Heterotopic Ossification Following Total Hip Arthroplasty: A Contemporary Approach-Based Review for Surgeons Utilizing the Direct Anterior Approach.

BACKGROUND: The direct anterior approach (DAA) has become the most frequently utilized surgical approach for total hip arthroplasty (THA) in the United States. There is a growing need to clarify the differential risk of complications associated with the DAA compared to other surgical approaches. Heterotopic ossification (HO) is a well-recognized complication following THA that may result in pain and stiffness. Despite its clinical relevance, the risk of HO in DAA patients remains poorly described. In this review, we provide a comprehensive overview of HO following THA, with a particular focus on the DAA. METHODS: A comprehensive literature search of the PubMed/Medline database was performed using search terms "total hip arthroplasty," "heterotopic ossification," and "approach." Article titles and abstracts were reviewed to determine relevance. Randomized controlled trials, systematic reviews, meta-analyses, comparative studies, and case series were included. Articles not published in the English language were excluded. RESULTS: HO results from trauma-induced differentiation of osteoprogenitor cells in soft tissue surrounding the hip joint. Surgical approach is a determinant of HO risk after THA, with the DAA producing the lowest incidence of HO. Other risk factors for the development of HO have been identified, including male gender and advanced age. Prophylaxis against HO includes perioperative nonsteroidal anti-inflammatory drugs, tranexamic acid, and local radiation therapy, while management involves surgical resection of ectopic bone in symptomatic patients. CONCLUSIONS: This review synthesizes data from recent systematic reviews and case series to provide arthroplasty surgeons with an understanding of postoperative HO risk, stratified by surgical approach.