiaolong Shen
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  5. Wen Yuan
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Corresponding author

Correspondence to Wen Yuan.

Additional information

C. Jian and W. Xinwei equally contributed to this work.

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Chen, J., Wang, X., Bai, W. et al. Prevalence of heterotopic ossification after cervical total disc arthroplasty: a meta-analysis. Eur Spine J 21, 674–680 (2012). https://doi.org/10.1007/s00586-011-2094-x

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  • DOI: https://doi.org/10.1007/s00586-011-2094-x

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