Acquired heterotopic ossification in hips and knees following encephalitis: case report and literature review

BMC Surgery

Xiangsheng Zhang¹  Tang Liu¹  Shuo Jie¹  Xianghong Zhang¹ 

[1] Department of Orthopedics, the Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan 410011, P.R. China

关键词: Knee;    Hip;    Encephalitis;    Heterotopic ossification;   

Others  :  1091833
DOI  :  10.1186/1471-2482-14-74

 received in 2014-01-27, accepted in 2014-09-30,  发布年份 2014

【 摘 要 】

Background

Heterotopic ossification (HO) is a rare and potentially detrimental complication of soft-tissue trauma, amputations, central nervous system injury (traumatic brain injuries, spinal cord lesions, tumors, encephalitis), vasculopathies, arthroplasties and burn injury, characterized by lamellar bone growth in non-osseous tissues such as the muscle and the joint capsule. Heterotopic ossification associated with encephalitis is rare and the occurrence of excessive, symptomatic heterotopic ossification around bilateral hips and bilateral knees is rarely described in the literature.

Case presentation

We present a 47-year-old man with heterotopic ossification in the bilateral hips and bilateral knees that prevented him from walking after being attacked by encephalitis as the case study. He developed severe pain and significantly impaired range of motion of bilateral hips and bilateral knees. Research so far revealed that the management of heterotopic ossification is controversial. After requiring revision surgery resection of heterotopic ossification, reconstruction of the medial collateral ligament and adjunctive pharmacotherapy of 200 mg Celecoxib for 8 weeks after operation, he regained mobility of his joints. On review of X-ray, there was no recurrence of HO and no loosening of rivets which were used in the reconstruction of medial collateral ligament.

Conclusion

Heterotopic ossification in the bilateral hip joints and bilateral knee joints associated with encephalitis have never been reported previously. Daily functions of heterotopic ossification patients can be hampered by pain, inflammation, reduced mobility, the loss of normal posture and other complications. Further studies of presumptive root causes, the early diagnosis, preventability and optimal therapeutic measures for heterotopic ossification following encephalitis are required. Different patient should be managed with different appropriated protocol based on the risk of individual patient and the institutional experience.

【 授权许可】

   
2014 Zhang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 1.

【 参考文献 】

• [1]Pape HC, Marsh S, Morley JR, Krettek C, Giannoudis PV: Current concepts in the development of heterotopic ossification. J Bone Joint Surg (Br) 2004, 86:783-787.
• [2]Kluger G, Kochs A, Holthausen H: Heterotopic ossification in childhood and adolescence. J Child Neurol 2000, 15:406-413.
• [3]Shimono K, Uchibe K, Kuboki T, Iwamoto M: The pathophysiology of heterotopic ossification: Current treatment considerations in dentistry. Jpn Dent Sci Rev 2014, 50:1-8.
• [4]Vanden Bossche L, Vanderstraeten G: Heterotopic ossification: a review. J Rehabil Med 2005, 37:129-136.
• [5]Sakellariou VI, Grigoriou E, Mavrogenis AF, Soucacos PN, Papagelopoulos PJ: Heterotopic ossification following traumatic brain injury and spinal cord injury: insight into the etiology and pathophysiology. J Musculoskelet Neuronal Interact 2012, 12(4):230-240.
• [6]Seipel R, Langner S, Platz T, Lippa M, Kuehn JP, Hosten N: Neurogenic heterotopic ossification: epidemiology and morphology on conventional radiographs in an early neurological rehabilitation population. Skeletal Radiol 2012, 41(1):61-66.
• [7]An HS, Ebraheim N, Kim K, Jackson WT, Kane JT: Heterotopic ossification and pseudosrthrosis in the shoulder following encephalitis: a case reprt and review of the literature. Clin Orthop Relat Res 1987, 219:291-298.
• [8]Jayasundara JA, Punchihewa GL, de Alwis DS, Rwnuka MD: Short-term outcome after resection of neurogenic heterotopic ossification around the hips and elbow following encephalitis. Singapore Med J 2012, 53:97-100.
• [9]Gannon FH, Valentine BA, Shore EM, Zasloff MA, Kaplan FS: Acute lymphocytic infiltration in an extremely early lesion of fibrodysplasia ossificans progressiva. Clin Orthop Rel Res 1998, 346:19-25.
• [10]Bidner SM, Rubins IM, Desjardins JV, Zukor DJ, Goltzman D: Evidence for a humoral mechanism for enhanced osteogenesis after head injury. J Bone Joint Surg Am 1990, 72:1144-1149.
• [11]Urist MR, Nakagewa M, Nakata N, Nogami H: Experimental myositis ossification: cartilage and bone formation in muscle in response to diffusible bone matrix-derived morphogen. Arch Pathol Lab Med 1978, 102:312-316.
• [12]Ho SSW, Stern PJ, Bruno LP: Pharmacological inhibition of prostaglandin E-2 in bone and its effect on pathological new bone formation in a rat brain model. Trans Orthop Res Soc 1988, 13:536.
• [13]Chalmers J, Gray DH, Rush J: Observations on the induction of bone in sofe tissues. J Bone Joint Surg (Br) 1975, 57:36-45.
• [14]Botolin S, Mauffrey C, Hammerberg EM, Hak DJ, Stahel PF: Heterotopic ossification in the reaming tract of a percutaneous antegrade femoral nail: a case report. J Med Case Rep 2013, 7:90. BioMed Central Full Text
• [15]Schipani E, Ryan HE, Didrickson S, Kobayashi T, Knight M, Johnson RS: Hypoxia in cartilage: HIF-1alpha is essential for chondrocyte growth arrest and survival. Genes Dev 2001, 15:2865-2876.
• [16]Garland DE, Blum CE, Waters RL: Periarticular heterotopic ossification in head-injured adult. Incidence and location. J Bone Joint Surg Am 1980, 62:1143-1146.
• [17]Mielants H, Vanhove E, de Neels J, Veys E: Clinical surgery of and pathogenic approach to para-articular ossificans in long-term coma. Acta Orthop Scand 1975, 46:190-198.
• [18]Tay SS, Lim PA: Acquired heterotopic ossification following encephalitis and intractable seizures. Ann Acad Med Singapour 2008, 37:809-810.
• [19]Subbarao JV, Garrison SJ: Heterotopic ossification: diagnosis and management, current concepts and controversies. J Spinal Cord Med 1999, 22:273-283.
• [20]Schurch B, Capaul M, Vallotton MB, Rossier AB: Prostaglandin E2 measurements: their value in the early diagnosis of heterotopic ossification in spinal cord injury patients. Arch Phys Med Rehabil 1997, 78:687-691.
• [21]Sawyer JR, Myers MA, Rosier RN, Puzas JE: Heterotopic ossification: clinical and cellular aspects. Calcif Tissue Int 1991, 49:208-215.
• [22]Garland DE: Early excision of heterotopic ossification about the elbow followed by radiation therapy. J Bone Joint Surg Am 1998, 80:453-454.
• [23]Peterson JR, Okagbare PI, De La Rosa S, Cilwa KE, Perosky JE, Eboda ON, Donneys A, Su GL, Buchman SR, Cederna PS, Wang SC, Kozloff KM, Morris MD, Levi B: Early detection of burn induced heterotopic ossification using transcutaneous Raman spectroscopy. Bone 2013, 54:28-34.
• [24]Banovac K, Williams JM, Patrick LD, Haniff YM: Prevention of heterotopic ossification spinal injury with indomethacin. Spinal Cord 2001, 39:370-374.
• [25]Johnson EE, Kay RM, Dorey FJ: Heterotopic ossification prophylaxis following operative treatment for acetabular fracture. Clin Orthop Relat Res 1994, 305:88-95.
• [26]Coventry MB, Scanlno PW: The use of radiation to discourage ectopic bone, a nine-year study in surgy about the hip. J Bone Joint Surg Am 1981, 63:201-208.
• [27]Garland DE, Hanscom DA, Keenan MA, Smith C, Moore T: Resection of heterotopic ossification in the adult with head trauma. J Bone Joint Surg Am 1985, 67:1261-1269.
• [28]Pittenger DE: Heterotopic ossification. Orthop Rev 1991, 20:33-39.
• [29]Garland DE: A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Relat Res 1991, 263:13-29.
• [30]Saito N, Horiuchi H, Takahashi H: Heterotopic ossification in the knee following encephalitis: a case report with a 10-year follow-up. Knee 2004, 11:63-65.
• [31]Devnani AS: Management of heterotopic ossification affecting both hips and knees. Singapore Med J 2008, 49:501-504.