Surgical Resection Combined with Adjuvant Radiotherapy and Non-Steroidal Anti-Inflammatory Drugs in the Treatment of Heterotopic Ossification Following Total Hip Arthroplasty

Abstract

Heterotopic 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.