Incidence of Heterotopic Ossification after Surface and Conventional Total Hip Arthroplasty: A Comparative Study Using Anterolateral Approach and Indomethacin Prophylaxis

Abstract

The incidence and severity of heterotopic ossification (HO) in two homogeneous groups of patients that received surface replacement arthroplasty (SRA) and conventional total hip arthroplasty (THA) were evaluated retrospectively. Thirty-nine patients undergoing 42 hip resurfacing procedures and 41 primary cementless THAs through an anterolateral approach received a 10-day course of 150 mg/die of indomethacin postoperatively. The median surgical time was 190 minutes and 156 minutes, respectively (P < 0.003). At a minimum 1-year followup, the development of HO was assessed on standard X-ray using Brooker grading. Ectopic bone formation was detected in five cases (11.9%, two Brooker grade I and three grade II) in the SRA group and in 14 hips (34.1%, 12 grade I and two grade II) treated with conventional THA, but the difference was not significant (P < 0.11). No clinically relevant periprosthetic ossification (Brooker III or IV) occurred in both groups. Although the difference was not statistically significant, the incidence of HO after SRA was lower than conventional THA. More extensive soft tissue trauma, bone debris, and longer operative time in hip resurfacing are not likely to be absolute risk factors for HO. Further investigations including larger patient populations are needed to confirm these findings.

Dislocation Rate Fallowing Posterior Total Hip Arthroplasty with Intra-Osseous Soft Tissue Repair

“…Other reported post operative complications were comparable to international figure & include; 0% for sciatic nerve injury [58,60,61], & DVT [60,62,63]. While is 3.73% for; infection [62], intra-operative fracture [62][63][64][65] & hetero-topic ossification [4,[66][67]. One patient was died with cardiac shock & represent 3.73% which is also comparable to international figure [14,67].…”

Heterotopic Ossification: Basic-Science Principles and Clinical Correlates

“…Although many studies have isolated specific factors that increase the risk for heterotopic ossification after spinal cord injury and burn injury, it remains unclear what patient-related factors lead to heterotopic ossification after hip arthroplasty 18,35 . Interestingly, surgical factors, such as extended ischemia time, type of approach, and the use of cemented implants, may increase the risk of heterotopic ossification 36 .…”

Pilot study for detection of early changes in tissue associated with heterotopic ossification: moving toward clinical use of Raman spectroscopy

“…The entity commonly produces deformity of soft tissues, difficulty with the use of prosthetics, joint ankylosis, skin ulceration and/or nerve entrapment (1,2). HO occurs in the setting of familial conditions, such as fibrodysplasia ossificans progressive (FOP), or as a complication of surgery, such as hip arthroplasty (3,4). However, HO is more common in military casualties, presumably due to the unique trauma resulting from blasts and high-velocity projectiles.…”