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Heterotopic Ossification

Incidence

Variable in reports from 3% to 50%

Only 2-7% have significant symptoms

More common in

  1. Men

  2. Ankylosing spondilitis

  3. Forestier disease

  4. Previously fused hip

  5. Hypertrophic osteoarthritis

  6. Postraumatic arthritis

  7. Previous heterotopic ossification on other side

Causes

  • Unknown

  • ? due to intraoperative muscle ischaemia and post op trauma

  • ? due to increased bone debris in cementless hip replacement

Xray

Calcification of soft tissues beginning as early as 2nd or 3rd week post op and maturing fully by 12 months

Brooker classification

 

Appearance on Xray

1

Islands of bone within soft tissues

11

Bone spurs from femur or pelvis with at least 1cm gap between opposing surfaces

111

Bone spurs from prox femur/ pelvis < 1cm between opposing surfaces

1V

Ankylosis

Histologically

  • Zonal pattern with mature bone peripherally and immature tissue at the centre (same as myositis ossificans)

Clinically

  • Usually painless

  • Can cause stiffness

  • Does not cause limp or loss of strength

Treatment

  • Surgery not usually advocated as can be difficult and cause bleeding, recurrence common

Prevention

  1. Low dose radiation

    • 800-1000 cGy immediately post op

  2. Indomethacin

    • 75 mg / day for 2-6 weeks

  Both can cause lack of porous ingrowth of ingrowth in uncemented components, but the component can be shielded with lead




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