Current concepts in the development of heterotopic ossification

Pape, Hans-Christian; Marsh, Sarah; Morley, John; Krettek, Christian; Giannoudis, P.V.

doi:10.1302/0301-620x.86b6.15356

Cited by 136 publications

(98 citation statements)

References 44 publications

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“…Once formed, heterotopic bone can be manage only with surgical excision. 6,8 In our study radiological finding of lobulated calcific mass of these pearls (Fig. 3) shows a distinct pattern confirming the diagnosis of HO.…”

Section: Discussionsupporting

confidence: 79%

“…7 HO the abnormal development of bone in areas of the body other than skeletal tissue, commonly occurs in association with traumatic brain injury and spinal cord injury. 1,5,6,8 Ectopic bone can develop from immature osteoid in a matter of weeks. 8 This clinical entity is still an enigma among scientists and clinicians, and current preclinical work has made slow but steady progress in our understanding of the etiology and pathophysiology behind heterotopic bone formation.…”

Section: Discussionmentioning

confidence: 99%

“…1,5,6,8 Ectopic bone can develop from immature osteoid in a matter of weeks. 8 This clinical entity is still an enigma among scientists and clinicians, and current preclinical work has made slow but steady progress in our understanding of the etiology and pathophysiology behind heterotopic bone formation. 1 HO can limit the range of motion of a number of different joints, most commonly the hip, knee, shoulder, and elbow.…”

Section: Discussionmentioning

confidence: 99%

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Pearls Around the Knee – Anatomico- Pathological Considerations. (Polemics)

Pradesh¹,

Chhaparwal²

2013

jemds

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In 1883 Reidel described heterotrophic ossification (HO) for the first time. A large number of predisposing factor are described in the literature, although the precise pathogenetic mechanism is still unknown. But, it is thought to be due to over expression of Bone morphogenetic protein (BMP) in peri-articular soft tissues.HO can limit the range of motion of a joint. These may be solitary or multiple painless periarticular masses which are lobular and densely calcified, diagnosed by USG, X-ray, CT and MRI. During routine dissection of right knee in a male cadaver aged between 60 to 65 years, while exposing the interior of knee by a transverse supra patellar incision the articular surface of patella and infra patellar pad of fat were exposed. A rounded projection about 2cm in size was visualized in the midline deep to synovial membrane of the infra patellar pad of fat. After incising the synovial membrane a large bony ossicle which looked like a pearl, was removed.In yet another case in a male cadaver aged between 60 to 65 years a hard, mass was felt in the infrapatellar part of right knee in its lateral part which was exposed by incising lateral patellar retinaculum & to our surprise, small pearl like object of the size smaller than 1cm, oval in shape and bony hard in consistency could be removed. Measurements and weights were recorded. Radiographs were taken. When the literature was searched it has been variously described as peri articular calcinosis, heterotrophic ossification (HO), tumoral calcinosis. Controversy still exists regarding its etiology, pathogenesis and nomenclature.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pearls Around the Knee – Anatomico- Pathological Considerations. (Polemics)

Pradesh¹,

Chhaparwal²

2013

jemds

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“…Therefore, prevention should be emphasized. Unfortunately, predicting or preventing the development of HO is very difficult [12][13]. Pharmacological interventions or local radiation therapy have been recommended as prophylaxis for HO, but the result is uncertain and controversial [11,[14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Management of multijoint stiffness of bilateral upper limbs secondary to heterotopic ossification: Case report and literature review

Min¹,

Liu²,

Han³

et al. 2014

J Rehabil Res Dev

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Abstract-The management of heterotopic ossification (HO) is controversial. Although some reports have investigated assessment and surgical resection techniques for HO affecting one or more joints, the cases of multijoint stiffness secondary to HO are rare. This article describes a rare case of HO affecting both upper limbs of a 32-year-old man that severely interfered with activities of daily living. We present the rehabilitation management of this case and the functional outcome 1 to 2 yr after excision of the ossific masses.

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“…Complications related to heterotopic bone in residual limbs include pain, overlying skin and muscle breakdown, poor prosthetic fit and function, need for surgical revision, and delayed rehabilitation [18]. Current treatment options are restricted to surgical excision of the offending bone [17]. Investigation of the effects of blast trauma on the musculoskeletal system must be a priority to enhance the care of warwounded veterans.…”

Section: Introductionmentioning

confidence: 99%

Does Blast Medium Affect Heterotopic Ossification in a Blast-amputation Model?

Yoo

Blevins

Gasbarro

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Heterotopic ossification (HO) develops after nearly 2 .3 of traumatic blast amputations in the contemporary battlefield. This phenomenon has potentially devastating consequences for servicemen and women and its pathophysiology warrants further investigation using a previously developed animal blast model. Questions/purposesWe asked, what is the (1) severity (quantity) and (2) type (location) of HO bone formation after a hindlimb blast amputation with two distinct blast media. We hypothesized that a more ''war-relevant'' blast medium could be a more accurate model and potentially intensify the development of HO. Methods Using a Sprague-Dawley rat model, the pathophysiology of ectopic bone formation in a traumatic hindlimb blast amputation was evaluated. Twenty-four animals underwent blast amputations and closure based on a previously established experimental model. Half the amputations were subjected to blasted sand and the other 1/2 to blasted water. Serial orthogonal radiography was performed on each animal until euthanasia at 24 weeks to track the development of HO. Heterotopic bone severity and type were assessed by three independent graders at each time using a novel grading scale to assess quantity and quality of HO. Results All animals had radiographic evidence of HO develop. No differences were observed in ectopic bone development between sand and water blasting regarding severity or type at any time. Animals that received water and sand blasting had moderate HO develop at 24 weeks (median, 2.0 and 2.5 weeks, respectively; range, 1-3 weeks; difference of medians, 0.5; p = 0.67). At the time of euthanasia, 10 animals that were water blasted had Type 3 HO compared with 11 in the sand-blasted group (p = 1.00).The institution of one or more of the authors (DEJ, VDP) has received, during the study period, funding from the United States Department of Defense Congressionally Directed Medical Research Program (Washington, DC, USA). One of the authors certifies that he (VDP), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,000-USD 1,000,000, from the United States Department of Defense Congressionally Directed Medical Research Program (Washington, DC, USA), an amount of USD 100,000-USD 1,000,000 from DePuy Orthopaedics (Warsaw, IN, USA), and USD 100,000-USD 1,000,000 from the Agency for Healthcare Research and Quality (Rockville, MD, USA). Conclusions Our study showed a clear development of HO after hindlimb blast amputation in a Sprague-Dawley rat model; however, no difference was observed in HO development based on the type of blast media. This suggests it is the blast mechanism that induces ectopic bone development, regardless of the blasted medium. The grading scale we developed for our animal-model study provided a reliable means of assessing HO severity and type. Clinical Relevance We anticipate that future investigations will elucidate similarities between service members' wartime extremity injuries and the animal...

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Current concepts in the development of heterotopic ossification

Cited by 136 publications

References 44 publications

Pearls Around the Knee – Anatomico- Pathological Considerations. (Polemics)

Pearls Around the Knee – Anatomico- Pathological Considerations. (Polemics)

Management of multijoint stiffness of bilateral upper limbs secondary to heterotopic ossification: Case report and literature review

Does Blast Medium Affect Heterotopic Ossification in a Blast-amputation Model?

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