Background Heterotopic Ossification (HO) is one of the most common complications after Total Hip Arthroplasty (THA). Its incidence is between 15–90%. Immune cell infiltration and inflammatory response initiates HO. Surgical approach, closure techniques, soft tissue handling also play an important role. Tranexamic Acid (TxA) has anti-fibrinolytic and anti-inflammatory response. It reduces the levels of CRP, IL-6, TNF-α, reactive oxygen species and MMP-9. There is evidence 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. Aim To identify whether local infiltration of TxA and different closure techniques can reduce the incidence of heterotopic ossification after primary THA. Methods This is a retrospective analysis of 235 patients who had THA. They were evaluated based of indication for surgery, approach, implant used, closure technique, intraoperative fracture, preoperative/postoperative/1 year follow up X rays. Results A total of 195 patients were included in the study. Out of these, 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. Conclusion 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.
Singh et al. (2025) studied this question.