Skip to main content
SpringerLink
Log in

Heterotopic Ossification Following Hip Replacement

  • Chapter
  • First Online:
Hip Arthroplasty

  • 188 Accesses

Abstract

Heterotopic ossification (HO) has often been reported as a complication after total hip arthroplasty. This chapter summarizes the risk factors, pathophysiology, diagnosis, prophylaxis, and treatment of heterotopic ossification. Male sex, surgical approach, previous history of ossification after surgery, and trochanteric or femoral osteotomy have been identified as high-risk cases. The classification system given by Brooker is the most commonly used. The current guidelines regarding the prophylaxis and treatment have been emphasized in the chapter. Non-steroidal anti-inflammatory drugs (NSAIDs) and radiation therapy are currently the most commonly used methods of HO prophylaxis. Selective COX-2 inhibitors have been recommended to be the safest and first choice for HO prophylaxis therapy. Treatment is required only if the patient is symptomatic and is aimed at pain relief and restoration of movement. Surgical excision is the treatment of choice for cases with severe joint stiffness, pain, and bony ankylosis.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Vanden Bossche L, Vanderstraeten G. Heterotopic ossification: a review. J Rehabil Med. 2005;37:129–36.

    Article  Google Scholar 

  2. Łęgosz P, et al. Heterotopic ossification: a challenging complication of total hip arthroplasty: risk factors, diagnosis, prophylaxis, and treatment. Biomed Res Int. 2019;2019:3860142.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Meyers C, et al. Heterotopic ossification: a comprehensive review. JBMR Plus. 2019;3(4):e10172.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Stołtny T, et al. Heterotopic ossification in patients after total hip replacement. Ortop Traumatol Rehabil. 2007;9(3):264–72.

    PubMed  Google Scholar 

  5. Zhu Y, et al. Incidence and risk factors for heterotopic ossification after total hip arthroplasty: a meta-analysis. Arch Orthop Trauma Surg. 2015;135(9):1307–14.

    Article  PubMed  Google Scholar 

  6. Board TN, et al. The prophylaxis and treatment of heterotopic ossification following lower limb arthroplasty. J Bone Joint Surg Br. 2007;89(4):434–40.

    Article  CAS  PubMed  Google Scholar 

  7. Pape HC, et al. Current concepts in the development of heterotopic ossification. J Bone Joint Surg Br. 2004;86(6):783–7.

    Article  CAS  PubMed  Google Scholar 

  8. Chalmers J, Gray DH, Rush J. Observations on the induction of bone in soft tissues. J Bone Joint Surg Br. 1975;57(1):36–45.

    Article  CAS  PubMed  Google Scholar 

  9. Koelbl O, Alberti WE, Seegenschmiedt MH. Heterotopic ossification prophylaxis-the hip. In: Radiotherapy for non-malignant disorders. Springer; 2008. p. 357–71.

    Chapter  Google Scholar 

  10. Hamblen D, Harris W, Rottger J. Myositis ossificans as a complication of hip arthroplasty. J Bone Joint Surg (Br). 1971;53:764.

    Google Scholar 

  11. DeLee J, Ferrari A, Charnley J. Ectopic bone formation following low friction arthroplasty of the hip. Clin Orthop Relat Res. 1976;121:53–9.

    Google Scholar 

  12. Kjaersgaard-Andersen P, et al. Heterotopic bone formation after noncemented total hip arthroplasty. Location of ectopic bone and the influence of postoperative antiinflammatory treatment. Clin Orthop Relat Res. 1990;252:156–62.

    Article  Google Scholar 

  13. Arcq M. Ectopic ossification: a complication after total hip replacement (author's transl). Arch Orthop Unfallchir. 1973;77(2):108–31.

    Article  CAS  PubMed  Google Scholar 

  14. Brooker AF, et al. 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 

  15. Iorio R, Healy WL. Heterotopic ossification after hip and knee arthroplasty: risk factors, prevention, and treatment. J Am Acad Orthop Surg. 2002;10(6):409–16.

    Article  PubMed  Google Scholar 

  16. Maloney WJ, et al. Incidence of heterotopic ossification after total hip replacement: effect of the type of fixation of the femoral component. J Bone Joint Surg Am. 1991;73(2):191–3.

    Article  CAS  PubMed  Google Scholar 

  17. Wright JG, Moran E, Bogoch E. Reliability and validity of the grading of heterotopic ossification. J Arthroplast. 1994;9(5):549–53.

    Article  CAS  Google Scholar 

  18. Della Valle AG, et al. Heterotopic ossification after total hip arthroplasty: a critical analysis of the Brooker classification and proposal of a simplified rating system. J Arthroplast. 2002;17(7):870–5.

    Article  Google Scholar 

  19. Ahrengart L. Periarticular heterotopic ossification after total hip arthroplasty. Risk factors and consequences. Clin Orthop Relat Res. 1991;263:49–58.

    Article  Google Scholar 

  20. Eggli S, Woo A. Risk factors for heterotopic ossification in total hip arthroplasty. Arch Orthop Trauma Surg. 2001;121:531–5.

    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. Sundaram NA, Murphy JC. Heterotopic bone formation following total hip arthroplasty in ankylosing spondylitis. Clin Orthop Relat Res. 1986;207:223–6.

    Article  Google Scholar 

  23. Hartwig CH, Sell S, Küsswetter W. Periarticular ossification following cement-free and cement fixed total endoprosthesis implantation in the hip joint. Z Orthop Ihre Grenzgeb. 1989;127(3):296–301.

    Article  CAS  PubMed  Google Scholar 

  24. Duck HJ, Mylod AG Jr. Heterotopic bone in hip arthroplasties. Cemented versus noncemented. Clin Orthop Relat Res. 1992;282:145–53.

    Article  Google Scholar 

  25. Nayak KN, et al. Prevalence of heterotopic ossification in cemented versus noncemented total hip joint replacement in patients with osteoarthrosis: a randomized clinical trial. Can J Surg. 1997;40(5):368–74.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Errico TJ, Fetto JF, Waugh TR. Heterotopic ossification. Incidence and relation to trochanteric osteotomy in 100 total hip arthroplasties. Clin Orthop Relat Res. 1984;190:138–41.

    Article  Google Scholar 

  27. Morrey BF, Adams RA, Cabanela ME. Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty. Clin Orthop Relat Res. 1984;188:160–7.

    Article  Google Scholar 

  28. Rama KR, et al. Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study. J Arthroplast. 2009;24(2):256–62.

    Article  Google Scholar 

  29. Geller JA, et al. Clinical significance of heterotopic ossification after metal-on-metal total hip resurfacing. Hip Int. 2014;24(2):129–35.

    Article  PubMed  Google Scholar 

  30. Kaplan FS, et al. Heterotopic ossification. J Am Acad Orthop Surg. 2004;12(2):116–25.

    Article  PubMed  Google Scholar 

  31. Fransen M, N.B., Non-steroidal anti-inflammatory drugs for preventing heterotopic bone formation after hip arthroplasty. Cochrane Database Syst Rev, 2004. 3: CD001160.

    Google Scholar 

  32. Neal BC, Rodgers A, Gray H, Clark T, Beaumont DD, House T, et al. No effect of low-dose aspirin for the prevention of heterotopic bone formation after total hip replacement: a randomized trial of 2,649 patients. Acta Orthop Scand. 2000;71(2):129–34.

    Article  CAS  PubMed  Google Scholar 

  33. McMahon JS, Waddell JP, Morton J. Effect of short-course indomethacin on heterotopic bone formation after uncemented total hip arthroplasty. J Arthroplast. 1991;6(3):259–64.

    Article  CAS  Google Scholar 

  34. Zhang AH, et al. A systematic review and meta-analysis of naproxen for prevention heterotopic ossification after hip surgery. Medicine (Baltimore). 2019;98(14):e14607.

    Article  CAS  PubMed  Google Scholar 

  35. Xue D, et al. Selective COX-2 inhibitor versus nonselective COX-1 and COX-2 inhibitor in the prevention of heterotopic ossification after total hip arthroplasty: a meta-analysis of randomised trials. Int Orthop. 2011;35(1):3–8.

    Article  PubMed  Google Scholar 

  36. Saudan M, et al. Celecoxib versus ibuprofen in the prevention of heterotopic ossification following total hip replacement: a prospective randomised trial. J Bone Joint Surg Br. 2007;89(2):155–9.

    Article  CAS  PubMed  Google Scholar 

  37. Winkler S, et al. Comparative clinical study of the prophylaxis of heterotopic ossifications after total hip arthroplasty using etoricoxib or diclofenac. Int Orthop. 2016;40(4):673–80.

    Article  PubMed  Google Scholar 

  38. Oberberg S, et al. Etoricoxib is safe and effective in preventing heterotopic ossification after primary total hip arthroplasty. J Orthop Surg Res. 2021;16(1):163.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Brunnekreef JJ, et al. Is etoricoxib effective in preventing heterotopic ossification after primary total hip arthroplasty? Int Orthop. 2013;37(4):583–7.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Zhu XT, Chen L, Lin JH. Selective COX-2 inhibitor versus non-selective COX-2 inhibitor for the prevention of heterotopic ossification after total hip arthroplasty: a meta-analysis. Medicine (Baltimore). 2018;97(31):e11649.

    Article  CAS  PubMed  Google Scholar 

  41. Joice M, Vasileiadis GI, Amanatullah DF. Non-steroidal anti-inflammatory drugs for heterotopic ossification prophylaxis after total hip arthroplasty: a systematic review and meta-analysis. Bone Joint J. 2018;100-b(7):915–22.

    Article  CAS  PubMed  Google Scholar 

  42. Liu JZ, et al. Heterotopic ossification prophylaxis after Total hip arthroplasty: randomized trial of 400 vs 700 cGy. J Arthroplast. 2017;32(4):1328–34.

    Article  Google Scholar 

  43. Popovic M, et al. Radiotherapy for the prophylaxis of heterotopic ossification: a systematic review and meta-analysis of published data. Radiother Oncol. 2014;113(1):10–7.

    Article  PubMed  Google Scholar 

  44. Pakos EE, et al. Is prophylaxis for heterotopic ossification with radiation therapy after THR associated with early loosening or carcinogenesis? Hip Int. 2020;30(5):559–63.

    Article  PubMed  Google Scholar 

  45. Vavken P, Castellani L, Sculco TP. Prophylaxis of heterotopic ossification of the hip: systematic review and meta-analysis. Clin Orthop Relat Res. 2009;467(12):3283.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Cai L, et al. 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 

  47. Pakos EE, et al. Combined radiotherapy and indomethacin for the prevention of heterotopic ossification after total hip arthroplasty. Strahlenther Onkol. 2009;185(8):500–5.

    Article  PubMed  Google Scholar 

  48. Wu FF, et al. NSAIDs combined with radiotherapy to prevent heterotopic ossification after total hip arthroplasty. Zhongguo Gu Shang. 2018;31(6):538–42.

    PubMed  Google Scholar 

  49. Cobb TK, et al. Functional outcome of excision of heterotopic ossification after total hip arthroplasty. Clin Orthop Relat Res. 1999;361:131–9.

    Article  Google Scholar 

  50. Wahl B, et al. Clinical and radiological results of surgical removal of periarticular ossifications after hip prosthesis implantation. Unfallchirurg. 2002;105(6):523–6.

    Article  CAS  PubMed  Google Scholar 

  51. Wick M, et al. Surgical excision of heterotopic bone after hip surgery followed by oral indomethacin application: is there a clinical benefit for the patient? Arch Orthop Trauma Surg. 1999;119(3–4):151–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, S.N. Medical College, Agra, Uttar Pradesh, India

    Amrit Goyal

  2. Department of Orthopedic Surgery, NYP-Lawrence Hospital Westchester, Bronxville, NY, USA

    Jeffrey A. Geller

  3. Division of Hip and Knee Reconstruction-Columbia University Medical Center, New York, NY, USA

    Jeffrey A. Geller

Authors
  1. Amrit Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey A. Geller
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Head of Orthopedics and Joint Replacement, Amrita Institute of Medical Sciences Amrita Vishwavidyapeetham, Faridabad, India

    Mrinal Sharma

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Goyal, A., Geller, J.A. (2023). Heterotopic Ossification Following Hip Replacement. In: Sharma, M. (eds) Hip Arthroplasty. Springer, Singapore. https://doi.org/10.1007/978-981-99-5517-6_33

Download citation

  • DOI: https://doi.org/10.1007/978-981-99-5517-6_33

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-5516-9

  • Online ISBN: 978-981-99-5517-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation