Sixty-two hips in fifty-five patients who were considered to be at risk
for postoperative heterotopic ossification were randomly divided into two
groups: one received a single 800-centigray dose of limited-field radiation
and the other, 1000 centigray of limited-field radiation in divided doses.
The risk for heterotopic-bone formation was identified on the basis of
previously described criteria, which included previous heterotopic
ossification after an operation about the hip, hypertrophic osteoarthritis
or post-traumatic osteoarthrosis characterized by formation of extensive
osteophytes, radiographic evidence of diffuse idiopathic skeletal
hyperostosis, ankylosing spondylitis, and male sex. The treatment portals
excluded prosthetic surfaces that were intended for biological fixation by
ingrowth of bone. At a minimum six-month follow-up, progression of
heterotopic ossification had occurred in seven (21 per cent) of thirty-four
hips in the first group and in six (21 per cent) of twenty-eight hips in
the second group. The ossification had advanced more than one grade in only
one hip. Extra-field ossification occurred in fifteen (43 per cent) of
thirty-five hips that had not had previous heterotopic ossification. Since
the time of the study, the treatment portal has been modified to include
the lateral aspect of the greater trochanter, so that the risk of bursitis
associated with ossification in this area is minimized. Single-dose
limited-field radiation is effective for the prevention of heterotopic
ossification, without compromise of early fixation of an uncemented
implant.