Heterotopic Ossification Follow-up

  • Author: Kresimir Banovac, MD, PhD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Dec 2, 2011
 

Further Inpatient Care

  • Patients with advanced HO who undergo surgical intervention generally require hospitalization and further inpatient care. For a discussion of care following anterior hip resection surgery, see Surgical Intervention.
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Further Outpatient Care

  • Monitoring of HO maturation
    • Monitoring of HO maturation should be performed regularly.
    • In patients with functional limitations for whom surgery is a consideration, radiography should be performed every 4-6 months.
    • CT scanning and MRI may offer more precise delineation of ectopic bone, which may be helpful in preoperative planning.
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Deterrence

  • As previously stated, the prophylactic use of medications to prevent HO has been studied in individuals with SCI, with promising outcomes.[18, 19] NSAIDs do have a role in the prevention of HO and in the prevention of postoperative recurrence after the excision of HO. Radiation therapy also may be used to prevent recurrence postoperatively in some patients.[3]
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Complications

  • Potential complications associated with surgical intervention in patients with HO include hemorrhage and postsurgical infections (see Surgical Intervention).
  • HO in patients with SCI may lead to other complications, such as pressure sores and DVT.[16, 17]
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Prognosis

  • Approximately 20-30% of patients with SCI develop clinically evident HO, and 3-8% of them develop severe functional limitations.
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Patient Education

  • Patient and family education is an important part of the treatment process in individuals with HO. Physical therapists may instruct patients and family members, if needed, to complete ROM exercises as instructed by the physician. Patients should also be taught to watch for signs of other potential complications when dealing with heterotopic ossification (in order, for example, to prevent pressure sores in patients with SCI).
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Contributor Information and Disclosures
Author

Kresimir Banovac, MD, PhD  Professor, Departments of Rehabilitation Medicine and Medicine, Associate Vice Chairman, Department of Rehabilitation Science, University of Miami Miller School of Medicine; Medical Director, Spinal Cord Injury Rehabilitation Unit, Jackson Memorial Medical Center

Kresimir Banovac, MD, PhD is a member of the following medical societies: American Spinal Injury Association

Disclosure: Nothing to disclose.

Coauthor(s)

John Speed  MBBS, Professor (Clinical), Division of Physical Medicine & Rehabilitation, Adjunct Associate Professor, Department of Physical Therapy, Adjunct Professor, Nursing Director, Traumatic Brain Injury Rehabilitation, Medical Director, Inpatient Rehabilitation Unit, University of Utah School of Medicine

John Speed is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Pain Society, Association of Academic Physiatrists, International Association for the Study of Pain, International Society of Physical and Rehabilitation Medicine, and Utah Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert L Sheridan, MD  Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School

Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health, Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References

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  2. Shafer DM, Bay C, Caruso DM, et al. The use of eidronate disodium in the prevention of heterotopic ossification in burn patients. Burns. May 2008;34(3):355-60. [Medline].

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  4. Rossier AB, Bussat P, Infante F, et al. Current facts of para-osteo-arthropathy (POA). Paraplegia. May 1973;11(1):38-78. [Medline].

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  11. Singh RS, Craig MC, Katholi CR, et al. The predictive value of creatine phosphokinase and alkaline phosphatase in identification of heterotopic ossification in patients after spinal cord injury. Arch Phys Med Rehabil. Nov 2003;84(11):1584-8. [Medline].

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  13. Estrores IM, Harrington A, Banovac K. C-reactive protein and erythrocyte sedimentation rate in patients with heterotopic ossification after spinal cord injury. J Spinal Cord Med. 2004;27(5):434-7. [Medline].

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  17. Varghese G, Williams K, Desmet A, et al. Nonarticular complication of heterotopic ossification: a clinical review. Arch Phys Med Rehabil. Nov 1991;72(12):1009-13. [Medline].

  18. Banovac K, Williams JM, Patrick LD, et al. Prevention of heterotopic ossification after spinal cord injury with indomethacin. Spinal Cord. Jul 2001;39(7):370-4. [Medline].

  19. Banovac K, Williams JM, Patrick LD, et al. Prevention of heterotopic ossification after spinal cord injury with COX-2 selective inhibitor (rofecoxib). Spinal Cord. Dec 2004;42(12):707-10. [Medline].

  20. Choi WJ, Lee JW. Heterotopic ossification after total ankle arthroplasty. J Bone Joint Surg Br. Nov 2011;93(11):1508-12. [Medline].

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