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Heterotopic Ossification in Cementless Trochanteric Sparing Short Stem Total Hip
Arthroplasty: Clinical Impact and Implant-Level Risk Assessment
#MMPMID41262430
Soltani Farsani A
; Tabatabaei Irani P
; Razzaghof M
; Poursalehian M
; Mortazavi SMJ
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41262430
show ga
BACKGROUND: Heterotopic ossification (HO) is a common complication of total hip
arthroplasty (THA), which can adversely affect patient satisfaction. Although the
direct anterior approach (DAA) has been associated with lower rates of HO, the
exact clinical impact of even low-grade ossification following DAA THA remains
underreported. We aimed to assess the clinical impact of HO in DAA THA and
identify demographics and implant-related risk factors. METHODS: A retrospective
single-center cohort study of 348 hips treated via DAA THA with a cementless
short stem between January 2011 and December 2021 was performed. HO was graded at
?12 months using the Brooker classification on standardized anteroposterior
radiographs. The Harris Hip Score (HHS), the Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC), and the Visual Analogue Scale (VAS)
were assessed at a mean of 4.3 years of follow-up. Comparative analyses and
multivariable logistic regression were performed to identify independent
predictors of HO. RESULTS: HO occurred in 18.1% of hips: Brooker grade I in
12.4%, II in 3.0%, and III in 3.0%; no grade IV lesions developed. At final
follow-up, patients without HO had significantly better outcomes compared with
those with HO (all p < 0.001). When stratified by severity, even low-grade HO
(Brooker I-II) was associated with significantly worse WOMAC (p = 0.023) and HHS
(p < 0.001) compared with the non-HO group. Although VAS pain was higher in the
low-grade group, the difference did not reach statistical significance (p =
0.084). On multivariable analysis, independent implant-related risk factors
included use of the Continuum acetabular cup (odds ratio [OR] 2.10; p = 0.014),
each additional millimeter of cup diameter (OR 1.16; p = 0.003), and longer
femoral neck length (OR 2.06; p = 0.006). CONCLUSIONS: HO was observed in nearly
one-fifth of hips, and even low-grade ossification was associated with
significantly worse mid-term functional outcomes. Cup design, size, and neck
length were identified as significant, modifiable predictors of HO risk. Careful
implant selection may help reduce the incidence of HO and enhance postoperative
function. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors
for a complete description of levels of evidence.
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