[Heterotopic ossifications in paraplegics]

Area of Science:

• Orthopedics
• Neurology
• Physiology

Context:

• Periarticular ossifications, specifically heterotopic ossification (HO), are a common complication in individuals with paraplegia.
• These ossifications predominantly occur around the hip joint, impacting mobility, particularly hip flexion.
• The incidence of clinically relevant HO in paraplegics is reported to be approximately 18%.

Purpose:

• To summarize the current understanding of periarticular ossifications in paraplegics.
• To highlight the typical presentation, location, and impact on joint function.
• To outline diagnostic approaches and general consensus on surgical intervention.

Summary:

• Periarticular ossifications in paraplegics most frequently manifest around the hip, leading to limitations in joint movement, primarily flexion.
• The ossification process occurs within the connective tissues of the muscle, and its precise etiology and pathogenesis are not fully understood.
• The joint capsule and the joint itself are generally not involved in the ossification process.

Impact:

• Understanding the incidence and characteristics of HO in paraplegics is crucial for patient management.
• The findings underscore the importance of assessing osteogenic activity using methods like alkaline phosphatase levels and bone scans.
• There is a consensus that surgical intervention for HO should be deferred until after the ossification has matured.