ECTOPIC OSSIFICATION FOLLOWING TOTAL HIP ARTHROPLASTY: IS DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS A RISK FACTOR?

Abstract

Total hip a≪hroplasty may be followed by ectopic bone formation. An increased frequency has been suspected in patients with diffuse idiopathic skeletal hypcrostosis (DISH). In 204 patients we found that, of the 38 subjects with pre-existing DISH, 29% developed postoperative ossification compared with only 10% in those without DISH (p ≪; 0.01). DISH is therefore a risk factor for postoperative ectopic bone formation. In a separate study of 1325 patients (not analysed for spinal DISH), we looked for correlations between the severity of postoperative ectopic bone and clinical measurements. Even for the more severe ossification grades (n = 112), only 10% reported serious pain and only 26% had reduced hip flexion (≪70°). Thus, periprosthetic ectopic bone is not sufficiently important to justify the routine use of preventative drugs such as bisphosphonates in patients with DISH undergoing total hip replacement.