INTRODUCTION AND IMPORTANCE: Heterotopic ossification (HO) is a relatively uncommon yet significant complication following total knee arthroplasty (TKA), with an incidence ranging from 3.8 % to 42 %. While surgical trauma and inflammation are known risk factors, cultural practices such as traditional oil massages may contribute to HO formation, though this remains underexplored. CASE PRESENTATION: We present a case of a 65-year-old woman with severe knee osteoarthritis who had uncomplicated bilateral TKA. The patient recovered well after surgery, experiencing notable pain alleviation and improved mobility. Imaging was prompted by minor knee stiffness and soreness at follow-up, which showed bilateral HO, with right side more prominent. Regular post-operative conventional oil massages were shown to be a possible contributing factor. Conservative treatment was started and because of the patient's minimal symptoms and retained functionality, radiotherapy and surgical excision were postponed. CASE DISCUSSION: Due to surgical stress and local inflammation, mesenchymal stem cells most likely undergo a transition into osteoblasts in HO after TKA. This instance illustrates how cultural customs, including oil massages, may exacerbate inflammation and lead to HO. Achieving positive results requires early diagnosis, patient education, and a multidisciplinary care strategy comprising physiotherapists, orthopedic surgeons, and rehabilitation specialists. CONCLUSION: This case emphasizes the importance of preoperative counseling on traditional practices that may interfere with recovery and early detection of complications such as HO. Conservative management is often sufficient for mild cases, while patient with functional limitation may require invasive interventions. Further research is needed to improve outcomes in TKA patients.