- See:
Ossification of Soft Tissues:
-
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:
-
HO of the elbow:
-
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;
- 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 700 to 800 cGy on POD 1;
- 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;
- Operative Resection:
- main disadvantage is risk of recurrence heterotopic ossification;
- if hetertopic ossfication has caused the loss of motion, consider 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;
Heterotopic ossification about the hip after intramedullary nailing for fractures of the femur.
Resection of heterotopic ossification in patients with spinal cord injuries.
Resection of heterotopic ossification in the adult with head trauma.
Heterotopic ossification around the hip with intramedullary nailing of the femur.
Heterotopic ossification as a complication of acetabular fracture. Prophylaxis with low-dose irradiation.
Prophylaxis with indomethacin for heterotopic bone. After open reduction of fractures of the acetabulum.
Clinical observations on fractures and heterotopic ossification in the spinal cord and traumatic brain injured populations.
Periarticular heterotopic ossification after total hip arthroplasty for primary coxarthrosis.
Prevention of heterotopic ossification in high-risk patients by radiation therapy.
Total hip arthroplasty. The role of antiinflammatory medications in the prevention of heterotopic ossification.
Surgical approaches for resection of heterotopic ossification in traumatic brain-injured adults.
Periarticular heterotopic ossification after total hip arthroplasty. Risk factors and consequences.
A clinical perspective on common forms of acquired heterotopic ossification.
Radiation therapy to prevent heterotopic ossification after cementless total hip arthroplasty.
The effect of radiation therapy on the fixation strength of an experimental porous-coated implant in dogs.
The use of radiation to discourage ectopic bone. A nine-year study in surgery about the hip.
Periarticular heterotopic ossification in head-injured adults. Incidence and location.
Heterotopic ossification around the hip in spinal cord-injured patients. A long-term follow-up study.
Prevention of heterotopic ossification with irradiation after total hip arthroplasty. Radiation therapy with a single dose of eight hundred centigray administered to a limited field.
Excision of heterotopic bone followed by irradiation after total hip arthroplasty.
Magnetic resonance imaging after pedicular screw fixation of the spine.
Prophylaxis with indomethacin for heterotopic ossification after Chiari osteotomy of the pelvis.
Heterotopic bone after hip arthroplasty. Defining the patient at risk.
Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty.
Heterotopic ossification as a complication of acetabular fracture. Prophylaxis with low-dose irradiation.
Heterotopic ossification following operative treatment of acetabular fracture. An analysis of risk factors.
Heterotopic ossification prophylaxis following operative treatment of acetabular fracture.
Extended iliofemoral versus triradiate approaches in management of associated acetabular fractures.
Ketorolac prophylaxis against heterotopic ossification after hip replacement.
Early Excision of Hetertopic Ossification about the Elbow followed by Radiation Therapy.
J.A. Mcauliffe MD, A.H. Wolfson MD.
JBJS Vol 79-A No 5. May 1997.
