Prophylaxis of Heterotopic Ossification of the Hip: Systematic Review and Meta-Analysis

Vavken, Patrick; Castellani, Lorenzo; Sculco, Thomas P.

doi:10.1007/s11999-009-0924-5

Cited by 109 publications

(67 citation statements)

References 32 publications

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“…However, these studies have not evaluated patient populations treated in a uniform surgical fashion by one surgeon, and risk factors were not consistent among those studies. In this retrospective study, which evaluated a relatively homogeneous patient population, and which excluded a number of patients who were identified in advance as being at high risk (and so who received prophylaxis with indomethacin), we showed rates of HO comparable to previous studies [9,28,32] and we identified prolonged mechanical ventilation as a risk factor for the development of severe HO. Although we cannot recommend for or against routine prophylaxis, patients who are expected to be ventilated for a prolonged period may benefit from prophylaxis.…”

Section: Discussionsupporting

confidence: 65%

Risk Factors for the Development of Heterotopic Ossification After Acetabular Fracture Fixation

Firoozabadi

O'Mara

Swenson

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Heterotopic ossification (HO) is a common complication of the operative treatment of acetabular fractures. Although the surgical approach has been shown to correlate with the development of ectopic bone, specific risk factors have not been elucidated. Questions/purposes The purposes of this study were to determine specific risk factors associated with the development of severe HO and the frequency with which patients develop severe HO after acetabular fracture fixation through an isolated Kocher-Langenbeck approach. Methods Using an institutional orthopaedic trauma database at a regional Level I trauma center, patients undergoing open treatment of acetabular fractures during the study period (January 2000 to January 2010) were identified. A review of medical records and imaging studies was performed on 508 patients who were treated by the senior author (MR) through an isolated Kocher-Langenbeck approach. During the study period, the senior author used indomethacin for HO prophylaxis in patients who had ipsilateral femur fracture treated with antegrade reamed medullary nailing or severe local soft tissue injury; 49 (10%) of the patients he treated with the Kocher-Langenbeck approach received prophylaxis, and they were excluded from this study, leaving a total of 459 patients who met inclusion criteria. Of those, 147 (29%) were lost to followup or did not have radiographs both before and at a minimum of 6 weeks (median, 1 week; range, 0-3 weeks), leaving 312 (61% of the patients treated with the Kocher-Langenbeck approach during this time) available for this analysis. Demographic data as well as information related to cause of injury, associated periacetabular findings, other system injuries, and treatment were gathered. Final followup radiographs were assessed for the presence of ectopic bone by two of the authors (TJO, AS) using the modified Brooker classification. Logistic regression was performed to identify possible predictors of development of severe ectopic bone. Results The only predictor we identified for the development of severe HO was the need for prolonged mechanical ventilation (odds ratio, 7

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Section: Discussionsupporting

confidence: 65%

Risk Factors for the Development of Heterotopic Ossification After Acetabular Fracture Fixation

Firoozabadi

O'Mara

Swenson

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…These medications did not appear effective in the present case histories, although they may have inhibited further development of HO. Nonsteroidal anti-inflammatory agents and radiation are known to be effective prophylaxis against HO following hip surgery in civilians [24]. A program description of the Walter Reed Amputee Patient Care Program indicates physicians prescribed nonsteroidal anti-inflammatory drugs such as Celebrex for combat amputees, unless contraindicated, for both prophylaxis and treatment of HO [25].…”

Section: Discussionmentioning

confidence: 99%

Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients

Melcer

Belnap²,

Walker³

et al. 2011

JRRD

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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/pressuretolerant 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.

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“…Another option is radiation treatment, which can be used for both therapeutic and prophylactic purposes in HO (4)(5)(6). The therapeutic use of radiation therapy in established HO was first described by Schaeffer and Sosner (5) in 1995, who found that giving a 2 gray dose of radiation for several consecutive days resulted in improved range of motion.…”

Section: Discussionmentioning

confidence: 99%

“…The patient was successfully treated with oral bisphosphonate and aggressive physiotherapy. drug such as indomethacin (6). It is generally recommended to initiate anti-inflammatory drug therapy within one day of surgery and to continue for a minimum of three weeks (8).…”

Section: Discussionmentioning

confidence: 99%

Management of pelvic heterotopic ossification post-myocutaneous flap reconstruction of a sacral pressure ulcer

2011

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A 16-year-old Caucasian boy with a diagnosis of spinal dysraphism at the L5 level presented with a two-month history of a recurrent right ischial pressure ulcer. His surgical history included debridement and flap reconstruction of previous sacral and right ischial ulcers. On physical examination, a stage IV pressure ulcer was present overlying the right ischium in the setting of local postsurgical scarring. Computed tomography confirmed right ischial osteomyelitis. The patient was treated with wide surgical debridement of the involved soft tissues, ostectomy of the right ischial tuberosity and right gluteus maximus myocutaneous flap reconstruction, with postoperative care in the prone and lateral positions. Three months postoperatively, the patient complained of limited hip mobility; a plain pelvis radiograph confirmed bilateral heterotopic ossification (HO) of the iliac crests to the femurs (Figure 1). The patient was subsequently treated with a six-month course of aggressive physical therapy (twice a day treatment sessions) and oral bisphosphonate (etidronate 20 mg/kg three times a day), which resulted in significant clinical and radiographic improvement of bilateral hip range of motion (Figure 2). DisCUssionHO has traditionally been a challenging diagnosis to successfully treat. Surgical excision has been described as the treatment of choice for symptomatic HO (1,2). As with all invasive surgical procedures, there is a risk of infection and blood loss (1), a considerable rehabilitation process and accumulation of scar tissue. Furthermore, due to the high recurrence rates, if surgical resection is performed on an immature lesion, treatment is often delayed for months before operative intervention is performed on mature lesions (3).Another option is radiation treatment, which can be used for both therapeutic and prophylactic purposes in HO (4-6). The therapeutic use of radiation therapy in established HO was first described by Schaeffer and Sosner (5) in 1995, who found that giving a 2 gray dose of radiation for several consecutive days resulted in improved range of motion. For prophylactic therapy, a single dose of 700 centigray administered within 48 h postoperatively is effective at reducing the recurrence rate of HO (7). Side effects of radiation therapy are common and present an obvious limitation to this treatment modality. An alternative postoperative prophylactic option is a course of a nonsteroidal anti-inflammatory Heterotopic ossification (HO) is a process whereby lamellar bone forms in the soft tissues surrounding a joint. The most common type of HO is traumatic myositis ossificans, which develops following traumatic injuries, burns or arthroplasty. A variety of other forms of HO also exist, such as those associated with central nervous system injury and systemic forms that can manifest at other joints simultaneously. Clinically, patients can present with decreased range of motion, pressure ulcers, nerve compression, swelling, pain or asymptomatically. Symptomatic patients are most commonly treated ...

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Prophylaxis of Heterotopic Ossification of the Hip: Systematic Review and Meta-Analysis

Cited by 109 publications

References 32 publications

Risk Factors for the Development of Heterotopic Ossification After Acetabular Fracture Fixation

Risk Factors for the Development of Heterotopic Ossification After Acetabular Fracture Fixation

Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients

Management of pelvic heterotopic ossification post-myocutaneous flap reconstruction of a sacral pressure ulcer

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