Heterotopic Ossification

(HO)
  • Definition

    Heterotopic ossification (HO) is the growth of bone in abnormal places like soft tissue. It can occur anywhere in the body. The hip, knees, shoulders and elbows are the most common locations. This condition can vary from minor to heavy growth.
    Treatment involves physical therapy, medications, and in some cases, surgery.
  • Causes

    The exact cause of HO is unknown. There may be a genetic link to the development of this condition.
  • Risk Factors

    Factors that may increase your chance of developing HO include:
    • Traumatic brain injury or stroke
    • Recent spinal cord injury, especially within the past 1-4 months
    • Hip surgery or other joint surgery
    • Burns
    • Long period of immobility
    • Joint infection
    • Trauma to muscle or soft tissue
  • Symptoms

    Symptoms vary based on the severity and site of the bone growth. HO may cause:
    • Decreased range of motion
    • Swelling or redness to joint(s)
    • Pain
    • Fever
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to a specialist. An orthopedic doctor focuses solely on problems of the bones and joints.
    Tests may include the following:
    • Blood tests
    • Urine tests
    • Bone scan
    • X-ray —may only be able to detect abnormal bone in later phases of the disease
    X-ray of Pelvic Repair
    repiared pelvis x-ray
    HO may not show up on x-ray until later stages.
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  • Treatment

    Talk with your doctor about the best plan for you. Options vary based on the scope of the disease, and include the following:
    Physical Therapy
    Therapy is an important part of treatment. Range of motion exercises will help to maintain mobility. It can also keep the disease from getting worse. Therapy may also include some stretching and strength training.
    Therapy is an important part of treatment. Range of motion exercises will help to maintain mobility. It can also keep the disease from getting worse. Therapy may also include some stretching and strength training.
    Medications
    Your doctor may prescribe:
    • Nonsteroidal antiinflammatory drugs (NSAIDs)
    • Bisphosphonates
    Radiation Therapy
    Radiation is used to prevent abnormal bone growth, mainly after hip surgery.
    Surgery
    Surgery may be used to remove the abnormal bone and increase range of motion. Radiation and medications are often given after surgery, since the disease can recur.
  • Prevention

    HO is not well understood. If you have any of the risk factors above, talk to your doctor about any symptoms you may have. Discuss whether you need to take preventative measures.
  • RESOURCES

    American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

    Spinal Cord Injury Information Network http://www.uab.edu/medicine/sci

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org

    Canadian Orthopaedic Foundation http://www.canorth.org

    References

    Black DL, Smith JD, Dalziel RE, Young DA, Shimmin A. Incidence of heterotopic ossification after hip resurfacing. Australian and New Zealand Journal of Surg. 2007;77:642-647.

    Frontera: Essentials of Physical Medicine and Rehabilitation .1st ed. Philadelphia; Hanley and Belfus; 2002.

    Pape HC, Marsh S, Morley JR,  Krettek C, Giannoudis PV. Current concepts in the development of heterotopic ossification. Journal of Bone and Joint Surgery. 2004;86(6):783-7.

    Spinal cord injury—InfoSheet #12. Spinal Cord Injury Information Network website. Available at: http://images.main.uab.edu/spinalcord/pdffiles/info-12.pdf . Accessed August 22, 2013.

    Zychowicz ME. Pathophysiology of heterotopic ossification. Orthop Nurs. 2013;32(3):173-177.

    Revision Information

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