Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Apr 16:2019:3860142.
doi: 10.1155/2019/3860142. eCollection 2019.

Heterotopic Ossification: A Challenging Complication of Total Hip Arthroplasty: Risk Factors, Diagnosis, Prophylaxis, and Treatment

Paweł Łęgosz  1 , Maciej Otworowski  1 , Aleksandra Sibilska  2 , Krzysztof Starszak  1 , Daniel Kotrych  3 , Adam Kwapisz  2 , Marek Synder  2
Affiliations
Review

Heterotopic Ossification: A Challenging Complication of Total Hip Arthroplasty: Risk Factors, Diagnosis, Prophylaxis, and Treatment

Paweł Łęgosz et al. Biomed Res Int. .

Abstract

Background: This review is intended to summarize the risk factors, classification, diagnosis, and treatment of heterotopic ossification (HO) of previously published studies.

Results: Heterotopic ossification is a common complication of total hip arthroplasty. Its prevalence is not the same in all of the patient groups. Frequency of HO varies from 15 to 90%. Hip ankylosis, male gender, and previous history of HO are said to be risk factors with a significant level. Diagnosis is based on a single AP radiograph: the Brooker classification that divides HO into four grades is the most commonly used. The confirmation test that can be used is a bone scan. A great amount of bone metabolic turnover markers have been tested, but none of them seems to be relevant in case of prevention or diagnosis of HO. The most effective prophylactic treatment is radiotherapy or administration of nonsteroidal anti-inflammatory drugs. Over the years a lot of different RT protocols have been tested. Nowadays the most often used regimen is 7 Gy given postoperatively in a single dose. The most commonly prescribed drug in prophylaxis of HO is indomethacin. Also, the efficacy of ibuprofen and diclofenac was proven. Recently researchers focused on selective COX-2 inhibitors. They appear to be as effective as nonselective NSAIDs having less side effects. The one and only treatment of HO is a revision arthroplasty.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Heterotopic ossification visible on an AP X-ray (a) and on a computed tomography scan (b) around right hip. It is a complete hip ankylosis. HO like this can completely sabotage functional outcomes of THR limiting the range of motion in all planes. This is why using right prophylaxis is so crucial (from the Department of Orthopaedics and Traumatology of the Musculoskeletal System, Infant Jesus Teaching Hospital, Medical University of Warsaw records).
Figure 2
Figure 2
The presence of HO Graded in Brooker Classification as I (a), II (b), III (c), and IV (d) on a follow-up after THR (from the Clinic of Orthopaedics and Paediatric Orthopaedics Medical University of Lodz records).
See this image and copyright information in PMC

References

    1. Kan S. L., Yang B., Ning G. Z., et al. Nonsteroidal anti-inflammatory drugs as prophylaxis for heterotopic ossification after total hip arthroplasty. Medicine. 2015;94(18):p. e828. doi: 10.1097/MD.0000000000000828. - DOI - PMC - PubMed
    1. Milakovic M., Popovic M., Raman S., Tsao M., Lam H., Chow E. Radiotherapy for the prophylaxis of heterotopic ossification: A systematic review and meta-analysis of randomized controlled trials. Radiotherapy & Oncology. 2015;116(1):4–9. doi: 10.1016/j.radonc.2015.05.022. - DOI - PubMed
    1. Kölbl O., Knelles D., Barthel T., Raunecker F., Flentje M., Eulert J. Preoperative irradiation versus the use of nonsteroidal anti-inflammatory drugs for prevention of heterotopic ossification following total hip replacement: the results of a randomized trial. International Journal of Radiation Oncology, Biology, Physics. 1998;42(2):397–401. doi: 10.1016/S0360-3016(98)00204-1. - DOI - PubMed
    1. Kienapfel H., Koller M., Wüst A., et al. Prevention of heterotopic bone formation after total hip arthroplasty: A prospective randomised study comparing postoperative radiation therapy with indomethacin medication. Archives of Orthopaedic and Trauma Surgery. 1999;119(5-6):296–302. doi: 10.1007/s004020050414. - DOI - PubMed
    1. Seegenschmiedt M. H., Goldmann A. R., Wölfel R., Hohmann D., Beck H., Sauer R. Prevention of heterotopic ossification (HO) after total hip replacement: randomized high versus low dose radiotherapy. Radiotherapy & Oncology. 1993;26(3):271–274. doi: 10.1016/0167-8140(93)90270-I. - DOI - PubMed

MeSH terms