Total Hip Arthroplasty Complications in Sickle Cell Disease: Systematic Review and Meta-Analysis.

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Abstract

Conflict of interest statement: The authors declare no conflicts of interest. 19. BMC Musculoskelet Disord. 2025 Aug 8;26(1):768. doi: 10.1186/s12891-025-09045-5. Periprosthetic joint infection and heterotopic ossification after total hip arthroplasty: systematic review and meta-analysis. Pulik Ł(#)(1), Łęgosz P(#)(2), Brzóska E(3), Mierzejewski B(3), Grabowska I(3), Ciemerych MA(3), Hube R(4). Author information: (1)Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 St, 02-005, Warsaw, Poland. Lukasz.pulik@wum.edu.pl. (2)Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 St, 02-005, Warsaw, Poland. (3)Department of Cytology, Faculty of Biology, University of Warsaw, Miecznikowa 1 St, 02-096, Warsaw, Poland. (4)OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany. (#)Contributed equally This meta-analysis addresses the relationship between infection developing after total hip arthroplasty (THA) and heterotopic ossification (HO). To critically assess the limitations of existing literature we screened for full-length peer-reviewed research articles listed in PubMed, Embase, and Web of Science over the past 20 years (2004-2024). The following search terms and Boolean operators were used: heterotopic ossification AND infection AND (hip replacement OR hip arthroplasty). A total of 14 articles were identified that describe periprosthetic joint infection (PJI) and HO after THA. Data summarized from 6 studies suitable for further meta-analysis yielded a cumulative sample size of 753 observations, with 186 recorded events of HO. The pooled RR was estimated at 2.22 (95% CI: 1.00 to 4.91, p = 0.0497), suggesting a more than twofold risk of HO compared to the group without PJI. Basic research findings support the hypothesis that bacterial pathogen-associated molecular patterns (PAMPs) can lead to osteogenesis through a toll-like receptor (TLR) and nuclear factor kappa B (NF-κB) pathway. Together, these results suggest that during revisions following THA for presumed non-septic reasons, the presence of HO warrants consideration for infection, as there is a potential heightened risk of pathologic ossification induced by PAMPs. © 2025. The Author(s). DOI: 10.1186/s12891-025-09045-5 PMCID: PMC12333120