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Heterotopic Ossification in Hip Arthroscopy: an Updated Review

  • Outcomes Research in Orthopedics (O Ayeni, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

Heterotopic ossification (HO) in hip arthroscopy is a common post-operative complication. This review was undertaken to provide an update (2014 present) on the current literature regarding HO in hip arthroscopy.

Recent Findings

Risk factors for HO post-hip arthroscopy include male gender, mixed impingement, picture, and the size of CAM resection. HO prophylaxis with NSAIDs has been proven to decrease the rate of HO post-hip arthroscopy; however, there is inherent risk to long-standing NSAIDs therapy. HO post-hip arthroscopy is not uncommon as a radiological finding, but symptomatic HO post-hip arthroscopy requiring revision surgery is a rare event, at < 1%. The outcomes for revision surgery for HO excision have fair outcomes.

Summary

The hip arthroscopist should stratify their patients based on known risk factors, and determine whether NSAIDs prophylaxis is warranted.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Beckmann JT, Wylie JD, Potter MQ, Maak TG, Greene TH, Aoki SK. Effect of naproxen prophylaxis on heterotopic ossification following hip arthroscopy: a double-blind randomized placebo-controlled trial. J Bone Joint Surg Am. 2015;97(24):2032–7 The only randomized controlled trial on the topic, best available evidence.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ong C, Hall M, Youm T. Surgical technique: arthroscopic treatment of heterotopic ossification of the hip after prior hip arthroscopy. Clin Orthop. 2013;471(4):1277–82.

    Article  PubMed  Google Scholar 

  3. Clohisy JC, Zebala LP, Nepple JJ, Pashos G. Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement. J Bone Joint Surg Am. 2010;92(8):1697–706.

    Article  PubMed  Google Scholar 

  4. Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy. 2008;24(5):540–6.

    Article  PubMed  Google Scholar 

  5. Bedi A, Zbeda RM, Bueno VF, Downie B, Dolan M, Kelly BT. The incidence of heterotopic ossification after hip arthroscopy. Am J Sports Med. 2012;40(4):854–63.

    Article  PubMed  Google Scholar 

  6. Randelli F, Pierannunzii L, Banci L, Ragone V, Aliprandi A, Buly R. Heterotopic ossifications after arthroscopic management of femoroacetabular impingement: the role of NSAID prophylaxis. J Orthop Traumatol. 2010;11(4):245–50.

    Article  PubMed  PubMed Central  Google Scholar 

  7. • Beckmann JT, Wylie JD, Kapron AL, Hanson JA, Maak TG, Aoki SK. The Effect of NSAID Prophylaxis and Operative Variables on Heterotopic Ossification After Hip Arthroscopy. Am J Sports Med. 2014;42(6):1359–64 A large study where at risk patients are identified.

    Article  PubMed  Google Scholar 

  8. • Uquillas CA, Youm T. Ultrasound-guided pulse lavage for heterotopic ossification after prior hip arthroscopy: a case report. JBJS Case Connect. 2014;4(3):e74–6 Interesting case report on a novel way to manage HO non-surgically.

    Article  PubMed  Google Scholar 

  9. • Amar E, Warschawski Y, Sampson TG, Atoun E, Steinberg EL, Rath E. Capsular closure does not affect development of heterotopic ossification after hip arthroscopy. Arthroscopy. 2015;31(2):225–30 A restrospective study comparing what is done in the hip arthroscopy, and relation to HO formation; in this case capsule management.

    Article  PubMed  Google Scholar 

  10. Amar E, Sharfman ZT, Rath E. Heterotopic ossification after hip arthroscopy. J Hip Preserv Surg. 2015;2(4):355–63.

    PubMed  PubMed Central  Google Scholar 

  11. • Hip LS. Arthroscopy and heterotopic ossification: is NSAID prophylaxis justified? Commentary on an article by James T. Beckmann, MD, MS, et al.: “Effect of naproxen prophylaxis on heterotopic ossification following hip arthroscopy: a double-blind randomized placebo-controlled trial”. J Bone Joint Surg Am. 2015;97(24):e80 Commentary discussing the importance of taking into consideration risk of NSAIDs to patients.

    Google Scholar 

  12. • Rath E, Warschawski Y, Maman E, Dolkart O, Sharfman ZT, Salai M, et al. Selective COX-2 inhibitors significantly reduce the occurrence of heterotopic ossification after hip arthroscopic surgery. Am J Sports Med. 2016;44(3):677–81 This study looks specifically at COX-2 inhibitors in hope to curb the GI irritation.

    Article  PubMed  Google Scholar 

  13. • Yeung M, Jamshidi S, Horner N, Simunovic N, Karlsson J, Ayeni OR. Efficacy of nonsteroidal anti-inflammatory drug prophylaxis for heterotrophic ossification in hip arthroscopy: a systematic review. Arthroscopy. 2016;32(3):519–25 Large systematic review on the topic providing insight into the current literature trends in hip arthroscopy and heterotopic ossification.

    Article  PubMed  Google Scholar 

  14. • Miller GK. Editorial Commentary: The efficacy of nonsteroidal anti-inflammatory drugs for prophylaxis of heterotopic ossification in hip arthroscopy--do we treat patients or X-rays? Arthroscopy. 2016;32(3):526–7 Commentary discussing the importance of taking into consideration the risk of NSAIDs to patients.

    Article  PubMed  Google Scholar 

  15. • Redmond JM, Keegan MA, Gupta A, Worsham JR, Hammarstedt JE, Domb BG. Outcomes of heterotopic ossification excision following revision hip arthroscopy. J Hip Preserv Surg. 2017;4(2):164–9 The only study looking at the results of revision surgery for HO excision.

    Article  PubMed  PubMed Central  Google Scholar 

  16. • Warschawski Y, Sharfman ZT, Amar E, Rath E. Anti-inflammatory prophylaxis prevents heterotopic ossification in contralateral side hip arthroscopy: a case report. J Orthop Case Rep. 2017;7(1):20–3 Interesting case report on HO prevention in a single patient.

    PubMed  PubMed Central  Google Scholar 

  17. Barth M, Willett GM, Oliphant K. Heterotopic ossification following hip arthroscopy. J Orthop Sports Phys Ther. 2018;48(4):344.

    Article  PubMed  Google Scholar 

  18. Kaplan FS, Glaser DL, Hebela N, Shore EM. Heterotopic ossification. J Am Acad Orthop Surg. 2004;12(2):116–25.

    Article  PubMed  Google Scholar 

  19. Rath E, Sherman H, Sampson TG, Ben Tov T, Maman E, Amar E. The incidence of heterotopic ossification in hip arthroscopy. Arthroscopy. 2013;29(3):427–33.

    Article  PubMed  Google Scholar 

  20. Brooker AF, Bowerman JW, Robinson RA, Riley LH. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55(8):1629–32.

    Article  CAS  PubMed  Google Scholar 

  21. Ritter MA, Vaughan RB. Ectopic ossification after total hip arthroplasty. Predisposing factors, frequency, and effect on results. J Bone Joint Surg Am. 1977;59(3):345–51.

    Article  CAS  PubMed  Google Scholar 

  22. Chan CC, Reid CM, Aw T-J, Liew D, Haas SJ, Krum H. Do COX-2 inhibitors raise blood pressure more than nonselective NSAIDs and placebo? An updated meta-analysis. J Hypertens. 2009;27(12):2332–41.

    Article  CAS  PubMed  Google Scholar 

  23. Zhu X-T, Chen L, Lin J-H. Selective COX-2 inhibitor versus non-selective COX-2 inhibitor for the prevention of heterotopic ossification after total hip arthroplasty. Medicine (Baltimore). 2018;97(31):e11649 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081155/.

    Article  CAS  Google Scholar 

  24. Cai L, Wang Z, Luo X, She W, Zhang H. Optimal strategies for the prevention of heterotopic ossification after total hip arthroplasty: a network meta-analysis. Int J Surg. 2019;62:74–85.

    Article  CAS  PubMed  Google Scholar 

  25. Baird EO, Kang QK. Prophylaxis of heterotopic ossification – an updated review. J Orthop Surg. 2009;4:12.

    Article  Google Scholar 

  26. Juarez JK, Wenke JC, Rivera JC. Treatments and preventative measures for trauma-induced heterotopic ossification: a review. Clin Transl Sci. 2018;11(4):365–70.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Battaglia M, Guaraldi F, Gori D, Castiello E, Arvat E, Sudanese A. Efficacy of triamcinolone acetate and methylprednisolone acetonide for intrabursal injection after ultrasound-guided percutaneous treatment in painful shoulder calcific tendonitis: a randomized controlled trial. Acta Radiol. 2017;58(8):964–70.

    Article  PubMed  Google Scholar 

  28. de Witte PB, Kolk A, Overes F, Nelissen RGHH, Reijnierse M. Rotator cuff calcific tendinitis: ultrasound-guided needling and lavage versus subacromial corticosteroids: five-year outcomes of a randomized controlled trial. Am J Sports Med. 2017;45(14):3305–14.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada

    Adrian Z. Kurz, Michael Riediger, Ryan Coughlin, Nicole Simunovic & Andrew Duong

  2. School of Medicine, St. George’s University, St. George’s, Grenada

    Eugenie LeRoux

  3. Crystal Clinic Orthopedic Center, 1622 East Turkeyfoot Lake Road, Akron, OH, 44312, USA

    Jovan R. Laskovski

  4. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. West, 4E15, Hamilton, ON, L8N 3Z5, Canada

    Olufemi R. Ayeni

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  1. Adrian Z. Kurz
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Correspondence to Olufemi R. Ayeni.

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Conflict of Interest

Adrian Z. Kurz, Eugenie LeRoux, Michael Riediger, Ryan Coughlin, Nicole Simunovic, and Andrew Duong each declare no potential conflicts of interest.

Jovan R. Laskovski reports personal fees from Smith and Nephew and Conmed Linvatec.

Olufemi R. Ayeni is on the speakers’ bureaus for Conmed and Smith and Nephew. Dr. Ayeni is a section editor for Current Reviews in Musculoskeletal Medicine.

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This article is part of the Topical Collection on Outcomes Research in Orthopedics

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Kurz, A.Z., LeRoux, E., Riediger, M. et al. Heterotopic Ossification in Hip Arthroscopy: an Updated Review. Curr Rev Musculoskelet Med 12, 147–155 (2019). https://doi.org/10.1007/s12178-019-09543-9

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  • DOI: https://doi.org/10.1007/s12178-019-09543-9

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