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Surgical Resection

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Surgical resection of HO post SCI is a well established treatment but still somewhat controversial.

Table: Surgical Resection of HO Post SCI

Discussion

Meiners et al. (1997) reported a case series of 29 individuals (10 with quadriplegia and 19 with paraplegia) who underwent HO resection at the hip followed by irradiation and eventually passive range of motion exercises. Mean hip range of motion increased from 21.95º pre-operatively to 94.51º intra-operatively and 82.68º at 4 year (mean) follow-up.

Garland and Orwin (1989) examined the effect of HO excision to improve range of motion in 19 individuals with SCI. They found that the largest gain of function occurred intra-operatively followed by a large loss of function within the first six months. At final follow-up (6 yr post-surgery), 3 of 24 hip joints where HO was surgically excised had similar or less motion when compared with preoperative motion, 15 improved between 10° and 39°, while six showed greater than 40° improvement.

The effectiveness of surgical excision followed by bisphosphonates was examined in two case series (Schuetz et al. 2005; Subbarao et al. 1987). Etidronate treatment post-surgical excision showed that patients were able to function independently in a wheelchair; however, they had severe restrictions in their range of motion (Subbarao et al. 1987). Surgical excision supplemented with pamidronate treatment resulted in no recurrence of HO post surgery (Schuetz et al. 2005).

Conclusion

There is level 4 evidence that resection of HO about the hip post SCI can dramatically improve restricted hip range of motion.

There is Level 4 evidence that surgical resection combined with pamidronate treatment effectively halts secondary HO progression.

  • Surgical resection of heterotopic ossification can improve hip range of motion.
  • Surgical resection and pamidronate treatment halts secondary HO progression.