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Heterotopic Ossification

(HO)

Pronounced: Het-toro-toe-pik Oss-if-a-kay-shun

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 large growths.

Causes    TOP

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

Risk Factors    TOP

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
  • Fractures
  • Some tendon injuries

Symptoms    TOP

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    TOP

You will be asked 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.

Your bodily fluids may be tested. This can be done with:

  • Blood tests
  • Urine tests

Images may be taken of your bodily structures. This can be done with:

X-ray of Pelvic Repair

repiared pelvis x-ray
HO may not show up on x-ray until later stages.
Copyright © Nucleus Medical Media, Inc.

Treatment    TOP

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.

Medications

Your doctor may prescribe:

  • Non-steroidal antiinflammatory drugs (NSAIDs) to reduce swelling and pain
  • Bisphosphonates to prevent the loss of bone

Radiation Therapy    TOP

Radiation is used to prevent abnormal bone growth, mainly after hip surgery.

Surgery    TOP

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    TOP

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 preventive measures, which are similar to treatments.

RESOURCES:

Ortho Info—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.
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:
...(Click grey area to select URL)
Published June 1997. Accessed May 9, 2016.
Zychowicz ME. Pathophysiology of heterotopic ossification. Orthop Nurs. 2013;32(3):173-177.
Last reviewed June 2016 by Michael Woods, MD
Last Updated: 6/1/2013

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