Abstract
BackgroundHeterotopic ossification (HO) is a frequent complication following orthopedic and trauma surgery. It often leads to substantial morbidity as many affected patients suffer from pain and joint contractures. Current prophylactic measures include nonsteroidal anti-inflammatory drugs (NSAID) and local radiation. However, several disadvantages such as delayed fracture healing and impaired ossification have been reported. For this reason, a novel approach for prevention of HO was searched for.We hypothesized that systemic administration of hydroxyethyl starch (HES), a substance known to influence microcirculation, would reduce formation of HO in a murine model.MethodsA pre-established murine model was used where HO has been shown to develop following Achilles tendon tenotomy. Twenty CD1 mice were randomly assigned to a control (n = 10) or treatment group (n = 10). The treatment group received two intravenous HES injections perioperatively, while the control group underwent tenotomy only. After ten weeks, the mice were euthanized and micro CT scans of the hind limbs were performed. HO was manually identified and quantitatively assessed. A Wilcoxon rank sum test was used for comparison of both groups.ResultsThe mean heterotopic bone volume in the control group was significantly larger compared to the HES group (2.276 mm3 vs. 0.271 mm3, p = 0.005). A reduction of mean ectopic bone volume of 88 % was found following administration of HES.ConclusionA substantial reduction of HO formation was found following perioperative short-term administration of HES. This work represents a preliminary study, necessitating further studies before drawing ultimate conclusions. However, this simple addition to current prophylactic measures might lead to a more effective prevention of HO in the future.
Highlights
Heterotopic ossification (HO) is a frequent complication following orthopedic and trauma surgery
Acetaminophen use and postoperative ambulation were comparable in both groups
Contrary to the original publication of McClure and colleagues, where HO was reported in 100 % of the tenotomized specimens, we found an overall occurrence of ectopic bone following this procedure in 88.9 % of all limbs (n = 32/36), while no HO was observed in 11.1 % (n = 4/36)
Summary
Heterotopic ossification (HO) is a frequent complication following orthopedic and trauma surgery. Heterotopic ossification (HO) is defined as the presence of lamellar bone in soft tissues, where bone does not normally occur [1] It is typically found following fractures and dislocations, burns, as well as operative procedures. It was suggested that this protein is liberated from normal bone in response to venous stasis, inflammation, or in case of a disease of the connective tissue attachments to bone [6]. All these conditions are often found in immobilized patients as well as following trauma. Prostaglandin E2 has been shown to influence the differentiation of stem cells as well [7, 8]
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