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Heterotopic Ossification


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


  • Unknown

  • ? due to intraoperative muscle ischaemia and post op trauma

  • ? due to increased bone debris in cementless hip replacement


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


Islands of bone within soft tissues


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


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




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


  • Usually painless

  • Can cause stiffness

  • Does not cause limp or loss of strength


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


  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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Bone Tumours
Bone Metastases
Bone Tumours - Diagnosis
Heterotopic Ossification
Notochordal Remnant Tumours
Soft Tissue Tumours
Tumour Like Conditions
Tumour Principles
Tumours of Unknown Origin
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