Ectopic ossification after hip arthroplasty.

Adequate endplate coverage by cervical disc prosthesis may reduce risk of heterotopic ossification

Complication of total hip prosthesis]

Heterotopic ossification (HO) is a significant post-injury complication that impairs the rehabilitation of U.S. combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively, and represents one of the major challenges facing military orthopedic surgeons [1-5]. HO refers to excess bone growth in soft tissues that can be seen developing in radiographs of residual limbs weeks after traumatic injury. In many cases, HO can cause symptoms such as skin breakdown and pain during prosthetic use and interfere with the patient's ability to walk. Most of these symptomatic patients can have their pain resolved through conservative treatments such as prosthetic adjustments to restore a comfortable fit. A minority of combat amputees eventually require surgical excision of the ectopic bone to relieve their HO symptoms [1-2]. Interestingly, some other patients show evidence of HO in radiographs without any apparent symptoms and therefore require no treatment. Unfortunately, little research has integrated radiographic and symptomatic evidence of HO to explain variability in symptoms among recent combat amputee patients.

Heterotopic ossification after total ankle replacement: ..

Key words: Afghanistan war, amputation, blast injury, combat amputee, heterotopic ossification, Iraq war, physical medicine, prosthesis, radiograph, rehabilitation.

Finally, heterotopic ossification apparently can occur in patients who elect to have amputations performed many months after combat injury. Two cases (3 and 5) were presented in which patients showed no radiographic evidence of ectopic bone growth until after elective amputation. The excess bone growth was not as substantial radiographically as the remaining cases of combat-related HO. However, it was unfortunately positioned in the residual limb relative to the prosthesis and therefore caused the patient pain during ambulation. Surgical excision was required in both cases to restore a comfortable prosthetic fit. Smith noted similar bone growth occasionally might occur following trauma-related amputations or when residual periosteum forms irregular bone spurs [28]. Whether recent combat amputees might have increased risk of this phenomenon is unclear. As mentioned, HO occurred in three of the eight patients who had delayed amputations in the present case series.


07/01/2018 · MEDLINE Abstract

Abstract — Heterotopic ossification (HO) is excess bone growth in soft tissues that frequently occurs in the residual limbs of combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively. HO can interfere with prosthetic use and walking and delay patient rehabilitation. This article describes symptomatic and/or radiographic evidence of HO in a patient series of combat amputees rehabilitating at a military amputee care clinic (27 patients/33 limbs). We conducted a retrospective review of patient records and physician interviews to document evidence of HO symptoms in these limbs (e.g., pain during prosthetic use, skin breakdown). Results showed HO-related symptoms in 10 of the 33 residual limbs. Radiographs were available for 25 of the 33 limbs, and a physician identified at least moderate HO in 15 of the radiographs. However, 5 of the 15 patients who showed at least moderate radiographic HO did not report adverse symptoms. Five individual patient histories described HO onset, symptoms, treatments, and outcomes. These case histories illustrated how HO location relative to pressure-sensitive/pressure-tolerant areas of the residual limb may determine whether patients experienced symptoms. These histories revealed the uncommon but novel finding of potential benefits of HO for prosthetic suspension.

Heterotopic ossification after primary shoulder arthroplasty

The aetiology of heterotopic ossification is still unknown. It has been reported that factors associated with heterotopic ossification include perioperative bleeding in the vicinity of implant, especially at the keel cut site, rough tissue dissection, underlying diffuse idiopathic skeletal hyperostosis (DISH) and annular repair after implantation of the prosthesis [, , , ]. The perioperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is recognised as important prophylactic treatment for patients undergoing total disc replacement [, ]. Therefore, meticulous haemostasis, gentle muscle dissection and the use of NSAID are generally recommended.