Ankylosed hips caused by heterotopic ossification after traumatic brain injury: a difficult problem

Heterotopic ossifications develop around major joints after severe traumatic brain injury and decrease the range of motion of the joints.

From 1982 to 1994, we operated on 22 ankylosed hips caused by heterotopic ossifications after traumatic brain injury. Our 15 patients had been hospitalized in the intensive care unit for a period of 8 to 57 days. Their preoperative neurologic status was evaluated precisely. Special interest was given also to the accurate estimation of the extent and location of the ectopic bone by using x-rays and computed tomography, as well as to the maturity of the bone by using Tc99 bone scan and measurements of serum alkaline phosphatase levels. Intraoperatively, we resected as much ectopic bone as was needed to achieve functional range of motion in the hip. Postoperatively, all the patients were administered 100 mg of indomethacin (suppository) per day for a month, antibiotics, and anticoagulants. They were also exposed to 1,000 cGy of radiation in two equal doses.

We achieved a least functional range of motion in 15 of 22 hips. Of the seven hips with poor results, six cases were attributable to the uncontrolled neurologic syndrome and only one poor result was attributable to severe heterotopic ossification recurrence. Wound complications did occur.

Ankylosed hips caused by heterotopic ossifications after traumatic brain injury are a difficult problem to manage. Accurate evaluation of the preoperative neurologic status is essential for the desired final outcome and the treatment options.