Recurrence Of Heterotopic Ossification Research Articles

Treatment and rehabilitation of post-traumatic elbow stiffness with heterotopic ossification.

To investigate surgical treatment, postoperative rehabilitation and prevention of heterotopic ossification (HO) in patients with post-traumatic elbow stiffness. We performed a retrospective review of patients with post-traumatic elbow stiffness combined with HO between 2007 and 2021. This study was performed on a total of 15 patients (18 elbows) admitted to our hospital, consisting of 12 males and 3 females, with post-traumatic stiffness of the elbow combined with HO, where elbow function could not be recovered by rehabilitation and orthosis treatment. Fifteen patients were treated by surgical excision of heterotopic bones and release of elbow contracture combined with postoperative rehabilitation and orthosis-wearing. Comprehensive treatments, including radiation, oral ibuprofen medication, and manipulation techniques to improve range of motion, were used to prevent HO recurrence. The flexion-extension arc and functional score of the elbow were measured after treatment and compared with the preoperative measurements. Roentgenography was used to observe HO recurrence. After surgical treatment and postoperative rehabilitation, the patients' range of motion improved, and the functional score improved considerably. The postoperative flexion-extension arc and The Hospital for Special Surgery (HSS) functional score were statistically significantly higher than the preoperative values (p < 0.01). Roentgenographic examination showed no HO recurrence during the follow-up period. Surgical excision of heterotopic bones and elbow contracture release combined with postoperative rehabilitation and preventative HO measures can be an effective treatment for cases of post-traumatic elbow stiffness combined with HO, for which conservative treatment is ineffective.

Tranexamic acid in patients with post-traumatic elbow stiffness: protocol for a randomised, double-blind, placebo-controlled trial investigating the effectiveness of tranexamic acid at reducing the recurrence of heterotopic ossification after open elbow arthrolysis

IntroductionExaggerated inflammatory response is one of the main mechanisms underlying heterotopic ossification (HO). It has been suggested that the antifibrinolytic drug tranexamic acid (TXA) can exert a significant anti-inflammatory effect...

Resection Outcomes of Posttraumatic Elbow Heterotopic Ossification: Multicenter Case Series at a Minimum 5-Year Follow-Up.

Heterotopic ossification (HO), a common complication after elbow trauma, causes severe limb disability. Resection is usually performed for posttraumatic elbow HO (PTEHO) to regain mobility, and although heavily reported, there has been no long-term (minimum, 5-year) follow-up. A total of 173 patients who underwent PTEHO resection were followed up for a minimum of 5 years in 4 hospitals between January of 2015 and August of 2016. Demographics, disease characteristics, and preoperative and minimum 5-year assessments were collected. After controlling for potential variables when dividing long-term range of motion (ROM) into less than 120 degrees and greater than or equal to 120 degrees, risk factors for ROM recovery to modern functional arc were identified through multivariable regression analysis. Clinically important improvements in ROM from 39 degrees to 124 degrees were obtained at final follow-up, and 74.6% achieved modern functional arc (≥120 degrees). Mayo Elbow Performance Index had clinically important increases from 69 to 93 points at final follow-up, and 96.5% reported excellent to good. Pain (numeric rating scale, from 1.9 to 0.6 points) and ulnar nerve symptoms were improved. The total complication rate was 15.6%, including new-onset ulnar nerve symptoms (5.8%), HO recurrence with clinical symptoms (6.9%), elbow instability (1.7%), and joint infection (1.2%). Previously reported high body mass index ( P = 0.002) and long disease duration ( P = 0.033) were equally identified as risk factors for not achieving modern functional arc; meanwhile, tobacco use ( P = 0.024) and ankylosed HO ( P < 0.001) were found to be new risk factors. Resection yields satisfactory outcomes for PTEHO at long-term follow-up of a minimum of 5 years. High body mass index, tobacco use, long disease duration, and ankylosed HO would negatively affect ROM recovery to a modern functional arc (≥120 degrees). Risk, III.

Role of radiotherapy in the management of heterotopic ossification

Heterotopic ossification (HO) is a process of pathological bone formation in non-osseous tissue. Frequently, it is a complication that occurs from various causes such as traumatic, neurogenic, or genetic disorders, where trauma is the most common cause. HO is of major concern as it can lead to functional disorders, pain, and even to joint ankylosis. Non-steroidal anti-inflammatory drugs and radiotherapy (RT) are preferred in the treatment of HO. RT serves as an important modality for the management of HO because RT potentially inhibits osteoprogenitor cell proliferation. This is a case report of an 18-year-old girl, who developed grade 4 HO at her right hip joint following a fall from height. She, then, underwent excision of heterotopic bone and RT to the right hip joint at a dose of 8 gray (Gy) delivered in 1 fraction, within 48 h of excision. The patient did not report any acute adverse effects related to RT and demonstrated clinical improvement in her range of motion without any recurrence of HO at her 3 and 6-month follow-ups.

Do Clinical Parameters Reflect Local Bone Metabolism in Heterotopic Ossification After Septic or Aseptic THA?

Do Clinical Parameters Reflect Local Bone Metabolism in Heterotopic Ossification After Septic or Aseptic THA?

Endoscopic Excision of Hip Heterotopic Ossification, Plus Indomethacin and Radiation, Is Effective in Treating and Preventing Recurrence

To describe the clinical and patient-reported outcomes of heterotopic ossification (HO) excision as well as the results of a standardized HO prophylaxis protocol among a group of patients who previously underwent open or arthroscopic hip surgery. Patients who developed HO after index hip surgery and were subsequently treated with arthroscopic excision of HO and postoperative HO prophylaxis using 2 weeks of indomethacin and radiation were retrospectively identified. All patients were seen by a single surgeon and were treated with the same arthroscopic technique. Patients were also placed on a regimen of 2 weeks of indomethacin 50 mg and radiation therapy with 700 cGy in one fraction on the first postoperative day. Outcomes assessed included recurrence of HO and conversion to total hip arthroplasty by latest follow-up. Other outcomes included Modified Harris Hip Scores and Non-Arthritic Hip Scores, which were collected preoperatively and at 1-year and 2-year follow-up. There were 5 female and 9 male subjects, with an average age of 39 years (range 22-66) and average body mass index of 27.1 (19.1-37.5). Average follow-up time was 46 months (range 4-136). No patients had experienced HO recurrence by latest follow-up. Only 2 patients converted to total hip arthroplasty, one at 6 months and the other at 11 months postexcision. Average outcome scores improved by 2-year follow-up (average Modified Harris Hip Scores 52.8 improved to 86.5, average Non-Arthritic Hip Scores 49.4 improved to 83.8). Minimally invasive arthroscopic excision of HO and postoperative prophylaxis with combined indomethacin and radiation therapy effectively treats and prevents the recurrence of HO. Level IV, case series, therapeutic.

Fifteen years’ experience of radiation therapy for resected advanced heterotopic ossification following motor vehicle accidents: outcome and side effects

BackgroundSurgical resection is the primary treatment for advanced-stage heterotopic ossification (HO), with a high incidence of local recurrence reaching up to 50%. Postoperative radiotherapy (PORT) and indomethacin are commonly used prophylactic strategies following surgery. The study aims to assess the safety and effectiveness of PORT in advanced-stage HO patients having motor vehicle accidents (MVA).MethodsMedical records of patients having HO following MVA between 2006 and 2021 were retrospectively reviewed. Thirty-nine patients with advanced disease (35 had hip HO and 4 had elbow HO) were included in the study.ResultsExcision of HO with joint preservation was performed for 82% of patients, while 18% had a joint replacement. Seven to 8 Gy radiation was given to all patients within 3 days postoperatively. A ninty seven percent of patients regained partially the movement range. The mean follow-up time was 74 months. Six patients had treatment failure, with only one having a recurrence of HO. The 8-year treatment failure-free rate (8-y TFFR) was 79.3±9%, and the 5-year HO failure-free rate (5y-HOFFR) was 97.2±3%. Acute side effects were experienced in 13% of patients but resolved without any consequences. Despite the relatively long follow-up time, we did not report any absolute infertility or secondary malignancies related to the radiation. The testicular mean calculated dose was 33±44 cGy, and the mean measured dose was 58±40 cGy. Of the 35 patients who received radiation to the pelvis, 26 were married, and all did not experience infertility post-treatment.ConclusionPORT proved an effective and safe treatment for advanced-stage HO disease. The treatment failure is mainly related to surgical difficulties due to advanced disease. Treatment using a 3-dimensional or intensity-modulated radiation therapy is not associated with serious side effects like second malignancy or absolute infertility.

Reccurence of Heterotopic Ossification as the Result of Total Hip Endoprosthesis Dislocation: A Case Report

Background. Heterotopic ossification (HO) is the formation of mature bone in soft tissues. HO in the hip area can be a consequence of both injury to the nervous system and local trauma. After total hip arthroplasty HO develops in 30% of cases.&#x0D; The aim of the study is to demonstrate a rare clinical case of a recurrence of HO in patient after a primary total hip arthroplasty, accompanied by ankylosing.&#x0D; Case presentation. A 32-year-old patient was admitted to the clinic for revision hip arthroplasty with a diagnosis long-standing dislocation of the right hip joint endoprosthesis head, heterotopic ossification 3 years after dislocation. During the surgery, there were difficulties with the sciatic nerve dissection, as well as the structures of the endoprosthesis. We removed all the ossifications that obstructed the dislocation of the endoprosthesis. The patient had sciatic nerve neuropathy on the right lower limb with lesions of the fibular and tibial nerves on the background of edema. The patient was discharged on the 21st day. The presented clinical case is interesting because the patients relapse could be caused by a combination of various risk factors. Taking into account the fact that the injury was received as a result of an accident and the patient had a fracture of the bones of the contralateral shin, it could be the effect of a local hip injury that aggravated the process.&#x0D; Conclusions. This clinical observation highlights the importance of preventing possible complications after surgery and maintaining feedback with patients, especially those belonging to the high-risk group. It is likely that with adequate prevention of the HO formation and timely reduction of dislocation, the problems described in the article after primary total hip arthroplasty could have been avoided.

Surgical Resection Combined with Adjuvant Radiotherapy and Non-Steroidal Anti-Inflammatory Drugs in the Treatment of Heterotopic Ossification Following Total Hip Arthroplasty.

Heterotopic ossification (HO) is a well-known complication following total hip arthroplasty (THA), with an average incidence of 30%. Patients are classified according to Brooker's staging system. In advanced stages (III and IV), HO may limit hip motion and cause intolerable pain. For these symptomatic stages, surgical excision is mandatory, usually combined with prophylaxis of recurrence with non-steroidal anti-inflammatory drugs (NSAIDs) and/or radiotherapy. We present the case of a 70-year-old woman who developed Stage IV HO after undergoing THA for left hip osteoarthritis. Surgical excision of the HO was performed eighteen months after THA, with adjuvant radiotherapy and indomethacin. After two years of follow-up, the patient had a good hip function with no recurrence of HO. Several authors have studied the effect of NSAIDs and radiotherapy in HO prophylaxis and in HO treatment but there is lack of reports concerning the combination of the two strategies with surgery in the postoperative period. We therefore report this successful case of post-THA HO treatment with surgical excision and post-operative radiotherapy and NSAIDs.

Surgical excision of heterotopic ossification associated with anti-N-methyl-d-aspartate receptor encephalitis: A case report.

Introduction and importanceHeterotopic ossification (HO) associated with Anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis is rare and the treatment strategy is unclear.Case presentationWe report the case of a 31-year-old female diagnosed with anti-NMDA receptor encephalitis from Osaka General Medical Center, Osaka, JAPAN that developed heterotopic ossification of the knees during prolonged coma. She was unable to walk because of pain and limited range of motion in both knees. Thirty months after the onset of the coma, surgical excision of the heterotopic bone in both knees was performed. The range of motion of both the knees improved markedly and she had no recurrence of heterotopic ossification on a three-year follow-up. Thus, this case can be used as a guide for surgeons with such patients.ConclusionsWe reported a case of heterotopic bone formation in the periarticular region of both bilateral knees in a patient who suffered a 2-month coma following anti-NMDA receptor encephalitis. Surgical excision of the heterotopic bones significantly improved the passive range of motion in both knees. Three years after the operation, the patient had no complaints about her knees, and there was no recurrence of HO.

Inhibition of ROS activity by controlled release of proanthocyanidins from mesoporous silica nanocomposites effectively ameliorates heterotopic ossification in tendon

• High levels of reactive oxygen species (ROS) were found in tendinopathy. • MSNs-PC promote tenogenesis differentiation of TSPCs. • MSNs-PC alleviated heterotopic tendon ossification by scavenging excess ROS. In the inflammatory environment of tendinopathy, tendon stem/progenitor cells (TSPCs) have been demonstrated to aberrantly differentiate into osteochondral lineage causing late-stage heterotopic ossification (HO) of the tendon, which severely damages tissue function and worsens patients’ activities. However, no effective treatment for tendinopathy currently exist because the mechanism underlying the TSPCs abnormal differentiation is unclear. In this article, high levels of reactive oxygen species (ROS) were found in tendinopathy samples. In vitro results revealed that proanthocyanidins (PC) can potentially regulate the differentiation of TSPCs by scavenging excess ROS, which would promote tenogenesis instead of chondrogenesis or osteogenesis. Moreover, in vivo results demonstrated that PC-loaded mesoporous silica nanocomposite (MSNs-PC) hinders the recurrence of HO in repaired tendons owing to the inhibition of oxidative stress, showing anti-inflammatory effects. Our findings indicate a high level of ROS in tendinopathy, which is probably the cause of aberrant differentiation of TSPCs. MSNs-PCs can effectively ameliorate HO of the tendon by scavenging excess ROS, providing a promising avenue to for other ROS-related diseases.

Comparing Options for Heterotopic Ossification Prophylaxis following Elbow Trauma: A Systematic Review and Meta-Analysis

Introduction Heterotopic ossification (HO) can be a potentially serious and devastating complication following traumatic injury to the elbow. HO prophylaxis options include nonsteroidal anti-inflammatory drugs (NSAIDs) and radiation therapy (RT) but neither has been proven more effective. The purpose of this review is to compare effectiveness and outcomes between NSAID and RT prophylaxis for HO about the elbow following a traumatic injury.Materials and Methods We performed a systematic review of PubMed and Cochrane Library for cases of HO prophylaxis following elbow trauma utilizing PRISMA guidelines to determine the most effective form of prophylaxis. Outcomes of interest included recurrence of HO, range of motion (ROM), and Mayo elbow performance index (MEPI). A total of 36 articles and 826 elbows of which 203 received RT and 623 received NSAID were identified and included in the final analysis.Results Rates of HO formation or recurrence following elbow trauma were similar between radiation and NSAID prophylaxis (15.6% vs. 22.2%, respectively p = 0.457). ROM was similar in flexion and extension arc (109.0 degrees in radiation vs. 112.8 in NSAIDs, p = 0.459) and in pronation and supination arc (118.9 degrees radiation vs. 134.7 degrees NSAIDs, p = 0.322). MEPI scores were 79.19 in the radiation group and 88.82 in the NSAIDs group at the final follow-up.Conclusion There is no statistical difference in HO development, recurrence, or final ROM between NSAIDs and RT prophylaxis following trauma to the elbow. We recommend the choice of modality based on patient characteristics, cost, and surgeon preference.Level of Evidence Level III.

HIP INJURY -- WRESTLING

HISTORY: A 21-year-old college wrestler presented with progressive, persistent pain in his right hip after undergoing arthroscopy at an outside institution. Despite multiple attempts at non-operative management, including activity modification, rest, physical therapy, and use of nonsteroidal anti-inflammatory drugs, pain and stiffness limited his sport-specific function. PHYSICAL EXAMINATION: Markedly limited active range of motion, particularly with hip flexion beyond 90 degrees; pain with range of motion DIFFERENTIAL DIAGNOSIS: 1. Chondral injury to femoral head 2. Injury (recurrence of tear) to acetabular labrum 3. Persistent cam type impingement of right hip 4. Chondromalacia of right acetabulum TEST AND RESULTS: Plain radiographs of pelvis and both hips MRI of right hip MR-arthrogram of right hip Results of all imaging studies were consistent with early progression of osteoarthritis, with changes considered advanced for a patient of his age. FINAL/WORKING DIAGNOSIS: Chondral injury and heterotopic ossification (HO) secondary to chronic cam type femoroacetabular impingement TREATMENT AND OUTCOMES: 1. Right hip revision arthroscopy with labral resection and labral reconstruction with allograft tissue 2. Right hip revision arthroscopic cheilectomy/femoroplasty 3. Right hip arthroscopic excision of HO fragment measuring 3 cm x 2 cm in anterior lateral joint capsule 4. Right hip arthroscopic chondroplasty of acetabulum with microfracture/bone marrow stimulation procedure 5. Immediate post-operative physical therapy (day of surgery) 6. Single dose of external beam radiation on post-operative day 1 to minimize risk of recurrence of HO 7. 20 pounds flat foot weightbearing restriction for six weeks 8. Naproxen 375 mg bid x 6 weeks to minimize risk or recurrence of HO 9. Continuous passive motion in immediate post-operative period

L’obésité comme facteur de risque d’ossifications hétérotopiques dans les raideurs du coude post traumatiques de l’enfant et adolescent

BackgroundPost-traumatic elbow stiffness and heterotopic ossification (HO) affects long-term life quality, as commonly in children and teenagers as in grownups. Childhood obesity considerably influences public health because it causes stroke, hypertension and diabetes mellitus. Previous research discussed its clinical complications in orthopedic diseases. However, no clinical research reveals the interaction between childhood obesity and HO after elbow injuries. HypothesisObesity might be a risk factor of recurrent HO after elbow arthrolysis in children and teenagers, correlated with the severity of postoperative HO. MethodsFifty-seven post-traumatic children and teenagers undergoing elbow arthrolysis were retrospectively reviewed and divided into underweight/normal-weight group (n=28) and overweight/obese group (n=29) according to the gender-specific body mass index (BMI)-for-age growth chart. The Hastings and Graham Classification was used to evaluate HO recurrence. We also assessed Mayo Elbow Performance Scores and range of motion. ResultsThe mean age, gender, pathogenesis, side of injury, time of injury, follow-up duration were analyzed. Overweight/obese children and teenagers were more likely to develop recurrent HO (p=0.005) than underweight/normal-weight children and teenagers. A significant difference in the severity of recurrent HO between two groups was confirmed (p=0.028). The range of motion was improved greatly in underweight/normal-weight group compared with that in overweight/obese group (p=0.001). ConclusionsThe HO recurrence difference between two groups confirmed the hypothesis. Although underlying mechanisms are unclear, weight control might promote postoperative and long-term rehabilitation of the elbow joint for children and teenagers. Level of evidenceLevel III, retrospective cohort study, treatment study.

Obesity may be a risk factor for recurrent heterotopic ossification in post-traumatic stiff elbow among children and teenagers

BackgroundPost-traumatic elbow stiffness and heterotopic ossification (HO) affects long-term life quality, as commonly in children and teenagers as in grownups. Childhood obesity considerably influences public health because it causes stroke, hypertension and diabetes mellitus. Previous research discussed its clinical complications in orthopedic diseases. However, no clinical research reveals the interaction between childhood obesity and HO after elbow injuries. HypothesisObesity might be a risk factor of recurrent HO after elbow arthrolysis in children and teenagers, correlated with the severity of postoperative HO. MethodsFifty seven post-traumatic children and teenagers undergoing elbow arthrolysis were retrospectively reviewed and divided into underweight/normal-weight group (n=28) and overweight/obese group (n=29) according to the gender-specific body mass index (BMI)-for-age growth chart. The Hastings and Graham classification was used to evaluate HO recurrence. We also assessed Mayo elbow performance scores and range of motion. ResultsThe mean age, gender, pathogenesis, side of injury, time of injury, follow-up duration were analyzed. Overweight/obese children and teenagers were more likely to develop recurrent HO (p=0.005) than underweight/normal-weight children and teenagers. A significant difference in the severity of recurrent HO between two groups was confirmed (p=0.028). The range of motion was improved greatly in underweight/normal-weight group compared with that in overweight/obese group (p=0.001). ConclusionsThe HO recurrence difference between two groups confirmed the hypothesis. Although underlying mechanisms are unclear, weight control might promote postoperative and long-term rehabilitation of the elbow joint for children and teenagers. Level of evidenceIII, retrospective cohort study, treatment study.

Mkx-Deficient Mice Exhibit Hedgehog Signaling-Dependent Ectopic Ossification in the Achilles Tendons.

Heterotopic ossification is the abnormal formation of mineralized bone in skin, muscle, tendon, or other soft tissues. Tendon ossification often occurs from acute tendon injury or chronic tendon degeneration, for which current treatment relies heavily on surgical removal of the ectopic bony tissues. Unfortunately, surgery creates additional trauma, which often causes recurrence of heterotopic ossification. The molecular mechanisms of heterotopic ossification are not well understood. Previous studies demonstrate that Mkx is a transcription factor crucial for postnatal tendon fibril growth. Here we report that Mkx-/- mutant mice exhibit ectopic ossification in the Achilles tendon within 1 month after birth and the tendon ossification deteriorates with age. Genetic lineage labeling revealed that the tendon ossification in Mkx-/- mice resulted from aberrant differentiation of tendon progenitor cells. Furthermore, tissue-specific inactivation of Mkx in tendon cells postnatally resulted in a similar ossification phenotype, indicating that Mkx plays a key role in tendon tissue homeostasis. Moreover, we show that Hedgehog signaling is ectopically activated at early stages of tendon ossification and that tissue-specific inactivation of Smoothened, which encodes the obligatory transducer of Hedgehog signaling, in the tendon cell lineage prevented or dramatically reduced tendon ossification in Mkx-/- mice. Together, these studies establish a new genetic mouse model of tendon ossification and provide new insight into its pathogenic mechanisms. © 2018 American Society for Bone and Mineral Research.

Role of radiotherapy in heterotopic ossification: a case report and literature review

Heterotopic ossification (HO), a process of pathological bone formation in non-osseous tissue limits range of motion and causes stiffness of the affected joints. In addition to the administration of non-steroidal anti-inflammatory drugs, radiotherapy (RT) serves as an alternative prophylactic modality for the management of HO because RT potentially inhibits osteoprogenitor cell proliferation. We report a case of a 52-year-old woman with known underlying medical conditions who developed grade 4 HO at her left hip joint following a cerebrovascular accident. She then underwent RT using conventional opposed anterior-posterior configurations to the left hip joint at a dose of 10 Gray (Gy) delivered in 2 fractions on 2 consecutive days, within 48 hours after excision of the HO. The patient did not report any acute adverse effects related to RT and demonstrated clinical improvement in her range of motion at the left hip without any recurrence of HO at her 2-year follow-up. Although HO is a rare disease entity, our results and those of prior studies demonstrate that the administration of RT using a 10 Gy dose delivered in 2 fractions postoperatively is a safe and effective prophylactic treatment option against HO.

Appropriate excision time of heterotopic ossification in elbow caused by trauma

ObjectiveThe aim of this study was to investigate the optimal timing for the resection of heterotopic ossification (HO) of the elbow. MethodsWe retrospectively reviewed 42 patients who were treated operatively for heterotopic ossification of the elbow from March 2010 to December 2014 at our institution. The patients were divided into early (before 12 months) and late (after 12 months) excision groups. In the early excision group (17 patients), the average time from the initial injury to HO excision was 7.4 (3–11) months, and in the late excision group (25 patients), the average time was 33.5 (12–240) months. Every patient was evaluated by range of motion (ROM), the Mayo Elbow Performance Score (MEPS), postoperative complications and HO recurrence. ResultsThe preoperative mean ROM in the late excision group was greater than that of the early excision group, suggesting that the ROM is expected to increase even without surgery. Both early and late surgery increased ROM and MEPS, but early surgery improved ROM and MEPS more than late surgery did (p < .05). ConclusionsEarly excision of HO can provide better elbow function, as indicated by ROM and MEPS. Considering that there were no notable differences in postoperative ROM and MEPS, HO recurrence, or postoperative complications, we concluded that early excision is safe and that the time from an elbow injury to surgery may be shortened. Level of EvidenceLevel III, therapeutic study.

Open surgical elbow contracture release after trauma: results and recommendations

Post-traumatic elbow contracture is a debilitating complication after elbow trauma. The purpose of this study was to characterize the affected patient population, operative management, and outcomes after operative elbow contracture release for treatment of post-traumatic elbow contracture. A retrospective record review was conducted to identify all patients who underwent post-traumatic elbow contracture release performed by 1 of 3 surgeons at one academic medical center. Patient demographics, injuries, operative details, outcomes, and complications were recorded. The study included 103 patients who met inclusion criteria. At the time of contracture release, patients were a mean age of 45.2 ± 15.6 years. Contracture release resulted in a significant mean increase to elbow extension/flexion arc of motion of 52° ± 18° (P < .0005). Not including recurrence of contracture, a subsequent complication occurred in 10 patients (10%). Radiographic recurrence of heterotopic ossification (HO) occurred in 14 patients (14%) after release. Ten patients (11%) elected to undergo a secondary operation to gain more motion. Soft tissue and bony elbow contracture release is effective. Patients with post-traumatic elbow contracture can make significant gains to their arc of motion after contracture release surgery and can expect to recover a functional elbow arc of motion. Patients with severe preoperative contracture may benefit from concomitant ulnar nerve decompression. HO prophylaxis did not affect the rate of HO recurrence or ultimate elbow range of motion. However, patients must be counseled that contracture may reoccur, and some patients may require or elect to have more than one procedure to achieve functional motion.

Results from the surgical resection of severe heterotopic ossification of the hip: a case series of 26 patients

Surgical resection of heterotopic ossification (HO) around the hip joint is often challenging. The aim of this study is to evaluate the clinical and radiological outcomes following surgical resection of Brooker's type III and IV HO of the hip. We retrospectively reviewed clinical and radiological data, between November 2006 and January 2013, of all patients who underwent surgical resection of severe HO of the hip. Brooker's grading, range of motion and the Harris Hip Score before and after surgery were recorded in all cases. The combined radiation (700cGy preoperatively) and indomethacin regimen was used to prevent heterotopic ossification recurrence. Twenty-six patients (22 males and 4 females) were included in our study. Mean patient age was 47.38years (range 24-72). The HO was graded as Brooker grade III in 3 patients (11.5%) and Brooker grade IV in 23 patients (88.5%). Mean time interval between HO development and resection was 40.8months (range 13-156months). All patients had CT scans prior to surgery. Mean follow-up was 31.4months (range 24-40months). There was no severe HO recurrence. Complications included one intraoperative injury of a femoral artery branch, one intraoperative femoral neck fracture treated with intramedullary nailing, one sciatic nerve injury and one superficial infection treated conservatively. Surgical resection of severe HO of the hip along with preoperative radiation and indomethacin provides excellent results; however, the complication rate is relatively high. Careful evaluation of the preoperative CT scan and wide exposure are required in order to identify all the involved neurovascular structures.