View Full Version : Heterotopic Ossification (HO)
I have HO restricting my range in both hips. My right hip is nearly dormant and I'm looking at options for removal of the bone mass impingeing on the pelvis/hip joints. Anyone have any info or advice? Doctor or institute? Any help would be appreciated.
08-09-2001, 09:30 AM
Have you been evaluated to determine if your HO has "matured". This means that it is no longer actively growning. This is generally done with a nuclear bone scan. It cannot be determined by regular Xray, CAT scan or MRI. It is important to never attempt surgery on HO until it has matured, which may take several years. If done too soon, surgery can actually cause HO to get worse and grow at a faster rate.
At best HO surgery is a difficult procedure with common complications. Extensive bleeding is common, and if a hematoma (blood clot) should develop after surgery in the wound, it can easily turn into an abcess and infection if not properly prevented or drained early. Bone infection (osteomyelitis) can result. It is important that the surgeon (generally an orthopedist) be very experienced in the surgical treatment of HO in people with either SCI or TBI (not just joint replacement patients, who can develop a syndrome like, but not identical to neuropathic HO).
If necessary, travel to a large center to get this done, and always have a second or even third opinion. You should be able to get a referral to an appropriate surgeon from any large SCI rehab center. (KLD)
08-13-2001, 01:33 PM
What is the cause(s) of H.O? Not enough ROM, stretching, standing frame?
08-13-2001, 02:59 PM
We really do not know why people with neurotrauma get HO. It occurs mostly in the hip or knee in people with SCI. It can also occur in those with traumatic brain injury (TBI) but here it is more common in the shoulder or elbow.
We do know that there is an association between more cases of HO and prolonged bedrest and poor nutrition during the immediate time after SCI (ICU phase), and it is seen much more in those who have an early pressure ulcer (during that same time). I have also seen it more in those who also had a TBI (even if just a concussion) at the same time as their SCI. It can also occur much later after injury, often starting immediately after a fracture or new pressure ulcer occurs. ROM exercises are actually not the cause, but a good treatment for it when it occurs. We used to think that damage to insensate joints was associated with this, but so far studies in this area have discounted this as a cause. (KLD)
I'm told Dallas has several good rehab centers, but am unfamiliar with them. Any suggestions? Also, I'm told Dr. Gottschaulk is very experienced with HO in SCIs. Have any of you heard of him or have a site where his qualifications might be checked? Perhaps sites to check into HO and ensuing complications?
The HO in my right hip is nearing maturity according to Nuc Bone scan of 10 weeks ago. A couple of weeks or so ago I took another to confirm/deny the maturity of the HO, but have yet to review the scan. I've also had a CT scan of the right hip which shows the HOs nearly all on the top of the thigh & hip with the hip joint appearing relatively easy to clean up. I understand the surgery is tricky with large amount of blood lost possible, but I sure would like to get my rom back and am weighing the lack of independence with the surgery risks.
08-14-2001, 10:41 AM
I do not fully understand HO. Can you explain it a little more. Is it lump of some kind. I have a lump around my tailbone annd do not know what it is. It does not seem to be an ulser (there is no redness) It is just a lump that appears from time to time and can be very painful. Never had any problems with ulser of any kind thank GOD. Going to see doc tommorow would like more info regarding HO.
08-14-2001, 02:30 PM
I had bad HO in rehab and nobody could tell me why or how i contracted it other than it was some kind of funky calcium thing.I have never thought about until now,they treated it apparently with lot's of rom excercies (it was in my hip).I have never had it checked since they said it was ok.My rom of motion seems to be fine,but how can a person tell without going through all those scans and crap.
11-26-2002, 05:52 PM
I have read several of the posts. Am I correct in the fact that:
HO mainly occurs in the first 2 years post SCI
HO affects joints and possibly bones below the injury level but not further than the knees.
Now my question: Does HO continue to become a problem after the 2 year post sci timeframe. The major clue to HO is loss of ROM. ?
11-26-2002, 07:48 PM
my H.O. was detected early while at in-patient rehab. i was treated with a weeks worth of low dosage radiation...which evidently did the trick as i've had no problems since. i don't know if this treatment is viable for later stages(or how experimental it was in the first place), but might be worth looking into.
11-26-2002, 07:54 PM
Sci nurse, is it never, never in feet?The DPM doctor said something about a bony overgrowths, that is what rang a bell for me. I am C5-6 and T7-8 SCI. I walk but walk slowly. I'm quite spastic.
12-06-2012, 07:54 PM
My step-father has been diagnosed with Heterotopic Ossification. He had a hip replacement about 15-20 years ago. His brother may also have HO. My step father is 67 and now uses a motorized wheel chair. Basically he is bed ridden, he can’t control his bowels and is in constant pain. My step-father is now in assisted living. My mother is living there with him and has seen multiple doctors. My mother recently reached out to the University of Washington and was told they were not willing to see him.
I am reaching out to anyone or entity that has information on Heterotopic Ossification and/or can at least direct me to someone that can help him. His in pain, all the doctors in my mother’s home town in Kennewick, WA have done is put him on morphine. We are not able to get answers or solutions.
We don't know what direction to go and at this point any suggestions are welcome.
12-06-2012, 08:06 PM
Considering your step-father's age is he a Vietnam era veteran? If so, he might try to be seen at the Seattle VA Hospital.
12-07-2012, 09:22 AM
There is a place in Columbus, Ga., http://www.hughston.com/ (http://www.hughston.com/), that could probably answer all your questions. The last time I visited, my orthopaedic surgeon told me there were 38 orthopaedic surgeons there. They have teams of specialties such as 8 doctors just for foot and ankles, 10 kneee specialists and etc. Many of Hollywood people go there as well as professional and college athletes. From Louisiana, it would not be too bad of a trip.
12-08-2012, 10:07 AM
HO is tough, it can be treated with oral medications to lessen the symptoms. It can cause a lot of problems with mobility of joints. Physiatrist and Orthopedists need to consult each other on what is appropriate. If you are not ambulatory, then surgery may not be offered.
cindy - I have not seen HO in the feet. DPM may have been referring to bone spurs which is not the same.