Two Cases of Left Hip Heterotopic Ossification Treated with Surgery and their Outcomes Postoperatively

Abstract

52-year-old woman was admitted to Trauma and Orthopedics department (TOD) due to septic arthritis (SA) in left hip joint (LHJ). Patient underwent three consecutive open debridement procedures. During the treatment, an intracerebral hematoma was discovered. Upon rehabilitation patient indicated severe pain in LHJ that impaired movement. Three months after admission CT showed heterotopic ossification (HO) in LHJ. Patient was recommended to complete treating postinfectious complications and refer to TOD for further evaluation and discussing treatment options. Five months after the first presentation, complete mechanical block could be seen in LHJ due to HO. Open left hip ossificate resection and LHJ redressation were performed. During procedure significant increase in range of motion (ROM) was obtained. Iatrogenic transection of the femoral nerve occurred and was treated surgically. After surgery, patient was subjected to early rehabilitation and later forwarded to rehabilitation department. Increase of active and passive ROM remained. 34-year-old man was admitted to TOD due to polytrauma, including multiple hip and acetabular fractures. Patient underwent three surgical interventions due to fractures. Month after admission, postoperative deep tissue infection in the fracture and Covid-19 were discovered and treated. Two years later, patient returned to TOD complaining about significant impairment of ROM in LHJ due to HO, which was surgically removed. Surgical treatment is rarely chosen for treatment of HO since alleviation of pain is not worth the risks, and HO can reoccur, preferring treatment with exercise and indomethacin, but when a significant increase of ROM is expected, surgical treatment is justified. These case reports show how surgical treatment of HO with mixed origin in patients with good expected outcomes and high involvement in their own rehabilitation should be at least considered. It is important to emphasize both pre and postoperative rehabilitation and prophylaxis.