Prevention of heterotopic ossification in high-risk patients with total hip arthroplasty: the experience of a combined therapeutic protocol

Abstract

The combination of radiotherapy and indomethacin for the prevention of heterotopic ossification (HO) in high-risk patients undergoing total hip arthroplasty (THA) has not been reported. The aim of this study was to present the experience of our department with this combined therapeutic protocol. Fifty-four patients who underwent THA received a single dose of 7 Gy of postoperative radiotherapy and 75 mg of indomethacin for 15 days. Patients were analysed for clinical and radiographical evidence of HO development at 1 year postoperatively. The overall radiographical incidence of HO was 20.4% (95%

Identifying the Cellular Mechanisms Leading to Heterotopic Ossification

“…Single dose radiotherapy is widely used and there is persuasive clinical evidence demonstrating its effectiveness as a HO prophylactic following surgery [15][16][17]. Furthermore, radiotherapy and NSAIDs may be given in combination pre-or post-operatively for high-risk patients [18]. This type of combination treatment has perhaps proven most effective for preventing HO recurrence following surgery (e.g.…”

“…This type of combination treatment has perhaps proven most effective for preventing HO recurrence following surgery (e.g. the excision of ectopic bone) [18]. However, radiotherapy is by no means ideal since it carries a number of potential risks such as malignancy, genetic mutations, and gonadal effects [19,20].…”

Treatments and Preventative Measures for Trauma‐Induced Heterotopic Ossification: A Review

“…Following total hip arthroplasty (THA), HO frequency has been reported to be between 2% and 90% 2. Posterior approaches for acetabular surgery, such as the Kocher‐Langenbeck approach, increase the risk of HO formation in the gluteus minimus muscle.…”

“…It does so by interfering with and suppressing mesenchymal‐cell progression to osteogenic cells 15, 22, 68. Preoperatively, RT delivery has shown varied reports of effectiveness 2. Some animal studies suggest that the inhibiting effect on bone healing after the use RT is more pronounced if it is administered closer to the time of the actual injury 63.…”

“…when Al‐Zahrawi described a complication of fracture as a “callus often occurs after the healing of a fracture…and sometimes there is limitation of the natural function of the limb…” 1. Outside of rare genetic forms of HO, any state that causes local soft tissue damage, such as high‐energy trauma injuries and surgical approaches, can cause HO 2. Because of its correlation with trauma, HO is among the postinjury and iatrogenic complications that can cause pain and impact a patient's recovery and rehabilitation efforts 3…”