ArticleScientific reports2019
Heterotopic Ossification in Orthopaedic and Trauma surgery: A Histopathological Ossification Score.
Article in Scientific reports, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Periprosthetic joint infection and heterotopic ossification after total hip arthroplasty: systematic review and meta-analysis.BMC musculoskeletal disorders · 2025Pooled it
- Heterotopic Ossification in Complete Adductor Longus Tears: A Retrospective Analysis of Associated Factors and Surgical Outcomes.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
- A proposal of a new periimplant breast pathology classification into 3 types.Scientific reports · 2026Article
- Outcomes and associated factors of revision procedures after failed total ankle arthroplasty: a comparative cohort analysis.Archives of orthopaedic and trauma surgery · 2026Article
- Heterotopic Ossification After Multiligament Knee Injury Is Associated With Knee-Spanning External Fixation and Central Nervous System Trauma.Orthopaedic journal of sports medicine · 2026Article
- The efficiency of ozone therapy in the prevention of heterotopic bone formation in an animal model.Joint diseases and related surgery · 2025Article
- Histology of neurogenic heterotopic ossification and comparison with its radiological expression in acute spinal cord injured patients.Spinal cord · 2025Article
- Knee-Spanning External Fixation in the Management of Knee Dislocations and Multiligamentous Knee Injuries: A Narrative Review.Open access journal of sports medicine · 2025Review
- Determining Which Combinatorial Combat-Relevant Factors Contribute to Heterotopic Ossification Formation in an Ovine Model.Bioengineering (Basel, Switzerland) · 2024Article
- Heterotopic hip ossification resection: monocentric experiences of associated factors, outcomes, and complications.International orthopaedics · 2024Article
- Outcomes of distal biceps repair at two-year follow-up.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Article
- Does drainage affect development of heterotopic ossification after total hip arthroplasty?The Journal of international medical research · 2022Article
- Are there really specific risk factors for heterotopic ossifications? A case report of 'non-risk factor' after total hip replacement.The Journal of international medical research · 2022Article
- Developing a combat-relevant translatable large animal model of heterotopic ossification.Bone reports · 2021Article
- Osteomyelitis in heterotopic ossification in a patient with congenital gigantism of the leg.Journal of bone and joint infection · 2021Article
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Authors and funding
6 authors at 3 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
Heterotopic Ossification (HO) is a potential long-term complication in orthopaedic surgery. It is commonly classified according to the Brooker classification, which is based on radiological findings. To our knowledge the correlation of histological features to the Brooker grade is unknown as is the association between HO and the indication for revision. The aim of this paper is to analyze the ossification grade of HO tissue in patients undergoing revision hip and knee arthroplasty and to propose a histologically based classification system for HO. We also assess the relationship between the grade of HO and the indication for revision (septic and aseptic revision). From January to May 2019 we collected 50 human HO samples from hip and knee revision arthroplasty cases. These tissue samples were double-blinded and sent for histopathological diagnostic. Based on these results, we developed a classification system for the progression of HO. The grade of ossification was based on three characteristics: Grade of heterotopic ossification (Grade 1-3), presence of necrosis (N0 or N1) and the presence of osteomyelitis (HOES-Score Type 1 to 5). Demographic data as well as surgical details and indication for surgery was prospectively collected from clinical records. Fifty tissue samples were harvested from 44 hips and 6 knee joints. Of these 33 exhibited Grade I ossifications (66%), followed by 11 Grade II (22%) and one Grade III (2%). Necrosis was noted in two tissue samples (4%) and 2 more had osteomyelitis findings according to HOES-Score. Six samples (12%) with radiologically suggestive of HO turned out to be wear-induced synovitis, SLIM Type 1. Of these cases 16 were septic (32%) and 34 aseptic (68%) revisions. Most of the HO tissue samples were classified as a low-grade. High-grade ossification-Score is rare. Higher grades of ossification seem to be associated with septic revision cases. Wear-induced synovitis potentially influences HO development. A histological scoring system for ossification grading can be derived from the data presented in this study.
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