Myositis ossificans after total hip replacement and perioperative muscle ischemia

It has been suggested that muscle ischemia could contribute to myositis ossificans and that the ischemia could result from prolonged retraction during surgery. Biopsy specimens of the gluteus medius muscle were taken at the beginning and the end of 30 primary total hip arthroplasties and the intracellular lactate and phosphocreatine (PCr) measured. Postoperative myositis ossificans was classified according to Brooker after 1 year, and the surface of the heterotopic bone projected above the greater trochanter in an anteroposterior roentgenogram was measured by planimetry. The findings suggest that muscle ischemia is not an important cause of myositis ossificans after hip arthroplasty, but elevated levels of lactate and lowered levels of intracellular PCr may occur as nonspecific responses to tissue trauma that through other mechanisms may lead to ossification.