Early Excision and Late Excision of Heterotopic Ossification after Traumatic Brain Injury Are Equivalent: A Systematic Review of the Literature

Abstract

Heterotopic ossification (HO) is a common complication in patients with coma after brain injury. As the optimal timing of surgical resection is still controversial and unclear, a review of the literature was performed in order to determine the impact of early operation on recurrence rate and joint mobility. We identified all types of studies dealing with surgical excision of HO in patients after head injury in major medical and publishers' databases. Publication bias and statistical heterogeneity were assessed by funnel-plot asymmetry and Galbraith regression. We abstracted demographic and outcome information from manuscripts that tabulated individual patient data (IPD) to build univariate logistic and linear regression models. Means and proportions for random-effects meta-regression analysis were also obtained. Of 318 studies originally identified, 16 observational studies enrolling 255 patients (212 men, 329 affected joints, mean age of 30.6 [+/-SEM of 1.4] years) were included in the analysis. The reported overall recurrence rate in eleven studies was 38/192 (19.8%). Both IPD and meta-regression analysis failed to show a marked impact of the interval to resection on the probability of recurrence (odds ratio 1.00, 95% CI 0.98-1.03). The predicted probability of recurrence after 13, 21, and 30 months of waiting was 9%, 14%, and 19%, respectively. The length of coma period and patient's neurologic deficit were statistically significant negative predictors for both recurrence rate and functional outcome. Although no conclusive inferences can be drawn from the identified studies, the available data do not support the concept that early excision triggers later recurrence.

Cationic Nanogel-mediated Runx2 and Osterix siRNA Delivery Decreases Mineralization in MC3T3 Cells

“…These treatments options include nonsteroidal antiinflammatory drugs (NSAIDs) and radiotherapy (often in combination), although adverse effects have been associated with their use [8,9,20,57]. Surgical excision of HO is another therapeutic option, although recurrence of HO at the surgical site may ensue [10,13,65]. Furthermore, contemporary treatment options are not engineered specifically to impede the biological mechanisms responsible for the production of bone in soft tissue.…”

Management of multijoint stiffness of bilateral upper limbs secondary to heterotopic ossification: Case report and literature review

“…HO in TBI cases usually occurs on hemiplegic limbs, whereas occurring in the neurologically noninvolved side is rare [7][8][9][10]. Chalidis et al [3] found that altering the natural course of HO is difficult once it has started [3,11]. Therefore, prevention should be emphasized.…”

“…Among the population of individuals with traumatic brain injury (TBI), the estimated prevalence of clinical heterotopic ossification (HO) is more than 20 percent [1], which can severely restrict range of motion (ROM) in the involved joints [1][2][3]. The effectiveness of pharmacological prophylaxis has not been irrefutably proven, and prophylactic irradiation runs a potential risk of malignancy [1,4].…”

A preliminary investigation on the effect of extracorporeal shock wave therapy as a treatment for neurogenic heterotopic ossification following traumatic brain injury. Part II: Effects on function

“…adversely affecting the quality of life of already physically compromised patients with TBI [2,[6][7][8][9][10] . Pharmacotherapy to date has not proven to be successful once NHO has formed [11,12] , thus surgical removal remains the only treatment option for NHO but is extremely invasive and not always possible for all TBI patients [13] .…”