Heterotopic Ossification Formation in Military Beneficiaries Following Hip- and Pelvic-Level Amputations

Abstract

Introduction Traumatic hip and pelvic level amputations are uncommon but devastating injuries and associated with numerous complications that can significantly affect quality of life for these patients. While heterotopic ossification (HO) formation has been reported at rates of up to 90% following traumatic, combat-related amputations, previous studies included few patients with more proximal hip and pelvic level amputations. Materials and Methods We conducted a retrospective review of the Military Health System medical record and identified patients with both traumatic and disease-related hip- and pelvic-level amputations performed between 2001 and 2017. We reviewed the most recent pelvis radiograph at least 3 months following amputation to determine bony resection level and the association between HO formation and reason for amputation (trauma versus disease related). Results Of 93 patients with post-amputation pelvis radiographs available, 66% (n = 61) had hip-level amputations and 34% (n = 32) had a hemipelvectomy. The median duration from the initial injury or surgery to the most recent radiograph was 393 days (interquartile range, 73–1,094). HO occurred in 75% of patients. Amputation secondary to trauma was a significant predictor of HO formation (χ2 = 24.58; P < .0001); however, there was no apparent relationship between the severity of HO and traumatic versus non-traumatic etiology (χ2 = 2.92; P = .09). Conclusions Amputations at the hip were more common than pelvic-level amputations in this study population, and three-fourths of hip- and pelvic-level amputation patients had radiographic evidence of HO. The rate of HO formation following blast injuries and other trauma was significantly higher compared with patients with non-traumatic amputations.

The lived experience of military beneficiaries with amputations at the hip and pelvic level

“…13 The incidence of HO formation in hip- and pelvic-level amputations is higher than that previously reported for more distal-level amputations, as highlighted in a recent review of military beneficiaries undergoing hip- and pelvic-level amputations with rates of HO as high as 95% in the setting of blast injuries. 14 Finally, surgical site infections are also common in war-related wounds, especially those resulting in amputation. D’Alleyrand et al noted that all 14 of their combat-related hemipelvectomy patients had developed at least one bacterial or fungal infection after surgery.…”