Extensive Heterotopic Ossification of Bilateral Hip and Knee Joints in a Patient with Recurrent Traumatic Injuries

Abstract

Background: Heterotopic ossification (HO) refers to the growth of lamellar bone in soft tissues. Extensive heterotopic ossification is rarely seen. In this case, we illustrate a 35-year-old civilian patient with extensive HO due to recurrent traumatic injuries with no neurological deficit. Case Presentation: A 35-year-old man, with a history of recurrent trauma episodes in the past year, presented with pain and swellings in bilateral lower limbs. Physical examination showed stiffness and deformities of bilateral hip and knee joints. Plain x-ray showed patchy ossification extending from hip joints to knee joints bilaterally. 3-dimensional Computer Tomography (3D-CT) showed extensive heterotopic ossifications along gluteal muscles, quadratus muscles and the deep fascia beneath, confirming the diagnosis of extensive heterotopic ossifications of bilateral hip and knee joints. Excision of ossified tissues and re-mobilization of iliotibial bands were performed. Early recovery after surgery (ERAS) strategy was used to speed up recovery. Conclusion: i) Extensive heterotopic ossification in civilian patients is possible. Clinical history should be reviewed to rule out recurrent traumatic injury. Surgery should be considered. ii) Three-dimensional Computer Tomography (3D-CT) is a viable tool for surgical planning to show the extent, site, and anatomical relationship with adjacent tissues. iii) Post-op early recovery after surgery (ERAS) should be considered for better clinical outcomes.