From the Research
The next step in management for a patient with a mature bone visible on their X-ray of the hip is orthopedic consultation for surgical evaluation and intervention. This finding likely represents heterotopic ossification (HO), which is abnormal bone formation in soft tissues. The orthopedic surgeon will determine if surgical excision is necessary based on the location, size, and associated symptoms such as pain, decreased range of motion, or functional limitations. Prior to surgery, CT imaging may be ordered for better visualization of the bone formation and surgical planning. If surgery is indicated, prophylactic measures to prevent recurrence should be implemented, including a short course of NSAIDs (such as indomethacin 25mg three times daily for 3-6 weeks) or single-dose radiation therapy (typically 700-800 cGy) within 24-48 hours post-operatively, as supported by a systematic review on radiation therapy for HO 1.
Some key points to consider in the management of HO include:
- The use of NSAIDs, such as celecoxib, which has been shown to be effective in preventing HO after total hip arthroplasty, according to a Bayesian network meta-analysis 2.
- The comparison of ibuprofen and indomethacin as prophylaxis for HO, which found similar efficacy between the two, as reported in a comparative study 3.
- The importance of delaying surgery until the heterotopic bone has fully matured, usually 12-18 months after initial formation, to reduce recurrence risk.
- The role of physical therapy in maintaining joint mobility and function, both pre- and post-operatively.
It is essential to prioritize the patient's morbidity, mortality, and quality of life when making management decisions, and to base these decisions on the most recent and highest-quality evidence available, such as the systematic review on radiation therapy for HO 1.