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PubMed1991

Total hip arthroplasty. The role of antiinflammatory medications in the prevention of heterotopic ossification.

Postoperative prophylaxis with antiinflammatory medications, primarily indomethacin, is extremely effective in preventing the severest degrees of heterotopic ossification (HO) after a total hip arthroplasty (THA) and the recurrence of excised HO developed after a previous hip surgery. Prophylaxis with indomethacin should be given in 25-mg doses three times daily for at least three weeks, starting on the first postoperative morning. However, a shorter treatment period may be equally effective in preventing the severest degrees of HO, and a postoperative delay of five days before the initiation of prophylaxis does not seem to be followed by the development of severe HO. As evaluated one year after surgery, treatment with antiinflammatory medications in the immediate postoperative weeks did not increase the incidence of implant-bone interface radiolucencies, aseptic loosening, or revisions in cemented or cementless THAs when compared with cases that did not have postoperative treatment. However, although no major complications have been reported regarding the use of antiinflammatory medications in the prevention of HO after THA, orthopedic surgeons prescribing such treatment should be aware of their contraindications as well as early and late side effects. Since several antiinflammatory agents are reported to be effective in preventing HO, future reports dealing with HO after THA should always include information about the postoperative antiinflammatory treatment used.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1991

Prevention of heterotopic ossification in high-risk patients by radiation therapy.

Heterotopic ossification (HO) is a frequent occurrence after cemented and cementless total hip arthroplasty (THA). Patients at risk for this complication include those with preexisting ipsilateral or contralateral HO, diffuse idiopathic skeletal hyperostosis, hypertrophic osteoarthrosis, posttraumatic arthritis, and ankylosing spondylitis. Low-dose radiation therapy effectively prevents HO in this high-risk group when treatment is begun early in the postoperative period. A prospective evaluation has established the efficacy of fractionated and single-dose radiation therapy protocols. Limited radiation portals are used in patients receiving cementless prostheses. A rectangular radiation portal obliquely oriented to the prosthesis enables radiation treatment of the periarticular soft tissues while avoiding exposure of the bone-prosthesis interface. Radiation therapy to this interface may inhibit or delay bony ingrowth. Radiation therapy is the only treatment used to prevent HO that is delivered locally and not systemically. Low-dose radiation therapy using a limited radiation portal is the treatment of choice to prevent HO in high-risk patients after cementless THA.

Hip Prosthesis↗
PubMed1991

Heterotopic ossification.

Heterotopic ossification is a frequently encountered orthopaedic condition with multiple etiologies. Although not commonly problematic, it can be a devastating complication. Prophylactic measures, early recognition, and appropriate treatment are paramount in the management of this disorder. This article presents a review of the literature, delineates predisposing factors and identification of high-risk patients, and discusses current modes of prophylaxis and treatment of neurogenic and postoperative heterotopic bone formation.

Adult↗
PubMed1991

The use of aspirin to prevent heterotopic ossification after total hip arthroplasty. A preliminary report.

The reported incidence of heterotopic ossification (HO) after total hip arthroplasty (THA) ranges up to 50%. HO causes pain and restricted range of motion (ROM) in a significant number of these THA patients. From 1983 to 1988, 177 primary cemented THAs were performed in 131 consecutive patients. Six hundred fifty milligrams of buffered aspirin administered twice daily for two weeks was used as a prophylaxis for thromboembolic disease. There was an unusually low incidence of HO in this group of patients. Aspirin treatment was instituted the night before surgery and continued for two weeks, except in 13 patients (7%) who had to stop treatment because of gastrointestinal symptoms. All patients had at least one year of roentgenographic study postoperatively. According to the Brooker Classification of HO, there were 169 (96%) Grade I and Grade 0 hips, six (3%) Grade II, two (1%) Grade III, and no Grade IV. None of the patients had symptomatic restriction of ROM attributable to heterotopic bone. Aspirin is a safe and inexpensive agent for prevention of HO after THA.

Aspirin↗
PubMed1991

[Roentgenological manifestation of ossification of the posterior longitudinal ligament in the cervical spine causing severe spinal canal stenosis--a group comparison with and without marked spinal cord dysfunction].

Relationship between the degree of clinical symptoms and the lateral roentgenograms of the cervical OPLL causing severe spinal canal stenosis was studied among patients whose roentgenological minimum antero-posterior diameters of the available spinal canals were under 9mm. Lateral roentgenograms of 28 clinically mild patients were compared with those of 20 clinically severe patients. The type of ossification, the extent of OPLL, the narrowest level of the available spinal canal, and the minimum a-p diameter were not statistically significant parameters. The degree of canal stenosis at the 1cm cranial and 1cm caudal levels from the narrowest level, and the axial extent of canal stenosis around the narrowest level were less significantly in the group with mild symptoms than in the group with severe symptoms.

Adult↗
PubMed1991

Nonarticular complication of heterotopic ossification: a clinical review.

Heterotopic ossification (HO) is a complication in neurologic lesions such as head injury and spinal cord injury. Limitation of range of motion and ankylosis as results of HO are well documented. In this report, ten instances of nonarticular complications after development of HO are described. There were three instances of vascular compression, five instances of ulnar nerve compression at the elbow, and two instances of suspected lymphedema. Clinical findings and radiographic evidence of these complications are described. Clinicians should be aware of these complications when HO is diagnosed. In addition, HO should be considered in the differential diagnosis of deep venous thrombosis in spinal cord injured and head injured patients.

Adolescent↗
PubMed1991

[Significance of the anterior floating method for cervical myelopathy due to the ossification of the posterior longitudinal ligament].

In order to determine the clinical effectiveness of anterior decompression(floating method) for treatment of cervical myelopathy caused by the ossification of the posterior longitudinal ligament(OPLL), 33 cases were followed over 5 years after treatment. The floating method utilized was a much simpler procedure than OPLL removal. The clinical results were as follows: excellent in 11 cases, good in 10, improved in 8, unchanged in 4. Three cases showed growth of the OPLL after surgery, but the symptoms in these cases did not deteriorate. Post-surgery the growth of the OPLL can be predicted by precise observation of the radiographs and the myelogram. The incidence of complication was 24 per cent post-surgery (8/33). These results indicate that the floating method appears to be a good treatment for cervical myelopathy from OPLL.

Adult↗
PubMed1990

Massive heterotopic ossification after biceps tendon rupture and tenodesis.

Few complications from tenodesis of the long head of the biceps brachii have been described despite the wide variety of techniques. In a 53-year-old man, rupture of this tendon was treated by tenodesis and was complicated by heterotopic ossification that severely limited the function of the shoulder joints. Nonsurgical conservative treatment of biceps tendon ruptures may avoid the possibility of this complication.

Humans↗
PubMed1990

A biophysical study of posttraumatic ectopic ossification. A case report.

Sites of ectopic ossification (EO) due to sports injury in a long-distance runner were biopsied and analyzed. The mineral content was compared to that of normal adult bone and to paraosteoarthropathy (POA) using biophysical methods. The degree of mineralization of bone tissue (DMBT) was employed as an evaluation of maturity of calcified tissue. Fluoride and carbonate content were determined. The crystal lattice dimensions expressed by the a and c parameters, crystal size, and/or lattice perfection were obtained with x-ray diffraction. All values were near those found in nonpathologic, newly deposited human compact bone. DMBT, crystal size, and/or lattice perfection were near those observed in a 24- to 30-month-old POA. The data suggest that posttraumatic EO represents otherwise normal young bone.

Adult↗
PubMed1990

Achilles tendon ossification and fracture.

We describe the case of a patient who had a fracture through an ossified Achilles tendon, and we illustrate a second case. Such ossification is uncommon, occurring most often after trauma or surgery. A subsequent fracture has been reported previously in only eight patients.

Achilles Tendon↗
PubMed1990

[Epidemiological study on ossification of the posterior longitudinal ligament (OPLL) in the cervical spine--comparison of the prevalence between Japanese and Taiwanese].

The etiology of OPLL still remains obscure. The purpose of this study is to clarify whether OPLL in the cervical spine occurs more often in the Japanese than in the Chinese and the Takasago tribe (native tribe) in Taiwan. Lateral X-ray films of the cervical spine in these inhabitants over the age of 30 years were studied. Results were as follows. The prevalent rate of OPLL in the cervical spine was significantly lower in the Chinese (p less than 0.01) and in the Takasago tribe (p less than 0.05) as compared to the Japanese in Kagoshima. OPLL was found in 2 out of 1,004 Chinese (0.2%), in 2 out of 529 Takasago tribe (0.4%), and in 9 out of 514 Japanese in Kagoshima (1.8%). The incidence of ossification of the anterior longitudinal ligament, Barsony's disease and posterior osteophyte was significantly higher in the Chinese, while there was no significant difference of their incidence between the Takasago tribe and the Japanese in Kagoshima. This study suggests that the difference in the prevalence of cervical OPLL exists between Japanese and Taiwanese. However, further epidemiological survey is needed to ascertain this point.

Adult↗
PubMed1990

Heterotopic ossification after total hip replacement.

Heterotopic bone formation occurs in up to 70% of patients who have undergone a total hip arthroplasty. Although histologically similar to mature skeletal bone, the ectopic tissue limits postoperative motion and causes pain in 2% to 4% of patients. The ossification is classified and graded according to radiographic appearance. Males with bilateral hypertrophic osteoarthritis who have had prior hip surgery are at high risk. Prophylaxis with Indocin or low-dose irradiation treatment is effective. Excision and irradiation therapy can treat established bony bridges.

Ankylosis↗
PubMed1990

[Bone mineral analysis in patients with ossification of the posterior longitudinal ligament of the spine].

The bone mineral content of the radial metaphysis, the radial diaphysis, the third lumbar vertebral bone and the second metacarpal bone were measured in 78 patients with ossification of the posterior longitudinal ligament (OPLL), and the results were compared with those of 170 age-matched controls. The following results were obtained. Bone mineral content was decreased in cases scoring less than 12 points in the Japanese Orthopaedic Association (JOA) myelopathy score. In males, the mild myelopathy group showed a significantly higher bone mineral content than the control group. In females, however, there was no significant difference between the mild myelopathy and control groups. This may be explained by the marked influence of age on the bone mineral content of females. These results suggest that mineral content in patients with OPLL has a tendency to increase, while the bone mineral content decreases in the severe myelopathy group.

Adult↗
PubMed1990

[Etiological study of spinal ligament ossification with special reference to dietary habits and serum sex hormones].

We studied the relationship between dietary habits and the ossification of the posterior longitudinal ligaments (OPLL) in 55 patients. We analyzed carbon and nitrogen isotope ratios of the patients' hair in order to measure the intake of various types of food. Two sets of questionnaire on the patients' food preference and the intake are also analyzed. The patients showed a tendency to prefer vegetable protein to animal protein, in comparison with the control. In 23 OPLL male patients, level of the estrogen in the serum was higher than in the control. The results suggest that the dietary habits of OPLL patients and the sex hormone imbalance are responsible for the development of OPLL.

Adult↗
PubMed1990

[Neuron-specific enolase and S-100 protein levels in cerebrospinal fluid of patients with cervical spondylosis and ossification of posterior longitudinal ligaments].

We examined the levels of neuron-specific enolase (NSE) and S-100 protein in the cerebrospinal fluid (CSF) in 39 cases of cervical spondylosis (CS), in 16 cases of ossification of posterior longitudinal ligaments (OPLL), and in 29 control subjects by means of highly sensitive enzyme immunoassay methods. The levels (mean +/- SD) of NSE and S-100 protein in the control subjects, CS cases, and OPLL cases were shown as follows: NSE = 4.7 +/- 2.1, 8.0 +/- 3.4, 6.0 +/- 3.1 ng/ml, S-100b = 0.42 +/- 0.22, 0.72 +/- 0.40, 0.67 +/- 0.27 ng/ml, respectively. CS patients with a muscle atrophy of upper limbs showed a rise in NSE levels and this was especially seen in cases of cervical spondylotic amyotrophy (CSA). There were positive correlations between the distance of the A-P diameters of the spinal canal and the amount of NSE in OPLL cases (r = -0.6915, p less than 0.01). CS patients with severe spinal cord compressions demonstrated by myelo CT showed higher levels of NSE and S-100b. These results suggest that NSE, S-100 protein can be used as reliable markers to evaluate the damage of the spinal cord in CS and OPLL.

Adult↗
PubMed1989

Resection of heterotopic ossification in patients with spinal cord injuries.

Nineteen spinal cord injury (SCI) patients were treated with resection of heterotopic ossification (HO) in 24 hips. The average follow-up period after surgery was 6.1 years. The mean time to surgery after injury was 50.6 months. The indication for surgery in all patients was improvement in hip motion to allow sitting. The average preoperative motion in flexion and extension was 11.5 degrees. The average intraoperative motion was 82.7 degrees. The average postoperative motion at the follow-up evaluation was 35.2 degrees. Fourteen of 19 patients (74%) had sufficient motion at the follow-up evaluation for sitting. Unlimited sitting tolerance was achieved in seven patients (37%), and seven patients (37%) had improved sitting posture with some time limitations. The average arc of motion in those patients able to sit at the follow-up evaluation was 41.5 degrees. Normal bone scans, alkaline phosphatase levels, and the mature roentgenographic appearance of HO were unreliable predictors of recurrence. The preoperative range of motion was the best predictor of improved postoperative range of motion since patients with retained motion did better than those with severe ankylosis. All six hips with severe recurrence had 0 degree of preoperative motion. The average degree of preoperative motion for all remaining hips was 15.3 degrees. The best predictor of recurrence was the roentgenographic grade of HO. Nineteen of 22 hips (86%) with a mild to severe recurrence had large amounts of bone preoperatively (Grades 3-5). Complications excluding recurrence occurred in 19 of 24 hips (79%) and included superficial wound infections in nine of 24 hips (38%) and deep persistent infections (osteomyelitis) in eight of 24 hips (33%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Risk factors for heterotopic ossification in spinal cord injury.

Heterotopic ossification (HO) is a complication in 16% to 53% of spinal cord injured (SCI) patients. One third of these patients have moderate to severe HO that adversely affects function or health. Pharmacologic prophylaxis of HO for all SCI patients continues to be controversial. High-risk criteria for HO formation identified in total hip replacement patients are not applicable to SCI. A review of the literature did not reveal specific risk factors for HO with SCI. The charts of 100 randomly selected SCI patients, 50 with HO and 50 without HO, were reviewed retrospectively to learn if criteria which would predict high-risk patients could be identified. A total of 14 variables, seven demographic (age, sex, race, level of lesion, completeness of lesion, cause of injury, and geographic locus of patient) and seven medical (bladder stones, fractures, pressure sores, deep vein thrombosis, pulmonary embolism, spasticity, and urinary tract infections) were studied. Four of the 14 variables (age, completeness of lesion, presence of pressure sores, and spasticity) were significantly related to HO formation. The risk factors appear to be additive. When all were present, 92% of patients were found to have HO. Before the findings are applied clinically, it is suggested that a prospective study be conducted to confirm the risk predictive value of these factors in HO.

Adult↗