Heteroptopic ossification.

[John C]

It does not appear to be a big problem, but I recently confirmed that I have some very minor hetertropic ossification, or in plain english, some small bits of bone formed where it is not supposed to; in my case a couple of pea size pieces in the muscle near the joint. I had noticed that these spots were becoming more clear in each subsequent x-ray since the surgery, so I asked the doctor what they were, and he replied heterotopic bone formations.
He had never brought it up when discussing the x-rays, and I think the reason for this is that they are very small, not causing problems, and there is no real treatment, other than going in surgically to remove the bone growth, which often is not successful. So, no point in bringing it up.
Again, these spots of bone in the soft tissue are very small, and appear to be stable, so I am not taking it as any big deal. The main reason I am mentioning it is because I may have brought it on myself, and want to explain why so that others may not make the same mistake.
From what I have read, heterotopic bone formation is not uncommon, and some say that it occurs in 30% to 50% of hip replacements, though I did not find any specific numbers for resurfacing. One of the standard treatment options to avoid the problem is to prescribe an NSAID like Celebrex for a few weeks after surgery, during the time that it is most likely to start. My doc did this, and I started taking it right after surgery. A week or so later, I was chatting with another surgeon who is a trusted friend and does a fair amount of joint replacements, though he does not do resurfacings. He said he was concerned that the Celebrex might affect the bone ingrowth, which is a common concern. Here is where I made the mistake of assuming that my surgeon had prescribed the Celebrex just for comfort and inflammation, and so I decided to stop taking it. There is no way of knowing whether I would still have the small spots of bone in the soft tissue if I had continued the Celebrex as prescribed, but in retrospect, it looks like it would have been smarter to have listened to my surgeons directions, and not get sidetracked.
From posts on this site, I know that many other patients were unaware of why their surgeon prescribed Celebrex after surgery, so hopefully my late lesson will be of use to others.

[Spanielsal]

Hi John

Thanks for sharing that. Is it uncomfortable?

[hernanu]

I had aspirin prescribed to me for several reasons, but my surgeon did mention that preventing problems with ossification was one. I took it for about 6 weeks, with decreasing amounts. Sorry you've got this, but glad it's not affecting you - how are you feeling?

[John C]

Thanks for asking, but I do not feel that it is a problem at all at this point. I do not feel any discomfort 99% of the time, and most of what I have felt in the past has been short bouts of bursitis. There are rare times, like doing one legged squats with weights, that I feel minor twinges in the area of the bone formation, but I have always thought that it has to do more with where things were cut; thought I cannot be sure. Having said all that, hetertopic bone formation can be painful, so I am lucky that mine is so small that I cannot feel it.

[lyn]

I'm 7 days post op from surgery with Dr. Gross and in his discharge notes he stated with me to take 2 celebrex for pain and to prevent heterotopic bone formation. I was glad he expaneded  on that.  Lyn

[Tin Soldier]

Sorry I'm late on this topic.  Hern - I was prescribed aspirin also and no celebrex.  I wonder if there is much of a difference with the two regarding Hetero Oss.  I suspect Celebrex is more focused on the type of tissue that it addresses?   

John - how close to the bone are the Oss's?  and are they just outside of the bone that was ground? like near the shoulder of the cap, or around the outside of the cup?  I don't know anything about it.  Sorry to hear about it though, it's good that it doesn't appear to be too problematic.

[hernanu]

Sorry I'm late on this topic.  Hern - I was prescribed aspirin also and no celebrex.  I wonder if there is much of a difference with the two regarding Hetero Oss.  I suspect Celebrex is more focused on the type of tissue that it addresses?   

John - how close to the bone are the Oss's?  and are they just outside of the bone that was ground? like near the shoulder of the cap, or around the outside of the cup?  I don't know anything about it.  Sorry to hear about it though, it's good that it doesn't appear to be too problematic.

There's all sorts of information on this, but both aspirin and celebrex seem to have a positive effect on prevention of HO. The only thing needed to consider is that some researchers think it may have a deleterious effect on forming the bond between the prosthesis and the bone. I think if administered correctly, it appears to help stop HO formation.

Here's a couple of links:

From the US National Institute of Health: http://www.ncbi.nlm.nih.gov/pubmed/21409458

From the Journal of Orthopaedic Surgery and Research: http://www.josr-online.com/content/4/1/12

[John C]

Hi Tin,
In my case, it looks like a couple of pea size pieces of bone floating a couple of mm's above where the neck meets the greater trochanter, so it is not that close to the prostheses or the area that was ground down; probably at least 2 cm away from the closest part of the cap. From pictures that I have seen of what can happen, I would say that my little pea size pieces are pretty irrelevant, but it did prompt me to remind others to follow the surgeons orders exactly, like I should have.

[Nemesis]

I had H / O to the 10th power from a hip scope.  Caused horrible pain and lost all movement in my leg and this caused my resurfacing. Dr Sumwent in and removed most if not all of the H/O and did the resurfacing. I then went thru radiation treatment and an NSAID that I developed a horrible allergy to. 2 weeks of crazy discomfort as I was terrified of developing H/O if I stopped the medication. 

There is light at the end of the tunnel. I have full function of my hip and can even leg press, jog, and do over 200 flights of stairs.

[hernanu]

That sounds great, Nemesis... although why you'd want to do those stairs when there are perfectly good elevators around is beyond me... 

How's the workouts with the youngster?

[Nemesis]

He is doing great. He may have a starting position at varsity wresting at a powerhouse school.  They are making a big push for state champs.

Me while my HR hip can do the grappling my other one will start to hurt. I made the hard decision to stop the grappling.  I can do everything but that and to be honest I am always in better shape when I don't grapple.  When i am not grappling I pay more attention to cardio from the standpoint of burning fat, my muscles are fuller and I feel stronger.  I still take my son to everything and coach him even when he is practicing.

[hernanu]

Good stuff!!!  A lot of my friends in the TKD school were originally wrestlers. Sounds like you're doing really well.

[Jason0411]

A friend of mine who has had both hips done with thrs had terrible problems with HO after his first THR before the second one they zapped him with radiation. Now the first one is so painful they are going to redo him and this time sort out what they missed in the first place.