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Shapira J, Yelton MJ, Chen JW, Rosinsky PJ, Maldonado DR, Meghpara M, Lall AC, Domb BG. Efficacy of NSAIDs versus radiotherapy for heterotopic ossification prophylaxis following total hip arthroplasty in high-risk patients: a systematic review and meta-analysis. Hip Int 2022; 32:576-590. [PMID: 33736491 DOI: 10.1177/1120700021991115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aims of this systematic review were: (1) to investigate the prophylactic effect of radiotherapy (RT) and NSAIDs in high-risk patients following total hip arthroplasty (THA); and (2) to compare the efficacy of non-selective and COX-II selective NSAIDs in preventing post-THA HO, utilising a meta-analysis of randomised control studies. METHODS The PubMed, Embase, and Cochrane Databases were searched for articles regarding HO following THA in March 2019. Studies were included if they contained data regarding HO incidence after THA or contained data regarding HO prophylaxis comparison of NSAIDs and/or RT in terms of dosage or duration. RESULTS 24 studies reported on populations that were not at high-risk for HO. These studies reported between 47.3% and 90.4% of their patient populations had no HO formation; between 2.8% and 52.7% had mild formation; and between 0.0% and 10.4% had severe formation. A total of 13 studies reported on populations at high-risk for HO. Studies analysing RT in high-risk patients reported between 28.6% and 97.4% of patients developed no HO formation; between 1.9% and 66.7% developed mild HO formation; and between 0.0% and 11.9% developed severe HO formation. Studies analysing NSAID treatment among high-risk populations reported between 76.6% and 88.9% had no HO formation; between 11.1% and 23.4% had mild HO formation, and between 0.0% and 1.8% had severe HO formation. 9 studies were identified as randomised control trials and subsequently used for meta-analysis. The relative risk for COX-II in developing any HO after THA was not significantly different compared to non-selective NSAIDs (RR 1.00; CI, 0.801-1.256; p = 0.489). CONCLUSIONS NSAIDs prophylaxis for HO may have better efficacy than RT in high-risk patients following THA. Non-selective and COX-II selective NSAIDs have comparable efficacy in preventing HO. Factors such as medical comorbidities and side-effect profile should dictate the prophylaxis recommendation.
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Affiliation(s)
- Jacob Shapira
- American Hip Institute Research Foundation, Chicago, IL, USA
| | | | - Jeffery W Chen
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | | | - Mitchell Meghpara
- American Hip Institute Research Foundation, Chicago, IL, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, IL, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, IL, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, IL, USA.,American Hip Institute, Chicago, IL, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, IL, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, IL, USA.,American Hip Institute, Chicago, IL, USA
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Ahmed MM, Alghunaim SM, Mosalem DM, Khairat SM, Hameed FA. Extracorporeal Shockwave Therapy for Painful Chronic Traumatic Heterotopic Ossification after Right Acetabulum Fracture Fixation: A Case Report and Literature Review. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.4726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Heterotopic ossification (HO) usually occurs in trauma, such as fractures. To the best of our knowledge, there is a lack of studies about the effects of shockwave on the size of HO in the literature.
AIM: The aim of this study was to describe the effects of extracorporeal shockwave therapy (ESWT) on the size of HO as well as the lower extremity functions in patients with fracture right acetabulum.
CASE REPORT: A 36-year-old gentleman had a traffic accident on August 30, 2015, resulted in a fracture of the right acetabulum treated by open reduction and internal fixation on September 2, 2015. The patient has complained of severe right hip pain with limitation of daily activities, especially walking, standing, and sitting, visual analog scale about 7-8/10 with painful and restricted ROM of the right hip. Plain X-ray of the right hip revealed HO at greater trochanter with a long axis length 37.3 mm. ESWT was applied for HO. ESWT was administered 6 times each weekly for 6 weeks. At 6-month follow-up, the size of HO had become slightly smaller with the improvement of pain, and lower extremities functions.
DISCUSSION: Soft tissues around HO have been regenerated from ischemia for several reasons such as ESWT stimulating angiogenesis and neurogenesis and the size of HO had become slightly smaller by radial shockwave therapy.
CONCLUSION: ESWT is a novel non-invasive and safe treatment for HO. The effects of ESWT on the size of HO had become slightly smaller with the improvement of lower extremities functions.
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Pakos EE, Papadopoulos DV, Gelalis ID, Tsantes AG, Gkiatas I, Kosmas D, Tsekeris PG, Xenakis TA. Is prophylaxis for heterotopic ossification with radiation therapy after THR associated with early loosening or carcinogenesis? Hip Int 2020; 30:559-563. [PMID: 30990093 DOI: 10.1177/1120700019842724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Heterotopic ossification may develop after major hip surgeries, thus preventive strategies including radiation therapy and non steroid anti-inflammatory drugs are commonly employed. There are certain concerns regarding the effects of radiation therapy on implant loosening and carcinogenesis. Our study aims to evaluate whether radiation therapy results in implant loosening or radiation-induced tumours in the long term. PATIENTS AND METHODS This was a prospective study including 97 high-risk patients for heterotopic ossification who underwent total hip arthroplasty. Patients were divided into 2 groups and received either a combination of radiation therapy and indomethacin (Group A), or indomethacin alone (Group B). Evaluated outcomes included implant loosening or development of radiation-induced tumours during the follow-up period. RESULTS The follow-up period of the study was 10 years. Group A consisted of 50 patients, while Group B consisted of 47 patients. 3 patients died during the follow-up. There were 2 cases of implant loosening, 1 from each of the 2 groups at 9 and 10 years after surgery respectively; thus, no statistically significant difference regarding implant loosening was found (p < 0.05). During the follow-up period no cases of radiation-induced tumours were identified. CONCLUSION Our results are consistent with those of other studies supporting the safety of radiation therapy as a preventive strategy for heterotopic ossification following major surgeries in high risk patients. Further studies with even longer follow-up may be required to definitely exclude the possibility of adverse outcomes linked with radiation therapy.
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Affiliation(s)
- Emilios E Pakos
- Department of Orthopaedics, University Hospital of Ioannina, Ioannina, Greece
| | | | - Ioannis D Gelalis
- Department of Orthopaedics, University Hospital of Ioannina, Ioannina, Greece
| | - Andreas G Tsantes
- Department of Orthopaedics, University Hospital of Ioannina, Ioannina, Greece
| | - Ioannis Gkiatas
- Department of Orthopaedics, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitrios Kosmas
- Department of Orthopaedics, University Hospital of Ioannina, Ioannina, Greece
| | - Pericles G Tsekeris
- Department of Radiation Oncology, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Theodoros A Xenakis
- Laboratory of Orthopedics and Biomechanics, University of Ioannina, School of Medicine, Ioannina, Greece
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Li F, Mao D, Pan X, Zhang X, Mi J, Rui Y. Celecoxib cannot inhibit the progression of initiated traumatic heterotopic ossification. J Shoulder Elbow Surg 2019; 28:2379-2385. [PMID: 31757369 DOI: 10.1016/j.jse.2019.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Heterotopic ossification (HO) is a recognized sequela after trauma and arthroplasty. The purpose of this study was to evaluate the therapeutic effect of celecoxib on HO. We hypothesized that celecoxib may inhibit the progression of initiated HO. METHODS We performed a retrospective review of 37 patients who underwent elbow joint surgery between January 2014 and June 2018. Seventeen patients were prescribed orally administered celecoxib (200 mg/dose, twice daily) for 2 months after the diagnosis of HO, whereas the remaining 20 patients were administered celecoxib for 1 month starting immediately after surgery. HO progression was evaluated by plain radiographs. By use of an Achilles tendon puncture-induced HO mouse model, the curative effect of celecoxib was illustrated at different HO progression stages. The mice were assigned to 1 of 4 groups: sham group, vehicle group, group receiving celecoxib on day 1, and group receiving celecoxib in week 6. Achilles tendons were analyzed by micro-computed tomography and histochemistry after 12 weeks. RESULTS Celecoxib did not inhibit the progression of initiated HO in the patients in whom HO was diagnosed, whereas those who received celecoxib after surgery had lower morbidity. Achilles tendon puncture effectively induced typical HO in mice. The ectopic bone volume was significantly reduced in the day 1 celecoxib group compared with the vehicle group; however, the difference was not statistically significant in the week 6 celecoxib group. CONCLUSIONS Administration of celecoxib starting immediately after surgery can significantly inhibit the formation of HO. Once HO is visible on plain radiographs or micro-computed tomography, celecoxib cannot effectively attenuate further progression of HO in humans and mice.
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Affiliation(s)
- Fengfeng Li
- Department of Orthopedics, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Dong Mao
- Research Institute of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xiaoyun Pan
- Research Institute of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xin Zhang
- Research Institute of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Jingyi Mi
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Yongjun Rui
- Department of Orthopedics, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China.
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Heterotopic Ossification: A Challenging Complication of Total Hip Arthroplasty: Risk Factors, Diagnosis, Prophylaxis, and Treatment. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3860142. [PMID: 31119167 PMCID: PMC6500709 DOI: 10.1155/2019/3860142] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 02/02/2019] [Accepted: 02/24/2019] [Indexed: 11/18/2022]
Abstract
Background This review is intended to summarize the risk factors, classification, diagnosis, and treatment of heterotopic ossification (HO) of previously published studies. Results Heterotopic ossification is a common complication of total hip arthroplasty. Its prevalence is not the same in all of the patient groups. Frequency of HO varies from 15 to 90%. Hip ankylosis, male gender, and previous history of HO are said to be risk factors with a significant level. Diagnosis is based on a single AP radiograph: the Brooker classification that divides HO into four grades is the most commonly used. The confirmation test that can be used is a bone scan. A great amount of bone metabolic turnover markers have been tested, but none of them seems to be relevant in case of prevention or diagnosis of HO. The most effective prophylactic treatment is radiotherapy or administration of nonsteroidal anti-inflammatory drugs. Over the years a lot of different RT protocols have been tested. Nowadays the most often used regimen is 7 Gy given postoperatively in a single dose. The most commonly prescribed drug in prophylaxis of HO is indomethacin. Also, the efficacy of ibuprofen and diclofenac was proven. Recently researchers focused on selective COX-2 inhibitors. They appear to be as effective as nonselective NSAIDs having less side effects. The one and only treatment of HO is a revision arthroplasty.
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Abstract
Skeletal development is exquisitely controlled both spatially and temporally by cell signaling networks. Gαs is the stimulatory α-subunit in a heterotrimeric G protein complex transducing the signaling of G-protein-coupled receptors (GPCRs), responsible for controlling both skeletal development and homeostasis. Gαs, encoded by the GNAS gene in humans, plays critical roles in skeletal development and homeostasis by regulating commitment, differentiation and maturation of skeletal cells. Gαs-mediated signaling interacts with the Wnt and Hedgehog signaling pathways, both crucial regulators of skeletal development, remodeling and injury repair. Genetic mutations that disrupt Gαs functions cause human disorders with severe skeletal defects, such as fibrous dysplasia of bone and heterotopic bone formation. This chapter focuses on the crucial roles of Gαs signaling during skeletal development and homeostasis, and the pathological mechanisms underlying skeletal diseases caused by GNAS mutations.
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Affiliation(s)
- Qian Cong
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, United States
| | - Ruoshi Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yingzi Yang
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, United States.
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Łęgosz P, Drela K, Pulik Ł, Sarzyńska S, Małdyk P. Challenges of heterotopic ossification-Molecular background and current treatment strategies. Clin Exp Pharmacol Physiol 2018; 45:1229-1235. [DOI: 10.1111/1440-1681.13025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Paweł Łęgosz
- Department of Orthopaedics and Traumatology; 1st Faculty of Medicine; Medical University of Warsaw; Warsaw Poland
| | - Katarzyna Drela
- NeuroRepair Department; Mossakowski Medical Research Centre; Polish Academy of Sciences; Warsaw Poland
| | - Łukasz Pulik
- Department of Orthopaedics and Traumatology; 1st Faculty of Medicine; Medical University of Warsaw; Warsaw Poland
| | - Sylwia Sarzyńska
- Department of Orthopaedics and Traumatology; 1st Faculty of Medicine; Medical University of Warsaw; Warsaw Poland
| | - Paweł Małdyk
- Department of Orthopaedics and Traumatology; 1st Faculty of Medicine; Medical University of Warsaw; Warsaw Poland
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Haglin JM, Kugelman DN, Christiano A, Konda SR, Paksima N, Egol KA. Open surgical elbow contracture release after trauma: results and recommendations. J Shoulder Elbow Surg 2018; 27:418-426. [PMID: 29290605 DOI: 10.1016/j.jse.2017.10.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/08/2017] [Accepted: 10/18/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Jack M Haglin
- Trauma Division, Orthopaedic Department, NYU Hospital for Joint Diseases, New York, NY, USA
| | - David N Kugelman
- Trauma Division, Orthopaedic Department, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Anthony Christiano
- Trauma Division, Orthopaedic Department, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Sanjit R Konda
- Trauma Division, Orthopaedic Department, NYU Hospital for Joint Diseases, New York, NY, USA; Trauma Division, Orthopaedic Department, Jamaica Hospital Medical Center, Queens, NY, USA
| | - Nader Paksima
- Trauma Division, Orthopaedic Department, NYU Hospital for Joint Diseases, New York, NY, USA; Trauma Division, Orthopaedic Department, Jamaica Hospital Medical Center, Queens, NY, USA
| | - Kenneth A Egol
- Trauma Division, Orthopaedic Department, NYU Hospital for Joint Diseases, New York, NY, USA; Trauma Division, Orthopaedic Department, Jamaica Hospital Medical Center, Queens, NY, USA.
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Mazonakis M, Berris T, Lyraraki E, Damilakis J. Cancer risk estimates from radiation therapy for heterotopic ossification prophylaxis after total hip arthroplasty. Med Phys 2014; 40:101702. [PMID: 24089892 DOI: 10.1118/1.4820366] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Heterotopic ossification (HO) is a frequent complication following total hip arthroplasty. This study was conducted to calculate the radiation dose to organs-at-risk and estimate the probability of cancer induction from radiotherapy for HO prophylaxis. METHODS Hip irradiation for HO with a 6 MV photon beam was simulated with the aid of a Monte Carlo model. A realistic humanoid phantom representing an average adult patient was implemented in Monte Carlo environment for dosimetric calculations. The average out-of-field radiation dose to stomach, liver, lung, prostate, bladder, thyroid, breast, uterus, and ovary was calculated. The organ-equivalent-dose to colon, that was partly included within the treatment field, was also determined. Organ dose calculations were carried out using three different field sizes. The dependence of organ doses upon the block insertion into primary beam for shielding colon and prosthesis was investigated. The lifetime attributable risk for cancer development was estimated using organ, age, and gender-specific risk coefficients. RESULTS For a typical target dose of 7 Gy, organ doses varied from 1.0 to 741.1 mGy by the field dimensions and organ location relative to the field edge. Blocked field irradiations resulted in a dose range of 1.4-146.3 mGy. The most probable detriment from open field treatment of male patients was colon cancer with a high risk of 564.3 × 10(-5) to 837.4 × 10(-5) depending upon the organ dose magnitude and the patient's age. The corresponding colon cancer risk for female patients was (372.2-541.0) × 10(-5). The probability of bladder cancer development was more than 113.7 × 10(-5) and 110.3 × 10(-5) for males and females, respectively. The cancer risk range to other individual organs was reduced to (0.003-68.5) × 10(-5). CONCLUSIONS The risk for cancer induction from radiation therapy for HO prophylaxis after total hip arthroplasty varies considerably by the treatment parameters, organ site in respect to treatment volume and patient's gender and age. The presented risk estimates may be useful in the follow-up studies of irradiated patients.
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Affiliation(s)
- Michalis Mazonakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003 Iraklion, Crete, Greece
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Koh KH, Lim TK, Lee HI, Park MJ. Surgical treatment of elbow stiffness caused by post-traumatic heterotopic ossification. J Shoulder Elbow Surg 2013; 22:1128-34. [PMID: 23796381 DOI: 10.1016/j.jse.2013.04.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/07/2013] [Accepted: 04/17/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) is considered as a common extrinsic cause of elbow stiffness. The purpose of this study was to show the results of surgical treatment for post-traumatic elbow stiffness caused by HO in a large, consecutive series of patients in a single unit. METHODS We retrospectively reviewed 77 surgically treated patients with post-traumatic elbow stiffness caused by HO. Final motion arc and Mayo Elbow Performance Index (MEPI) were assessed as final results. Univariable and multivariable analyses were done to determine which factors had an effect on the final motion arc. RESULTS The average arc of elbow motion increased from 45° preoperatively to 112°, with an improvement of 67° at the final follow-up evaluation. The mean MEPI score was 91.9. At the final evaluation, 65 patients (84.4%) obtained a total motion arc of ≥100°. Recurrent HO was observed in 16 patients postoperatively, and 6 underwent repeated surgical release. The time from the initial injury to surgical release with a cutoff value of 19 months was the only independent factor affecting the final range of motion (ROM) in multivariable median regression analysis. With the numbers studied, no significant association was found between the final ROM and other clinical variables except for the recurrence of HO (93° vs 117°). CONCLUSIONS From the results of our study, we can support the surgical treatment of elbow stiffness caused by post-traumatic HO regardless of preoperative ROM. However, recurrence of heterotopic bone and delay in surgery of more than 19 months are associated with less favorable results.
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Affiliation(s)
- Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea
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Pavlou G, Kyrkos M, Tsialogiannis E, Korres N, Tsiridis E. Pharmacological treatment of heterotopic ossification following hip surgery: an update. Expert Opin Pharmacother 2012; 13:619-22. [PMID: 22404455 DOI: 10.1517/14656566.2012.662342] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Heterotopic ossification is a frequent complication following total hip arthroplasty and acetabular surgery. Formation of ectopic lamellar bone in tissues that exhibit no potential for ossification can lead to associated pain and decrease in function. Prophylaxis and treatment protocols aim to reduce the incidence, by both the use of nonsteroidal anti-inflammatory drug (NSAID) regimens and localized radiotherapy. New therapeutic modalities including bone morphogenetic proteins (BMP) inhibitors like Noggin, BMP type 1 receptor inhibition, nuclear retinoic acid receptor-gamma agonists (RAR-γ), and free radical scavengers are currently under investigation.
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Mishra MV, Austin L, Parvizi J, Ramsey M, Showalter TN. Safety and efficacy of radiation therapy as secondary prophylaxis for heterotopic ossification of non-hip joints. J Med Imaging Radiat Oncol 2011; 55:333-6. [PMID: 21696569 DOI: 10.1111/j.1754-9485.2011.02275.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Prophylactic radiation therapy (RT) is an established adjuvant therapy for heterotopic ossification (HO) of the hip when delivered in the immediate pre- or postoperative setting. Its role in prevention of recurrence after excision of HO is supported by randomised trials for HO of the hip, but there is scant evidence to demonstrate the safety and efficacy of a similar approach in non-hip joints. In the current study, we evaluate radiological and functional outcomes after prophylactic RT for prevention of HO of the knee and upper extremity. METHODS With institutional review board (IRB) approval, patients treated at our institution with prophylactic RT for non-hip HO from 1998 to 2009 were identified. Records were reviewed, including pre- and postoperative records, operative reports and radiography. The primary objectives were to determine the safety of RT and rate of treatment failure, as defined by need for further surgical intervention. RESULTS A total of 30 patients received prophylactic RT for HO of the elbow (n=21), MCP joint (n=1) and knee (n=8). Twenty-nine of the 30 patients were treated within 24-48h postoperatively, and one patient was treated within 24h preoperatively. Based on institutional policy, only patients considered to be at high risk of recurrence were selected to receive prophylactic RT. Patients were treated to a dose of 7Gy in one fraction, with two parallel opposed. Complications following treatment included two patients with postoperative wound infections, one patient with a ruptured triceps tendon and one patient with a fracture within the treatment field. Follow-up information was available for 26 of 30 patients, with a median follow-up time of 16months (range, 2-143months). Recurrent HO, requiring surgical re-excision, developed in 10.5% (n=2) of patients who were followed for upper extremity HO (n=19). For patients followed after RT for HO of the knee (n=7), there were no recurrences of HO that required further intervention. CONCLUSION In this group of patients at high risk for developing further HO, prophylactic RT appears to be a safe adjunct to surgery and is effective in prevention of HO recurrence. Results are similar to published reports of HO of the hip and support the use of surgical excision and perioperative, prophylactic RT for HO of non-hip joints.
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Affiliation(s)
- Mark V Mishra
- Department of Radiation Oncology, Kimmel Cancer Center and Thomas Jefferson University Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA19107, USA
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Maccotta O, Toulze R, Beya R, Vasse B. Calcification post-traumatique du muscle ilio-psoas. À propos d’un cas et revue de la littérature. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.jts.2011.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Siemers F, Stollwerck PL, Lohmeyer JA, Namdar T, Mailänder P. [Heterotopic ossifications in major burn injuries : An interdisciplinary challenge]. Chirurg 2010; 81:647-52. [PMID: 20186381 DOI: 10.1007/s00104-009-1850-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Heterotopic ossifications in peri-articular tissue can appear after severe head injury, spinal trauma or local joint trauma. Following extensive burns, heterotopic ossifications are a rare, but severe complication with an unknown pathogenesis. In a retrospective analysis of 672 patients who were treated in our burn center over the last 10 years we identified 5 cases (0.74%) of heterotopic ossification.
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Affiliation(s)
- F Siemers
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck.
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Heyd R, Seegenschmiedt MH, Rades D, Winkler C, Eich HT, Bruns F, Gosheger G, Willich N, Micke O. [The significance of radiation therapy for symptomatic vertebral hemangiomas (SVH)]. Strahlenther Onkol 2010; 186:430-5. [PMID: 20803283 DOI: 10.1007/s00066-010-2140-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/05/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of radiation therapy (RT) for symptomatic vertebral hemangioma (SVH). MATERIAL AND METHODS Based on the Registry for Rare Benign Disorders (RRBD) of the German Cooperative Group on Radiation Therapy for Benign Diseases (GCG-BD), the clinical information, treatment plans and outcome data from seven cooperating German RT institutions were analyzed retrospectively. RESULTS Over a period of 39 years (1969-2008), a total of 84 patients with 96 symptomatic lesions underwent RT. The predominant indication was pain in 97.6%, and, in addition, 28.6% of patients had neurological deficits. The median total dose was 34 Gy (4.5-45 Gy), and the median single dose 2.0 Gy (0.5-3.0 Gy). After a median follow-up of 68 months (6-422 months), complete symptom relief (CR) occurred in 61.9% of patients, 28.6% had partial relief, and 9.5% had no relief (NR). The overall response rate (CR + PR) was 90.5%. In 26.2% of patients, radiologic signs of remineralization were noted. After a median follow-up of 70 months (8-124 months), symptom progression occurred in eight patients (9.5%). Therefore, the long-term rate of local control was 80.9%. Multivariate statistical analysis revealed a significantly higher rate of symptom relief and local control for total doses > or = 34 Gy. Side effects > RTOG/EORTC grade 2 were not observed. CONCLUSION RT is a safe and effective for treatment of SVH. Total doses of at least 34 Gy are recommended to achieve optimal treatment response.
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Affiliation(s)
- Reinhard Heyd
- Strahlenklinik, Klinikum Offenbach, Offenbach, Germany.
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