Heterotopic Ossification Table 6 Surgical Resection of HO Post SCI

Author Year
Country
PEDro Score
Research Design
Total Sample Size

Methods

Outcome

Yang et al. 2017
United States
Case Series
N=8

Population: Mean age: 58.25 yr; Gender: males=8; Severity of injury: AIS: A=4, B=3, D=1.
Interventions: Surgical resection, two patients had additional prophylactic radiation, and one had pharmacological prophylaxis.
Outcome Measures: Mortality, healed surgical site.
  1. One of the eight patients died at 9mo post-op.
  2. Six of the eight patients treated for HO healed well, while one had ongoing healing at 6 mo post-op.

Genet et al. 2011
France
Case series
N=86

Population: Gender: males=70, females=16; Mean age=27.1 yr; Mean time since injury=13.1 mo.
Treatment: Charts of patients who underwent surgical resection for HO were examined.
Outcome Measures: Recurrence of HO.
  1. Most common site of HO was hips (74.4%).
  2. HO recurrence was seen in 5.8% of patients.
  3. Sepsis was a common side effect post-surgery.
  4. Recurrence was not associated with etiology of injury (p=0.46) or sex (p=1.00).
  5. A significant association was found between recurrence and delay until first surgery for SCI (p<0.01).

Schuetz et al. 2005
Switzerland
Case Series
N=7

Population: SCI: Age=47-68 yr; Gender: males=7; Level of injury: thoracic=1, tetraplegia=2.
Treatment: 
All patients underwent excision-surgery for removal of HO. Pamidronate was administered IV peri- and post-op, starting at a dose level of 120 mg for 1st 12 hrs and gradually increasing for a total of 6-14 days.
Outcome Measures:
Prevalence of HO.
  1. None of the patients treated with pamidronate showed clinical, x-ray or lab signs of HO recurrence or new HO at time of F/U (5-54 mo post-op).

Meiners et al. 1997
Germany
Case Series
Ninitial=31 (43 hips); Nfinal=29 (41 hips)

Population: Mean age=37.87 yr; Gender: males=28, females=1; Level of injury: paraplegia=19, tetraplegia=10; Severity of injury: complete 22, incomplete 7; Time since injury=17-298 mo; Hip side: l=16, r=23.
Intervention:
Resection of HO of the hip via ventral approach. Post-operation: Wk 1–irradiation of hip with a linear accelerator; Day 15–passive movement exercises implemented.
Outcome Measures:
Range of motion (flexion and extension) pre-, post-, intra-operatively and at follow-up.
  1. Mean range of motion improved from 21.95° pre-operatively to 94.51° intra-operatively, to 82.68° post-operatively (mean=4.2 yr).

Garland & Orwin 1989
USA
Case Series
N=19

Population: Mean age=22.5 yr; Level of injury: paraplegia=8, tetraplegia=11; Severity of injury: complete 12, incomplete 7.
Intervention: Records of those who underwent hip resection for HO between 1970 and 1985 were reviewed.
Outcome Measures: Range of motion, recurrence rate, and adverse effects.
  1. Of 24 hips operated on, three had similar or less motion when compared with preoperative motion, 15 had 10-39° improvement, and 6 had >40° improvement.
  2. Total recurrence rate was 92% (22 of 24 hips).
  3. A high number of complications, infections and blood loss occurred.

Subbarao et al. 1987
USA
Case Series
N=5

Population: Age range=29-41 yr; Time since injury=18-197 mo.
Treatment: Didronel given 10 d-2 wk preoperatively, medication withheld for immediate postop period (72 hrs) and continued for minimum of 3 mo. All patients underwent wedge resection at hip to permit free movement of hip in flexion.
Outcome Measures: Effects of treatment.
  1. All patients at last follow-up were able to function independently in their wheelchairs except one (was able to function independently in a semi-reclining wheelchair).
  2. Patients had severe restriction of range of motion in involved joints.

Note: F/U=follow-up; ROM=range of motion; W/C=wheelchair

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