Surgical Resection Combined with Adjuvant Radiotherapy and Non-Steroidal Anti-Inflammatory Drugs in the Treatment of Heterotopic Ossification Following Total Hip Arthroplasty
Keywords:Anti-Inflammatory Agents, Non-Steroidal, Arthroplasty, Replacement, Hip, Ossification, Heterotopic/drug therapy, Heterotopic/radiotherapy
AbstractHeterotopic ossification (HO) is a well-known complication following total hip arthroplasty (THA), with an average incidence of 30%. Patients are classified according to Brooker’s staging system. In advanced stages (III and IV), HO may limit hip motion and cause intolerable pain. For these symptomatic stages, surgical excision is mandatory, usually combined with prophylaxis of recurrence with non-steroidal anti-inflammatory drugs (NSAIDs) and/or radiotherapy. We present the case of a 70-year-old woman who developed Stage IV HO after undergoing THA for left hip osteoarthritis. Surgical excision of the HO was performed eighteen months after THA, with adjuvant radiotherapy and indomethacin. After two years of follow-up, the patient had a good hip function with no recurrence of HO. Several authors have studied the effect of NSAIDs and radiotherapy in HO prophylaxis and in HO treatment but there is lack of reports concerning the combination of the two strategies with surgery in the postoperative period. We therefore report this successful case of post-THA HO treatment with surgical excision and post-operative radiotherapy and NSAIDs.
Zhu Y, Zhang F, Chen W, Zhang Q, Liu S, Zhang Y. Incidence and risk factors for heterotopic ossification after total hip arthroplasty: a metaanalysis. Arch Orthop Trauma Surg. 2015;135:1307-14.
Neal B, Gray H, MacMahon S, Dunn L. Incidence of heterotopic bone formation after major hip surgery. ANZ J Surg. 2002;72:808-21.
Łȩgosz P, Otworowski M, Sibilska A, Starszak K, Kotrych D, Kwapisz A, et al. Heterotopic ossification: a challenging complication of total hip arthroplasty: risk factors, diagnosis, prophylaxis, and treatment. BioMed Res Int. 2019:2019:3860142.
Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement; incidence and a method of classification; J Bone Joint Surg Am. 1973;55:1629-32.
Macheras GA, Lepetsos P, Leonidou A, Anastasopoulos PP, Galanakos SP, Tsiridis E. Results from the surgical resection of severe heterotopic ossification of the hip: a case series of 26 patients. Eur J Orthop Surg Traumatol. 2017;27:1097-102.
Chao ST, Lee SY, Borden LS, Joyce MJ, Krebs VE, Suh JH. External beam radiation helps prevent heterotopic bone formation in patients with a history of heterotopic ossification. J Arthroplasty. 2006;21:731-6.
Shapira J, Yelton MJ, Chen JW, Rosinsky PJ, Maldonado DR, Meghpara M, et al. Efficacy of NSAIDs versus radiotherapy for heterotopic ossification prophylaxis following total hip arthroplasty in high-risk patients: a systematic review and meta-analysis. Hip Int. 2021 (in press). doi: 10.1177/1120700021991115.
Schaeffer MA, Sosner J. Heterotopic ossification: treatment of established bone with radiation therapy. Arch Phys Med Rehabil. 1995;76:284-6.
Joice M, Vasileiadis GI, Amanatullah DF. Non-steroidal anti-inflammatory drugs for heterotopic ossification prophylaxis after total hip arthroplasty. Bone Joint J. 2018;100B:915-22.
Kjærsgaard-Andersen P, Nafei A, Teichert G, Kristensen O, Schmidt SA, Keller J, et al. Indomethacin for prevention of heterotopic ossification: a randomized controlled study in 41 hip arthroplasties. Acta Orthop. 1993;64:639-42.
Pakos EE, Stafilas KS, Tsekeris PG, Politis AN, Mitsionis G, Xenakis TA. Combined radiotherapy and indomethacin for the prevention of heterotopic ossification after total hip arthroplasty. Strahlenther Onkol. 2009;185:500-5.
How to Cite
Copyright (c) 2023 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.