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. 2025 Jan 3:8:41323.
doi: 10.2340/jrm-cc.v8.41323. eCollection 2025.

EARLY SURGERY IN RARE KNEE HETEROTOPIC OSSIFICATION LEADS TO SUCCESSFUL FUNCTIONAL OUTCOME: A CASE REPORT

Stijn Pierreux  1 , Samar M Hatem  1   2   3   4 , Stijn Roggeman  1 , Marc Schiltz  1   2   3   4
Affiliations

EARLY SURGERY IN RARE KNEE HETEROTOPIC OSSIFICATION LEADS TO SUCCESSFUL FUNCTIONAL OUTCOME: A CASE REPORT

Stijn Pierreux et al. J Rehabil Med Clin Commun. .

Abstract

Background: Heterotopic ossification is a common complication after joint replacement surgery, such as hip or knee arthroplasty. In the intensive care unit, it is most commonly associated with traumatic brain injury or spinal cord injury. To prevent recurrence, surgical resection of heterotopic ossification is recommended once the ectopic bone has fully matured, which is estimated to occur after at least 12 months.

Case presentation: This case describes a young woman with no relevant previous medical history who developed severe bilateral heterotopic ossification on the anteromedial sides of her knees after an intensive care unit stay. Passive flexion of both knees was limited to 50°. X-ray was a simple diagnostic tool. Predisposing factors were extended immobilization, prolonged systematic inflammatory condition and mechanical ventilation. Due to the failure of initial conservative therapy, the heterotopic ossification was resected early, 4 months after onset of first symptoms. Following an intensive rehabilitation program, a normal, pain-free gait and full range of motion of both knees were achieved 9 months after surgery.

Conclusion: This case report demonstrates that early resection of heterotopic ossification can result in a good clinical and functional outcome.

Keywords: early surgery; functional outcome; heterotopic ossification; knee; rehabilitation.

Plain language summary

Heterotopic ossification is the formation of bone in soft tissues, typically around joints like hip, knee and shoulder, causing significant pain and loss of function in the affected limb. Generally, surgical resection of the excess bone is recommended once the heterotopic ossification is fully matured, which may take at least 12 months. In this case, a young woman developed severe heterotopic ossification on the inner sides of both knees after a prolonged intensive care unit stay. She experienced intense pain, limited knee bending and severely impaired walking. As initial non-surgical treatments failed, the heterotopic ossification was surgically removed just 4 months after the onset of the first pain symptoms. After surgery and an intensive rehabilitation program, she regained pain-free walking and full range of motion in her knees. This case demonstrates that early surgical intervention for heterotopic ossification can lead to good clinical and functional outcomes.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Evolution of the passive range of motion (flexion) of both knees (squares) in degrees assessed with a goniometer, and pain intensity (triangles) assessed with a Numeric Rating Scale ranging from 0 to 10.
Fig. 2
Fig. 2
Sequential anteroposterior radiographical images showing bilateral extra-articular calcifications on the anteromedial side of the knees (white arrows). (A) Radiological diagnosis of heterotopic ossification. (B) Three weeks after surgery. (C) Two months after surgery.
Fig. 3
Fig. 3
Magnetic resonance imaging of the left knee in a 26-year-old woman without previous relevant medical history, showing extensive heterotopic ossification in the medial femoro-patellar recess with a slight extension to the vastus medius muscle (white arrows). (A) Transversal T2-weighted fast spin echo and (B) Coronal PD-weighted fast spin echo with fat-saturation.
Fig. 4
Fig. 4
(A) Transversal SPECT-CT of the knees with fused images showing active bilateral heterotopic ossifications 6 weeks after first symptoms. (B) 3D reconstructed image showing the localization of heterotopic ossifications with regard to the knee joint.
Fig. 5
Fig. 5
Serum alkaline phosphatase levels during hospitalization showing a peak at 23 days after admission to intensive care unit.
See this image and copyright information in PMC

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