HETEROTOPIC OSSIFICATION AFTER TOTAL HIP ARTHROPLASTY: EFFECT OF PERICAPSULAR TRANEXAMIC ACID AND DIFFERENT CLOSURE TECHNIQUES

Heterotopic Ossification (HO) is one of the commonest complications after Total Hip Arthroplasty (THA) with incidence ranges from 15–90%. Surgical approach, closure techniques, soft tissue handling play an important role in development of HO. Immune cell infiltration and inflammatory response are the initiating factors for HO. Some studies have shown that Tranexamic Acid (TxA) apart from its anti-fibrinolytic properties, it also has an anti-inflammatory response. It reduces the levels of CRP, IL-6, TNF-α, reactive oxygen species and MMP-9. Another study showed that TXA reduces the recurrence of HO after excision in elbow injury. There are currently no studies demonstrating effect of local TXA on HO after THA. This is a retrospective observational study where patients undergoing elective primary THA were selected and divided into different groups depending on approach, capsular closure, abductor closure technique and whether they received TXA capsular infiltration during the time of closure. Their immediate post op and 1 year follow up X rays were then evaluated based on Brooker's classification for evidence of HO. A total of 195 patients who had THA were evaluated and included in the study. A total of 175 were performed using modified Hardinge approach. There was a statistically significant reduction in HO when the patients received peri capsular infiltration of TxA during closure (p<0.05). Closure of capsule and abductors as a single layer significantly reduced HO as opposed to multi layered closure (p<0.05). Posterior approach had remarkably lower HO post-surgery. There was no significant difference between cemented and uncemented implants. Local infiltration of TXA significantly reduces incidence of HO after THA. However, there is a need of further prospective studies with a larger patient population to support these findings.