Heterotopic Ossification After Modern Total Hip Arthroplasty: Predisposing Factors, Prophylaxis, and Surgical Treatment

Abstract

Heterotopic ossification (HO) is a common radiographic finding and potentially serious complication after modern total hip arthroplasty. Although historically associated with the posterolateral approach, HO has been noted in 10% to 40% of patients having direct anterior or anterior-based muscle sparing approaches. The available data are uncertain whether robotic arm–assisted procedures are associated with this complication. Current prophylaxis for patients considered high risk of this complication includes postoperative, nonsteroidal, anti-inflammatory medication for several weeks or low-dose perioperative irradiation. The surgical treatment of symptomatic HO associated with severely restricted motion or ankylosis of the hip should be individualized but may include wide excision of bone, acetabular revision to prevent instability, and prophylaxis to prevent recurrence.

Heterotopic ossification after hip arthroplasty: role of bone SPECT/CT scintigraphy

“…Además, algunos artículos recogen el incremento sérico de citoquinas inflamatorias (TNF, IL-1, IL-6 y proteína quimioatrayente de monocitos) y fosfatasa alcalina en las fases iniciales de esta formación ósea, también presentes en el proceso reparativo postraumático (5). La gammagrafía permite el diagnóstico precoz de la OH antes de que se observen alteraciones en la RX, incluso siendo más precoz que en TC/RM (6).…”