Ankylosing Neurogenic Myositis Ossificans of the Hip: A Case Series and Review of Literature

Surgical Triumph Over Huge Nontraumatic Myositis Ossificans of the Gluteal Region in an Epileptic Patient With History of Stroke: A Case Report

Myositis ossificans (MO) is a benign condition where bone forms within muscles due to increased activity of the periarticular tissues. Trauma is the most common cause. Nontraumatic MO is exceedingly rare. We present a rare instance of nontraumatic MO affecting the hip in a 32-year-old patient. The patient had a known case of seizure disorder and also had a history of a cerebrovascular accident (CVA). Despite the absence of trauma or known predisposing factors, the patient developed a sizable mass in the left hip, causing pain and restricted range of motion (ROM). Surgical excision of the mass was successful, resulting in complete removal and subsequent improvement in hip function and pain relief during postoperative recovery. Histopathological examination confirmed the diagnosis of MO. The patient's ROM normalized, and there were no signs of recurrence at the one-year follow-up. This case highlights the importance of recognizing MO in hip pain cases without trauma. Timely surgery through the approach described effectively removes the mass, preventing recurrence without compromising vital structures. It showcases a successful multidisciplinary approach for rare musculoskeletal conditions, offering valuable insights into similar cases.

Embolization followed by resection of the heterotopic hip joint ossification with spinal cord injury

BACKGROUND

Heterotopic ossification of large joints, such as knees and hips, has been reported after spinal cord injury, possibly leading to decreased activity of daily living due to a limited range of motion of the affected joint. Therefore, heterotopic ossification resection is performed to improve the range of motion, but it might cause massive bleeding as a complication.

METHODS

In this case, the patient had a history of spinal cord injury and developed heterotopic ossification after the left hip injury. He had left hip ankylosis and could not transfer to a wheelchair by himself; therefore, heterotopic ossification resection was planned. On conducting contrast-enhanced computed tomography, the supplying arteries extending to the heterotopic ossification could be identified. A day before the surgery, embolization of the branches by interventional radiology was performed.

RESULTS

Heterotopic ossification resection was performed with an 820-ml blood loss. Postoperative rehabilitation was continued, and range of motion continued to improve without heterotopic ossification recurrence 2 years post-surgery.

CONCLUSIONS

The combination of preoperative contrast-enhanced computed tomography and embolization was useful in treating heterotopic ossification.

Neurogenic heterotopic ossificans of hips in a case of expanded dengue syndrome following critical illness polyneuropathy

We present a case of 71-year-old man with bilateral hip neurogenic heterotopic ossificans following critical illness polyneuropathy as a complication of expanded dengue syndrome. His left hip was stiff and showed a circumferential ossific mass. After initial medical management, the patient underwent excision of ossific mass using posterior approach. For adequate excision, femoral head and neck were resected and a hybrid total hip arthroplasty was performed. The patient was followed up for 2 years and showed good clinical outcome without recurrence of heterotopic ossification. This case highlights the rare aetiology of neurogenic heterotopic ossification which is critical illness polyneuropathy following expanded dengue syndrome. It highlights that adequate resection and a total hip arthroplasty can be a viable option in selected cases of circumferential heterotopic ossification in old individuals.

Post-stroke bilateral heterotopic ossification: An acute problem with long-lasting consequences

Heterotopic ossification (HO) is a complication of injury to the central nervous system in which production of lamellar bone within the soft tissues occurs resulting in pain, reduced range of motion (ROM) and loss of functional capacity. Heterotopic ossification is rarely seen in stroke patients and mostly affects the paretic side. In this article, we present a case of established bilateral HO of the hips soon after stroke onset. A 77-year-old female patient with a five-month history of stroke presented to our rehabilitation clinic. Physical examination revealed sensorimotor aphasia, right-sided hemiplegia, bilateral painful limited ROM of the hips and left knee contracture. An anteroposterior X-ray of the pelvis revealed previously undiagnosed bilateral HO of the hips. The patient and her relatives declined operative interventions. The patient was discussed in the departmental meeting and it was agreed that she would not be able to partake in an active inpatient rehabilitation program. She was discharged with a home exercise plan. This case highlights the importance of HO, of both the paretic and non-paretic side, being included in the differential diagnosis of post-stroke patients presenting with joint pain and reduced ROM, both acutely and in the long-term. This may aid the timely diagnosis and management of HO, a pathology which has detrimental effects on functionality.

Pharmacologic prophylaxis for heterotopic ossification following spinal cord injury: A systematic review and meta-analysi

Heterotopic ossification(HO) is a common complication following spinal cord injury(SCI); however, its underlying pathophysiology remains relatively unknown. Although there are options for treating HO, prophylactic treatment is limited. Additionally, evidence supporting the effectiveness of these prophylactic treatments is scarce. Electronic literature search was conducted using four databases. Studies comparing prophylactic medication for HO versus placebo for patients with acute spinal cord injury were included. A meta-analysis comparing the incidence of HO between the two groups was conducted, with a subgroup analysis of non-steroidal anti-inflammatory drugs (NSAIDs) and non-NSAIDs. A total of 5 studies and 815 patients were included. Overall incidence of HO was 9.73 % (n = 25) in the medication group versus 16.5 %(n = 92) in the placebo group. However, the two groups do not statistcally differ(p = 0.21). In the subgroup analysis for NSAIDs, those who received prophylactic treatment with NSAIDs had a lower incidence of HO compared to those who received placebo (RR[95 % CI]:0.32[0.15, 0.68]; p = 0.003). As for studies that used bisphosphonates, a statistically significant difference in incidence of HO was not found (RR[95 % CI]:1.30[0.52, 3.24];p = 0.58) and the overall evidence was inconclusive. In present systematic review and meta-analysis comparing prophylactic medications to placebo for prevention of HO, we found similar incidence rates for both groups. However, subgroup analysis showed a significantly lower incidence rate for those who recevied NSAIDs for HO prophylaxis. Altough this finding is promising for secondary prevention of HO among patients suffering from SCI, further prospective studies with longer follow-ups are required to assess other appropriate medications for HO prevention.

The role of preoperative vascular imaging and embolisation for the surgical resection of bilateral hip heterotopic ossification

The surgical excision of heterotopic ossification can provide improved function for patients; however, complications can include damage to nearby vessels and nerves, blood loss and recurrence. In the preoperative planning for excision, our case report describes the combination of CT angiography, preoperative embolisation of involved vascular structures and the use of intraoperative vascular surgery for dissection around key structures to aid in the reduction of morbidity in these patients.