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Heterotopic Ossification

Summary

There is strong Level 1a evidence (from two RCTs: Banovac et al. 2001; Banovac et al. 2004) that non-steroidal anti-inflammatory medications can reduce the incidence of heterotopic ossification when administered early after a spinal cord injury.

There is Level 5 evidence (from one observational study: Buschbacher et al. 1992) that Warfarin inhibits the development of heterotopic ossification post spinal cord injury.

There is conflicting Level 2 evidence (from two prospective controlled trials: Banovac et al. 1993; Banovac et al. 1997) and Level 4 evidence (from one case series; Branovac 2000) that Etidronate can stop the progression of heterotopic ossification once the diagnosis is made and prevent further HO sites.

There is level 2 evidence (from one prospective controlled trial: Ploumis et al. 2015) that Alendronate does not inhibit the development of heterotopic ossification and in fact may contribute to the development of contractures.

There is Level 2 evidence (from one prospective controlled trial: Banovac et al. 1997) that Etidronate is not effective once radiographs are positive for HO.

There is Level 4 evidence (from one case series: Schuetz et al. 2005) that pamidronate effectively halts secondary HO progression after surgical resection of HO.

There is Level 1b evidence (from one RCT: Durovic et al. 2009) that Pulse Low Intensity Electromagnetic Field therapy is an effective prophylaxis of HO post SCI.

There is moderate Level 4 evidence (from three case series studies: Sautter-Bihl et al. 2000; Sautter-Bihl et al. 2001; Museler et al. 2017) that radiotherapy reduces the progression and recurrence of heterotopic ossification.

There is level 4 evidence (from four case series: Garland & Orwin 1989; Meiners et al. 1997; Genet et al. 2011; Yang et al. 2017) that resection of HO about the hip post SCI can dramatically improve restricted hip range of motion; however, post-surgical recurrence and complications are a concern for this treatment.

There is Level 4 evidence (from one case series: Schuetz et al. 2005) that surgical resection combined with pamidronate treatment effectively halts secondary HO progression.

There is level 4 evidence (from one case series: Subbarao et al. 1987) that surgical resection combined with etidronate treatment improves independence with wheelchair use but contributes to reduced range of motion.

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