Skip to main content
SpringerLink
Log in

Aspirin Decreases Heterotopic Ossification After Hip Resurfacing

  • Symposium: Update on Hard-on-Hard Bearings in Hip Arthroplasty
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Heterotopic ossification (HO) is a concern for patients undergoing hip surgery, especially surface replacement arthroplasty (SRA) who tend to be younger, more active, and anticipate good motion. It is unclear, however, whether HO occurs more frequently after SRA than traditional total hip arthroplasty (THA) and whether aspirin influences the risk.

Questions/purposes

We therefore determined the incidence of HO after hip resurfacing compared with THA and determined whether aspirin influenced the incidence or severity of HO.

Methods

Retrospectively we compared three patient cohorts: SRA with aspirin (176 hips; 160 patients), SRA with warfarin (60 hips; 57 patients), and THA with warfarin (240 hips; 222 patients). All patients satisfied the same selection criteria and all surgeries were performed through the posterolateral approach using spinal anesthesia. HO was classified using the technique of Brooker et al. comparing the preoperative, immediate postoperative, and 6- to 12-month followup radiographs (minimum, 1 year; mean, 2.7 years).

Results

In the SRA with aspirin group, HO was detected in four of 151 hips (2.6%; two Grade I; one Grade II; one Grade III); in the SRA with warfarin group, eight of 46 hips (17.4%) had HO with four hips (8.7%) having severe HO (Grade III). All 12 patients with HO in both SRA groups were male. The HO incidence and severity was less for the SRA patients treated with aspirin compared with those treated with warfarin. In the THA with warfarin control group, HO was detected in five of 189 hips (2.6%; two Grade I; three Grade II). The HO incidence and severity were the same between the THA with warfarin and the SRA with aspirin cohorts.

Conclusions

The risk of HO is greater in SRA than in THA in patients treated with warfarin postoperatively; aspirin appears to decrease the incidence and severity of HO after hip resurfacing surgery to a similar level as total hip arthroplasty.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–D

Similar content being viewed by others

References

  1. Ahrengart L, Sahlin K, Lindgren U. Myositis ossificans after total hip replacement and perioperative muscle ischemia. J Arthroplasty. 1987;2:65–69.

    Article  PubMed  CAS  Google Scholar 

  2. Amstutz HC, Beaule PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA. Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am. 2004;86:28–39.

    PubMed  Google Scholar 

  3. Amstutz HC, Thomas BJ, Jinnah R, Kim W, Grogan T, Yale C. Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66:228–241.

    PubMed  CAS  Google Scholar 

  4. Back DL, Smith JD, Dalziel RE, Young DA, Shimmin A. Incidence of heterotopic ossification after hip resurfacing. ANZ J Surg. 2007;77:642–647.

    Article  PubMed  Google Scholar 

  5. Bek D, Beksac B, Della Valle AG, Sculco TP, Salvati EA. Aspirin decreases the prevalence and severity of heterotopic ossification after 1-stage bilateral total hip arthroplasty for osteoarthrosis. J Arthroplasty. 2009;24:226–232.

    Article  PubMed  Google Scholar 

  6. Blasingame JP, Resnick D, Coutts RD, Danzig LA. Extensive spinal osteophytosis as a risk factor for heterotopic bone formation after total hip arthroplasty. Clin Orthop Relat Res. 1981;161:191–197.

    PubMed  Google Scholar 

  7. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–1632.

    PubMed  CAS  Google Scholar 

  8. Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br. 1972;54:61–76.

    PubMed  CAS  Google Scholar 

  9. De Smet KA, Pattyn C, Verdonk R. Early results of primary Birmingham hip resurfacing using a hybrid metal-on-metal couple. Hip International. 2002;12:158–162.

    Google Scholar 

  10. DeLee J, Ferrari A, Charnley J. Ectopic bone formation following low friction arthroplasty of the hip. Clin Orthop Relat Res. 1976;121:53–59.

    PubMed  Google Scholar 

  11. Ekelund A, Brosjo O, Nilsson OS. Experimental induction of heterotopic bone. Clin Orthop Relat Res. 1991;263:102–112.

    PubMed  Google Scholar 

  12. Errico TJ, Fetto JF, Waugh TR. Heterotopic ossification. Incidence and relation to trochanteric osteotomy in 100 total hip arthroplasties. Clin Orthop Relat Res. 1984;190:138–141.

    PubMed  Google Scholar 

  13. Freiberg AA, Cantor R, Freiberg RA. The use of aspirin to prevent heterotopic ossification after total hip arthroplasty. A preliminary report. Clin Orthop Relat Res. 1991;267:93–96.

    PubMed  Google Scholar 

  14. Haas SB, Barrack RL, Westrich G, Lachiewicz PF. Venous thromboembolic disease after total hip and knee arthroplasty. J Bone Joint Surg Am. 2008;90:2764–2780.

    PubMed  Google Scholar 

  15. Iorio R, Healy WL. Heterotopic ossification after hip and knee arthroplasty: risk factors, prevention, and treatment. J Am Acad Orthop Surg. 2002;10:409–416.

    PubMed  Google Scholar 

  16. Kaplan FS, Glaser DL, Hebela N, Shore EM. Heterotopic ossification. J Am Acad Orthop Surg. 2004;12:116–125.

    PubMed  Google Scholar 

  17. Kjaersgaard-Andersen P, Ritter MA. Short-term treatment with nonsteroidal antiinflammatory medications to prevent heterotopic bone formation after total hip arthroplasty. A preliminary report. Clin Orthop Relat Res. 1992;279:157–162.

    PubMed  Google Scholar 

  18. Knahr K, Salzer M, Eyb R, Frank P, Blauensteiner W. Heterotopic ossification with total hip endoprostheses in various models of thrombosis prophylaxis. J Arthroplasty. 1988;3:1–8.

    Article  PubMed  CAS  Google Scholar 

  19. Langan P, Weiss CA. Femoral stem failure and ectopic bone formation in total hip arthropalsty: four case reports. Clin Orthop Relat Res. 1980;146:205–208.

    PubMed  Google Scholar 

  20. Lazansky MG. Complications revisited. The debit side of total hip replacement. Clin Orthop Relat Res. 1973;95:96–103.

    PubMed  Google Scholar 

  21. Matos M, Amstutz HC, Finerman GA. Myositis ossificans following total hip replacement. J Bone Joint Surg Am. 1975;57:137–140.

    Google Scholar 

  22. McMinn D, Treacy R, Lin K, Pynsent P. Metal on metal surface replacement of the hip. Experience of the McMinn prothesis. Clin Orthop Relat Res. 1996;329(Suppl):S89–98.

    Article  PubMed  Google Scholar 

  23. Neal B, Gray H, MacMahon S, Dunn L. Incidence of heterotopic bone formation after major hip surgery. ANZ J Surg. 2002;72:808–821.

    Article  PubMed  Google Scholar 

  24. Nollen AJ, Slooff TJ. Para-articular ossifications after total hip replacement. Acta Orthop Scand. 1973;44:230–241.

    Article  PubMed  CAS  Google Scholar 

  25. Nunley RM, Della Valle CJ, Barrack RL. Is patient selection important for hip resurfacing? Clin Orthop Relat Res. 2009;467:56–65.

    Article  PubMed  Google Scholar 

  26. Nunley RM, Zhu J, Brooks PJ, Engh CA Jr, Raterman SJ, Rogerson JS, Barrack RL. The learning curve for adopting hip resurfacing among hip specialists. Clin Orthop Relat Res. 2010;468:382–391.

    Article  PubMed  Google Scholar 

  27. Pagnani MJ, Pellicci PM, Salvati EA. Effect of aspirin on heterotopic ossification after total hip arthroplasty in men who have osteoarthrosis. J Bone Joint Surg Am. 1991;73:924–929.

    PubMed  CAS  Google Scholar 

  28. Parvizi J, Azzam K, Rothman RH. Deep venous thrombosis prophylaxis for total joint arthroplasty: American Academy of Orthopaedic Surgeons guidelines. J Arthroplasty. 2008;23:2–5.

    Article  PubMed  Google Scholar 

  29. Rama KR, Vendittoli PA, Ganapathi M, Borgmann R, Roy A, Lavigne M. Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty. 2009;24:256–262.

    Article  PubMed  Google Scholar 

  30. Riegler HF, Harris CM. Heterotopic bone formation after total hip arthroplasty. Clin Orthop Relat Res. 1976;117:209–216.

    PubMed  Google Scholar 

  31. Rosendahl S, Christoffersen JK, Norgaard M. Para-articular ossification following hip replacement. 70 arthroplasties ad modum Moore using McFarland’s approach. Acta Orthop Scand. 1977;48:400–404.

    Article  PubMed  CAS  Google Scholar 

  32. Sodemann B, Persson PE, Nilsson OS. Periarticular heterotopic ossification after total hip arthroplasty for primary coxarthrosis. Clin Orthop Relat Res. 1988;236:150–157.

    Google Scholar 

  33. Wright JG, Moran E, Bogoch E. Reliability and validity of the grading of heterotopic ossification. J Arthroplasty. 1994;9:549–553.

    Article  PubMed  CAS  Google Scholar 

  34. Wurnig C, Eyb R, Auersperg V. Indomethacin for prevention of ectopic ossification in cementless hip arthroplasties. A prospective 1-year study of 100 cases. Acta Orthop Scand. 1992;63:628–630.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO, 63110, USA

    Ryan M. Nunley MD, Jinjun Zhu MD, PhD, John C. Clohisy MD & Robert L. Barrack MD

Authors
  1. Ryan M. Nunley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jinjun Zhu MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John C. Clohisy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert L. Barrack MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryan M. Nunley MD.

Additional information

One of the authors (RLB) is a designer (royalty income) for Smith & Nephew (Memphis, TN) and receives institutional research support from Smith & Nephew. One of the authors (RMN) receives institutional research support from Smith & Nephew and is a consultant for Smith & Nephew, Wright Medical Technology (Arlington, TN), and Salient Surgical Technology (Portsmouth, NH). One of the authors (JCC) receives institutional support from Wright Medical Technology.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Washington University, St Louis, MO, USA.

About this article

Cite this article

Nunley, R.M., Zhu, J., Clohisy, J.C. et al. Aspirin Decreases Heterotopic Ossification After Hip Resurfacing. Clin Orthop Relat Res 469, 1614–1620 (2011). https://doi.org/10.1007/s11999-011-1846-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-1846-6

Keywords

Search

Navigation