- See:
Ossification of Soft Tissues: and
Myositis Ossificans
- Discussion:
- may present w/ signs of localized inflammation or pain, elevated skin temp, ect.
- tends to occur after thr,
spinal injury,
head injury (11%),
burns, bruises;
-
Events leading to HO;
- mesenchymal cell (XRT prevents induced differentiation)
-
osteoblast
- matrix (EHDP)
-
osteocyte
- HO following THR:
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Radiation therapy to prevent heterotopic ossification after cementless total hip arthroplasty.
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The effect of radiation therapy on the fixation strength of an experimental porous-coated implant in dogs.
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Heterotopic bone after hip arthroplasty. Defining the patient at risk.
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Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty.
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Ketorolac prophylaxis against heterotopic ossification after hip replacement.
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Excision of heterotopic bone followed by irradiation after total hip arthroplasty.
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Prevention of HO w/ irradiation after THA arthroplasty. Radiation therapy with a single dose of eight hundred centigray administered to a limited field.
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Total hip arthroplasty. The role of antiinflammatory medications in the prevention of heterotopic ossification.
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Periarticular heterotopic ossification after total hip arthroplasty for primary coxarthrosis.
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Periarticular heterotopic ossification after total hip arthroplasty. Risk factors and consequences.
- HO following acetabular fracture (
acetabular frx)
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Heterotopic ossification as a complication of acetabular fracture. Prophylaxis with low-dose irradiation.
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Heterotopic ossification following operative treatment of acetabular fracture. An analysis of risk factors.
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Heterotopic ossification prophylaxis following operative treatment of acetabular fracture.
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Extended iliofemoral versus triradiate approaches in management of associated acetabular fractures.
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Heterotopic ossification as a complication of acetabular fracture. Prophylaxis with low-dose irradiation.
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Prophylaxis with indomethacin for heterotopic bone. After open reduction of fractures of the acetabulum.
- HO of the elbow:
- Early Excision of Hetertopic Ossification about the Elbow followed by Radiation Therapy. J.A. Mcauliffe MD et al JBJS Vol 79-A No 5. May 1997.
- HO following spinal cord trauma:
- radiographically develops in 3-5% of patients, 1-4 mo (or upto 18 mo) after injury;
- it occurs below the level of the injury, usually at major joints;
- incidence is 40% (1/2 of these are clinically significant);
- after transection of spinal cord, ossification often takes place in soft tissues adjacent to large joints;
- lower extremities are particularly suseptible & most dramatic changes are seen in Knee > Pelvis > Hip;
- characteristic finding is a bilateral accretion of well defined bone which encircle the joints;
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Resection of heterotopic ossification in patients with spinal cord injuries.
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Resection of heterotopic ossification in the adult with head trauma.
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Clinical observations on fractures and heterotopic ossification in the spinal cord and traumatic brain injured populations.
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Surgical approaches for resection of heterotopic ossification in traumatic brain-injured adults.
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Periarticular heterotopic ossification in head-injured adults. Incidence and location.
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Heterotopic ossification around the hip in spinal cord-injured patients. A long-term follow-up study.
- Radiographic Studies:
- x-rays: soft tissue ossification usually does not appear in 1st mo
-
bone scans may reveal incr isotopic intake by the second weak;
- Labs:
-
alkaline phosphatase activity correlates w/ bone scans;
- Non Operative Treatment:
-
NSAIA
-
Indomethacin 25 mg PO tid for 3-6 months;
-
Etidronate
- theoretically works by delaying mineralization of osteoid
- diphosphonates do not prevent heterotopic bone formation in lab animals but they do delay of mineralization of osteoid.
- delay in mineralization caused by diphosphanates are reversed when the disphosphonates are discontinued;
- Radiation Therapy:
- single does of 600 to 800 centgray of radiation given within 24 hours of surgery preoperatively or 72 hours postoperatively;
- a relative contra-indication of XRT may be
posterior hip dislocation w/ femoral head frx, since there is a theoretical risk of contributing to AVN or non-union;
- cost: $ 2,000 to 2,500;
- references:
- Preop irradiation versus the use of NSAIDS for prevention of HO following THR. Int J Radiat Oncol Biol Phys 1998;42:397-401
- Radiotherapy vs NSAIDS for prevention of HO after major hip surgery: A meta-analysis. Int J Radiat Oncol Biol Phys 2004;60:888-895
- Operative Resection:
- main disadvantage is risk of recurrence heterotopic ossification;
- operative timing:
- if HO has caused the loss of motion, some recommend allowing process to mature (sharp cortical and trabecular markings) before operative resection;
- some recommend waiting 12 months before operative resection;
- once serial radiographs have shown that the ossification is mature w/ sharp peripheral edges and no indication of expansion, resection is considered;
-
bone scans and
alkaline phosphatase may not be helpful in predicting maturity of the ossification;
- in the study by
Genet et al., a consecutive series of 143 patients w/ traumatic brain injury and spinal cord injury;
- some patients had complete ankylosis, and some had severe limitation of motion;
- patients with ankylosis had improvement from an average of 0° to 90° of hip flexion but had only 63° of motion;
- patients without ankylosis had improvement from an average of 38° to 95° of motion, with 83° of motion;
- authors noted the importance of estimating bone mineral density prior to surgery to assess the risk of intraoperative fracture;
- delayed surgery can increase in intra-articular pathology and osteoporosis;
Heterotopic ossification about the hip after intramedullary nailing for fractures of the femur.
Heterotopic ossification around the hip with intramedullary nailing of the femur.
Prevention of heterotopic ossification in high-risk patients by radiation therapy.
A clinical perspective on common forms of acquired heterotopic ossification.
The use of radiation to discourage ectopic bone. A nine-year study in surgery about the hip.
Prophylaxis with indomethacin for heterotopic ossification after Chiari osteotomy of the pelvis.
