Simplified Biplanar Classification for Heterotopic Ossification Is More Predictive of Patient-Reported Outcomes Than the Brooker Classification After Anterior Total Hip Arthroplasty
Authors: Onsen LT, Ouyang VW, Jimenez AE, Monahan PF, Lall AC, Domb BG
DOI: 10.1177/11207000211039173
Background
Heterotopic ossification (HO) after total hip arthroplasty (THA) can compromise patient outcomes. The Brooker classification has traditionally been used to assess HO, but its clinical utility is limited in non-bridging cases. This study evaluates the predictive value of a simplified biplanar classification system compared to the Brooker system.
Methods
A total of 513 patients who underwent anterior THA were evaluated for HO using both classification systems. Patient-reported outcomes (PROs) were collected at a minimum of two years postoperatively.
Key Findings
- The biplanar classification demonstrated stronger correlations with postoperative PROs than the Brooker classification, especially in non-bridging HO.
- Grade 2 HO in the biplanar system was significantly associated with worse hip function and increased pain.
- The biplanar system showed better interobserver reliability.
Conclusions
The simplified biplanar classification is more predictive of functional outcomes than the Brooker classification and may provide better clinical utility for evaluating HO in THA patients.
What Does This Mean for Providers?
- Consider adopting the biplanar classification in your postoperative assessment of HO, especially for anterior THA cases.
- This system may allow for more accurate prognosis and targeted interventions for patients with non-bridging HO who are at risk for suboptimal outcomes.
- Better alignment between imaging findings and PROs supports improved patient counseling and individualized care.