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
. 2022 Apr 1;42(4):e331-e335.
doi: 10.1097/BPO.0000000000002072.

Incidence and Risk Factors for Heterotopic Ossification in a Matched Cohort Adolescent Population Undergoing Hip Arthroscopy

Aliya G Feroe  1   2 , Mahad M Hassan  1   2 , Rachel A Flaugh  1   2 , Stephen P Maier  1   2 , Danielle L Cook  1 , Yi-Meng Yen  1   2 , Mininder S Kocher  1   2
Affiliations

Incidence and Risk Factors for Heterotopic Ossification in a Matched Cohort Adolescent Population Undergoing Hip Arthroscopy

Aliya G Feroe et al. J Pediatr Orthop. .

Abstract

Background: Heterotopic ossification (HO) is a known complication after hip arthroscopy in adults, positively associated with larger cam resection, male sex, older age, and obesity, and negatively associated with nonsteroidal anti-inflammatory drug (NSAID) use and capsular closure. However, it has not been well-documented in adolescents. The purpose of this study was to determine the incidence and risk factors for the development of HO in adolescent patients undergoing hip arthroscopy.

Methods: Clinical and operative records from a pediatric institution were queried to identify patients aged 21 years or younger who underwent hip arthroscopy between 2008 and 2018. The 27 cases that developed HO were matched 1:4 on age and sex with 107 controls. The bivariate analysis assessed the relationship between demographic and perioperative factors on the development of HO. Multivariable logistic regression evaluated the association between prophylactic NSAID use (indomethacin 75 mg, 3 wk) and HO, controlling for surgeon and extent of cam resection (change in alpha angle).

Results: Twenty-seven of 595 (4.5%) hips that underwent hip arthroscopy developed HO within 2 years of surgery. Prophylactic indomethacin was not significantly associated with developing HO [30% (8/27), P=0.83], after controlling for surgeon and extent of cam resection-nor were age, sex, and body mass index percentile. Of patients who developed HO, a smaller proportion underwent reoperation for HO excision among those who received prophylactic indomethacin than those who did not [13% (1/8) vs. 63% (12/19), P=0.03].

Conclusions: The incidence of HO within 2 years of hip arthroscopy in this adolescent population was 4.5%. Although studies in the adult hip arthroscopy population have pointed to a protective role of NSAIDs (eg, indomethacin) in radiographic HO, the effect was less certain in this adolescent sample. Larger studies are important to further evaluate the role of prophylactic NSAIDs and variations in arthroscopic technique in developing HO.

Level of evidence: Level III-therapeutic, case-control study.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Randelli F, Pierannunzii L, Banci L, et al. Heterotopic ossifications after arthroscopic management of femoroacetabular impingement: the role of NSAID prophylaxis. J Orthop Traumatol. 2010;11:245–250.
    1. Bedi A, Zbeda RM, Bueno VF, et al. The incidence of heterotopic ossification after hip arthroscopy. Am J Sports Med. 2012;40:854–863.
    1. Gao GY, Zhang X, Dai LH, et al. Heterotopic ossification after arthroscopy for hip impingement syndrome. Chin Med J (Engl). 2019;132:827–833.
    1. Ong C, Hall M, Youm T. Surgical technique: arthroscopic treatment of heterotopic ossification of the hip after prior hip arthroscopy. Clin Orthop Relat Res. 2013;471:1277–1282.
    1. Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy. 2008;24:540–546.