Identification of Risk Factors in the Development of Heterotopic Ossification After Primary Total Hip Arthroplasty

Sukhmani Singh; Saam Morshed; Daria Motamedi; Joseph Kidane; Alexandra Paul; Edward C Hsiao; Kelly L Wentworth

doi:10.1210/clinem/dgac249

Identification of Risk Factors in the Development of Heterotopic Ossification After Primary Total Hip Arthroplasty

J Clin Endocrinol Metab. 2022 Aug 18;107(9):e3944-e3952. doi: 10.1210/clinem/dgac249.

Authors

Sukhmani Singh¹, Saam Morshed², Daria Motamedi³, Joseph Kidane⁴, Alexandra Paul⁵, Edward C Hsiao^{1

6}, Kelly L Wentworth^{1

7}

Affiliations

¹ Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
² Departments of Orthopedic Surgery, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
³ Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
⁴ Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁵ Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
⁶ The Institute for Human Genetics, The Program in Craniofacial Biology, and the Robert L. Kroc Chair in Rheumatic and Connective Tissue Diseases III, University of California-San Francisco, San Francisco, CA, USA.
⁷ Division of Endocrinology and Metabolism, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA,USA.

Abstract

Purpose: Heterotopic ossification (HO) is a process by which bone forms abnormally in soft tissues. Known risk factors for developing HO include male sex, spinal cord injury, trauma, and surgery. We investigated additional risk factors in the development of HO after hip arthroplasty.

Methods: We performed a retrospective review of electronic medical records of 4070 individuals who underwent hip arthroplasty from September 2010 to October 2019 at the University of California, San Francisco Hospital. Demographics, anthropometrics, medications, and comorbid conditions were used in logistic regression analysis to identify factors associated with the development of HO.

Results: A total of 2541 patients underwent primary hip arthroplasty in the analyzed timeframe (46.04% men, mean age at procedure: 62.13 ± 13.29 years). The incidence of postsurgical HO was 3% (n = 80). A larger proportion of individuals who developed HO had underlying osteoporosis (P < 0.001), vitamin D deficiency (P < 0.001), spine disease (P < 0.001), type 1 or 2 diabetes (P < 0.001), amenorrhea (P = 0.037), postmenopausal status (P < 0.001), parathyroid disorders (P = 0.011), and history of pathologic fracture (P = 0.005). Significant predictors for HO development were Black/African American race [odds ratio (OR) 2.97, P = 0.005], preexisting osteoporosis (OR 2.72, P = 0.001), spine disease (OR 2.04, P = 0.036), and low estrogen states (OR 1.99, P = 0.025). In the overall group, 75.64% received perioperative nonsteroidal anti-inflammatory drugs (NSAIDs), which negatively correlated with HO formation (OR 0.39, P = 0.001).

Conclusions: We identified new factors potentially associated with an increased risk of developing HO after primary hip arthroplasty, including African American race, osteoporosis, and low estrogen states. These patients may benefit from HO prophylaxis, such as perioperative NSAIDs.

Keywords: heterotopic ossification; hip arthroplasty; hip surgery; prophylaxis.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Anti-Inflammatory Agents, Non-Steroidal / adverse effects
Arthroplasty, Replacement, Hip* / adverse effects
Estrogens
Female
Humans
Male
Ossification, Heterotopic* / epidemiology
Ossification, Heterotopic* / etiology
Osteoporosis* / complications
Osteoporosis* / etiology
Risk Factors

Substances

Anti-Inflammatory Agents, Non-Steroidal
Estrogens

Abstract

Publication types

MeSH terms

Substances

Grants and funding