Low Heterotopic Ossification Recurrence Following Surgical Excision in a Total Hip Arthroplasty Population

Postoperative heterotopic ossification (HO) is a rare, but important complication following total hip arthroplasty (THA). Historically, surgical HO excision has been associated with a high incidence of complications and recurrence, and data are limited to guide treatment strategies. The purpose of this study was to assess functional and radiographic outcomes of HO excision with contemporary techniques following THA.

A retrospective case series was performed of patients who underwent HO excision following THA from 2011 to 2025. Study patients were identified through an electronic health records search for HO excision. Preoperative and postoperative clinical, functional, and radiographic outcomes were collected, including patient-reported Visual Analog Scale for Pain, range of motion, HO recurrence, all-cause revision, and complication rates. There were 45 patients who had Brooker grade III (n = 19, 42%) or IV (n = 26, 58%) HO following a primary THA identified and included. Postoperatively, 20 (44%) patients received both radiation (Seven Gy) on postoperative day one and prophylactic nonsteroidal anti-inflammatories for 10 to 14 days; 18 (40%) received radiation alone; and four (9%) received nonsteroidal anti-inflammatories alone.

There were four (9%) cases of radiographic HO recurrence, including just one case of recurrent bridging HO (Brooker grade IV) and a single reoperation for persistent HO. There was one case of periprosthetic joint infection, one case of instability, and no cases of nerve injury. The mean pain score, use of gait aids, and hip range of motion improved in all planes postoperatively (P < 0.001).

In a large series of 45 cases involving Brooker grade III or IV HO excision following THA, a low rate of clinically relevant HO recurrence was found, along with a low reoperation rate, and improved pain and function at final follow-up.