Heterotopic ossifications following implant surgery--epidemiology, therapeutical approaches and current concepts.
The pathophysiology of heterotopic ossification (HO) is still ill-understood. Several risk factors such as osteoarthritis, male gender and injury patterns like traumatic brain injury and severe soft tissue damage have been described. Furthermore, the pathophysiology of local and systemic factors has been investigated leading to an extended knowledge especially on the molecular level. Knowledge of the involved cell types and mediators led to the now widely used prophylactic and therapeutic strategies to prevent heterotopic ossifications. Out of these findings, the beneficial effects of NSAIDs and radiotherapy on HO prophylaxis have been proven for a number of indications such as total hip arthroplasty and acetabular surgery. However, there is little information about the potential effects on heterotopic ossifications around the elbow. Surgical treatment may be considered in some cases, but there are only limited indications. Generally, only clinically relevant bone formations should be resected. Following surgical resection, beneficial effects on range of motion and pain relief has been described. An accurate perioperative regimen is crucial and includes prophylactic medication. In combination with radiotherapy, low recurrence rates were described but there are still controversies about the optimal timing for surgical resection.
Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. zeckey.christian@mh-hannover.de
Christian
C
Zeckey
Frank
F
Hildebrand
Michael
M
Frink
Christian
C
Krettek
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018890:Chemoprevention; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D009999:Ossification, Heterotopic / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal
J Bone Joint Surg Br. 2006 Dec;88(12):1613-7
17159174
Clin Orthop Relat Res. 1982 Aug;(168):38-41
6809389
Clin Orthop Relat Res. 1983 Dec;(181):220-8
6416729
J Bone Joint Surg Am. 1979 Jul;61(5):760-3
110815
Clin Orthop Relat Res. 1995 Apr;(313):115-9
7641468
Int J Radiat Oncol Biol Phys. 1990 Apr;18(4):861-5
2323973
J Arthroplasty. 1995 Aug;10(4):413-9
8522997
Injury. 2007 Mar;38(3):334-43
17141240
Clin Orthop Relat Res. 1993 Aug;(293):153-9
8339476
J Bone Joint Surg Br. 1987 Aug;69(4):525-8
3611151
Acta Orthop Scand. 1997 Feb;68(1):46-50
9057567
Clin Orthop Relat Res. 1986 Jun;(207):223-6
3087671
J Bone Joint Surg Br. 1997 Jul;79(4):596-602
9250745
Am J Respir Cell Mol Biol. 2009 Apr;40(4):474-81
18931326
ANZ J Surg. 2007 Aug;77(8):642-7
17635276
J Arthroplasty. 1998 Dec;13(8):854-9
9880175
J Bone Joint Surg Br. 2007 Feb;89(2):155-9
17322426
J Trauma. 1988 Aug;28(8):1207-13
3137364
Unfallchirurg. 2006 Jul;109(7):556-62
16786326
Clin Orthop Relat Res. 1988 Aug;(233):86-101
3135969
Paraplegia. 1982 Aug;20(4):208-16
6215609
J Bone Joint Surg Br. 1975 Feb;57(1):36-45
1090627
Clin Orthop Relat Res. 1982 Jul;(167):113-7
6807593
Am J Phys Med Rehabil. 1999 May-Jun;78(3):259-71
10340424
Int J Radiat Oncol Biol Phys. 1994 Aug 30;30(1):55-62
8083129
J Burn Care Rehabil. 1996 Mar-Apr;17(2):150-4
8675505
Clin Orthop Relat Res. 1984 Sep;(188):160-7
6467711
Calcif Tissue Int. 1991 Sep;49(3):208-15
1933586
J Bone Joint Surg Br. 2003 Jul;85(5):700-5
12892193
Injury. 1996 May;27(4):233-54
8762784
ANZ J Surg. 2002 Nov;72(11):808-21
12437693
J Bone Joint Surg Am. 1998 Feb;80(2):248-57
9486731
Acta Orthop Scand. 1977;48(4):400-4
411321
Hip. 1987;:25-38
3102406
J Bone Joint Surg Am. 1992 Feb;74(2):186-200
1541613
J Bone Joint Surg Br. 1997 Nov;79(6):959-63
9393912
J Bone Joint Surg Am. 1997 May;79(5):749-55
9160948
Clin Orthop Relat Res. 1991 Feb;(263):87-93
1899641
J Arthroplasty. 1988;3(3):229-34
3141590
Arch Orthop Trauma Surg. 2002 Jun;122(5):274-8
12070646
Bull Hosp Jt Dis. 2003;61(3-4):151-4
15156818
Clin Orthop Relat Res. 2009 Feb;467(2):526-30
18820982
Clin Orthop Relat Res. 1972 Jul-Aug;86:95-101
4538004
Arch Phys Med Rehabil. 1997 Jul;78(7):687-91
9228869
J Bone Joint Surg Br. 1983 Aug;65(4):405-11
6409905
Scand J Rehabil Med. 1981;13(1):31-7
6791273
N Engl J Med. 1996 Aug 22;335(8):555-61
8678932
J Bone Joint Surg Am. 1981 Jul;63(6):872-7
7240327
Cochrane Database Syst Rev. 2004;(3):CD001160
15266441
Clin Orthop Relat Res. 1978 Jul-Aug;(134):102-30
103669
Clin Orthop Relat Res. 2002 Nov;(404):208-13
12439262
J Bone Joint Surg Am. 2004 Jan;86(1):28-39
14711942
J Arthroplasty. 2004 Jan;19(1):14-8
14716644
Clin Orthop Relat Res. 1991 Feb;(263):13-29
1899635
J Arthroplasty. 2006 Aug;21(5):731-6
16877161
Scand J Trauma Resusc Emerg Med. 2009 Oct 13;17:55
19825174
BMJ. 2006 Sep 9;333(7567):519
16885182
J Arthroplasty. 1996 Jan;11(1):58-63
8676119
Clin Orthop Relat Res. 2000 Jan;(370):65-86
10660703
Clin Orthop Relat Res. 1991 Nov;(272):8-15
1934755
Paraplegia. 1973 May;11(1):79-85
4714220
Arch Orthop Unfallchir. 1973 Nov 13;77(2):108-31
4204120
J Bone Joint Surg Am. 1990 Feb;72(2):245-7
2105963
Clin Orthop Relat Res. 2009 Dec;467(12):3283-9
19517202
Injury. 2005 Mar;36(3):363-8
15710151
Arch Phys Med Rehabil. 1992 Mar;73(3):258-62
1543430
J Orthop Surg (Hong Kong). 2000 Dec;8(2):53-57
12468861
J Am Acad Orthop Surg. 2002 Nov-Dec;10(6):409-16
12470043
J Bone Joint Surg Br. 2005 Jan;87(1):2-9
15686228
J Bone Joint Surg Am. 1973 Dec;55(8):1629-32
4217797
Hand Clin. 1994 Aug;10(3):417-37
7962148
Int J Radiat Oncol Biol Phys. 1999 Sep 1;45(2):461-6
10487572
Arch Dis Child. 1953 Apr;28(138):98-103
13041283
J Bone Joint Surg Br. 2005 Feb;87(2):167-70
15736736
J Trauma. 1978 Sep;18(9):667-70
104047
N Engl J Med. 2002 Jan 10;346(2):99-106
11784876
J Bone Joint Surg Am. 1991 Feb;73(2):191-3
1899666
Int Orthop. 2006 Apr;30(2):79-83
16482442
Clin Orthop Relat Res. 1976 Nov-Dec;(121):53-9
825341
J Bone Joint Surg Am. 1981 Feb;63(2):201-8
6780568
J Arthroplasty. 1989;4(2):125-31
2501453
J Bone Joint Surg Br. 2004 Aug;86(6):783-7
15330014
J Bone Joint Surg Br. 2001 Apr;83(3):332-4
11341414
J Trauma. 1995 Oct;39(4):707-11
7473960
J Bone Joint Surg Br. 1972 Feb;54(1):61-76
5011747
J Arthroplasty. 2003 Sep;18(6):760-4
14513450
J Orthop Trauma. 2001 May;15(4):229-37
11371787
J Arthroplasty. 1990;5 Suppl:S43-6
2123000
Int J Radiat Oncol Biol Phys. 1988 Mar;14(3):471-6
3343154
J Arthroplasty. 2004 Jun;19(4):447-52
15188102
Int J Radiat Oncol Biol Phys. 1997 Aug 1;39(1):161-71
9300751
Clin Radiol. 1991 Mar;43(3):190-6
1901533
J Bone Joint Surg Am. 1977 Apr;59(3):345-51
403193
Clin Orthop Relat Res. 1991 Feb;(263):49-58
1899637
Acta Orthop Scand. 1996 Feb;67(1):29-32
8615097
Clin Orthop Relat Res. 1999 Apr;(361):131-9
10212606
J Hand Surg Am. 1988 Jan;13(1):120-4
3127457
Clin Orthop Relat Res. 1994 Aug;(305):96-105
8050252
J Arthroplasty. 1993 Apr;8(2):113-6
8478626
J Orthop Trauma. 1992;6(4):427-32
1494095
Int J Radiat Oncol Biol Phys. 2004 Nov 1;60(3):888-95
15465207
J Bone Joint Surg Br. 1998 Mar;80(2):259-63
9546456
J Trauma. 1993 Jan;34(1):161-3
8437187
J Arthroplasty. 2009 Feb;24(2):256-62
18534415