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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 4, 434-440.
doi: 10.1302/0301-620X.89B4.18845  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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The prophylaxis and treatment of heterotopic ossification following lower limb arthroplasty

T. N. Board, MRCS, MSc, FRCS(Orth), Lecturer in Orthopaedics, Specialist Registrar1; A. Karva, MBBS, MRCS, MS(Orth), Clinical Fellow in Orthopaedics1; R. E. Board, MBChB, MSc, MRCP, Specialist Registrar in Medical Oncology2; A. K. Gambhir, MBChB, FRCS(Orth), Consultant Orthopaedic Surgeon1; and M. L. Porter, MBChB, FRCS(Ed), FRCS(Orth), Consultant Orthopaedic Surgeon1

1 Wrightington Hospital for Joint Diseases, Appley Bridge, Wigan WN6 9EP, UK.
2 Christie Hospital, Wilmslow Road, Manchester M20 4BX, UK.

Correspondence should be sent to Mr T. N. Board; e-mail: tim{at}timboard.co.uk

Heterotopic ossification following joint replacement in the lower limb occurs in 3% to 90% of cases. Higher grades of heterotopic ossification can result in significant limitation of function and can negate the benefits of joint replacement. The understanding of the pathophysiology of this condition has improved in recent years. It would appear to be related to a combination of systemic and local factors, including over-expression of bone morphogenetic protein-4. There is currently little evidence to support the routine use of prophylaxis for heterotopic ossification in arthroplasty patients, but prophylaxis is recommended by some for high-risk patients. Radiotherapy given as one dose of 7 Gy to 8 Gy, either pre-operatively (< four hours before) or post-operatively (within 72 hours of surgery), appears to be more effective than indometacin therapy (75 mg daily for six weeks). In cases of prophylaxis against recurrent heterotopic ossification following excision, recent work has suggested that a combination of radiotherapy and indometacin is effective. Advances in our understanding of this condition may permit the development of newer, safer treatment modalities.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General