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At least 793 records · Page 44Linked to original sources
PubMed2003

Indomethacin versus meloxicam for prevention of heterotopic ossification after total hip arthroplasty.

BACKGROUND: Heterotopic ossification (HO) is a recognized postsurgical complication after total hip arthroplasty. Brooker et al. [6] established a grading system to define the degree of HO. The results of several studies have shown that non-steroidal anti-inflammatory drugs (NSAID) and radiation therapy reliably reduce the occurrence of severe HO. The exact cause and mechanism of bone formation are not known. The efficacy of indomethacin versus meloxicam for the prevention of heterotopic periarticular ossification and clinical NSAID side-effects after primary, cementless total hip arthroplasty was evaluated. METHODS: Probands underwent cementless total hip replacements at the Orthopaedic Department, Hospital Wiener Neustadt, from January 1997 to January 1998, did not take NSAID up to 4 weeks preoperatively and had no NSAID contraindications. Patients were separated into two groups by different hospitalisation floors. All patients selected for this study suffered from primary or secondary coxarthrosis. Data were collected as a prospective, randomised, parallel group study. Patients were given 50 mg indomethacin 2 times daily ( n=58) vs 7.5 mg meloxicam ( n=58) in a 12-day treatment course. RESULTS: A two-sided Cochran-Armitage trend test showed no statistically significant difference ( p<0.05) for one of the drugs regarding influence on ectopic bone formation according to the grading system of Brooker et al. CONCLUSION: Our study demonstrates that there is no statistically significant trend that indomethacin or meloxicam protects a hip arthroplasty better from heterotopic bone formation. We prefer indomethacin therapy because it is almost half the price of meloxicam therapy, and we recommend indomethacin in a 12-day treatment course given 50 mg 2 times daily as an effective, inexpensive and easily administered HO prophylaxis.

Aged↗
PubMed2004

The value of expanded polytetrafluoroethylene in preventing early re-ossification after craniosynostosis surgery: an experimental animal study in the rat.

BACKGROUND: Early re-ossification at the suturectomy site after craniosynostosis surgery remains an important problem. Many surgical methods have been used to address this, including placement of various types of absorbable and non-absorbable material between the bone edges at the site. This experimental study investigated the value of expanded polytetrafluoroethylene (ePTFE) membrane as a barrier to calvarial reclosure after craniosynostosis surgery in rats. METHOD: Thirty-five 2-week-old Sprague-Dawley rats were divided into two groups. In Group A (n = 17), ePTFE membranes were placed in the defect formed by a left coronal suturectomy. The Group B rats (n = 18) underwent left coronal suturectomy only. Animals were sacrificed at 1, 2 and 4 months postoperatively. In each case, the skull was removed and the operative site was examined for fibrosis, new bone formation, bone bridging, neovascularization and inflammatory response. FINDINGS: The two groups were similar with respect to neovascularization and new bone formation. By the end of the fourth postoperative month, 50% of the Group B specimens showed fibrosis and 50% showed bridging between the bone edges at the suturectomy site. In contrast, at the same stage in Group A, only 16.6% of the specimens exhibited a small amount of fibrosis, and none showed bone bridging between the edges. INTERPRETATION: Expanded PTFE is one of the most inert materials used in surgery. The study showed that inserting ePTFE membrane as a barrier between the bone edges at the suturectomy site prevents early re-ossification after craniosynostosis surgery in rats.

Animals↗
PubMed1999

Bone mineral density in patients with ossification of the posterior longitudinal ligament in the cervical spine.

Bone mineral density (BMD) has not been clearly determined in patients with ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. BMD in patients with OPLL was measured in the third vertebral body in the lateral projection and in the distal part of the radius in the anteroposterior projection using dual-energy X-ray absorptiometry (DXA). Patients with OPLL had significantly higher BMD than healthy controls in both the lumbar spine and radius. Observing BMD by gender and age group, high BMD was recognized especially in female patients over 60 years of age. Significantly increased BMD was observed in patients with ankylosing spinal hyperostosis (ASH) in addition to OPLL. These findings suggest that patients with OPLL may tend to develop systemic hyperostosis, leading to the pathological ectopic ossification observed in OPLL.

Absorptiometry, Photon↗
PubMed2003

Carpal tunnel syndrome due to heterotopic ossification.

We report a rare case of carpal tunnel syndrome due to heterotopic ossification in the carpal tunnel in a 34-year-old woman without antecedents of neurological injury, musculoskeletal trauma, or metabolic disorder. To our knowledge, this is the first reported case. Incomplete excision of heterotopic ossification resulted in partial relief of symptoms.

Adult↗
PubMed2000

Recent progress in the study of pathogenesis of ossification of the posterior longitudinal ligament.

The pathogenesis of ossification of the posterior longitudinal ligament (OPLL) is still unknown. Gene analysis and molecular biology have been introduced in recent years, and etiologic and pathological clarifications are being achieved. An important role of the genetic background in the development of this disease was demonstrated by pedigree survey, twin survey, and HLA haplotype study. The results of gene linkage study showed that patients with OPLL have a significantly higher incidence of genetic abnormalities found in the XI collagen (alpha)2 gene (COL11A2) region. From the gene mapping of this abnormality, the abnormal N-propeptide of the COL11A2 gene was found to be responsible. We are planning to undertake genetic analysis of the whole of chromosome VI to find the pathogenic genes responsible for OPLL in addition to COL11A2. A cell biological approach is also necessary to make clear the relationship between abnormalities of the COL11A2 gene and ossification of the ligament. In future, identification of the susceptible gene, elucidation of its function, and study toward the development of preventive and therapeutic drugs will advance.

Chromosome Mapping↗
PubMed1989

II. Stylohyoid chain ossification: a discussion of etiology.

It has been estimated that between 2% and 4% of the general adult population has radiographic evidence of an ossification of the stylohyoid chain. In an effort to prove that this is also the case in children and adolescents, 150 panoramic radiographs were examined at the Department of Pedodontics of St. Justine's Hospital in Montreal, Quebec, Canada. A total of 300 styloid processes and stylohyoid chains were evaluated and measured radiographically. The patients' mean age was 11 years. The mean length of the styloid processes was 10 mm. Forty percent of the population without symptoms studied showed some evidence of stylohyoid ligament ossification. Sixty percent of these were males; 40% were females. It was also found that 65.6% had no history of cervicopharyngeal trauma on review of the medical and dental histories.

Adolescent↗
PubMed1996

Ossification of the posterior longitudinal ligament of the cervical spine in Asian Indians--a multiracial comparison.

Ossification of the Posterior longitudinal ligament (OPLL) has been thought to be a predominantly Japanese disease with few reports among the non-orientals and Caucasians. A prospective clinicoradiological study of 47 symptomatic Caucasoid Indians is reported. Twenty-seven patients presented with myelopathy, twelve with myeloradiculopathy and six with radiculopathy. 'Total' configuration of OPLL was the most frequent (70%). The most frequent location was at C3 and C4 levels. The thickness of OPLL ranged from 2.5 mm to 11.5 mm. Canal stenosis was most severe in patients with 'total' type of OPLL. Ossification of other spinal ligaments were seen in 50% of the patients. Twenty-one patients underwent decompressive laminectomy and twenty of them improved. The difference in the cervical canal diameters and the configuration of OPLL between the Japanese and our population (Caucasoid Indians) may be of therapeutic relevance.

Adult↗
PubMed1994

Randomized trial comparing preoperative versus postoperative irradiation for prevention of heterotopic ossification following prosthetic total hip replacement: preliminary results.

PURPOSE: Previous in vivo data support effectiveness of preoperative irradiation in suppressing heterotopic ossification (HTO) in a rat model. A prospectively randomized, multiinstitution clinical trial to assess the comparative efficacy of preoperative vs. postoperative irradiation in preventing HTO in total hip replacement patients was undertaken. METHODS AND MATERIALS: One hundred and twenty-two patients (124 hips) with significant risk factors for HTO following elective total hip replacement were randomized to receive irradiation via either preoperative (< 4 h before surgery) or "standard" postoperative (< 48 h after surgery) schedules. Single 7-8 Gy fractions were administered. Treatment volume included soft tissues between periacetabular region of pelvis and intertrochanteric portion of femur. All but nine patients had biologic fixation prostheses, the porous-coated portions of which were shielded. Radiographs of treated hips were obtained immediately and at 2 and 6 months postsurgery. Heterotopic ossification was scored according to the Brooker Grading system. RESULTS: Ninety-eight patients are evaluable (55 preoperative, 43 postoperative) with median follow-up of 38 weeks. No significant differences were noted in the incidence of overall HTO (26% preoperative vs. 28% postoperative, p = 1.0) or clinically significant Brooker grade 3 or 4 HTO (2% preoperative vs. 5% postoperative, p = 0.58). No significant differences in treatment variables (including time interval between preoperative irradiation and surgery) were evident on comparing preoperatively treated patients forming HTO with those who did not. CONCLUSION: Prophylactic irradiation of the operative site within 4 h prior to elective total hip replacement appears to be comparably effective to the currently accepted postoperative treatment schedules in prevention of clinically significant HTO about the hip. This finding is of importance in terms of patient comfort, ease of treatment, and avoidance of possible complications associated with moving the patient to the radiotherapy department in the immediate postoperative period.

Aged↗
PubMed1988

Abnormal ossification in thanatophoric dysplasia.

Thanatophoric dysplasia (TD) is a lethal human bone dysplasia characterized by severe dwarfism. It pathogenesis is thought to involve an abnormal ossifying fibrous tissue that disrupts the skeletal growth plate. We employed a combined morphologic, immunohistochemical and biochemical approach to better define the nature of this tissue in growth plate cartilage from 15 TD fetuses and infants in whom the abnormality was observed. The tissue was organized into tufts comprised of a cap of interstitial connective tissue, a transition region containing preosteoblastic cells near the cap and osteoblastic cells near the base, and a mineralized base which formed the subchondral bone trabeculae. The morphology of the cells and the presence of type I collagen in all regions of the tufts suggested that they were foci of membraneous ossification. However, elements of cartilage matrix (type II collagen, proteoglycan, link protein) were identified in the pericellular matrix of the osteoblastic cells and adjacent osteocytic cells. These observations suggest that a peculiar form of ossification occurs in the TD growth plate and may be involved in the pathogenesis of the disorder.

Collagen↗
PubMed2005

Forward deviation of the mandibular condyle enhances endochondral ossification of condylar cartilage indicated by increased expression of type X collagen.

OBJECTIVE: Using type X collagen as a marker, this research was designed to examine the alteration of condylar growth in response to mandibular condylar forward positioning. METHODS: One hundred female Sprague-Dawley rats with 5 weeks of age were randomly divided into five experimental and five control groups. In the experimental groups, bite jumping appliances created forward positioning of the condyle. The experimental rats, together with the age-matched controls, were sacrificed on days 3, 7, 14, 21 and 30, respectively. Tissue sections were cut in the sagittal plane through the mandibular condyle and were processed for in situ hybridization and immunostaining of type X collagen and then for quantitative imaging analyses. RESULTS: (1) Both type X collagen mRNA in situ hybridization signals and type X collagen immunostaining were localized within the hypertrophic zone of the condylar cartilage. (2) With condylar forward positioning, the level of type X collagen mRNA signals (8,541 +/- 74 microm(2) at peak) was 300% higher than that in the controls (2,117 +/- 78 microm(2) at peak); type X collagen immunostaining in condylar advancing groups (54,864 +/- 134 microm(2) at peak) was 254% more than that in the controls (15,470 +/- 121 microm(2) at peak). (3) The amount of type X collagen mRNA signals and immunostaining in experimental and control groups reached the highest levels at day 14 and day 21, respectively, indicating that an increase in endochondral ossification occurred 21 days after condylar forward deviation. CONCLUSION: Condylar forward repositioning provokes an enhanced maturation of condylar chondrocytes resulting in increased synthesis of type X collagen, a extracellular protein that attributes to endochondral ossification.

Animals↗
PubMed2004

The incidence of heterotopic ossification after total knee arthroplasty.

Five hundred consecutive patients undergoing primary cemented knee arthroplasties were prospectively followed up and evaluated for the presence of heterotopic ossification. Of the patients studied, 95% had osteoarthritis and 5% had inflammation. A radiographic grading system was devised based on the size and location of the heterotopic bone. The overall incidence of heterotopic ossification in this group was 15%. The patients who developed HO tended to be heavier than the average and were more likely to be men. This is the most comprehensive prospective study of the incidence of HO in primary cemented knee arthroplasty. Other than a small subset of the patients (4 of 500), HO does not appear to have a major influence on the outcome of knee arthroplasty.

Aged↗
PubMed2005

Severe symptomatic heterotopic ossification and dislocation: a complication after two-incision minimally invasive total hip arthroplasty.

Minimally invasive total hip arthroplasty (THA) continues to be surrounded by controversy. Some proponents argue that they are able to achieve reduced soft tissue trauma, blood loss, postoperative pain, and hospitalization time as well as a more cosmetically pleasing surgical scar. Types of complications similar to those of a more open exposure are now being reported with these techniques. One such complication is the development of severe symptomatic heterotopic ossification requiring treatment. This case report profiles a patient who required removal of Brooker stage III heterotopic ossification after a 2-incision minimally invasive total hip THA. This is the first report of this complication after 2-incision THA.

Arthroplasty, Replacement, Hip↗
PubMed2006

Heterotopic ossification of percutaneous nephrostomy tract.

Heterotopic ossification is a rare, abnormal formation of true bone within extraskeletal soft tissues and is a common complication after musculoskeletal trauma or orthopedic procedures. We report a case of heterotopic ossification of a percutaneous nephrostomy tract causing flank pain and masquerading as a retained nephrostomy catheter in a young steroid-dependent man with sarcoidosis 2 years after percutaneous nephrolithotomy. The patient's underlying sarcoidosis combined with local tissue ischemia likely contributed to this rare complication.

Adult↗
PubMedDate not supplied

Progressive osseous heteroplasia: an uncommon cause of ossification of soft tissues.

Whereas the deposition of calcium within soft tissues is not infrequent, the development of highly structured, mineralized tissue histologically identifiable as true bone is uncommon and can cause a variety of clinical features. This article reports the clinical and radiological features in a patient with progressive osseous heteroplasia (POH), a recently identified disorder characterized by heterotopic ossification. The patient, a female, was 20 years of age at presentation. In addition to abnormal ossifications, she had short metacarpals at the fourth and fifth rays and short metatarsals at the second rays. Her parents were unaffected. Until the results of Rosenfeld and Kaplan in 1995 reporting POH in two boys, typical features had only been reported in females (n=8). POH is usually sporadic; however, familial associations and atypical phenotypes have been reported.

Adult↗
PubMed2001

Bronchial anastomotic stricutre caused by ossification of an intercostal muscle flap.

We report a case of heterotopic ossification of a pedicled intercostal muscle flap that had been wrapped circumferentially around a bronchial sleeve anastomosis. This ossification caused severe bronchial stenosis and recurrent pneumonias. Stent insertion failed, and the patient ultimately required completion pneumonectomy. We recommended that caution be used when wrapping intercostal muscle around any important lumen.

Airway Obstruction↗
PubMed1995

Heterotopic ossification: treatment of established bone with radiation therapy.

Ectopic bone formation or heterotopic ossification (HO) is frequently seen on rehabilitation units after total hip arthroplasties, burns, and neurological injuries. Currently the major role for treatment is in prophylaxis and the major methods include anti-inflammatory medications, irradiation, and diphosphanate administration. These prophylactic measures are generally considered to be ineffective for the treatment of ectopic bone once it has already formed. We describe two cases of HO for which a radiation therapy protocol was used to treat established, ectopic bone after it had become problematic. Both patients were found to have increased range of motion and decreased complaints of pain after treatment, though no gross plain film x-ray changes were noted. We conclude that radiation therapy may be useful not only for prophylaxis of heterotopic ossification but for ectopic bone after it has been formed, especially when pain and progressively decreased range of motion are problematic.

Adult↗
PubMed2002

Inhibitory effect of bFGF on endochondral heterotopic ossification.

Basic fibroblast growth factor (bFGF) is reported to stimulate repair of fracture and bony defects in in vivo animal studies. However, most studies performed in vitro demonstrate inhibitory effect of bFGF on cartilage and bone differentiation. To understand the discrepancy observed in in vivo and in vitro studies, we evaluated the effect of bFGF on chondro-osteogenesis initiated by bone matrix powder (MP). MP was implanted in the murine hamstring muscles with or without administration of bFGF. Injection of 1 microg of bFGF markedly reduced the size of heterotopic bone induced by MP, as detected by X-ray. Injection of 10 microg of bFGF completely inhibited ossification and only fibrous tissues were observed at the site of MP implantation. The expressions of alkaline phosphatase and osteocalcin mRNAs, markers for bone differentiation, were completely suppressed by 10 microg of bFGF. These results demonstrate the inhibitory effect of bFGF on endochondral ossification in vivo, implicating a precaution for its use in musculo-skeletal disorders.

Alkaline Phosphatase↗
PubMedDate not supplied

Posterior approaches in the management of cervical spondylosis and ossification of the posterior longitudinal ligament.

BACKGROUND: If the cervical lordotic curvature has been well preserved, spondylostenosis or ossification of the posterior longitudinal ligament, with or without instability, may be approached posteriorly in selected older patients (over 65 years of age). Posterior surgical alternatives include the laminectomy with or without fusion, or laminoplasty. However, in younger patients or in geriatric patients with predominantly anterior disease with kyphosis, direct anterior surgical procedures yield better results. METHODS: Laminectomy with medial facetectomy and foraminotomy is classically performed in cases in which stability is preserved. However, posterior stabilization using either facet wiring or lateral mass fusion may be warranted. Although some consider the "open door" laminoplasty a reasonable alternative for dorsal decompression, limitations include restricted access to the hinged side, a potential for "closing of the door," and it does not offer a "real" fusion. RESULTS: Postoperative neurologic improvement may approximate an 85% incidence of good to excellent results. However, where a posterior decompression has been chosen, particularly in younger individuals with or without a lordotic curvature, or in older patients with kyphosis, they will fail to significantly improve, and will be susceptible to early neurologic deterioration. CONCLUSIONS: Posterior approaches to cervical disease may be successful in geriatric individuals in whom the cervical lordotic curvature has been well preserved. However, it is inappropriate for either older or younger patients with predominantly anterior disease, for whom direct anterior decompression with or without posterior stabilization is indicated. In those patients with significant ventral ossification of the posterior longitudinal ligament (OPLL), direct anterior resection will result in improved neurologic outcomes, whereas posterior decompression will fail to achieve a similar degree of neurologic recovery. Furthermore, dorsal decompression of OPLL may promote a more rapid progression of OPLL growth and concomitant neurologic deterioration.

Adult↗