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PubMed2002

[Heterotopic ossification in Guillain-Barré syndrome].

INTRODUCTION: Heterotopic ossification are frequent in central nervous disease, on the opposite just a few cases have been described in peripheral disorders. PURPOSE: To describe three cases of Guillain-Barré syndrome complicated by heterotopic ossification. METHODS: From the detailed case reports and a review of the literature. RESULTS: The authors report three cases of heterotopic ossification in Guillain-Barré syndrome. Each of them had serious symptom and had to go in intensive care. Two of them had encephalopathy. A patient had compression of ulnar nerve as complication of heterotopic ossification. In all cases the consequence of the heterotopic ossifications lead to a great functional handicap. DISCUSSION: Heterotopic ossification is a frequent complication in central neurologic lesions such spinal cord injury or brain injury. Just a few cases following peripheral nerve disorders have been reported. Serious neurologic deficit and encephalopathy may influence the apparition of heterotopic ossifications in patients suffering from Guillain-Barre syndrome. This possibility of complication must be known by the clinicians who should have a special attention to such patients.

Adult↗

PubMedDate not supplied

Current therapy in the management of heterotopic ossification of the elbow: a review with case studies.

Heterotopic ossification, or the appearance of ectopic bone in para-articular soft tissues after surgery, immobilization, or trauma, complicates the surgical and physiatric management of injured joints. The chief symptoms of heterotopic ossification are joint and muscle pain and a compromised range of motion. Current therapies for prevention or treatment of heterotopic ossification include surgery, physical therapy, radiation therapy, and medical management. Unlike heterotopic ossification of the hip, heterotopic ossification of the elbow has not been extensively investigated, leaving its optimal management ill-defined. To remedy this deficiency, we review risk factors, clinical anatomy, physical findings, proposed mechanisms, and current practice for treatment and prevention of heterotopic ossification. We then consider and draw conclusions from four cases of elbow injury treated at our institutions (three complicated by heterotopic ossification) in which treatment included surgery, radiation therapy, physical therapy, and medical therapy. We summarize our institutional practices and conclude with a call for a randomized clinical trial to better define optimal management of heterotopic ossification of the elbow.

Adult↗

PubMed1993

Heterotopic ossification following primary total knee arthroplasty.

Heterotopic ossification is a rare complication following primary total knee arthroplasty and may be symptomatic if massive enough. The authors retrospectively reviewed 158 primary total knee arthroplasties from 1985 to 1989 and found 6 cases (3.8%) of heterotopic ossification. Patients were graded before and after surgery according to the Hospital for Special Surgery total knee arthroplasty score and their histories were reviewed for the presence of recognized risk factors for heterotopic ossification and whether a manipulation under anesthesia was performed. This report describes the incidence of, appearance of, and clinical risk factors for heterotopic ossification following primary total knee arthroplasty in this series. A radiographic grading system is proposed.

Aged↗

PubMed1999

Heterotopic ossification in non-traumatic myelopathies.

Heterotopic ossification (HO) is an important complication of spinal cord and brain injuries but is rarely reported among patients with non-traumatic myelopathies. In a prospective study on medical problems seven (6.04%) among the 114 subjects with non-traumatic myelopathies had heterotopic ossification. All of them had involvement of hip joints. The co-morbid conditions were: urinary tract infection, seven; spasticity, three; pressure sores, five; and deep venous thrombosis, one. The initial diagnosis was often other than heterotopic ossification. Erythrocyte sedimentation rate and serum alkaline phosphatase levels were elevated in all subjects. Following rest and non-steroidal anti-inflammatory drugs, the range of motion improved in two patients. Heterotopic ossification can occur in patients with non-traumatic myelopathies and has risk factors and clinical features similar to patients with traumatic spinal cord injury. A high index of suspicion about this complication is necessary for early diagnosis and prompt intervention.

Adolescent↗

PubMed2001

Radiation prophylaxis for heterotopic ossification of the knee.

Heterotopic ossification (HO) occurs in 42% of patients who have undergone total knee arthroplasty. Bone formation usually is found in the quadriceps expansion and causes minimal to no symptoms. Specific therapy usually is unnecessary, but cases have been reported in which manipulation under anesthesia or revision arthroplasty has been required. We report a small series of 5 patients (6 knees) who have undergone surgical intervention for HO of the knee with radiotherapy given postoperatively for prophylaxis against future HO. Although this series is small, it appears that the use of prophylactic radiation may reduce recurrence after resection of symptomatic HO after total knee arthroplasty. Further investigation is required to confirm these preliminary findings.

Adult↗

PubMed2001

Refractory heterotopic ossification with complications.

BACKGROUND: Heterotopic ossification (HO) following spinal cord injury can lead to various complications, including venous thrombosis, autonomic dysreflexia, and pressure ulcers. We report refractory, complicated HO in a 19-year-old man with C8 incomplete tetraplegia. He first presented at 9 weeks postinjury with fever and swelling of his right leg. Ultrasound indicated a deep venous thrombosis (DVT). Persistent symptoms prompted triple-phase bone scan and magnetic resonance imaging (MRI), which revealed HO compressing the right external iliac vein and no evidence of DVT. The HO was complicated by hypercoagulability. CLINICAL COURSE: The HO was refractory to oral indomethacin and etidronate; therefore, intravenous etidronate was instituted, resulting in only a transient decrease in alkaline phosphatase. Local irradiation of the right hip did not decrease the activity of HO. The patient was discharged on oral etidronate, indomethacin, and warfarin. This complicated case raises issues regarding early diagnosis and aggressive treatment of HO, as well as treatment of associated hypercoagulability.

Constriction, Pathologic↗

PubMed2001

Re-irradiation for prophylaxis of heterotopic ossification after hip surgery.

Heterotopic ossification (HO) may occur after total hip arthroplasty, but fortunately most patients are asymptomatic. Rick factors for HO include previous HO, hypertrophic osteoarthritis, diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, Paget's disease and post-traumatic arthritis. Both pre-operative and post-operative radiotherapy are effective in the prevention of HO in 85-95% of high-risk patients treated. In the few patients who needed re-operation for a variety of reasons, we found that re-irradiation is possible and safe. These case reports present our experience with single dose re-irradiation of the hip in an attempt to prevent post-operative HO.

Adult↗

PubMed1993

Heterotopic ossification complicating critical illness.

Heterotopic ossification (HO), deposition of para-articular ectopic bone, is associated with musculoskeletal trauma and certain congenital and metabolic disorders. Additionally, HO may follow paralysis from diverse traumatic and nontraumatic neurologic insults. We describe three cases of HO associated with catastrophic nontraumatic respiratory illness requiring prolonged chemical paralysis and cardiorespiratory support.

Adult↗

PubMed1991

Nonarticular complication of heterotopic ossification: a clinical review.

Heterotopic ossification (HO) is a complication in neurologic lesions such as head injury and spinal cord injury. Limitation of range of motion and ankylosis as results of HO are well documented. In this report, ten instances of nonarticular complications after development of HO are described. There were three instances of vascular compression, five instances of ulnar nerve compression at the elbow, and two instances of suspected lymphedema. Clinical findings and radiographic evidence of these complications are described. Clinicians should be aware of these complications when HO is diagnosed. In addition, HO should be considered in the differential diagnosis of deep venous thrombosis in spinal cord injured and head injured patients.

Adolescent↗

PubMed2002

Heterotopic ossification around distal femur after total knee arthroplasty.

Heterotopic ossification after total knee arthroplasty is not well recognized. We found heterotopic ossification around the distal femur in 10 (5%) of 221 knees after primary total knee arthroplasty and evaluated clinical findings as well as risk factors. The duration of follow-up ranged from 1 to 5 years. Most patients with heterotopic ossification showed clinical findings that were suspected of being early infection after surgery such as continuing low-grade fever and erythematous, warm, and swollen knees, whereas blood examinations were normal. Heterotopic ossification developed by a mean period of 5 weeks, and the size increased for a mean period of 9 weeks. The maximum size of the ossification was <5 cm in 9 knees and >5 cm in 1 knee. After that, the size decreased without any treatment in all knees, and the ossification finally disappeared in 2 knees. Osteoarthrosis and the presence of postoperative effusion were the significant risk factors in the development of heterotopic ossification. Although it is difficult to draw valid conclusions from our small study, heterotopic ossification at the distal femur after total knee arthroplasty needed no treatment and was not progressive, nor did it affect the short-term outcome in this study.

Adult↗

PubMed1989

The role of post-operative radiation in the prevention of heterotopic ossification in patients with post-traumatic acetabular fracture.

Heterotopic ossification (HO) with subsequent pain and limitation of motion of the lower extremity is a common and significant problem for patients who suffer traumatic acetabular fracture (TAF). The incidence of heterotopic ossification is markedly increased for patients requiring surgical repair depending on the degree of trauma and the type of surgical repair necessary. Radiation therapy (RT) has proven to be the most effective surgical adjunct for the prevention of heterotopic ossification in patients undergoing total hip replacement (THR), but has not been reported in patients with traumatic fracture and repair. This report details an experience with patients treated at a Shock Trauma Center with extensile repair and immediate (within 48 hr) post-operative radiation therapy given as 5 daily fractions of 2 Gy in 5 to 7 days to a total dose of 10 Gy using megavoltage radiation therapy. A total of 30 consecutive patients (RT group) have been treated at our institution since June 1985. The last 20 patients treated with surgery only (non-RT group) prior to initiation of this study were used as a control group. Heterotopic ossification was seen to some degree in 50% of all radiation therapy patients, but was severe in only three of 30 (10%) of cases [three (10%) had Brooker III HO and no patients had ankylosis (Brooker IV HO)]. In contrast, some degree of heterotopic ossification was seen in 90% of the non-radiation therapy patients, and was severe in 10 of 20 (50%) of patients [seven (35%) had Brooker III HO whereas three (15%) had ankylosis (Brooker IV)]. This difference is significant for both total incidence and incidence of severe cases (p less than 0.01). This reduction in heterotopic ossification incidence approaches the magnitude reported for high-risk patients with total hip replacement. Even though the incidence of severe heterotopic ossification after radiation therapy for total hip replacement is approximately 5% and for traumatic acetabular fracture patients it is double (10%), the actual incidence of heterotopic ossification without radiation therapy is different in the two conditions. For total hip replacement, the incidence is about 30% and for traumatic acetabular fracture it is 50%. Radiation therapy has again proven itself to be an excellent surgical adjunct to prevent heterotopic ossification, this time in traumatic acetabular fracture patients.

Acetabulum↗

PubMed1987

Heterotopic ossification in hemiplegia following stroke.

Heterotopic ossification is a recognized complication in patients with head injury, burns, paraplegia, or direct trauma to muscle tissue. Heterotopic ossification with hemiplegia following stroke is considered rare. A case of a 53-year-old patient with right hemiplegia who developed painful right hip, limiting range of movement and progress in ambulation, is presented. X-ray and laboratory tests confirmed the presence of heterotopic ossification, suggesting that this condition may not be so rare in patients with a cerebrovascular accident, but may escape recognition, with pain being considered to stem from soft-tissue strain, premorbid arthritis, or altered sensation commonly associated with stroke.

Cerebrovascular Disorders↗

PubMed2002

Idiopathic heterotopic ossification in the intensive care setting.

Heterotopic ossification is characterised by the periarticular deposition of ectopic bone. It typically occurs after trauma, neurogenic injury, or congenital causes. Idiopathic heterotopic ossification has been rarely reported. A patient who developed idiopathic heterotopic ossification in the intensive care unit without any known predisposing conditions is presented.

Adult↗

PubMed1992

Postoperative heterotopic ossification in the child with cerebral palsy: three case reports.

Three children with cerebral palsy and mental retardation showed irritability after surgical procedures. They were subsequently diagnosed as having heterotopic ossification. Heterotopic ossification developed around the hip in all cases--two after bilateral adductor releases at the operative site and the third after spinal fusion at a site unrelated to the surgery.

Adult↗

PubMed1994

Radiation therapy to prevent heterotopic ossification in cementless total hip arthroplasty.

Heterotopic ossification is the most frequent complication in total hip arthroplasty. In this prospective trial the influence of radiation therapy on heterotopic ossification in cementless total hip arthroplasty was investigated. Radiation therapy reduces the incidence and the degree of heterotopic ossification, especially in hips with a poor preoperative range of motion.

Aged↗

PubMed2006

Heterotopic ossification of percutaneous nephrostomy tract.

Heterotopic ossification is a rare, abnormal formation of true bone within extraskeletal soft tissues and is a common complication after musculoskeletal trauma or orthopedic procedures. We report a case of heterotopic ossification of a percutaneous nephrostomy tract causing flank pain and masquerading as a retained nephrostomy catheter in a young steroid-dependent man with sarcoidosis 2 years after percutaneous nephrolithotomy. The patient's underlying sarcoidosis combined with local tissue ischemia likely contributed to this rare complication.

Adult↗

PubMed1996

Preoperative irradiation for prevention of heterotopic ossification following total hip arthroplasty.

Eighty-six hips in eighty-five patients who were considered to be at risk for heterotopic ossification following a total hip arthroplasty were prospectively randomized or assigned to one of two treatment groups that received a single 800-centigray dose of limited-field radiation either preoperatively (Group I) or postoperatively (Group II). The risk factors for postoperative heterotopic ossification included previous heterotopic ossification following an operation about the hip, hypertrophic osteoarthrosis or post-traumatic osteoarthrosis characterized by the presence of extensive osteophytes, radiographic evidence of diffuse idiopathic skeletal hyperostosis, and ankylosing spondylitis. The hips in Group I were irradiated within 6.1 hours before the operation and those in Group II, within 51.3 hours after the operation. Either extra-field ossification or heterotopic ossification was observed in forty-one (48 per cent) of the eighty-six hips, thereby confirming the high risk for the population in this study. After a minimum duration of follow-up of six months, thirty-seven (76 per cent) of the forty-nine hips that had been treated with preoperative irradiation exhibited no new heterotopic ossification and eleven, progression to grade-I or II ossification. The remaining hip in that group was in a woman who had Paget disease as well as previous grade-IV (ankylosing) heterotopic ossification about the ipsilateral hip; heterotopic ossification progressed from grade II on the radiographs made immediately after the index revision procedure to grade III at the most recent follow-up assessment. Of the thirty-seven hips that had been treated with postoperative irradiation, twenty-seven (73 per cent) exhibited no new heterotopic ossification and nine had progression from grade-0 to grade-I ossification. The remaining hip in that group was in a man who had Parkinson disease and previous grade-III ossification about the ipsilateral hip; heterotopic ossification progressed from grade III immediately post-operatively to grade IV at the time of the most recent evaluation. Extra-field ossification was identified in twelve (24 per cent) of the forty-nine hips that had been irradiated preoperatively compared with three (8 per cent) of the thirty-seven hips that had been irradiated postoperatively (p = 0.05). Extra-field ossification was not associated with clinical symptoms of bursitis of the greater trochanter in any hip. Three of the ten hips that had a revision operation subsequently had a non-union of the greater trochanter; all three had been treated with preoperative irradiation. The findings of the present study suggest that pre-operative irradiation is effective for the prevention of heterotopic ossification following total hip arthroplasty and that it eliminates the discomfort and morbidity that are associated with conventional postoperative treatment. Furthermore, the efficacy of preoperative irradiation suggests that osteogenic precursor cells that are active in this process are derived from the local tissues within the operative field rather than from distant blood-borne cell lines.

Adult↗

PubMed1995

Heterotopic ossification induced by hypoxia in a retrosternal gastric tube following transhiatal oesophagectomy.

A 71 year old man underwent retrosternal gastric tube reconstruction following transhiatal oesophagectomy for squamous cell carcinoma. On the second post-operative day, the patient developed a cardiac arythmia with secondary hypotension followed by hypoxaemia necessitating artificial ventilation. Two weeks after surgery, endoscopy revealed massive necrosis of the proximal segment of the gastric tube extending from the anastomosis in the neck to the watershed area. Three weeks later, the patient died and a necropsy was performed. Macroscopic evaluation of the gastric tube revealed a sharply demarcated and fully ossificated proximal segment. Heterotopic ossification was present on histological examination. This condition has only been described in conjunction with primary or metastatic gastric adenocarcinoma. The location of the ossification and the presence of temporary systemic hypoxia suggest that the latter was the main factor responsible for the ossificative response.

Aged↗