Heterotopic ossification: a challenging complication of total hip arthroplastyrisk factors, diagnosis, prophylaxis and treatment

Legosz P,Synder M,Otworowski M,Sibilska A,Kotrych D,Starszak K

doi:10.4172/1758-4272.1000189

Abstract

Background: This review is intended to summaries the risk factors, classification, diagnosis and treatment of heterotopic ossification (HO) of previously published studies. Results: Heterotopic Ossification is a common complication of total hip arthroplasty. Its prevalence isn’t the same in all of the patient groups. Frequency of HO varies from 15% to 90%. Hip ankylosis, male gender and previous history of HO are said to be risk factors with a significant level. Diagnosis is based on a single AP radiograph-the Brooker classification that divides HO into four grades is the most commonly used. The confirmation test that can be used is a bone scan. A great amount of bone metabolic turnover markers have been tested, but none of them seems to be relevant in case of prevention or diagnosis of HO. The most effective prophylactic treatment is radiotherapy or administration of nonsteroidal anti-inflammatory drugs. Over the years a lot of different RT protocols has been tested. Nowadays the most often used regimen is 7 Gy given postoperatively in a single dose. The most commonly prescribed drug in prophylaxis of HO is indomethacin. Also, the efficacy of ibuprofen and diclofenac were proven. Recently researchers focused on selective COX-2 inhibitors. They appear to be as effective as nonselective NSAIDs having less side effects. The one and only treatment of HO is a revision arthroplasty.

Highlights

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare form of inflammatory arthritis, typically affecting elderly men with a clinical picture of symmetric polyarthritis and pitting edema on the dorsum of hands, and sometimes the feet
Several reports have considered this to be a form of polymyalgia rheumatica and even seronegative rheumatoid arthritis, but several differences in the clinical presentation and pathophysiologic mechanisms indicate that it may be a separate entity
The name includes the term synovitis, the most characteristic finding is tenosynovitis of the extensor tendons of the hands, RS3PE has been described in association with other rheumatologic disease including sarcoidosis [3], gout [4], Sjogren syndrome [5] and polymyalgia rheumatica [6,7]

Summary

International Journal of Clinical Rheumatology

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE): A case report and brief review. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare form of inflammatory arthritis, most often affecting elderly individuals and characterized by polyarthritis most commonly affecting the hands and feet in a symmetric fashion, associated with pitting edema on the dorsum of the hands (and occasionally the feet). Symptoms often spontaneously remit and are usually very responsive to low dose glucocorticoids. RS3PE has been considered as forme fruste of polymyalgia rheumatica. It can occur as a paraneoplastic syndrome and can sometimes be a harbinger of malignancy. This article describes a case of RS3PE, followed by a review of literature about this very intriguing rheumatologic disease

Introduction

Case presentation

Discussion

Conclusion