Prevention of Heterotopic Bone Formation in High Risk Patients Post-Total Hip Arthroplasty

A retrospective study was carried out to evaluate prophylaxis for heterotopic ossification (HO) about the hip joint post total hip arthroplasty (THA). Between 1990 and 1996, 20 patients with known risk for developing HO were treated prophylactically to prevent this complication. Patients at risk were divided into 3 groups based on risk factors for HO formation (previous ipsilateral hip HO formation, previous contralateral hip HO formation and bilateral hypertrophic osteoarthritis) Single fraction radiotherapy of 600, 700 or 800 cGy was administered postoperatively to all patients. The aim was to irradiate all patients within 72 hours of THA. 12 (60%) patients received in addition a short course of postoperative indomethacin for less than 13 days. Patients in this study were investigated for the following treatment variables: relative risk for forming HO, radiotherapy doses administered, time delays between surgery and irradiation, combined radiotherapy and indomethacin treatment versus radiotherapy alone, and surgical approach used for THA. Heterotopic ossification in patients was measured radiographically by use of the Brooker grading sytem, and was assessed clinically by use of the Harris Hip Score (HHS). A significant difference was found between relative risk groups (p = 0.02). Patients with previous HO formation in the ipsilateral hip joint were at greater risk of developing HO than those with previous contralateral HO formation. Moreover both of these groups were at greater risk than those with advanced bilateral hypertrophic osteoarthritis. Other variables studied showed differences that were not significant due to small sample numbers. This study, though limited by sample number, addresses questions regarding effective radiotherapy dosage, time delays acceptable before irradiation postoperatively, usefulness of short course postoperative indomethacin, and preferred operative approaches to minimise HO.

[1]  M. Flentje,et al.  Prevention of heterotopic ossification after total hip replacement. Using nonsteroidal antiinflammatory drugs versus radiation therapy: A prospective randomized trial: Nichtsteroidales Antirheumatikum versus Strahlentherapie , 1997 .

[2]  R. Fingeroth,et al.  Single Dose 6 Gy Prophylaxis for Heterotopic Ossification After Total Hip Arthroplasty , 1995, Clinical orthopaedics and related research.

[3]  B. Rask,et al.  Single-dose irradiation for the prevention of heterotopic ossification after total hip arthroplasty. A comparison of doses of five hundred and fifty and seven hundred centigray. , 1995, The Journal of bone and joint surgery. American volume.

[4]  R. Heyd,et al.  Prevention of heterotopic ossification (HO) after total hip replacement. , 1994, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[5]  U. Lindgren,et al.  Heterotopic bone after hip arthroplasty. Defining the patient at risk. , 1993, Clinical orthopaedics and related research.

[6]  C. DeFlitch,et al.  Postoperative hip irradiation in prevention of heterotopic ossification: causes of treatment failure. , 1993, Radiology.

[7]  W. Maloney,et al.  Prophylaxis for heterotopic bone formation after total hip arthroplasty using low-dose radiation in high-risk patients. , 1992, Clinical orthopaedics and related research.

[8]  P. Rubin,et al.  Prevention of heterotopic ossification with irradiation after total hip arthroplasty. Radiation therapy with a single dose of eight hundred centigray administered to a limited field. , 1992, The Journal of bone and joint surgery. American volume.

[9]  L. Dai,et al.  [Ectopic ossification following total hip replacement]. , 1992, Zhonghua wai ke za zhi [Chinese journal of surgery].

[10]  T. Gruen,et al.  Radiation therapy to prevent heterotopic ossification after cementless total hip arthroplasty. , 1991, Clinical orthopaedics and related research.

[11]  S. S. Kristensen,et al.  The use of indomethacin to prevent the formation of heterotopic bone after total hip replacement. A randomized, double-blind clinical trial. , 1988, The Journal of bone and joint surgery. American volume.

[12]  P. Kjaersgaard-Andersen,et al.  [Para-articular ossification after total hip replacement]. , 1987, Ugeskrift for laeger.

[13]  C. M. Evarts,et al.  The prevention of heterotopic ossification in high-risk patients by low-dose radiation therapy after total hip arthroplasty. , 1986, The Journal of bone and joint surgery. American volume.

[14]  M. Ritter,et al.  Prophylactic indomethacin for the prevention of heterotopic bone formation following total hip arthroplasty. , 1985, Clinical orthopaedics and related research.

[15]  B. Morrey,et al.  Comparison of Heterotopic Bone After Anterolateral, Transtrochanteric, and Posterior Approaches for Total Hip Arthroplasty , 1984, Clinical orthopaedics and related research.

[16]  M Owen,et al.  The origin of bone cells in the postnatal organism. , 1980, Arthritis and rheumatism.

[17]  J. Christoffersen,et al.  Para-articular ossification following hip replacement. 70 arthroplasties ad modum Moore using McFarland's approach. , 1977, Acta orthopaedica Scandinavica.

[18]  L. Riley,et al.  Ectopic ossification following total hip replacement. Incidence and a method of classification. , 1973, The Journal of bone and joint surgery. American volume.

[19]  J. Charnley,et al.  The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. , 1972, The Journal of bone and joint surgery. British volume.

[20]  Friedenstein Ay.  Induction of bone tissue by transitional epithelium. , 1968 .

[21]  A. Y. Friedenstein.  Induction of bone tissue by transitional epithelium. , 1968, Clinical orthopaedics and related research.