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Updated: Jun 13, 2025

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The Unrecognized Orthopedic Burden of COVID-19: Heterotopic Ossification of the Hip Joint

J Jelsma, J R W Crutsen, R Y Jessurun

    Acta Orthopaedica Belgica
    |January 27, 2025
    PubMed

    Insights

    Long intensive care unit (ICU) stays for COVID-19 patients can lead to heterotopic ossifications (HO). This case report highlights hip joint HO in two patients post-COVID-19, emphasizing the need for preventative orthopedic strategies.

    Area of Science:

    • Orthopedic Surgery
    • Infectious Diseases
    • Critical Care Medicine

    Background:

    • COVID-19 significantly impacts healthcare systems and patient outcomes.
    • Long-term intensive care unit (ICU) admission, particularly with mechanical ventilation and prone positioning, is linked to heterotopic ossifications (HO).
    • Heterotopic ossifications (HO) present a less recognized but significant complication in severe COVID-19 cases.

    Purpose of the Study:

    • To highlight the orthopedic burden of COVID-19, specifically focusing on heterotopic ossifications (HO).
    • To present two cases of major hip joint HO following COVID-19 infection.
    • To underscore the unrecognized complications of the pandemic from an orthopedic perspective.

    Main Methods:

    • Case report detailing two patients with hip joint HO after COVID-19.
    • Review of current literature on HO prevalence in COVID-19 patients.
    • Analysis of potential preventative and treatment strategies for HO.

    Main Results:

    • Two patients developed significant hip joint heterotopic ossifications (HO) after severe COVID-19 requiring prolonged ICU care.
    • Literature indicates a higher prevalence of HO in COVID-19 patients needing mechanical ventilation and prone positioning.
    • Effective prevention and standardized treatment for HO remain challenging.

    Conclusions:

    • COVID-19 patients requiring extended ICU care are at risk for heterotopic ossifications (HO).
    • Early passive mobilization, even during prone positioning, serum ALP monitoring, NSAID use, and timely radiotherapy are advised.
    • Orthopedic surgeons must be aware of this complication to improve patient management and outcomes.

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