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Published in: Journal of Orthopaedic Surgery and Research 1/2010

Open Access 01-12-2010 | Case report

Acceptable outcome following resection of bilateral large popliteal space heterotopic ossification masses in a spinal cord injured patient: a case report

Authors: Ramin Espandar, Babak Haghpanah

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2010

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Abstract

Spinal cord injury is a well-known predisposing factor for development of heterotopic ossification around the joints especially hip and elbow. Heterotopic ossification about the knee is usually located medially, laterally or anteriorly; besides, the knee is generally fixed in flexion. There are only a few reports of heterotopic bone formation at the posterior aspect of the knee (popliteal space) and fixation of both knees in extension; so, there is little experience in operative management of such a problem.
Here, we present a 39-years old paraplegic man who was referred to us five years after trauma with a request of above knee amputation due to sever impairment of his life style and adaptive capacity for daily living because of difficulties in using wheelchair. The principle reason for the impairment was fixed full extension of both knees as the result of bilateral large heterotopic ossification masses in popliteal fossae. The bony masses were surgically resected with acceptable outcome. The anatomic position of the ossified masses as well as ankylosis of both knees in full extension, and the acceptable functional outcome of surgery which was done after a long period of five years following injury makes this case unique.
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Literature
1.
go back to reference Board TN, Karva A, Board RE, Gambhir AK, Porter ML: The prophylaxis and treatment of heterotopic ossification following lower limb arthroplasty. J Bone Joint Surg Br. 2007, 89: 434-440. 10.1302/0301-620X.89B4.18845.CrossRefPubMed Board TN, Karva A, Board RE, Gambhir AK, Porter ML: The prophylaxis and treatment of heterotopic ossification following lower limb arthroplasty. J Bone Joint Surg Br. 2007, 89: 434-440. 10.1302/0301-620X.89B4.18845.CrossRefPubMed
2.
go back to reference Garland DE, Blum CE, Waters RL: Periarticular heterotopic ossification in head-injured adults. Incidence and location. J Bone Joint Surg Am. 1980, 62: 1143-1146.PubMed Garland DE, Blum CE, Waters RL: Periarticular heterotopic ossification in head-injured adults. Incidence and location. J Bone Joint Surg Am. 1980, 62: 1143-1146.PubMed
3.
go back to reference Johns JS, Cifu DX, Keyser-Marcus L, Jolles PR, Fratkin MJ: Impact of clinically significant heterotopic ossification on functional outcome after traumatic brain injury. J Head Trauma Rehabil. 1999, 14: 269-276. 10.1097/00001199-199906000-00007.CrossRefPubMed Johns JS, Cifu DX, Keyser-Marcus L, Jolles PR, Fratkin MJ: Impact of clinically significant heterotopic ossification on functional outcome after traumatic brain injury. J Head Trauma Rehabil. 1999, 14: 269-276. 10.1097/00001199-199906000-00007.CrossRefPubMed
4.
go back to reference Pohl F, Seufert J, Tauscher A, Lehmann H, Springorum HW, Flentje M, Koelbl O: The influence of heterotopic ossification on functional status of hip joint following total hip arthroplasty. Strahlenther Onkol. 2005, 181: 529-533. 10.1007/s00066-005-1352-4.CrossRefPubMed Pohl F, Seufert J, Tauscher A, Lehmann H, Springorum HW, Flentje M, Koelbl O: The influence of heterotopic ossification on functional status of hip joint following total hip arthroplasty. Strahlenther Onkol. 2005, 181: 529-533. 10.1007/s00066-005-1352-4.CrossRefPubMed
5.
go back to reference Zeilig G, Weingarden HP, Levy R, Peer I, Ohry A, Blumen N: Heterotopic ossification in Guillain-Barre syndrome: incidence and effects on functional outcome with long-term follow-up. Arch Phys Med Rehabil. 2006, 87: 92-95. 10.1016/j.apmr.2005.07.308.CrossRefPubMed Zeilig G, Weingarden HP, Levy R, Peer I, Ohry A, Blumen N: Heterotopic ossification in Guillain-Barre syndrome: incidence and effects on functional outcome with long-term follow-up. Arch Phys Med Rehabil. 2006, 87: 92-95. 10.1016/j.apmr.2005.07.308.CrossRefPubMed
6.
go back to reference Fuller DA, Mark A, Keenan MA: Excision of heterotopic ossification from the knee: a functional outcome study. Clin Orthop Relat Res. 2005, 438: 197-203. 10.1097/00003086-200509000-00033.CrossRefPubMed Fuller DA, Mark A, Keenan MA: Excision of heterotopic ossification from the knee: a functional outcome study. Clin Orthop Relat Res. 2005, 438: 197-203. 10.1097/00003086-200509000-00033.CrossRefPubMed
7.
go back to reference Charnley G, Judet T, Garreau de Loubresse C, Mollaret O: Excision of heterotopic ossification around the knee following brain injury. Injury. 1996, 27: 125-128. 10.1016/0020-1383(95)00180-8.CrossRefPubMed Charnley G, Judet T, Garreau de Loubresse C, Mollaret O: Excision of heterotopic ossification around the knee following brain injury. Injury. 1996, 27: 125-128. 10.1016/0020-1383(95)00180-8.CrossRefPubMed
8.
go back to reference Cobb TK, Berry DJ, Wallrichs SL, Ilstrup DM, Morrey BF: Functional outcome of excision of heterotopic ossification after total hip arthroplasty. Clin Orthop Relat Res. 1999, 131-139. 10.1097/00003086-199904000-00018. Cobb TK, Berry DJ, Wallrichs SL, Ilstrup DM, Morrey BF: Functional outcome of excision of heterotopic ossification after total hip arthroplasty. Clin Orthop Relat Res. 1999, 131-139. 10.1097/00003086-199904000-00018.
9.
go back to reference Mitsionis GI, Lykissas MG, Kalos N, Paschos N, Beris AE, Georgoulis AD, Xenakis TA: Functional outcome after excision of heterotopic ossification about the knee in ICU patients. Int Orthop. 2008, 33 (6): 1619-25. 10.1007/s00264-008-0618-8.PubMedCentralCrossRefPubMed Mitsionis GI, Lykissas MG, Kalos N, Paschos N, Beris AE, Georgoulis AD, Xenakis TA: Functional outcome after excision of heterotopic ossification about the knee in ICU patients. Int Orthop. 2008, 33 (6): 1619-25. 10.1007/s00264-008-0618-8.PubMedCentralCrossRefPubMed
10.
go back to reference Moore TJ: Functional outcome following surgical excision of heterotopic ossification in patients with traumatic brain injury. J Orthop Trauma. 1993, 7: 11-14. 10.1097/00005131-199302000-00003.CrossRefPubMed Moore TJ: Functional outcome following surgical excision of heterotopic ossification in patients with traumatic brain injury. J Orthop Trauma. 1993, 7: 11-14. 10.1097/00005131-199302000-00003.CrossRefPubMed
11.
go back to reference Garland DE: A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Relat Res. 1991, 13-29. Garland DE: A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Relat Res. 1991, 13-29.
12.
go back to reference Ippolito E, Formisano R, Farsetti P, Caterini R, Penta F: Excision for the treatment of periarticular ossification of the knee in patients who have a traumatic brain injury. J Bone Joint Surg Am. 1999, 81: 783-789. 10.1302/0301-620X.81B5.9197.CrossRefPubMed Ippolito E, Formisano R, Farsetti P, Caterini R, Penta F: Excision for the treatment of periarticular ossification of the knee in patients who have a traumatic brain injury. J Bone Joint Surg Am. 1999, 81: 783-789. 10.1302/0301-620X.81B5.9197.CrossRefPubMed
13.
go back to reference Anderson MC, Lais RL: Excision of heterotopic ossification of the popliteal space following traumatic brain injury. J Orthop Trauma. 2004, 18: 190-192. 10.1097/00005131-200403000-00013.CrossRefPubMed Anderson MC, Lais RL: Excision of heterotopic ossification of the popliteal space following traumatic brain injury. J Orthop Trauma. 2004, 18: 190-192. 10.1097/00005131-200403000-00013.CrossRefPubMed
14.
go back to reference Kaplan FS, Glaser DL, Hebela N, Shore EM: Heterotopic ossification. J Am Acad Orthop Surg. 2004, 12: 116-125.PubMed Kaplan FS, Glaser DL, Hebela N, Shore EM: Heterotopic ossification. J Am Acad Orthop Surg. 2004, 12: 116-125.PubMed
15.
go back to reference Melamed E, Robinson D, Halperin N, Wallach N, Keren O, Groswasser Z: Brain injury-related heterotopic bone formation: treatment strategy and results. Am J Phys Med Rehabil. 2002, 81: 670-674. 10.1097/00002060-200209000-00006.CrossRefPubMed Melamed E, Robinson D, Halperin N, Wallach N, Keren O, Groswasser Z: Brain injury-related heterotopic bone formation: treatment strategy and results. Am J Phys Med Rehabil. 2002, 81: 670-674. 10.1097/00002060-200209000-00006.CrossRefPubMed
16.
go back to reference Sarafis KA, Karatzas GD, Yotis CL: Ankylosed hips caused by heterotopic ossification after traumatic brain injury: a difficult problem. J Trauma. 1999, 46: 104-109. 10.1097/00005373-199901000-00017.CrossRefPubMed Sarafis KA, Karatzas GD, Yotis CL: Ankylosed hips caused by heterotopic ossification after traumatic brain injury: a difficult problem. J Trauma. 1999, 46: 104-109. 10.1097/00005373-199901000-00017.CrossRefPubMed
17.
go back to reference Chalmers J, Gray DH, Rush J: Observations on the induction of bone in soft tissues. J Bone Joint Surg Br. 1975, 57: 36-45.PubMed Chalmers J, Gray DH, Rush J: Observations on the induction of bone in soft tissues. J Bone Joint Surg Br. 1975, 57: 36-45.PubMed
18.
go back to reference Cohen MM: Bone morphogenetic proteins with some comments on fibrodysplasia ossificans progressiva and NOGGIN. Am J Med Genet. 2002, 109: 87-92. 10.1002/ajmg.10289.CrossRefPubMed Cohen MM: Bone morphogenetic proteins with some comments on fibrodysplasia ossificans progressiva and NOGGIN. Am J Med Genet. 2002, 109: 87-92. 10.1002/ajmg.10289.CrossRefPubMed
19.
go back to reference Cohen RB, Hahn GV, Tabas JA, Peeper J, Levitz CL, Sando A, Sando N, Zasloff M, Kaplan FS: The natural history of heterotopic ossification in patients who have fibrodysplasia ossificans progressiva. A study of forty-four patients. J Bone Joint Surg Am. 1993, 75: 215-219.PubMed Cohen RB, Hahn GV, Tabas JA, Peeper J, Levitz CL, Sando A, Sando N, Zasloff M, Kaplan FS: The natural history of heterotopic ossification in patients who have fibrodysplasia ossificans progressiva. A study of forty-four patients. J Bone Joint Surg Am. 1993, 75: 215-219.PubMed
20.
go back to reference Feldman G, Li M, Martin S, Urbanek M, Urtizberea JA, Fardeau M, LeMerrer M, Connor JM, Triffitt J, Smith R: Fibrodysplasia ossificans progressiva, a heritable disorder of severe heterotopic ossification, maps to human chromosome 4q27-31. Am J Hum Genet. 2000, 66: 128-135. 10.1086/302724.PubMedCentralCrossRefPubMed Feldman G, Li M, Martin S, Urbanek M, Urtizberea JA, Fardeau M, LeMerrer M, Connor JM, Triffitt J, Smith R: Fibrodysplasia ossificans progressiva, a heritable disorder of severe heterotopic ossification, maps to human chromosome 4q27-31. Am J Hum Genet. 2000, 66: 128-135. 10.1086/302724.PubMedCentralCrossRefPubMed
21.
go back to reference Fontaine K, Semonin O, Legarde JP, Lenoir G, Lucotte G: A new mutation of the noggin gene in a French Fibrodysplasia ossificans progressiva (FOP) family. Genet Couns. 2005, 16: 149-154.PubMed Fontaine K, Semonin O, Legarde JP, Lenoir G, Lucotte G: A new mutation of the noggin gene in a French Fibrodysplasia ossificans progressiva (FOP) family. Genet Couns. 2005, 16: 149-154.PubMed
22.
go back to reference Lucotte G, Houzet A, Hubans C, Lagarde JP, Lenoir G: Mutations of the noggin (NOG) and of the activin A type I receptor (ACVR1) genes in a series of twenty-seven French fibrodysplasia ossificans progressiva (FOP) patients. Genet Couns. 2009, 20: 53-62.PubMed Lucotte G, Houzet A, Hubans C, Lagarde JP, Lenoir G: Mutations of the noggin (NOG) and of the activin A type I receptor (ACVR1) genes in a series of twenty-seven French fibrodysplasia ossificans progressiva (FOP) patients. Genet Couns. 2009, 20: 53-62.PubMed
23.
go back to reference Lucotte G, Lagarde JP: Mutations of the noggin and of the activin A type I receptor genes in fibrodysplasia ossificans progressiva (FOP). Genet Couns. 2007, 18: 349-352.PubMed Lucotte G, Lagarde JP: Mutations of the noggin and of the activin A type I receptor genes in fibrodysplasia ossificans progressiva (FOP). Genet Couns. 2007, 18: 349-352.PubMed
24.
go back to reference Ahn J, Serrano de la Pena L, Shore EM, Kaplan FS: Paresis of a bone morphogenetic protein-antagonist response in a genetic disorder of heterotopic skeletogenesis. J Bone Joint Surg Am. 2003, 85-A: 667-674.PubMed Ahn J, Serrano de la Pena L, Shore EM, Kaplan FS: Paresis of a bone morphogenetic protein-antagonist response in a genetic disorder of heterotopic skeletogenesis. J Bone Joint Surg Am. 2003, 85-A: 667-674.PubMed
25.
go back to reference Vanden Bossche L, Vanderstraeten G: Heterotopic ossification: a review. J Rehabil Med. 2005, 37: 129-136. 10.1080/16501970510027628.CrossRefPubMed Vanden Bossche L, Vanderstraeten G: Heterotopic ossification: a review. J Rehabil Med. 2005, 37: 129-136. 10.1080/16501970510027628.CrossRefPubMed
26.
go back to reference Balboni TA, Gobezie R, Mamon HJ: Heterotopic ossification: Pathophysiology, clinical features, and the role of radiotherapy for prophylaxis. Int J Radiat Oncol Biol Phys. 2006, 65: 1289-1299. 10.1016/j.ijrobp.2006.03.053.CrossRefPubMed Balboni TA, Gobezie R, Mamon HJ: Heterotopic ossification: Pathophysiology, clinical features, and the role of radiotherapy for prophylaxis. Int J Radiat Oncol Biol Phys. 2006, 65: 1289-1299. 10.1016/j.ijrobp.2006.03.053.CrossRefPubMed
Metadata
Title
Acceptable outcome following resection of bilateral large popliteal space heterotopic ossification masses in a spinal cord injured patient: a case report
Authors
Ramin Espandar
Babak Haghpanah
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2010
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/1749-799X-5-39

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