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PubMed1987

[A morphological study of the etiology and growth of ossification of the posterior longitudinal ligament of the spine].

To know causative and growth factors of ossification of the posterior longitudinal ligament (OPLL) of the spine, we carried out morphological investigation on 212 cases with OPLL and 9 cases of autopsies without OPLL. The results are as follows: 1) The etiology of OPLL ensued from enchondral ossification of ligamentous fibers has not only its primary source in a hereditary factor of polygenic character, but also anatomical stress, age and sex may be influential in causative factors. 2) When the degree of the hereditary factor is weak, the lesion initiates near the posterior border of the vertebral body and grow into a segmental or localized type of OPLL in the final form. When the degree of the hereditary factor is strong, a wide ossification of a continuous or mixed type of OPLL initiates all at once and grow up with movement of the spine, after which modeling continues to take place. 3) New ossification growth over time will arise from the stress resulting from movement of the spine.

Adult↗
PubMed1988

Osteonecrosis and ossification disturbance of the femoral head in spontaneously hypertensive rats.

The usefulness of spontaneously hypertensive rats (SHR) as a model animal for Perthes disease was evaluated because bone necrosis and ossification disturbance are frequently found in SHR. Twenty femoral heads from twenty-week-old male SHR were compared with twenty femoral heads from each control strain, Wistar Kyoto rat, Wistar rat and Donryu rat, in radiological and histological studies. SHR radiographs revealed flattening of the femoral head, radiolucent area and absence of trabeculae in the ossific nucleus as well as shortening and broadening of the neck. In the histological study of epiphysis in SHR, bone necrosis and various stages of its repair process and ossification disturbance represented the main findings. Incidence of these abnormal findings were significantly higher than in the control groups. Clarification of the causes of bone necrosis and ossification disturbance in SHR will provide a key to the understanding of the pathogenesis in Perthes disease.

Animals↗
PubMed1985

[Anatomical study of the yellow ligament of the spine with special reference to its ossification].

In thoracolumbar spine, the interlaminar and the capsular portion of the yellow ligament differed in their location and direction of elastic fibers. However, the capsular portion in most cervical spines were not considered to represent elastic tissues. At the ligament-osseous junction (enthesis) in the thoracolumbar spine, decreased elastic fibers, hyalinized collagen fibers, emergence of fibrocartilaginoid cells and intra-ligamentous calcification were noted. In the cervical spine and in part of the thoracolumbar spin, however, elastic fibers were close to the bony tissue partially penetrating it without the above-mentioned histological findings. Small ossification in the yellow ligament of a cadaver was considered to be "degenerative enthesopathy (enthesophyte)" originating from "enthesis". But in operative cases, the ossification had the same direction and location as those of the small ossification seen in a cadaver, but endogenous factors were strongly suggested because of the extensive change in matrix prior to ossification.

Adult↗
PubMed1977

[Periarticular ossification following replacement of the hip-joint. Clinical and radiologic examination of 697 hip-joints (author's transl)].

Systematic examination of 733 cases of replacement of the hip-joint, operated on with an identical technique and method of post-operative treatment. Frequency and severity of periarticular ossification, their relationship to pre-operative arthrosis and their effect on joint function are described. Development and localization of periarticular ossification, their higher incidence after tearing off of the trochanter, removal of osteophytes and occurrence of hematomata hint at surgical trauma as one of the causes. Preliminary operations on the proximal end of femur did not influence ectopic ossification. Ossification of grade I did not interfere with function, grades II and III limited movement in varying degrees.

Follow-Up Studies↗
PubMed1983

Sciatic nerve compression by preexisting heterotopic ossification during general anesthesia in the dorsal lithotomy position.

This report documents the 4th patient reported with sciatic nerve compression by heterotopic ossification and the 1st case occurring during general anesthesia. A 25-year-old woman developed right sciatic nerve dysfunction after a 30-minute dilatation and curettage in the dorsal lithotomy position. Postoperative x-rays revealed a large area of heterotopic ossification above the right greater trochanter. The patient had sustained a traumatic midshaft fracture of the right femur seven years previously, which required intramedullary nail fixation. It is postulated that during the D and C in the dorsal lithotomy position, the heterotopic ossification was displaced posteromedically, compressing the sciatic nerve that had already been placed at maximal stretch. The patient recovered partially. Electrodiagnostic studies were of considerable value in localization of the lesion and confirmation of the mechanism of injury. It is concluded that preexisting heterotopic ossification of the hip may compress the sciatic nerve during surgery in the dorsal lithotomy position.

Adult↗
PubMed1983

Diphosphonate treatment for heterotopic ossification in spinal cord injury patients.

Nine patients who had spinal cord injury and were receiving diphosphonate therapy for established neurogenic heterotopic ossification in 14 hips were followed up for an average of 14 months. Diphosphonate therapy at a dosage of 10 mg/kg/day when prescribed an average of 26 days after diagnosis did not prevent radiographically evident progression of heterotopic ossification. The interval of one to 30 days between clinical diagnosis and institution of diphosphonate treatment did not appear to affect the duration of radiographic progression or the final radiographic grade at maturity. Disodium etidronate therapy did not prevent the appearance of heterotopic ossification in three previously unaffected hips, although the final radiographic grade was mild. The radiographic progression of heterotopic ossification averaged 5.3 months. No clinically detectable side effects were attributable to the medication at the dosage prescribed after an average of 14 months of therapy. Due to the radiographic progression noted in patients who received 10 mg/kg/day, diphosphonate has been increased to dosages of 20 mg/kg for six months after early diagnosis.

Adolescent↗
PubMed1983

Ectopic ossification following total hip replacement in juvenile chronic arthritis.

Of twenty-one patients with juvenile chronic arthritis (seventeen with juvenile rheumatoid arthritis and four with juvenile ankylosing spondylitis) who had total hip replacement before the age of thirty years, thirteen patients (62 per cent) showed different degrees of ectopic ossification: nine (53 per cent) of the seventeen with juvenile rheumatoid arthritis and all four of those with juvenile ankylosing spondylitis. Human leukocyte antigen B5 was found with an increased frequency in the patients with ectopic ossification. Functional capacity was not impaired regardless of the severity of the ectopic ossification. As in patients with adult-onset disease, ectopic ossification after total hip replacement occurred with a higher frequency in the patients with juvenile-onset ankylosing spondylitis than in those with juvenile-onset rheumatoid arthritis.

Adolescent↗
PubMedDate not supplied

Myelopathy due to ossification or calcification of the ligamentum flavum: radiologic and histologic evaluations.

The clinical, radiologic, and histologic features of ossification and calcification of the ligamentum flavum were studied in 18 patients. Ossification (15 patients) usually occurred in the lower thoracic spine in men of various ages, while calcification (three patients) was found exclusively in the cervical region of older women. Histologic examinations of ossification showed mature lamellar bone associated with proliferated cartilage replacing the ligamentum flavum (endochondral ossification). This corresponded well with radiographic and computed tomographic (CT) appearances. In the cases with calcification of the ligamentum flavum, calcification within the degenerated ligamentous fibers was observed on histologic examination, and correlated well with an oval nodular density on radiographs and CT. The two conditions differ in clinical, radiologic, and histologic considerations. Pathomechanisms in the development of these lesions and clinical significance are also discussed.

Adult↗
PubMed1983

Correlation between ossification and inflammation using a rat experimental model.

In seronegative spondylarthropathies both inflammation and ossification can be demonstrated. Inflammation is a hallmark of diseases associated with antigen HLA-B27 in ankylosing spondylitis, Reiter's syndrome, and acute uveitis. Ossification is traditionally considered the end product of inflammation, but clinical examination does not show that this is always the case in man. The relationship between inflammation and ossification is not demonstrated in experiments on spinal involvement in adjuvant arthritis in the rat. Using that experimental model, we tested the efficacy of 3 nonsteroidal antiinflammatory drugs (indomethacin, naproxen, and phenylbutazone) given at dosages comparable to those employed in clinical practice, but at a lower level than those used by drug companies in animals. Results show that the drug exhibiting almost no antiinflammatory activity in the rat at the dosage used, phenylbutazone, was the most powerful inhibitor of ossification. Another mechanism of local osteogenesis must be sought to explain such a phenomenon.

Animals↗
PubMed1982

Heterotopic ossification of the hip as a complication of tetanus.

Heterotopic ossification is a very rare complication of tetanus. In one case heterotopic ossification occurred around both hip joints. The values of serum creatine phosphokinase had been elevated significantly when the patient had major muscle spasms. The elevation in serum alkaline phosphatase values following that in creatine phosphokinase values persisted for about four weeks. Partial resection of the bone mass about the right hip joint resulted in a satisfactory improvement in performance of daily activities. The specimens incised at operation revealed both lamellar and woven bone surrounded by fibrous connective tissue. Very near the bone mass were severely degenerated muscle fibers. In addition, evidence suggesting metaplasia of fibroblasts to osteoblasts was seen in some areas. Clinical and laboratory data indicate trauma as a main etiologic factor of heterotopic ossification following tetanus. Heterotopic bone formation should be considered if elevation of the serum alkaline phosphatase values persists beyond the period of elevation of serum creatine phosphokinase values. Artificial ventilation may be beneficial for preventing heterotopic ossification following tetanus if it is administered before there is significant elevation of the serum creatine phosphokinase values.

Adult↗
PubMed1982

The effect of indomethacin on para-articular ectopic ossification following total hip arthroplasty.

Three patients exhibiting Grade III para-articular ectopic ossification following bilateral hip arthroplasty were successfully treated by excision of the bone and small-dose, short-term indomethacin therapy. Based on these results, a preliminary study was performed to determine the effect of indomethacin used prophylactically in patients who were predisposed to ectopic ossification and were undergoing total hip arthroplasty. Of a retrospective control group of 24 hips with extensive bilateral osteoarthritis, 63% were found to develop ectopic ossification following arthroplasty compared to 17% of a similar group treated with indomethacin (p less than 0.001). The ectopic ossification in the indomethacin-treated group possibly was of lesser severity (Grade I) than that encountered in the control group.

Adult↗
PubMed1994

[Pre- and postoperative radiotherapy to prevent heterotopic ossification of the hip joint].

BACKGROUND: In-vivo experimental data indicate that both pre- and postoperative radiotherapy can prevent heterotopic ossification after hip surgery. This comparison was clinically tested in a randomized study. PATIENTS AND METHODS: From June 1992 to September 1993, 84 patients with high risk for the development of heterotopic ossification were randomized. The treatment concept consisted either of preoperative radiotherapy within four hours prior to surgery (arm A) or postoperative radiotherapy within 72 hours following hip surgery (arm B). Preoperative radiotherapy was given in one fraction of 7 Gy, while the postoperative radiotherapy was delivered in five fractions of each 3.5 Gy (total 17.5 Gy). All patient variables (age, sex, prior surgery) and predisposing risk factors were comparable in both treatment arms. For the radiological assessment of heterotopic ossification according to (Brooker-Score) X-rays of the pelvis or hip were evaluated which had been taken immediately pre- and postoperatively as well as at least six months following surgery and prophylactic irradiation. The functional hip status was evaluated pre- and postoperatively using the Harris-Score. Cases in which the Brooker- and/or Harris-Score worsened during the postoperative follow-up as compared to the pre- and immediate postoperative situations were considered as treatment failures. RESULTS: Of 44 patients with at least six months follow-up 41 (93%) experienced a successful prophylaxis. Two failures were observed in the preoperative and one in the postoperative group. The prophylactic efficacy was not influenced if the pre- or postoperative interval was longer than prescribed. All intra- and postoperative complications were comparable for both treatment groups. The mean interval to partial strain (50% body weight) of the operated hip was longer in the preoperative group (mean 19 +/- 27 days) as compared to the postoperative group (mean 8 +/- 13 days). With respect to full strain (100% body weight), the results were equal in both groups. The functional hip status decreased in two patients. Again the mean overall improvement in the postoperative group was larger (mean 42.7 +/- 17.1 points) as compared to the preoperative group (mean 34.3 +/- 13.7 points). CONCLUSIONS: Preoperative and postoperative radiotherapy have equal prophylactic efficacy to prevent heterotopic ossification following hip surgery. The main advantage of preoperative radiotherapy are the simple management of the patient, the reduction of possible complications associated with transport and positioning of the patient in the postoperative period as well as excellent acceptance of this treatment concept by patients, nurses and staff.

Aged↗
PubMed1993

Effect of a persistent inflammatory process on experimental heterotopic ossification. The influence of macrophages.

1. We investigated the effect of a persistent carrageenin- or nystatin-induced inflammatory reaction on heterotopic ossification produced by the subcutaneous implant of a demineralized bone matrix in female Swiss mice (25 to 35 g). 2. Subcutaneous carrageenin injection (0.3 ml of a 2% solution in saline) into mice induced an inflammatory reaction characterized by a mature granuloma predominantly of macrophages containing particles of the irritant in their cytoplasm and which remained unchanged until the end of the experiment (40th day). 3. Subcutaneous nystatin inoculation (30,000 IU in 0.3 ml saline) induced an inflammatory reaction consisting initially of macrophages (4th day) but later turning into an epithelioid granuloma (7th day) consisting predominantly of epithelioid cells and which was present up to the 21st day when it was gradually replaced by adipocytes up to the 30th day. 4. An intramuscular implant of demineralized bone matrix (DBM, approximately 10 mg) induced the formation of cartilage and bone tissue and of hemopoietic bone marrow (heterotopic ossification) in 100% of the control animals (N = 5). An intramuscular DBM implant in animals that received carrageenin (N = 19) or nystatin (N = 21) induced heterotopic ossification in 100 and 57% (P < 0.01) of the animals, respectively. 5. The response to a dorsal subcutaneous DBM implant was essentially negative in control animals (N = 5), whereas implants performed near the site injected with carrageenin (N = 28) or nystatin (N = 31) produced a response in 71 (P < 0.01) and 36% (P < 0.01) of the animals, respectively. A DBM implant into the contralateral (control) dorsal subcutaneous tissue of the same animals that received carrageenin (N = 25) or nystatin (N = 29) resulted in heterotopic ossification in 64 (P < 0.01) and 7% of the animals, respectively. 6. The results suggest that the macrophages present in the mature granuloma induced by carrageenin somehow favored the development of metaplastic plates after subcutaneous DBM implant and that this effect may be systemic since the same response was observed in contralateral subcutaneous tissue.

Animals↗
PubMed1993

[Achilles tendon ossification and achillodynia].

Achilles tendon ossification is a rare and asymptomatic condition. The possible sequelae of tendinitis, bursitis and fracture are some of the causes of achillodynia. Achillodynia is often unrelieved by conservative management and excision of the ossification may be necessary. Moreover, ossification were found in 3 of 41 patients with spontaneous rupture of the Achilles tendon. Predisposing degenerative changes of the tendon were found in all patients. Thus there is no evidence that ossification by itself may increase the risk of tendon rupture.

Achilles Tendon↗
PubMed1995

Thallium-201 accumulation in myositis ossificans and in juxta-articular ossification.

We present the findings on 201Tl and 99mTc-MDP scintigraphy in three patients suffering from heterotopic ossification (two patients presenting with myositis ossificans and one patient presenting with juxta-articular ossification in combination with myositis ossificans). Since resection of the lesions has to be delayed until stabilization, 99mTc-MDP is often used as a parameter of lesional activity, although it is not optimal. For this clinical problem, we evaluated 201Tl scintigraphy as a marker of metabolic activity. In addition to the well-documented uptake of 99mTc-MDP, marked accumulation of 201Tl was observed in all heterotopic ossification sites. Hence, our results support the use of 201Tl scintigraphy in the therapeutic management and monitoring of conditions associated with ectopic ossification. On the other hand, although myositis ossificans is sometimes clinically, radiographically and even histologically confused with extraosseous osteogenic sarcoma, 201Tl accumulation may not be a helpful factor in the differential diagnosis due to the presence of tracer accumulation in both disorders.

Adult↗
PubMed1997

Bone morphogenetic protein receptors and activin receptors are highly expressed in ossified ligament tissues of patients with ossification of the posterior longitudinal ligament.

Ossification of the posterior longitudinal ligament (OPLL) is a pathological ossification in the spinal ligament, with formation of ectopic bone mainly through endochondral ossification. Bone morphogenetic proteins (BMPs) and activins are multifunctional proteins that belong to the transforming growth factor-beta superfamily and that have been implicated in the formation of new bone and cartilage. BMPs and activins signal via type I and type II receptors for BMPs (BMPRs) and activins (ActRs), respectively. OP-1/BMP-7 binds to BMPR-II and ActR-II and forms complexes with BMPR-IA and -IB and ActR-I. We studied the expression of BMPR-IA, -IB, and -II, ActR-I, ActR-II, and OP-1/BMP-7 by immunohistochemistry in ossified ligament tissues of patients with OPLL and control ligament tissues from patients with cervical disc herniation. The expression of BMPRs and ActRs was elevated in OPLL compared with controls. Expressions of BMPR-IA, -IB, and -II were observed not only in chondrocytes at the fibrocartilage tissue around the calcified zone but also in fibroblast-like spindle cells at the nonossified ligament. ActR-I and -II were found co-localized in the hypertrophic chondrocytes near the calcified zone and in the ossified tissue. OP-1/BMP-7 was expressed in chondrocytes near the calcified zone. In the control cases, the BMPRs and ActRs were only weakly expressed in the fibrocartilage tissue at the site of ligament attachments to bone and OP-1/BMP-7 was not detected. Enhanced expression of BMPRs at the nonossified ligament in OPLL patients suggests that these cells have a greater potential to differentiate into osteogenic cells than ligament cells from non-OPLL patients. The high expression of BMPRs and ActRs in the ectopic ossified ligament suggests that BMPs and activin may be tightly involved in the pathological ossification process of OPLL.

Activin Receptors↗
PubMedDate not supplied

Removal of heterotopic ossifications followed by cobalt therapy after hip arthroplasty.

The authors report 7 cases in which removal of high grade ossification which developed after hip arthroplasty was performed: all of the patients were treated postoperatively by radiation therapy with the purpose of preventing recurrence of ossification. After surgery ossification was present, but to a moderate degree, in 6 out of 7 cases examined; movement had clearly improved. The results obtained show that removal surgery is justified if movement of the hip is considerably impaired (ankylosis) and that prevention plays an essential role and must be carried out every time that the patient risks the development of ossification.

Aged↗
PubMed1997

Prevalence of heterotopic ossification in cemented versus noncemented total hip joint replacement in patients with osteoarthrosis: a randomized clinical trial.

OBJECTIVE: To determine the prevalence of heterotopic bone formation in cemented versus noncemented total hip joint replacement. DESIGN: A prospective randomized controlled trial. Follow-up ranged from 2 to 6 years (mean 4 years). SETTING: A university hospital. PATIENTS: Two hundred and twenty-six patients who had primary or secondary osteoarthrosis of the hip were stratified according to type of fixation, surgeon and age. Patients were randomized within strata: 112 received noncemented total hip prostheses and 114 received cemented prostheses. The 2 groups were similar with respect to age and sex. INTERVENTION: Primary total hip arthroplasty. A cemented (methylmethacrylate) or noncemented prosthesis was inserted by a lateral surgical approach. MAIN OUTCOME MEASURE: The Brooker classification was used to grade heterotopic bone formation from postoperative radiographs. RESULTS: Overall, 148 (66%) hips had no heterotopic ossification, 56 (25%) were Brooker class I, 14 (6%) were class II, 8 (3%) were class III and none were class IV. In the noncemented group of patients, 76 (68%) hips had no heterotopic ossification, 25 (22%) were Brooker class I, 7 (6%) were class II, 4 (4%) were class III and none were class IV. In the cemented group of patients, 72 (63%) hips had no heterotopic ossification, 31 (27%) hips were Brooker class I, 7 (6%) were class II, 4 (4%) were class III and none were class IV. CONCLUSION: There was no significant difference in the prevalence of heterotopic ossification between cemented and noncemented total hip replacements in patients with osteoarthrosis.

Aged↗