Abstract
BackgroundHeterotopic ossification (HO) is a complication after tissue trauma, fracture and surgery (i.e. total hip arthroplasty). Prophylaxis is the most effective therapy. If HO formations become symptomatic and limit patients’ quality of life, revision surgery is indicated and is usually combined with a perioperative oral prophylaxis (NSAIDs) and/or irradiation. However, a long-term use of NSAIDs can induce gastro-intestinal or cardiac side-effects and possible bony non-unions during fracture healing. Subject of this study was to assess the current status of HO prophylaxis after injuries or fractures and to evaluate current indications and strategies for excision of symptomatic HO.MethodsBetween 2013 and 2014, a questionnaire was sent to 119 orthopaedic and trauma surgery departments in Germany. Participation was voluntary and all acquired data was given anonymously.ResultsThe cumulative feedback rate was 71 %. Trauma and orthopaedic surgery departments in Germany recommend oral HO prophylaxis after acetabulum and femoral neck fractures, elbow dislocation, and fracture or dislocation of the radial head. Pain upon movement and an increasing loss of range of motion in the affected joint are considered to be clear indications for HO surgery. A partial removal of ROM-limiting HO formations was also considered important. The vast majority of all departments include perioperative oral HO prophylaxis and/or irradiation if surgical HO removal is planned. The choice and duration of NSAIDs is highly variable.ConclusionHO is of clinical significance in current traumatology and orthopaedics. Certain fractures and injuries are prone to HO, and prophylactic measures should be taken. The respondents in this survey assessed current therapeutic strategies for HO formations similarly. These concepts are in line with the literature. However, the duration of perioperative oral HO prophylaxis varied greatly among the specialist centres. This is significant as a long-term use of NSAIDs fosters a potential risk for the patients’ safety and could influence the clinical outcome. National and international guidelines need to be developed to further reduce HO rates and improve patients’ safety in trauma and orthopaedic surgery.
Highlights
Heterotopic ossification (HO) is a complication after tissue trauma, fracture and surgery
The evaluation of surgical strategy and techniques for HO excision were moderately different among orthopaedic and trauma surgeons
The use of Ribonucleic acid i (RNAi) might become an additional new alternative [26]. These options are currently at an experimental stage but could become available in the near future to further reduce HO rates in orthopaedic and trauma surgery. This survey indicates that orthopaedic and trauma surgeons in Germany consider HO to be of clinical relevance in their daily practice
Summary
Heterotopic ossification (HO) is a complication after tissue trauma, fracture and surgery (i.e. total hip arthroplasty). Heterotopic ossification (HO) can occur after tissue trauma (i.e. gunshot wounds), cerebral and spinal cord injury, bone fractures or surgery such as total hip arthroplasty (THA) [1, 2]. An effective HO prophylaxis requires identifying known risk factors in the patient, using gentle surgical techniques and applying perioperative non-steroidal anti rheumatic drugs (NSAIDs), COX-2 blockers and lowdose irradiation [2].
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