SP09. Prevalence Of Heterotopic Ossification Following Below Knee Amputation
Year: 2024
Type: article
Study design: Observational Study
Abstract: Purpose: Heterotopic ossification (HO) is an often painful formation of extra bone in the setting of musculoskeletal polytrauma. In addition, pain following amputation may also be caused by symptomatic neuromas. Animal studies have demonstrated a neural regulation of HO suggesting a potential relationship between the mechanism of pathological osseous and nerve regeneration. We have identified cases with HO formation in proximity of common neuroma loci. The baseline occurrence of HO in transtibial amputees, and their relationship to passive nerve surgical techniques such as neurovascular ligation and traction neurectomy is not known. Therefore, we aim to analyze the occurrence of HO following transtibial amputation who underwent passive nerve surgical techniques at time of amputation. Methods: Patients were included if they underwent care for a transtibial amputation before 2023 at a tertiary care center. Chart review was conducted to collect data on demographics and residual limb pain. The most recent X-ray of the transtibial residual limb, before potential revision surgery, was assessed for the occurrence of HO. The occurrence and distribution of HO were summarized and analyzed for nerve surgical technique conducted at time of amputation. Patients who underwent TMR/RPNI at time of amputation were excluded. Results: 107 patients were included. The most common indication for amputation was peripheral vascular disease (PVD, n=53/107 (49.5%)). The median time between amputation and X-ray was 22.5 months (range: 0.1-629.9 months). HO was identified in 56 patients (52.4%). Tibial HO occurred in 42 (75.0%), which was localized on the distal tibial stump in 38 patients (90.5%), and on the proximal tibial shaft in 7 patients (16.7%). Forty patients (71.4%) had fibular HO; 39 patients (97.5%) had distal fibular stump HO and 3 patients (7.7%) had proximal fibular shaft HO. In all 56 patients, HO was contiguous with the distal residual bone, 5 patients (8.9%) also had floating HO loci. Fifty patients reported residual limb pain, which was significantly more common when HO was also present (p=0.039). The occurrence of HO between patients with (n=32/66 (48.5%)) and without (n=25/41 (61.1%)) PVD and/or diabetes was equally distributed (p=0.291) Conclusion: Heterotopic ossification is a common finding in patients undergoing transtibial amputation, occurring in 52.4% of cases following passive nerve surgical techniques and was associated with residual limb pain. Future investigation will evaluate the correlation of contemporary nerve techniques like TMR and RPNI with the presence of HO. These findings may aid in surgeon and patient awareness about the occurrence of HO, and potential prevention of the HO-neuroma complex.
Institution: Massachusetts General Hospital
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W4394953534