We present the case of an 11-year-old girl with cerebral palsy, who developed
bilateral spontaneous ankylosis of the hips as a result of heterotopic
ossification following hip surgery. This was treated successfully by a
combination of surgical excision, single dose radiotherapy and bisphosphonate
treatment at five months from the time of the original surgery. A review of the
literature shows that a combination treatment can be recommended in severe cases
of heterotopic ossification to prevent recurrence. A review of neurogenic
heterotopic ossification is presented.
FreebournT.M.,
BarberD.B.,
AbleA.C..
The treatment of immature heterotopic ossification in spinal
cord injury with combinaton surgery, radiation therapy and
NSAID.Spinal Cord1999; 37:
50–3.
4.
GarlandD.E..
A Clinical perspective on common forms of acquired
heterotopic ossification.Clin Orthop1991; 263:
13–29.
5.
KrumS.D.,
MillerF..
Heterotopic ossification after hip and spine surgery in
children with cerebral palsy.J Paediatr Orthop1993; 13:
739–43.
6.
McHaleK.A..
Bilateral spontaneous arthrodesis of the hips after combined
shelf acetabular augmentation and femoral varus osteotomies.J Paediatr Orthop1991; 11:
108–11.
7.
PapeH.C.,
MarshS.,
MorleyJ.R.,
KrettekC.,
GiannoudisP.V..
Current concepts in the development of heterotopic
ossification.J Bone Joint Surg (Br)2004; 86-B:
783–87.
McAuliffeJ.A.,
WolfsonA.H..
Early excision of heterotopic ossification about the elbow
followed by radiation therapy.J Bone Joint Surg (Am)1997; 79-A:
749–55.
10.
CoventryM.B.,
ScanlonP.W..
The use of radiation to discourage ectopic bone: a nine-year
study in surgery about the hip.J Bone Joint Surg (Am)1981; 63-A:
201–08.
11.
SchaefferM.A.,
SosnerJ..
Heterotopic ossification: treatment of established bone with
radiation therapy.Arch Phys Med Rehabil1995; 76:
284–6.
12.
MeinersT.,
AbelR.,
BohmV.,
GernerH.J..
Resection of heterotopic ossification of the hip in spinal
cord injured patients.Spinal Cord1997; 35:
443–5.
13.
BradyL.W..
Radiation induced sarcomas of bone.Skeletal Radiol1972; 4:
72–8.
14.
KuijkA.A.V.,
VanKuppevelt,
Van der
schaafD.B..
Osteonecrosis after treatment for heterotopic ossification in
spinal cord injury with the combination of surgery, irradiation and an
NSAID.Spinal Cord2000; 38:
319–24.
15.
WickM.,
MullerE.J.,
HahnM.P.,
MuhrG..
Surgical excision of heterotopic bone after hip surgery
followed by oral indomethacin application: is there a clinical benefit for
the patient.Arch Orthop Trauma Surg1999; 119:
151–5.
16.
SubbaraoJ.V.,
NemchauskyB.A.,
GratzerM.,
HinesE..
Resection of heterotopic ossification and didronel
therapy-regaining wheelchair independence in the spinal cord injured
patient.J Am Paraplegia Soc1987; 10:
3–7.
17.
KnellesD.,
BarthelT.,
KarrerA.,
KrausU.,
EulertJ.,
KolblO..
Prevention of heterotopic ossification after total hip
replacement. A prospective, randomised study using acetylsalicylic acid,
indomethacin and fractional or single-dose irradiation.J Bone Joint Surg (Br)1997; 79-B:
596–602.
18.
MooreK.D.,
GossK.,
AnglenJ.O..
Indomethacin versus radiation therapy for prophylaxis against
heterotopic ossification in acetabular fractures: A randomised, prospective
study.J Bone Joint Surg (Br)1998; 80-B:
259–63.
