Optimal Timing of Preoperative Radiation for Prophylaxis Against Heterotopic Ossification

Rumi, Mustasim N.; Deol, Gurvinder S.; Bergandi, Jason A.; Singapuri, Kishor; Pellegrini, Vincent D.

doi:10.2106/jbjs.c.00974

Cited by 16 publications

(13 citation statements)

References 51 publications

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“…The mRNA and protein levels for a number of molecules were significantly altered within 2 weeks of injury. Myofibroblast numbers, the chance of posttraumatic contractures and to institute nonsteroidal anti-inflammatory therapy or radiation treatment perioperatively, in order to prevent recurrence of heterotopic ossification following surgical releases (Rumi et al 2005, Cohen 2006, Doornberg and Jupiter 2006. These clinical experiences support the early changes in the joint capsule reported in the current study.…”

Section: Discussionmentioning

confidence: 99%

“…Early motion after joint injury lessens the severity of contracture and modern internal fixation techniques have advanced this practice in the last century (Doornberg and Jupiter 2006). Methods to prevent heterotopic ossification have to be instituted within a few days of the injury (Rumi et al 2005). We have now investigated early changes in the joint capsule of the animal model of posttraumatic contracture in an attempt to ascertain changes correlated with contracture development.…”

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confidence: 99%

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Cellular, matrix, and growth factor components of the joint capsule are modified early in the process of posttraumatic contracture formation in a rabbit model

et al. 2008

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Background and purpose A recently developed animal model of posttraumatic contractures reflects the chronic stages of the human condition. To understand the initiation of the process, we evaluated the cellular, matrix, and growth factor changes in the joint capsule in the early stages of the animal model, which would not be possible in humans.Methods 18 skeletally mature rabbits had intraarticular cortical windows removed from the medial and lateral femoral condyles, and the knee joint was immobilized. The contralateral unoperated limb served as a control. Equal numbers of rabbits were killed 2, 4, and 6 weeks after surgery. Myofibroblast, mRNA, and protein determinations were done with immunohistochemistry, RT-PCR, and western blot, respectively.Results Myofibroblast numbers were statistically significantly elevated in the joint capsules of the experimental knees as compared to control knees. The mRNA and protein levels for collagen types I and III, matrix metalloproteinases 1 and 13, and transforming growth factor β1 were statistically significantly greater, and for tissue inhibitor of matrix metalloproteinases 1 significantly less, in the experimental capsules than in the control capsules.Interpretation The experimental joint capsule changes in the acute stages of posttraumatic contractures are similar to those in the chronic stages of the process in this model. Thus, it appears that the mechanisms that attenuate the acute stages of the response to injury are circumvented, contributing to a prolonged modulation of myofibroblast numbers, matrix molecules and growth factors, and leading to joint contractures.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Cellular, matrix, and growth factor components of the joint capsule are modified early in the process of posttraumatic contracture formation in a rabbit model

et al. 2008

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“…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]. We administered oral indomethacin as a routine after each operation because some studies had reported its role in prophylaxis for HO [20][21].…”

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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“…After wound closure, postoperative AP and lateral radiographs of the residual limb were obtained as baseline images. The rats were maintained for 24 weeks, and serial orthogonal radiographs of the residual limb were obtained at 10 days and at 4,8,12,16,20, and 24 weeks. Euthanasia was planned for all animals at 24 weeks.…”

Section: Methodsmentioning

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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Optimal Timing of Preoperative Radiation for Prophylaxis Against Heterotopic Ossification

Cited by 16 publications

References 51 publications

Cellular, matrix, and growth factor components of the joint capsule are modified early in the process of posttraumatic contracture formation in a rabbit model

Cellular, matrix, and growth factor components of the joint capsule are modified early in the process of posttraumatic contracture formation in a rabbit model

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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