Resection of heterotopic ossification of the hip in spinal cord injured patients

Abstract

Twenty nine spinal cord injury patients were treated by resection of heterotopic ossi®cation in 41 hips. The average follow-up period after surgery was 4.2 years. The mean time to surgery after injury was 82.1 months. The indications for surgery were seating problems, loss of function, pressure sores and pain. The average preoperative motion in¯exion and extension was 21.958, the average intraoperative motion was 94.518. The average motion at follow-up evaluation was 82.688. Clinical relevant recurrence occurred in three patients. Complications excluding recurrence occurred in 10 hips, including deep and super®cial wound infections, fracture, aneurysm and pressure ulcer. The operation was followed by a speci®c regime of physiotherapy and radiation therapy.

Neurogenic heterotopic ossification in spinal cord injury

“…49,116,171,175 Operative resection of NHO is generally associated with severe complications and poor outcome. 45,49,71,173 ± 176 It has been suggested that the recurrence of NHO after resection can be reduced, if the NHO is removed during a radionuclide steady stage, however, this policy is not supported by unequivocal clinical evidence.…”

“…Stover 174 has reported intra-operative fracturation of the femoral head in 5% and post-operative (spontaneous) fracturation in 3 ± 16% of the SCI patients operated for NHO around the hip joint. Since other authors mention a higher percentage (29%) 175 of SCI patients with femoral heads too brittle to preserve during operation, the real incidence of this problem may be even higher. NHO resection is also associated with a poor outcome due to a high recurrence rate.…”

“…172 ± 175 However, operative resection of NHO has been associated with severe complications and poor outcome. 171 These complications include deep (2 ± 5%) 174,175 or super®cial infection (7 ± 38%), 45,49,174,175 post-operative haemorrhage (5 ± 38%), 45,173 and excessive intra-operative bleeding requiring (multiple) blood transfusions (9 ± 83%). 49,174 ± 176 Moreover, intra-and post-operative fracturation of bone may occur in the case of severe osteoporosis.…”

“…As for THA, both irradiation and indomethacin seem to be e ective in reducing the occurrence of heterotropic ossi®cation after THA, 152,153,160 ± 163 whereas EHDP has been abandoned due to its ine ectiveness on bone matrix formation and the high risk of`rebound' ossi®cation. 142,146 In SCI patients EHDP, 174 NSAID, irradiation, 163,165,166,170,175 or a combination of treatments 177 ± 179 have all been recommended to reduce the NHO recurrence after surgery, however, no controlled studies are available. 163,165,166,170,174 ± 179 …”

Microvascular changes in the lower extremities of paraplegics with heterotopic ossification

“…1 In about 15% of these patients, HO induces severe complications such as reduction of the articular movements leading to loss of sitting position, pressure sores, increase in spasticity and pain, which are indications for operative resection of HO. 2,3 The etiology of HO is still unknown and causes of the disease include bone metabolic changes, traumatic lesions and vaso-motor disturbances. 4 ± 7 Recent experimental studies demonstrated the increase of the serum osteoblast mitogenic activity together with an increased condroblastic and osteoblastic activity as consequence of a decreased tissue oxygenation in spinal cord injury.…”