Management and Prevention of Postamputation Heterotopic Ossification

Abstract

Heterotopic bone growth is a common finding following partial foot amputation that can predispose to recurrent wounds and osteomyelitis. Heterotopic ossification is the formation of excess mature lamellar bone in the soft tissues adjacent to bone that is exacerbated by trauma or surgical intervention. With a reported incidence as high as 75 % following certain procedures, this unwanted bone growth following local amputation can lead to a prominence on the plantar aspect of the foot that may predispose the patient to recurrent neuropathic ulceration. Not infrequently, these sites of re-ulceration can become complicated by osteomyelitis, necessitating repeat partial foot amputation. This can be a devastating complication in the diabetic neuropathic patient already considered at high risk for limb amputation. Several perioperative and intraoperative prophylactic measures can be employed to minimize the potential for the development of heterotopic ossification. Intraoperative surgical techniques to minimize the potential for bone-forming hematoma should routinely be applied. In the patient deemed at high risk for heterotopic bone growth, single-dose prophylactic radiation therapy can be applied to the affected foot in the perioperative period. Heterotopic ossification is a common and potentially detrimental complication of partial foot amputations that requires routine prophylactic consideration.