Hip Ankylosis Caused by Heterotopic Ossification: A Case Report
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Published:
Oct 17, 2024
Keywords:
Heterotopic ossification, hip, hip replacement, Brooker
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Abstract
We present the case of a 59-year-old patient with heterotopic ossification in the right hip. This condition developed as a result of right hemiplegia secondary to a traumatic brain injury sustained in a traffic accident. Subsequently, the patient suffered an intracapsular fracture of the left hip, which required joint replacement surgery. Due to the patient’s neurological limitations and postoperative immobility, Brooker grade IV heterotopic ossification with ankylosis developed in the non-operated hip. Surgical resection of the ossification was necessary, and it was found to be highly vascularized and in close proximity to the pelvic neurovascular bundle. Postoperatively, the patient was treated with radiation therapy and non-steroidal anti-inflammatory drugs. At the one-year follow-up, significant improvements in range of motion and independence were observed, with no signs of recurrence.
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How to Cite
Londoño García, R., Avendaño, V. A., Cano González, M. Ángel, Arboleda, J. P., & Moore Velásquez, J. L. (2024). Hip Ankylosis Caused by Heterotopic Ossification: A Case Report . Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(5), 519-527. https://doi.org/10.15417/issn.1852-7434.2024.89.5.1909
Section
Case Presentations
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References
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18. Grohs JG, Schmidt M, Wanivenhaus A. Selective COX-2 inhibitor versus indomethacin for the prevention of
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19. Haran M, Bhuta T, Lee B. Pharmacological interventions for treating acute heterotopic ossification. Cochrane
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20. Fransen M, Anderson C, Douglas J, MacMahon S, Neal B, Norton R, et al. Safety and efficacy of routine
postoperative ibuprofen for pain and disability related to ectopic bone formation after hip replacement surgery
(HIPAID): randomised controlled trial. BMJ 2006;9;333(7567):519. https://doi.org/10.1136/bmj.38925.471146.4F
21. Popovic M, Agarwal A, Zhang L, Yip C, Kreder HJ, Nousiainen MT, et al. Radiotherapy for the prophylaxis of
heterotopic ossification: a systematic review and meta-analysis of published data. Radiother Oncol 2014;113(1):10-7. https://doi.org/10.1016/j.radonc.2014.08.025
22. Seegenschmiedt MH, Martus P, Goldmann AR, Wölfel R, Keilholz L, Sauer R. Preoperative versus postoperative
radiotherapy for prevention of heterotopic ossification (HO): first results of a randomized trial in high-risk patients. Int J Radiat Oncol Biol Phys 1994;30;30(1):63-73. https://doi.org/10.1016/0360-3016(94)90520-7
23. Ploumis A, Belbasis L, Ntzani E, Tsekeris P, Xenakis T. Radiotherapy for prevention of heterotopic ossification of the elbow: a systematic review of the literature. J Shoulder Elbow Surg 2013;22(11):1580-8. https://doi.org/10.1016/j.jse.2013.07.045
24. Coons D, Godleski M. Range of motion exercises in the setting of burn-associated heterotopic ossification at the elbow: case series and discussion. Burns 2013;39(4):e34-8. https://doi.org/10.1016/j.burns.2012.10.014
25. Pakos EE, Ioannidis JP. Radiotherapy vs. nonsteroidal anti-inflammatory drugs for the prevention of heterotopic ossification after major hip procedures: a meta-analysis of randomized trials. Int J Radiat Oncol Biol Phys 2004;60(3):888-95. https://doi.org/10.1016/j.ijrobp.2003.11.015
presentación de un caso. Rev Esp Cir Osteoarticular [Internet] 2019;54(227). Disponible en:
https://rodrigo.uv.es/bitstream/handle/10550/71856/7058135.pdf?sequence=1&isAllowed=y
2. Shehab D, Elgazzar AH, Collier BD. Heterotopic ossification. J Nucl Med 2002;43(3):346-53. PMID: 11884494
3. Cunha DA, Camargos S, Passos VMA, Mello CM, Vaz LS, Lima LRS. Heterotopic ossification after stroke: Clinical
profile and severity of ossification. J Stroke Cerebrovasc Dis 2019;28(2):513-20. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.10.032
4. Bedi A, Zbeda RM, Bueno VF, Downie B, Dolan M, Kelly BT. The incidence of heterotopic ossification after hip
arthroscopy. Am J Sports Med 2012;40(4):854-63. https://doi.org/10.1177/0363546511434285
5. Cipriano CA, Pill SG, Keenan MA. Heterotopic ossification following traumatic brain injury and spinal cord injury. J Am Acad Orthop Surg 2009;17(11):689-97. https://doi.org/10.5435/00124635-200911000-00003
6. Medina A, Shankowsky H, Savaryn B, Shukalak B, Tredget EE. Characterization of heterotopic ossification in burn patients. J Burn Care Res 2014;35(3):251-6. https://doi.org/10.1097/BCR.0b013e3182957768
7. DeBaun MR, Ziino C, LaPrade C, Pun S, Avedian RS, Bellino MJ. An anatomic classification for heterotopic
ossification about the hip. J Orthop 2020;28;21:228-31. https://doi.org/10.1016/j.jor.2020.03.038
8. Hug KT, Alton TB, Gee AO. Classifications in brief: Brooker classification of heterotopic ossification after total hip arthroplasty. Clin Orthop Relat Res 2015;473(6):2154-7. https://doi.org/10.1007/s11999-014-4076-x
9. Wosczyna MN, Biswas AA, Cogswell CA, Goldhamer DJ. Multipotent progenitors resident in the skeletal muscle
interstitium exhibit robust BMP dependent osteogenic activity and mediate heterotopic ossification. J Bone Miner
Res 2012;27(5):1004-17. https://doi.org/10.1002/jbmr.1562
10. Bidner SM, Rubins IM, Desjardins JV, Zukor DJ, Goltzman D. Evidence for a humoral mechanism for enhanced
osteogenesis after head injury. J Bone Joint Surg Am 1990;72(8):1144-9. PMID: 2398084
11. Salisbury E, Rodenberg E, Sonnet C, Hipp J, Gannon FH, Vadakkan TJ, et al. Sensory nerve induced inflammation contributes to heterotopic ossification. J Cell Biochem 2011;112(10):2748-58. https://doi.org/10.1002/jcb.23225
12. Kurer MH, Khoker MA, Dandona P. Human osteoblast stimulation by sera from paraplegic patients with heterotopic ossification. Paraplegia 1992;30(3):165-8. https://doi.org/10.1038/sc.1992.48
13. Cholok D, Chung MT, Ranganathan K, Ucer S, Day D, Davis TA, et al. Heterotopic ossification and the elucidation of pathologic differentiation. Bone 2018;109:12-21. https://doi.org/10.1016/j.bone.2017.09.019
14. Ranganathan K, Loder S, Agarwal S, Wong VW, Forsberg J, Davis TA, et al. Heterotopic ossification: Basic-science principles and clinical correlates. J Bone Joint Surg Am 2015;1;97(13):1101-11. https://doi.org/10.2106/JBJS.N.01056
15. Barbato M, D’Angelo E, Di Loreto G, Menna A, Di Francesco A, Salini V, et al. Adherence to routine use of
pharmacological prophylaxis of heterotopic ossification after total hip arthroplasty: results from an Italian
multicenter, prospective, observational survey. J Orthop Traumatol 2012;13(2):63-7.
https://doi.org/10.1007/s10195-012-0180-4
16. Blackwell KA, Raisz LG, Pilbeam CC. Prostaglandins in bone: bad cop, good cop? Trends Endocrinol Metab 2010; 21(5):294-301. https://doi.org/10.1016/j.tem.2009.12.004
17. Joice M, Vasileiadis GI, Amanatullah DF. Non-steroidal anti-inflammatory drugs for heterotopic ossification
prophylaxis after total hip arthroplasty: a systematic review and meta-analysis. Bone Joint J 2018;100-B(7):915-22.
https://doi.org/10.1302/0301-620X.100B7.BJJ-2017-1467.R1
18. Grohs JG, Schmidt M, Wanivenhaus A. Selective COX-2 inhibitor versus indomethacin for the prevention of
heterotopic ossification after hip replacement: a double-blind randomized trial of 100 patients with 1-year follow-up. Acta Orthop 2007;78(1):95-8. https://doi.org10.1080/17453670610013484
19. Haran M, Bhuta T, Lee B. Pharmacological interventions for treating acute heterotopic ossification. Cochrane
Database Syst Rev 2004;(4):CD003321. https://doi.org/10.1002/14651858.CD003321.pub3
20. Fransen M, Anderson C, Douglas J, MacMahon S, Neal B, Norton R, et al. Safety and efficacy of routine
postoperative ibuprofen for pain and disability related to ectopic bone formation after hip replacement surgery
(HIPAID): randomised controlled trial. BMJ 2006;9;333(7567):519. https://doi.org/10.1136/bmj.38925.471146.4F
21. Popovic M, Agarwal A, Zhang L, Yip C, Kreder HJ, Nousiainen MT, et al. Radiotherapy for the prophylaxis of
heterotopic ossification: a systematic review and meta-analysis of published data. Radiother Oncol 2014;113(1):10-7. https://doi.org/10.1016/j.radonc.2014.08.025
22. Seegenschmiedt MH, Martus P, Goldmann AR, Wölfel R, Keilholz L, Sauer R. Preoperative versus postoperative
radiotherapy for prevention of heterotopic ossification (HO): first results of a randomized trial in high-risk patients. Int J Radiat Oncol Biol Phys 1994;30;30(1):63-73. https://doi.org/10.1016/0360-3016(94)90520-7
23. Ploumis A, Belbasis L, Ntzani E, Tsekeris P, Xenakis T. Radiotherapy for prevention of heterotopic ossification of the elbow: a systematic review of the literature. J Shoulder Elbow Surg 2013;22(11):1580-8. https://doi.org/10.1016/j.jse.2013.07.045
24. Coons D, Godleski M. Range of motion exercises in the setting of burn-associated heterotopic ossification at the elbow: case series and discussion. Burns 2013;39(4):e34-8. https://doi.org/10.1016/j.burns.2012.10.014
25. Pakos EE, Ioannidis JP. Radiotherapy vs. nonsteroidal anti-inflammatory drugs for the prevention of heterotopic ossification after major hip procedures: a meta-analysis of randomized trials. Int J Radiat Oncol Biol Phys 2004;60(3):888-95. https://doi.org/10.1016/j.ijrobp.2003.11.015