Preoperative arterial and venous embolization of heterotopic ossification of the hip: a case-control study

Heterotopic ossification (HO) is an abnormal bone mass in soft tissue, often complicating spinal cord or brain injuries with paralysis. When ossification limits joint amplitudes and becomes symptomatic, surgical excision may be necessary, although it carries a high risk of hemorrhage. This study evaluates the role of preoperative arterial embolization on peri-operative bleeding.

A retrospective case-control study was conducted on patients undergoing hip HO resection between September 2019 and April 2024. Only anteromedial or circumferential HO were included. Data on blood loss, transfusion requirements, duration of surgery, and length of hospital stay were analyzed. Embolization was performed with microspheres 500-700 μm and/or coils. Statistical significance was determined using the Mann-Whitney U test (P < 0.05).

A total of 18 resections of HO and 9 preoperative embolizations were performed. Embolization was technically successful in all cases, with an average of 1.2 embolized arteries per patient. Venous embolization was performed in three specific cases. The mean surgical time was 127 min. The estimated mean blood loss was 1.789 mL, with no significant reduction with embolization (P = 0.25). However, embolized patients had a significantly shorter hospital stay (6.2 vs. 8 days, P = 0.03). One complication (arterial thrombosis downstream of the puncture site) was reported and successfully treated.

Preoperative embolization may improve recovery by shortening hospital stay; however, its impact on surgical bleeding remains unclear. Further studies are needed to refine embolization strategies and evaluate long-term outcomes, including recurrence rates.

Preoperative embolization is a promising adjunct to complex HO hip resections, with a favorable safety profile that justifies its consideration in multidisciplinary surgical planning.