Incidence and risk factors for heterotopic ossification following periprosthetic joint infection of the hip

  • Thomas RosteiusEmail author
  • Valentin Rausch
  • Simon Pätzholz
  • Sebastian Lotzien
  • Hinnerk Baecker
  • Thomas Armin Schildhauer
  • Jan Geßmann
Hip Arthroplasty



Heterotopic ossifications (HOs) commonly occur following total hip arthroplasty. Data regarding the appearance of HO after periprosthetic joint infection (PJI) of the hip are rare. Therefore, the aim of this study was to analyze the incidence and potential risk factors for the development of HO in patients with PJI of the hip.

Materials and methods

We performed a single-center, retrospective study including patients treated with a two- or multistage operation and patients undergoing salvage procedure in cases of PJI of the hip with a minimum follow-up of 6 months. A total of 150 patients were included in the analysis. The Brooker-scale was used to classify HO. Patients were divided in three groups: (1) No HO, (2) HO Brooker type 1–4, and (3) high-grade HO (HO Brooker type 3 and 4). In each group, we checked possible risk factors for the development of HO for statistical significance.


Patients included in our study had a mean age of 70.4 ± 12.1 years. Of all patients, 75 were women (50%). HOs could be found in 70 patients (46.7%). Twenty-seven patients showed HO Brooker type 1, 23 type 2, 15 type 3 and 5 type 4. Male gender [odds ratio (OR) 2.14; p = 0.022], smoking (OR 5.75; p = 0.025) were significant risk factors for HO. A chronic infection (OR 3.54; p = 0.029) and a higher number of procedures (p = 0.009) were significant risk factors for the development of high-grade HO.


HOs often occur following surgical care of PJI. Male gender, smoking, a chronic infection and high number of operations are risk factors for developing HO after PJI.


Heterotopic ossification Periprosthetic joint infection Risk factors Total hip arthroplasty Revision hip arthroplasty 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

All authors confirm that there is no conflict of interest.

Ethical statement

There is a positive statement of the Institutional Review Board for this work (Registered number 4669-13).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General and Trauma SurgeryBG University Hospital BergmannsheilBochumGermany
  2. 2.Department of Radiological Diagnostics, Interventional Radiology and Nuclear MedicineBG University Hospital BergmannsheilBochumGermany

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