Resection of heterotopic ossifications of the hip in paraplegics

Abstract

Objective

Improvement of hip mobility.

Decrease of spasticity.

Decrease or elimination of pain.

Indications

Complete ankylosis of hip.

Partial ankylosis interfering with function.

Contraindications

Ongoing bone formation in paraplegics.

Signs of a high remodeling rate (as detected by bone scan, alkaline phosphatase, radiograph).

Acute infection, in particular urinary tract infection due to bladder incontinence.

Absence of functional limitation.

Surgical Technique

Skin incision starting at the anterior superior iliac spine and following the sartorius muscle. Detachment of the sartorius proximally and subperiosteal exposure of the ossification. Stepwise resection under image intensifier control. The joint capsule should be spared. Postoperative radiotherapy.

Postoperative Care

Irradiation. Bed rest for 14 days without mobilization of hip. Then careful exercises until a flexion of 90° has been reached, use of a wheelchair.

Results

Between July 1985 and March 1996, we operated 31 patients (43 hips). 29 patients (28 men, one woman, average age 37.9 [23.3–68.3] years) were followed up after an average of 50 (18–193) months. The mean total range of motion (extension/flexion) amounted to 22° (0–80°) preoperatively, to 95° (60–120°) intraoperatively after resection, and to 83° (80–120°) at the time of follow-up. Complications were recorded after ten interventions: five patients had to undergo eleven revisions. Complications in the remaining patients healed under conservative care. The patients assessed the result of the given hip as being good or excellent 33 times, as being satisfactory four times, and as being poor four times.