Heterotopic ossification after total hip arthroplasty: When is development completed?

Abstract

Background Heterotopic ossifications (HO) are a common complication after total hip arthroplasty (THA). Nonsteroidal anti-inflammatory drugs have proven to reduce the occurrence of HO. It is still unclear when the formation of HO is finished. Aim of our study was to answer this question. Methods In a prospective study, the occurrence of periarticular HO was checked during the follow-up (FU) examinations. In total, 75 consecutive patients who underwent THA were included. To ensure a high follow-up rate, only patients with a life expectancy of at least 10 years were included. A medical ossification prophylaxis with mostly etoricoxib (90 mg once daily) was administered. Follow-up examinations were performed at 3 months, 1 year, 3, 5, and 10 years postoperatively. Each time, a clinical and radiological examination was carried out. The HO was graded according to Brooker’s method. Results Low-grade HO classified by Brooker grade I and II occurred significantly more frequent than HO grade III. In patients with present HO, a possible increase in Brooker stage could further be observed within 3 years postoperatively. After 3 years, the formation of HO was completed in all patients. Conclusion Three years after THA, the formation of HO is complete. After more than 3 years postoperatively, if HO occurs or increases, other triggering causes such as new trauma, periarticular infection, or implant loosening should be considered.

Role of aspirin in the prevention of heterotopic ossification following total hip replacement: a systematic review and meta‐analysis

“…Thirdly, we did not evaluate the effect of ASA on patients undergoing THA with different risk profiles for HO due to limited information. A fourth limitation was the inconsistent follow‐up period across included papers; more importantly, they are relatively short to capture HO, based on a recent study suggesting that the formation of HO is complete in 3 years after THA 48 . Notwithstanding these limitations, the present study addresses the shortcoming of prior studies and assists in our understanding of the role of ASA played in the management of THA, providing an abundant room for further research progress in the future.…”

Heterotopic Ossification After Modern Total Hip Arthroplasty: Predisposing Factors, Prophylaxis, and Surgical Treatment

“…One prospective study of 75 patients given routine etoricoxib after noncemented THA reported that the formation of HO was not completed until 3 years. 31 However, compliance with medication was poor, and only nine patients increased one Brooker stage between 1-year and 3-year follow-up time. 31 The maturation of HO can be evaluated on plain radiographs or CT scans, but sometimes the HO can only be seen on lateral radiographs.…”

“…31 However, compliance with medication was poor, and only nine patients increased one Brooker stage between 1-year and 3-year follow-up time. 31 The maturation of HO can be evaluated on plain radiographs or CT scans, but sometimes the HO can only be seen on lateral radiographs. 2 A normal serum alkaline phosphatase level may suggest maturation of the bone.…”

“…Completion of a 6-week course of indomethacin or etoricoxib has been 63 and 69%, respectively. 31,35 In one study, celecoxib was associated with an increased risk of a cardiovascular event. 36 Aspirin, 325 mg once or twice daily or 81 mg twice daily, has been used for venous thromboembolism prophylaxis for THA patients at so-called standard risk of this complication.…”

“…32 However, one study of 75 noncemented THA reported that the formation of HO continued until 3 years postoperatively. 31 A bone scan may be helpful in the evaluation of the activity of HO, with “normal” uptake suggestive of maturation. 32,36 The serum alkaline phosphatase level, elevated during the active stages of HO, should normalize once maturation is complete.…”