Heterotopic ossification (HO) is a form of pathologic bone that often occurs in the elbow after a substantial traumatic injury and can complicate the functional outcome of the affected upper extremity. This article is designed to help the treating therapist better understand the complex process of HO.

What is treatment for heterotopic ossification?

Patients with a high risk of developing HO are often given prophylactic treatment following primary or revision arthroplasty. All patients undergoing excision of symptomatic HO should also receive some form of prophylaxis. The two main treatments available are radiation therapy and NSAIDs.

What does heterotopic ossification mean?

Heterotopic ossification (HO) is the presence of bone in soft tissue where bone normally does not exist. The acquired form of HO most frequently is seen with either musculoskeletal trauma, spinal cord injury, or central nervous system injury.

Can you fix heterotopic ossification?

For now, the only way to treat heterotopic ossification is to wait for it to stop growing and cut it out which never completely restores joint function. This new research suggests that there may be a way to treat it at the cellular level.

Is heterotopic ossification a bone spur?

SURGICAL MANAGEMENT

Right hip has bone spurs originating from femur and pelvis with less than 1 cm between opposing bone surfaces (heterotopic ossification, Brooker stage 3).

New Bone formation in elbow: Heterotrophic Ossification

How painful is heterotopic ossification?

Heterotopic Ossification (HO) is the abnormal growth of bone in the non-skeletal tissues including muscle, tendons or other soft tissue. When HO develops, new bone grows at three times the normal rate, resulting in jagged, painful joints.

When should heterotopic ossification be removed?

In the case of heterotopic ossification, the only effective treatment is excision, also called resection. Dr. Nwachukwu will often delay surgical excision for 5-6 months following the initial hip trauma and/or inciting surgery, allowing the bone growth to mature and for a distinct fibrous capsule to develop.

What does heterotopic ossification feel like?

The most common symptom of heterotopic ossification is stiffness of a joint. Most people who develop heterotopic ossification cannot feel the abnormal bone, but notice the bone growth getting in the way of normal movements.

Is heterotopic ossification a disability?

Heterotopic ossification is a condition affecting an appreciable minority of critical care patients; it can have long-lasting effects on recovery and return to functional status. Ectopic bone forms in soft tissues near the large joints, causing pain, swelling, limitation of movement and ultimate disability.

How do you diagnose heterotopic ossification?

Signs and symptoms of heterotopic ossification

A diagnosis of HO can be made clinically if localized inflammatory reaction, palpable mass, or limited range of motion (ROM) is observed. Clinically, the onset of larger masses of HO is often characteristic of any inflammatory reaction.

What causes heterotopic bone growth?

Causes. Heterotopic ossification of varying severity can be caused by surgery or trauma to the hips and legs. About every third patient who has total hip arthroplasty (joint replacement) or a severe fracture of the long bones of the lower leg will develop heterotopic ossification, but is uncommonly symptomatic.

Can heterotopic ossification cancerous?

Although heterotopic ossification has been reported in cancer patients, it was located at the primary and metastatic tumor sites. Parathyroid hormone-related protein in gastric cancers with heterotopic ossification.

How can heterotopic ossification be prevented?

Combined radiotherapy and indomethacin was effective in preventing heterotopic ossification after total hip arthroplasty. The evaluation of this efficacy compared with radiotherapy or NSAIDs alone should be the future target of larger randomized designs.

How long does it take for heterotopic ossification to mature?

HO is often thought to take approximately 12 months to mature; however, surgical treatment of posttraumatic HO at the elbow has been performed effectively at 3 and 6 months post trauma.

Why does ossification happen?

The cartilage cells die out and are replaced by osteoblasts clustered in ossification centres. Bone formation proceeds outward from these centres. This replacement of cartilage by bone is known as endochondral ossification.

Where does heterotopic ossification occur?

HO occurs with the highest frequency at the elbow, followed by the shoulder, and subsequently the hip. Owing to its location around joints, those patients with burn injury–induced HO often have a restriction in the range of motion as an early manifestation of the ossification.

What causes bones to grow abnormally?

Fibrous dysplasia is a condition that causes abnormal growth or swelling of bone. The cause seems to be a genetic change that alters the usual growth of the bone's connective tissue.

How do you stop bone growth?

1. Include plenty of calcium in your diet. For adults ages 19 to 50 and men ages 51 to 70, the Recommended Dietary Allowance (RDA) is 1,000 milligrams (mg) of calcium a day. ...
2. Pay attention to vitamin D. ...
3. Include physical activity in your daily routine. ...
4. Avoid substance abuse.

What does the term ossification mean?

1a : the natural process of bone formation. b : the hardening (as of muscular tissue) into a bony substance. 2 : a mass or particle of ossified tissue. 3 : a tendency toward or state of being molded into a rigid, conventional, sterile, or unimaginative condition.

What is the difference between myositis ossificans and heterotopic ossification?

Myositis ossificans (MO) is the most common form of heterotopic ossification usually within large muscles. Its importance stems in large part from its ability to mimic more aggressive pathological processes. Myositis ossificans is one of the skeletal “don't touch” lesions.

Is ossification and calcification the same?

Ossification, or osteogenesis, is the process of bone formation by osteoblasts. Ossification is distinct from the process of calcification; whereas calcification takes place during the ossification of bones, it can also occur in other tissues.

Which joint is the most common site for heterotopic ossification in burn patients?

By far the most common sites affected are the elbows resulting in marked reduction in ROM and function, often associated with ulnar nerve compression. Involvement of other joints including shoulders, hips, knees, forearms¹⁵ and the tempromandibular joints (TMJ)¹⁶ have been documented.

What are FOP flare ups?

What is a FOP Flare-up? People living with FOP may experience unpredictable episodes of soft tissue swelling, pain, reduced movement, stiffness, referred to as 'flare‐ups'. These flare-ups usually result in extra bone formation, but not always.

What is heterotopic animal?

A heterotroph is an organism that consumes other organisms in a food chain. 5 - 8. Biology, Ecology. 210.

How does burn cause edema?

The rapid formation of edema in the area of burn injury is due to the increased capillary permeability, diminished oncotic pressure, increased interstitial oncotic pressure, shift in the interstitial space compliance, and lymphatic damage, and other unaffected tissue swelling.