1142 - Adjunctive Strategies to Optimize Outcomes After Total Hip Arthroplasty in Spinal Cord Injury: A Case Report

Spinal cord injury with heterotrophic ossification to left hip requiring total hip arthroplasty

Case Description: 29-year-old male with C8 AIS B spinal cord injury (SCI) developed heterotopic ossification (HO) of the left hip and underwent capsulectomy with HO resection. Two years later, he presented with recurrent left hip HO and right hip subluxation that prevented him from sitting in his wheelchair despite meloxicam and alendronate. Bilateral total hip arthroplasty (THA) with debridement was recommended with inpatient rehabilitation after each procedure.

Following left THA, HO prophylaxis included weekly alendronate for one month and daily meloxicam. Alongside standard therapy, a continuous passive motion (CPM) device was used, resulting in improved left hip range of motion (ROM) by discharge.

One month later, he underwent right THA. This course was complicated by anemia requiring transfusion; alendronate was continued but meloxicam withheld due to bleeding risk while CPM was still utilized. By discharge, ROM improved bilaterally and he was able to sit comfortably in his wheelchair at follow-up.

Discussions: CPM use was associated with improved ROM in both hips in our case. This rarely reported finding highlights CPM as a possible adjunct to standard rehabilitation in SCI patients with THA. Bisphosphonate therapy has shown mixed efficacy for HO prevention but may help maintain periprosthetic bone density and reduce aseptic loosening after THA.

Conclusions: This case demonstrates multifaceted management of HO and hip degeneration in SCI requiring THA and emphasizes CPM and bisphosphonate therapy as adjunctive strategies to enhance ROM and limit HO formation. Larger prospective studies are needed to define their roles in this population.