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PubMed1998

Prevention of periarticular heterotopic ossification after endoprosthetic hip joint replacement by means of diclofenac.

This prospective study involves 644 patients who received ossification prophylaxis by means of the drug diclofenac after implantation (87.5%) or revision (12.5%) of a total hip endoprosthesis between August 1992 and June 1994. One hundred patients (15.5%) stopped the treatment because of side-effects of the drug, and medication was stopped when gastrointestinal troubles occurred. The follow-up examination after 6 months revealed ossification of HO degree 1 according to Brooker in 13.8% of cases, of degree 2 in 4.8%, and of degree 3 in 1.4% of cases. Severe HO of degree 4 was not observed at all, and 80% of the patients exhibited no ossification what ever. Thus, in comparison to our own studies and to the literature, diclofenac must be regarded as an extremely effective drug for the prevention of ossification.

Administration, Oral↗
PubMed1999

Postoperative ossifications of the shoulder. Incidence and clinical impact.

Periarticular ossifications of the shoulder after surgery have been described since the beginning of the century. Risk factors and the clinical impact of heterotopic bone formation have been discussed controversially. After open surgery on the shoulder, 131 patients (rotator cuff repair n = 106, acromioplasty n = 25) were included in a retrospective study if pre- and postoperative X-rays were available. The age of the 90 men and 41 women averaged 51 years (range 29-67 years). The minimum follow-up was 2 years. Also, 108 patients were interviewed by questionnaire to estimate the subjective outcome of the procedure (5 patients were reported dead). A clinical examination was carried out on 86 patients using the Constant score for evaluation of the objective outcome. Heterotopic ossifications were found in 35 cases (26.7%), 28 of them after rotator cuff reconstruction and 7 after acromioplasty. A good to excellent result was reported by 89% (n = 65) of the patients without and by 80% (n = 28) of the patients with ossifications. The Constant score averaged 69 points and 74 points (n = 60), respectively. A significant difference between the two collectives could not be calculated. As significant risk factors for the formation of heterotopic bone, the existence of osteoarthritis and the duration and complexity of the procedure could be cited. The appearance of periarticular ossifications after surgery of the shoulder seems to be of minor clinical impact. Severe cases with major functional deficits should and can be prevented by a fast and atraumatic operation technique.

Acromion↗
PubMed1999

No effective prophylaxis of heterotopic ossification with short-term ibuprofen.

Ninety-five patients underwent primary total hip arthroplasty and routinely received ibuprofen for 5 days as prophylaxis for heterotopic ossification. This group was compared with a group of 99 patients who received indomethacin for 7 days as prophylaxis. After a follow-up of 1 year, the incidence of heterotopic ossification in the ibuprofen group was significantly higher than in the indomethacin group. The widespread ossification, Brooker grades III and IV, was prevented better by indomethacin than by ibuprofen. We conclude that ibuprofen for 5 days is not effective as prophylaxis for heterotopic ossification after primary total hip arthroplasty.

Adult↗
PubMed2004

Heterotopic ossification of rectal adenocarcinoma: report of a case.

Heterotopic ossification of gastrointestinal tract tumors is rare. We report the case of a 67-year-old man with heterotopic ossification of a rectal adenocarcinoma. The patient presented with intermittent abdominal pain and frequent diarrhea, and colonoscopic examination showed a large polypoid tumor partially obstructing the rectal lumen. Abdominal computed tomography (CT) revealed a large tumor in the rectal lumen with calcified spots. We performed low anterior resection of the rectum, and histologic examination showed a well-differentiated adenocarcinoma with heterotopic ossification infiltrating the full thickness of the rectum. Local recurrence and liver metastases were found 2 months after surgery, and the patient died 3 months later. Such a rapidly progressive course of rectal adenocarcinoma with heterotopic ossification is very unusual.

Abdominal Pain↗
PubMed1993

Assessment of hip abductor function in relation to peritrochanteric heterotopic ossification after closed femoral nailing.

The relationship between peritrochanteric heterotopic ossification and the strength of hip abduction after closed intramedullary nailing for femoral shaft fractures was investigated in 25 patients after a mean follow-up of 2 years (range 9 months to 4 years). The power of hip abduction was assessed and compared with the normal hip. Of the 21 patients with heterotopic ossification, 16 had measurable weakness of hip abduction. Grade III heterotopic ossification resulted in 8-20 per cent weakness of hip abduction, but this was not associated with any disability or symptoms. Clinically important abductor weakness is more likely to be due to ipsilateral fractures or a long nail rather than heterotopic ossification.

Adolescent↗
PubMed1991

Ossification of posterior longitudinal ligament of the cervical spine in non-Japanese Asians.

"The Japanese disease," ossification of the posterior longitudinal ligament, is not confined to the Japanese only. A similar incidence of 0.8% was found in this study among non-Japanese Asians. Of 5167 patients who attended the Mount Elizabeth Hospital in Singapore for cervical spine complaints, 43 patients were found to have ossification of the posterior longitudinal ligament, forming the largest non-Japanese series. All but one patient were of Mongolian origin, and males were affected four times more commonly than females. Diabetes mellitus was present in 16%. There was a significant association between ossification of the posterior longitudinal ligament and calcification of other cervical paraspinal ligaments. It is suggested that a generalized tendency to calcification may be an important etiological factor in ossification of the posterior longitudinal ligament. Four of the patients required surgery, and in our experience, anterior spinal fusion with removal of the ossified ligament or multilevel laminoplasty gives satisfactory results.

Adult↗
PubMed1981

Heterotopic ossification following hip replacement or spinal cord injury. Two clinical studies with EHDP.

We report two double-blind, placebo-controlled studies of the effects of disodium etidronate (EHDP) on the incidence and severity of heterotopic ossification following total hip arthroplasty or spinal cord injury. The large placebo groups in these studies allowed the estimation of the incidence of heterotopic ossification in these patient populations. Heterotopic ossification occurred in 65% of patients after hip replacement and in the majority of these within 15 weeks. Clinically significant ossification occurred in 19% of affected patients. The incidence of heterotopic calcification after spinal cord injury was less (35%) but followed a similar natural history. Treatment with EHDP reduced the incidence and severity of lesions both at the time of stopping EHDP and up to 9 months after treatment.

Double-Blind Method↗
PubMed1996

Endometrial ossification successfully treated by hysteroscopic resection.

BACKGROUND: Endometrial ossification is a rare condition. The common feature in most reported cases is a previous history of abortion and retention of fetal bones. Few cases of endometrial ossification can be explained by osseous metaplasia. Clinical presentation may include abnormal vaginal bleeding or discharge, dysmenorrhoea, pelvic pain, and secondary infertility. Hysterectomy or dilation and curettage have been the usual therapeutic methods used. Recently, some cases have been treated by means of hysteroscopic resection. CASE: We report a case of endometrial ossification in a woman who presented with dysmenorrhoea, dyspareunia and pelvic pain. The patient had a pregnancy voluntarily terminated at 16 weeks. Five subsequent routine annual gynaecological exams, including ultrasonographies, were normal. A new gestation was also voluntarily terminated at 6 weeks. One month later the patient started with clinical manifestations. Ultrasonograms performed 4 months after the second abortion revealed a strong uterine echogenic band. Bone tissue was successfully removed by hysteroscopic resection. CONCLUSION: This case adds further evidence favouring new bone formation in the uterus as a pathogenic mechanism for endometrial ossification and illustrates the feasibility of hysteroscopic treatment for this condition.

Abortion, Induced↗
PubMed2006

Adenovirus-mediated transfer of siRNA against Runx2/Cbfa1 inhibits the formation of heterotopic ossification in animal model.

The heterotopic ossification of muscles, tendons, and ligaments is a common problem faced by orthopaedic surgeons. Runx2/Cbfa1 plays an essential role during the osteoblast differentiation and is considered as a molecular switch in osteoblast biology. RNA interference technology is a powerful tool for silencing endogenous or exogenous genes in mammalian cells. In this study, we investigated the effect of Runx2/Cbfa1-specific siRNA on osteoblast differentiation and mineralization in osteoblastic cells, and then constructed adenovirus containing siRNA against Runx2/Cbfa1 (Ad-Runx2-siRNA) to inhibit the formation of heterotopic ossification induced by BMP4, demineralized bone matrix, and trauma in animal model. Our results showed that the Runx2/Cbfa1-specific siRNA could inhibit the expression of Runx2/Cbfa1 at the level of mRNA and protein. Analysis of the expression of osteoblast maturation genes including type I collagen, osteopontin, bone sialoprotein, and osteocalcin, alkaline phosphatase activity, and matrix mineralization (von kossa) revealed that osteoblast differentiation was inhibited in cultured primary mouse osteoblasts transduced with Ad-Runx2-siRNA. Furthermore, adenovirus-mediated transfer of siRNA against Runx2/Cbfa1 could inhibit the formation of heterotopic ossification induced by BMP4, demineralized bone matrix, and trauma in animal model. It is likely that the inhibition of Runx2/Cbfa1 by RNAi could be developed as a powerful approach to prevent or treat heterotopic ossification.

Adenoviridae↗
PubMed1997

Heterotopic ossification: a comparison between reamed and unreamed femoral nailing.

Heterotopic ossification in the abductor region of the hip following reamed intramedullary femoral nailing has an incidence as high as 68 per cent. A definitive triggering factor for heterotopic ossification remains obscure, but it has been suggested that there may be both local and systemic influences. Previous work has only been able to show a statistical correlation with systemic factors. Sixty antegrade femoral nailings were performed in 58 patients, of which 32 were unreamed. There was no significant difference between the two groups for systemic risk factors known to have statistical correlation with the formation of heterotopic bone. The incidence of heterotopic ossification in the reamed nail group was 35.7 per cent and 9.4 per cent in the unreamed nail group (P = 0.01). The difference in the incidence of heterotopic bone formation seems to be due to local factors, in particular the generation of osteogenic reaming debris, which are important in the pathophysiology of heterotopic ossification seen in femoral intramedullary nailing.

Adolescent↗
PubMed1986

Limited dermal ossification: clinical features and natural history.

For 9 years we have observed a girl who has ossification in the dermis with a strikingly limited distribution. Recently a second girl with similar dermal ossification restricted to a single extremity was identified. The ectopic bone is histologically identical to normal membranous bone. These two patients have no obvious underlying cause for soft tissue bone formation, and no disorder of calcium or phosphate metabolism. Ossification first involved the dermal and subcutaneous connective tissue, and with time advanced locally in the affected areas to bridge joints and limit mobility. The ossification has now extended to involve muscle fascia but has not involved the muscle itself. This disease appears to represent a heretofore unrecognized disorder of mesenchymal differentiation.

Bone and Bones↗
PubMed2002

[Heterotopic ossification and brain injury].

OBJECTIVES: The aim of the study was to evaluate the incidence and the risk factors of heterotopic ossifications in patients with severe traumatic brain injury. MATERIAL AND METHODS: This retrospective study was conducted in a sample of 86 patients during a two years period. These patients were receiving care in an acute rehabilitation setting designed for traumatic brain injury patients emerging from coma. The statistical analysis used chi(2) and Fisher tests. RESULTS, DISCUSSION: Forty-nine heterotopic ossifications were observed in 24 patients (incidence 28.57%, 2.04/patient). Most of them were localised at the level of the hip, of the elbow and of the knee. No significant relation was found between heterotopic ossification and sex, age, clinical severity, motor impairment, spasticity or autonomic dysreflexia. On the contrary, associated limb fractures, specially when requiring a surgical treatment, were found to be correlated to a greater incidence of heterotopic ossification. CONCLUSION: Some of the risk factors observed in the present study were in accordance with those previously described in the literature. This work shows the difficult place of the initial care of patients with severe traumatic brain injury specially during there stay in intensive care units.

Adult↗
PubMed2000

[Periarticular heterotopic ossification secondary to central neurogenic dysfunction].

A case of a 48 year old woman with a medical background of tetraparesis related to a right lobectomy and periarticular ossification development (that included both knee joints) is presented. Bone scintigraphy was performed to evaluate the metabolism of the bone lesions. The scintigraphic pattern showed an important involvement of the medial and lateral left knee and medial right knee compartments, initially attributed to degenerative osteoarthritis. We believe that the presentation of this case report is interesting for two reasons: 1) the rareness of knee involvement in periarticular heterotopic ossification related to cerebral dysfunction, and 2) the possibility of a false positive diagnosis: osteoarthritic involvement versus juxta-articular ossification. This paper reviews the role of diagnostic imaging methods in the assessment of periarticular heterotopic ossification and the differential scintigraphic diagnosis regarding to osteoarticular disorders (more frequent among the general population).

Female↗
PubMed2002

[Dendriform pulmonary ossification associated with idiopathic pulmonary fibrosis].

Diffuse pulmonary ossification, a rare condition characterized by metaplastic ossification of the lung, is usually associated with diseases causing diffuse pulmonary lesions. Two types dendriform and nodular have been identified. In dendriform ossification, the less common type, osseous ramifications occur along the distal airways, with occasional islets of bone marrow. We report a case of diffuse dendriform pulmonary ossification associated with idiopathic pulmonary fibrosis. The diagnosis was based on histological examination, which demonstrated multiple nodules and ramified osseous spicules around the lung, mainly at the lower lobes, where the fibrotic lesions were also most evident.

Aged↗
PubMed1994

Localization of collagen types I, II, and III mRNAs in human heterotopic ossification by non-radioactive in situ hybridization.

Heterotopic ossification is a metabolically active process which shares several properties of orthotopic bone formation and, therefore, represents an excellent model for the investigation of matrix components. A novel tool for studying the ossifying process at the level of transcription is the technique of non-radioactive in situ hybridization. Using digoxigenin labeled cDNA probes we investigated the distribution patterns of types I, II and III collagen mRNAs in heterotopic ossification of pressure sores of paraplegic patients. The three collagen mRNAs exhibited substantially divergent distribution patterns. Type I (alpha 1) collagen mRNA was predominantly detectable in preosteoblasts, prechondroblasts and chondrocytes of the ossification zone. Type II (alpha 1) collagen mRNA was nearly exclusively found in cells of the chondrogenic lineage. Type III (alpha 1) collagen mRNA was detectable at low levels in soft tissue, but was strongly expressed by prechondroblasts and chondrocytes of heterotopic cartilage. Our in situ hybridization experiments provide evidence that chondrogenic cells in heterotopic ossification show a phenotypic alteration in collagen type expression. These results indicate that chondrocytes of heterotopic cartilage show a co-expression of types I (alpha 1), II (alpha 1) and III (alpha 1) collagen mRNAs.

Collagen↗
PubMed1991

Variation of quantitative and qualitative changes of enchondral ossification in heterozygous achondroplasia.

Whereas the radiologic features of achondroplasia--the most common type of skeletal dysplasia in adults--are clearly defined there is still some debate about the severity and the type of histologic changes. Earlier descriptions reported severe disturbance of enchondral ossification to be typical of achondroplasia: They are, however, misleading by dealing mostly with cases of lethal neonatal dwarfism (e.g. thanatophoric dysplasia). Newer findings confirmed that only minor, quantitative lesions are typical of heterozygous achondroplasia. But even in recent years some observers noted more severe changes of enchondral ossification. An extensive histologic skeletal survey in a newborn achondroplastic male revealed remarkable findings: It clearly showed that in addition to a generalized, but moderate narrowing of the zones of enchondral ossification focal severe changes were present in various epiphyseal plates including clusterlike arrangement of enlarged chondrocytes, vacuolization, premature calcification and important fibrosis of cartilagineous matrix with membranous ossification. Our findings thus enable us to reconcile the seemingly divergent statements made before.

Achondroplasia↗
PubMed2004

Celecoxib versus indomethacin in the prevention of heterotopic ossification after total hip arthroplasty.

A cyclo-oxygenase (COX)-1 and COX-2 inhibitor (indomethacin) and a selective COX-2 inhibitor (celecoxib) were compared in the prevention of heterotopic ossification after total hip arthroplasty. In 250 patients receiving indomethacin and in 150 patients receiving celecoxib for 20 days after surgery, an overall incidence of heterotopic ossification of 17.5% and 14.3% was seen, respectively (difference not statistically significant: P > .05). No grade III or IV ossifications were seen in either group. Twenty-one patients in the indomethacin group (8.4%) and 3 patients in the celecoxib group (2.0%) required treatment discontinuation, because of side effects (P < .05). Celecoxib, a selective COX-2 inhibitor, shows the same efficacy as indomethacin in the prevention of heterotopic ossification after hip prosthesis with significantly fewer side effects.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

Heterotopic ossification following primary total knee arthroplasty.

Heterotopic ossification is a rare complication following primary total knee arthroplasty and may be symptomatic if massive enough. The authors retrospectively reviewed 158 primary total knee arthroplasties from 1985 to 1989 and found 6 cases (3.8%) of heterotopic ossification. Patients were graded before and after surgery according to the Hospital for Special Surgery total knee arthroplasty score and their histories were reviewed for the presence of recognized risk factors for heterotopic ossification and whether a manipulation under anesthesia was performed. This report describes the incidence of, appearance of, and clinical risk factors for heterotopic ossification following primary total knee arthroplasty in this series. A radiographic grading system is proposed.

Aged↗