A small percentage of affected individuals are at risk for development of sarcomas as a result of malignant transformation.

For example, genu valgum (knock knees), ankle valgus, ulnar bowing and shortening, and radial head subluxation are encountered.

Such manifestations usually result from disruption of physeal growth especially that osteochondromas typically arise at the metaphyseal ends of long bones in close proximity to the physis.

[1][5] Intra-articular osteochondromas of the hip can induce limitation of range of motion, joint pain and acetabular dysplasia.

As Cueller et al. note: "[E]ncoding glycosyltransferases involved in the biosynthesis of ubiquitously expressed heparan sulphate (HS) chains, are associated with MHE.

It is thought that normal chondrocyte proliferation and differentiation may be affected, leading to abnormal bone growth.

[15] For individuals with HME who are considering starting a family, preimplantation genetic testing and prenatal diagnosis are available to determine if their unborn child has inherited the disease.

Indeed, other work has shown that boys/men tend to have worse disease than females, as well as that the number of exostoses in affected members of the same family can vary greatly.

Most common locations are:[19] HME can lead to the shortening and bowing of bones; affected individuals often have a short stature.

Depending on their location the exostoses can cause problems including: pain or numbness from nerve compression, vascular compromise, inequality of limb length, irritation of tendon and muscle, Madelung's deformity[20] as well as a limited range of motion at the joints upon which they encroach.

A person with HME has an increased risk of developing a rare form of bone cancer called chondrosarcoma as an adult.

[1][3] The success of surgery is not well-correlated with specific patient or disease characteristics, making it challenging to predict who will benefit most from intervention.

The construction of well-designed prospective studies that can provide a more clear relationship between surgical procedures, patient characteristics and outcomes is on high demand.

Total hip arthroplasty in individuals with HMO is challenging because of distortion of anatomy and repeated surgeries performed to address complaints related to exostosis.