Anterior intertrochanteric ossification after total hip arthroplasty

Aim: Heterotopic paraarticular ossifications are usually identified by an anterior-posterior radiograph of the corresponding hip and are consecutively classified by the well accepted methods of Brooker, Arcq or deLee. In these methods ossifications are solely evaluated by the means of a single a-p radiograph, hence a major part of ossifications located in the anterior intertrochanteric region cannot be evaluated. Our study deals with the incidence of ossifications exclusively verifiable by an axial readiograph. Method: In the present study 209 patients' axial radiographs were retrospectively analysed by using our simple method of,classification. In the axial projection these ossifications are situated anterior of the intertrochanteric region, therefore we created the term "anterior intertrochanteric ossificatio (AIO)". After developing a simple topographic scheme we classified these appearances by localisation and size. Results: After total hip arthroplasty by using the transgluteal approach ossifications situated in the anterior intertrochanteric region can develop. These ossifications appear as bone islands, shield or clip like (without fixed connection to the femoral cortical bone) or as solid exostoses. Due to their strict anterior localisation these formations are often solely verifiable by the means of an axial (Lauenstein) radiograph. We were able to identify anterior intertrochanteric ossifications (AIO) in 97 out of 209 patients (48.4%), 27 patients (13%) developing an anterior intertrochanteric ossification were classified grade O according to the methods of Brooker, Arcq and deLee. Conclusion: According to the widely accepted methods of classification of pararticular ossifications depending on,a single a-p radiograph of the corresponding hip, 13% of paraarticular ossifications would remain undocumented;because of their strict anterior intertrochanteric position.