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Author Topic: heterotopic ossification  (Read 8159 times)

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stavros

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heterotopic ossification
« on: January 03, 2012, 12:04:42 AM »
I had a right Birmingham hip resurfacing on October 7 2011. Everything was OK first post-op visit to my specialist 3 weeks later, apart from some numbness in my thigh. I had to keep taking Endone for another 3 weeks as the pain wouldn't go away. I had a lot of trouble raising my knee from the beginning and found that it improved with exercise but only to about halfway compared to my good leg. On my last visit to the Physio he was worried at my lack of improvement i.e. 0 external rotation, 5-10 degree FFD, 40-50 degree hip flexion and he sent a letter with me to give to my specialist at my 3 month post-op check-up. The specialist looked concerned and sent me for an Xray which confirmed the presence of heterotopic ossification. He has sent a note to my physio and hopes to improve my range of motion, otherwise it will be excision of ossification at 12 months. I am not keen on further surgery but can't drive well, as my hip hurts and I have difficulty operating the brake. Does anyone else have similar experiences and how was it resolved?

Pat Walter

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Re: heterotopic ossification
« Reply #1 on: January 03, 2012, 01:24:26 AM »
Hi Stavros

Sorry to hear you are having problems.  You are still healing.  You are only 3 months post op and many people take a long time to heal.  A lot depends on how deteriorated your hip was before your surgery.  If you were in pain and limped around for a long time, it will take a long time to get back to normal. 

Who was your surgeon?  Is your acetabular cup properly placed?  Cups not placed properly can cause impingement and problems.  It is important that you device be placed just right.  If you are not sure, you can send your x-rays to several of the top surgeons for a free consult for a second opinion.

Pat

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3/15/06 LBHR De Smet

obxpelican

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Re: heterotopic ossification
« Reply #2 on: January 03, 2012, 02:14:36 AM »
I am always sad to hear about problems that people sometimes have, especially considering that most people (97% +) have very good results.   But that's why this site exists, to guide people to hip resurfacing and to help those who have had problems.

Sorry to hear about your problems, hope it all works out in the end. Please keep us posted.

BTW, who was your doctor?


Chuck
Chuck
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OtterDriver

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Re: heterotopic ossification
« Reply #3 on: January 03, 2012, 02:34:12 AM »
Hello Stavros! 

Sorry to hear of your situation...I think I recall correctly that calcium or bone tissue starts forming up outside the skeleton with that condition!?  I'm about ten days behind you, and for the most part seem to be trouble free so far (I'm knocking on my head as I type that!).  Hopefully someone here can shed some light on a resolution for you!

Best of luck to you, Bruce

Jimt

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Re: heterotopic ossification
« Reply #4 on: January 03, 2012, 04:09:46 AM »
Otter,

I know I was told to take 700 mg aspirin for six weeks post op to keep bone tissue or growth from forming.  I had never heard of aspirin for this type of situation I thought it was just for blood thinning.  Unless I misunderstood the PA.   
Right bhr 12-02-2011. Dr Su

stavros

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Re: heterotopic ossification
« Reply #5 on: January 03, 2012, 04:14:30 AM »
aspirin was prescribed to me also but only 150mg for blood thinning. I believe there is some belief that aspirin does help prevent ossification

Nemesis

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Re: heterotopic ossification
« Reply #6 on: January 04, 2012, 04:03:34 AM »
I had horrific heterotropic ossification from a prior surgery that practically froze my hip in place.  This in turned caused the need for further surgery an hip resurfacing. 

My hip resurfacing was on 06/06/2011 by Dr. Su.  To prevent further complications with heterotropic ossification I had to wait over a year from the first surgery to make sure the bone growth had stopped.  Dr. Su then did the surgery having to take an hour longer than usual to cut out past ossification and do the hip resurfacing very carefully.  After surgery I was put on indomethicin which I developed a horrible allergy to at 28 days (they wanted 6 weeks but I couldn't).  Dr. Su then had the hip radiated to further stop unwanted bone growth. 

Dr. Su said in over 1800 hip resurfacing and another crazy amount of hip replacements he has only seen ossification as mine in 3 other cases but only in hip resurfacing never operations or hip replacements.

Today I am doing great.  I have full range of motion to my chest and working on bringing my foot to my groin.  I also did 90 flights of stairs in 20 minutes yesterday.  I will not kid you though.  I did my own rehab and it HURT.  I would cover my face with a towel so that no one would see my face and possible watery eyes.  At times I would swear I could hear the muscle tear/give.


stavros

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Re: heterotopic ossification
« Reply #7 on: January 04, 2012, 05:15:15 AM »
Thanks nemesis, your post gives me hope. I fitted a modification to my vehicle's brake pedal yesterday so that I can slide my foot from the accelerator to the brake, as I was unable to lift my foot sufficiently to apply the brake otherwise. Did a quick run into town, seems to have solved that problem, apart from the persistant ache I get from sitting down in that position.

It sounds like you put in a big effort to gain back your ROM, my daughter told me the other day "no pain no gain"

Nemesis

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Re: heterotopic ossification
« Reply #8 on: January 05, 2012, 05:12:12 AM »
I have been working out since 12. I have been injured so bad ambulance workers told me they were amazed that I got up.  I have been thrown like a rag doll.  I have been punched so hard and often that I hoped I would get knocked out to end it. None of it even comes close to the ordeal I went thru to get my hip working again.  I am still not done as I still intend to get to a high level of strength and fitness in the hip.  I mention all this because you must realize the hard rode ahead but great it with determination and a smirk knowing you are stronger.

danebuxbaum

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Re: heterotopic ossification
« Reply #9 on: January 06, 2012, 09:53:18 PM »
I think I may have some of this as well. But it only showed up on the one year followup X ray and the bone seems to be floating in the middle of muscle. There is no pain. I had the X ray done by a local surgeon who does not do resurfacing as I had my BHR operation many miles away with Dr. Brooks (who saw the same Xray). He (the local guy) said it was very common. So I didn't worry about it. I have had no pain whatsoever but have developed an occasional click when I walk. This isn't always present, just some times. I inquired with Dr. Brooks' PA about the click but he did not respond. So I didn't worry about it.
I am surprised that I never heard about H.O. before my operation. I had done a lot of research on this site and I never saw it come up nor was I informed of it's commonness by Dr. Brooks.  Anyway, I'm not worried*, just adding to the conversation here.
*should I be?

hernanu

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Re: heterotopic ossification
« Reply #10 on: January 07, 2012, 03:06:20 AM »
    I found this interesting article from the US national institute of health (NIH).

http://www.ncbi.nlm.nih.gov/pubmed/21409458

The study was done to look at the frequency of heterotopic ossification in HR (which they call SRA) with and without aspirin and THR (which they call THA) without aspirin. The non-aspirin HR and THR were treated with warfarin.

According to this study, the incidence of ossification in HR with just warfarin was 17.4 %, with 8.7% severe. In the HR group treated postoperatively with aspirin, the incidence dropped to 2.6%, which equated the THR group that had warfarin only.

I drew a few things from this -

  • Ossification happens at 17% for non-aspirin HR, if treated after the operation with aspirin, it drops to 2.6%.
  • Another thing to get is that all of the ossification cases were male - but that wasn't the goal of the study, so take that into account.
  • THRs don't have the elevated amount of ossification.
  • HR rates lower to THR rates when treated with aspirin.
  • Even with untreated HRs, the serious ossification happens at 8.7%

In all pretty interesting, but at low rates, so that it is yet another thing to consider, and it may argue for aspirin to be included in the post-operative treatment.[/list]
« Last Edit: January 07, 2012, 03:10:03 AM by hernanu »
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

stavros

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Re: heterotopic ossification
« Reply #11 on: January 07, 2012, 07:17:29 AM »
HO is graded from Brooker grade 1 to 4 with grade 3 and 4 having symptoms. I think grades 1 to 2 are reasonably common and cause no problems. Grade 3 has symptoms such as decreased ROM and stiffness, grade 4 is serious and can cause serious ROM problems i.e. frozen. I have looked at a few different papers on HO and some reccommend aspirin and some say it has little use - I think the jury is still out.

hernanu

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Re: heterotopic ossification
« Reply #12 on: January 07, 2012, 02:37:34 PM »
Agreed - the paper (new, 2011), says that of the ossification seen in HR, none was higher than 3, and most were 1 or 2.
« Last Edit: January 07, 2012, 02:38:44 PM by hernanu »
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

danebuxbaum

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Re: heterotopic ossification
« Reply #13 on: January 09, 2012, 08:45:43 PM »
Well I resumed the use of Celebrex at about 2 weeks post op and am still eating it. What's more, the HR did not show up on the first x ray study (6 weeks post op) but did at one year.
I might add that I stopped doing the recommended exercises at about 3 months post op and have not resumed since.
And just in case my clicking is related to this HR, it has really become more pronounced within the last 4 months or so and I hardly ever felt it within my first year.

Is the HR likely to get worse as time progresses? Educated opinions anyone?

Luanna

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Re: heterotopic ossification
« Reply #14 on: January 09, 2012, 08:56:14 PM »
Hern -
Does it say in the articles how much aspirin was prescribed and for how long?  Just curious as I took aspirin as my blood thinner for 14 days after surgery but didn't think it had anything to do with HO.

Luanna
RHR 8/30/2011 - Dr. Pritchett - Stryker Trident Shell /X3 Poly liner acetabular cup. BHR head.

hernanu

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Re: heterotopic ossification
« Reply #15 on: January 09, 2012, 09:05:16 PM »
It doesn't say the amount, it's only the abstract, although I'm sure the regular paper can be retrieved. *** this is actually available for $35 from springer press, didn't want to drop the bucks, so... ***

In a previous life, I did hemophilia (Von Willibrand's disease, for those who care) research as a biochemist in a medical school, I regularly used aspirin in my studies to extend the life of a clot, or to induce hemophilia like conditions (add enough, you don't clot). Aspirin is a powerful drug in what it does (interfere with clotting), and it lasts for a while in the bloodstream.

I'd actually be interested in the dosage for this study. I also saw a reference that I didn't look into that also looked at the efficacy of aspirin vs. coumadin in lowering heterotopic ossification in THR, may look into that.

Again, not a medical person here, just noted this abstract of a study.

*** Update ****

Here's the THR study abstract (and the full paper is free) with coumadin:

http://www.ncbi.nlm.nih.gov/pubmed/21162704

again, women have a lower incidence here as well.

In the THR/coumadin study, the aspirin treated patients were prescribed 325 mg 2X per day, as I was by my surgeon, while the coumadin patients had about 5 mg of coumadin per day, both sets continued treatment for six weeks.

The study used existing patient information, did not actively treat patients for the study, so the decision was made by the surgeon.

« Last Edit: January 09, 2012, 09:18:34 PM by hernanu »
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

Luanna

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Re: heterotopic ossification
« Reply #16 on: January 09, 2012, 09:38:07 PM »
Thanks Hern. Very helpful.

PS - My Akita has Von Willibrand's disease. She's alive at almost 12 years. 2 major emergencies trip to vet hospital for transfusion and platelets - but can't complain. Now back on topic -  sorry to digress.

Luanna
RHR 8/30/2011 - Dr. Pritchett - Stryker Trident Shell /X3 Poly liner acetabular cup. BHR head.

hernanu

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Re: heterotopic ossification
« Reply #17 on: January 09, 2012, 09:43:52 PM »
Wow. Your Akita's lucky to have such a good owner. Good luck, I'm sure she's well worth it.
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

OtterDriver

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Re: heterotopic ossification
« Reply #18 on: January 09, 2012, 10:58:46 PM »
Hello Danebuxbaum!

I presume you meant HO where you typed HR!?  Does your clicking seem to emanate from the hip specifically?

Bruce

stavros

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Re: heterotopic ossification
« Reply #19 on: January 16, 2012, 11:21:27 AM »
Went to see physiotherapist today - he affirmed my poor ROM  by pushing my leg to its new limits and encouraged me to continue the exercises. He is not optomistic of me gaining more movement, but I have to maintain what I have now. I have a new appointment to see my specialist end of March with a new Xray to gauge development of HO. Looks like I'll have to trade in my manual truck for an auto vehicle so I can drive again ! Walking is OK but hip is stiff I find it quite tiring. Even after a short drive (as a passenger) I need to use a cane to get mobile as hip stiffens up and becomes quite painful. I don't relish the idea of more surgery, to excise the HO, but it may be inevitable.

 

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