The Surgical Management of the Rare Neurogenic Myositis Ossificans of the Hip: A Report of 3 Cases

Abstract

Introduction: Myositis ossificans (MO) is a benign non-neoplastic condition in which heterotopic bone formation occurs in soft tissues. Neurogenic MO is one variant of MO where the lesion is a result of neurological disorders, including brain and spinal cord injuries, especially when followed by immobility and spasticity. MO can also be a result of direct trauma or even genetic mutations. Case Report: We present three cases of young men (16, 37, and 22-year-old) who developed MO of the hip joint following brain or spinal cord injuries. One of them had also sustained a direct trauma to the affected hip joint at the time of the accident. All three patients presented with inability to walk independently due to diminished range of motion at the affected joint. X-rays and computerized tomography (CT) scans with 3-dimentional (3D) reconstruction suggested the diagnosis of MO, but the serum alkaline phosphatase was within normal limits at the time of presentation. The first case had bilateral involvement with unmistakable separation between the heterotopic bone formation and the frank hip joints on CT. This patient underwent successful staged excision of the ossifications. The second patient had unilateral hip joint involvement with the absence of clear separation between the heterotopic bone formation and the hip joint, thus, underwent total hip replacement for the affected side as excision was not possible. The third patienthad unilateral hip joint involvement and underwent excision of the ossification with dynamic hip screw insertion after sustaining a stable intertrochanteric fracture intraoperatively. Postoperatively, all three patients received physiotherapy and oral indomethacin. Upon recovery, they were able to walk independently with a near-normal range of motion at the hip joint. There was no evidence of recurrence upon follow-up visits, and CT scans in patients I and II. Follow-ups for patient III were not possible as the patient died 1 month after surgery due t

Non‐traumatic myositis ossificans circumscripta in the anterior abdominal wall of a seven‐year‐old Ugandan child: A case report

“…There are different management approaches reported in the literature, that includes immobilization, elevation, ice application, cold laser, acetic acid iontophoresis, extracorporeal shockwave therapy, and surgical excision 23,31 . Among the different management approaches, surgical excision is the most common treatment for non‐traumatic myositis ossificans seen in an unusual site 32 . The presented case had surgical excision of the mass.…”

“… 23 , 31 Among the different management approaches, surgical excision is the most common treatment for non‐traumatic myositis ossificans seen in an unusual site. 32 The presented case had surgical excision of the mass.…”

Are there really specific risk factors for heterotopic ossifications? A case report of ‘non-risk factor’ after total hip replacement

“… 7 The most common causes include previous musculoskeletal injuries (including perioperative injuries), spinal cord injuries and craniocerebral injuries, especially those resulting in long immobilization of the patient, such as coma, paresis or paralysis. 8 Among the factors reducing the risk of heterotopic ossification after surgical treatment of hip joints, the literature emphasizes the advantage of cementless arthroplasty over cemented prostheses and the treatment of hip fractures over elective procedures. Despite the relatively frequent occurrence of ossification, there are many ways to treat cases complicated by dysfunction of the operated joint.…”