The Knee · 2026
Chronic kidney disease, myocardial infarction, and hepatitis are independent risk factors for heterotopic ossification following revision total knee arthroplasty.
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Budin Maximilian, Seidel Daniela, Gehrke Thorsten, Citak Mustafa
Аннотация
BACKGROUND: Heterotopic ossification (HO) following total knee arthroplasty (TKA) can cause significant morbidity, yet patient-specific risk factors are poorly defined. This study aimed to identify patient-related risk factors associated with HO in patients who required revision total knee arthroplasty.
METHODS: This retrospective case-control study reviewed data from 63,114 TKA (1996 and 2021). The HO group comprised 135 patients who underwent revision TKA with confirmed HO. The control group included 39,572 primary TKA patients with a minimum three-year follow-up. Patient demographics and comorbidities were analyzed using binary logistic regression to identify independent risk factors for HO.
RESULTS: Binary logistic regression indicated that chronic kidney disease (OR = 3.79; 95% CI 2.07-6.93), a history of myocardial infarction (OR = 2.35; 95% CI 1.12-4.94), and hepatitis (OR = 3.02; 95% CI 1.12-7.49) are significant risk factors for HO. Patients in HO group were more likely male (p < 0.001), taller (p = 0.006), and had higher Charlson Comorbidity Index scores (p < 0.001).
CONCLUSION: Chronic kidney disease, myocardial infarction history, and hepatitis are independent risk factors for HO in patients undergoing revision TKA. These conditions, which share a basis in chronic inflammation, may increase HO risk by predisposing patients to periprosthetic joint infections (PJI). Clinicians should maintain a high suspicion for both conditions in high-risk patients, as incidental HO on radiographs could be a marker for subclinical PJI.
METHODS: This retrospective case-control study reviewed data from 63,114 TKA (1996 and 2021). The HO group comprised 135 patients who underwent revision TKA with confirmed HO. The control group included 39,572 primary TKA patients with a minimum three-year follow-up. Patient demographics and comorbidities were analyzed using binary logistic regression to identify independent risk factors for HO.
RESULTS: Binary logistic regression indicated that chronic kidney disease (OR = 3.79; 95% CI 2.07-6.93), a history of myocardial infarction (OR = 2.35; 95% CI 1.12-4.94), and hepatitis (OR = 3.02; 95% CI 1.12-7.49) are significant risk factors for HO. Patients in HO group were more likely male (p < 0.001), taller (p = 0.006), and had higher Charlson Comorbidity Index scores (p < 0.001).
CONCLUSION: Chronic kidney disease, myocardial infarction history, and hepatitis are independent risk factors for HO in patients undergoing revision TKA. These conditions, which share a basis in chronic inflammation, may increase HO risk by predisposing patients to periprosthetic joint infections (PJI). Clinicians should maintain a high suspicion for both conditions in high-risk patients, as incidental HO on radiographs could be a marker for subclinical PJI.