JOA - 2026-04-03 - Journal Article
Risk Factors for the Development of Heterotopic Ossification After Conversion Total Hip Arthroplasty.
Riley JW, Aparicio HA, Clark CJ, Goodman JT, House M, Montgomery SJ
Topics
Key Takeaway
Prior heterotopic ossification after index fixation confers a 3x increased risk of HO after conversion THA, with an overall HO incidence of 33.3% in this cohort.
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Summary
This study examined risk factors for HO development after conversion THA from prior ORIF of acetabular fractures or IM nailing of hip fractures in 75 hips at a single center. HO developed in 25 hips (33.3%); prior HO at the operative hip (present in 56% of those who developed HO post-conversion) conferred a statistically significant 3x increased risk. Prolonged operative time and African American race were also independent risk factors; prophylaxis after the index procedure did not reduce HO risk at conversion.
Key Limitation
The absence of reported follow-up duration and lack of standardized prophylaxis protocol across the cohort prevent determination of whether HO incidence or severity differed based on time from index procedure to conversion or prophylaxis agent used.
Original Abstract
INTRODUCTION
Heterotopic ossification is an extensively studied complication of primary total hip arthroplasty (THA); however, there remains a paucity of research as to its incidence with conversion to THA from prior internal fixation of acetabular or hip fractures.
METHODS
The authors conducted a single-center retrospective chart review of patients who underwent conversion to total hip arthroplasty following open reduction internal fixation of acetabular fractures or intramedullary nailing of hip fractures, focusing on analysis of demographics, comorbidities, surgical details, prophylaxis methods, and radiographic Brooker classification.
RESULTS
Among 75 hips, 25 (33.3%) developed progressive heterotopic ossification following conversion surgery. Of these 25 hips, 14 (56.0%) had prior heterotopic ossification following initial surgery, showing a statistically significant three-times increased risk of developing heterotopic ossification in patients who had prior ectopic bone about the operative hip compared to those who did not. Longer operative times at conversion surgery and African American race also led to a significantly increased risk for heterotopic ossification. There was no significant association observed between prophylaxis following initial surgery and the development of heterotopic ossification following conversion.
CONCLUSION
Our results demonstrated a significantly higher risk of heterotopic ossification following conversion to THA in patients who had prior postoperative heterotopic ossification in the operative hip compared to those who did not, prolonged operative times, and African American race. Prophylaxis after initial surgery had no effect on heterotopic ossification development following subsequent conversion to THA. This study highlights the need for further research on heterotopic ossification following conversion total hip arthroplasty and consideration of prophylactic heterotopic ossification treatment in high-risk patients.