Dr. Timothy K. Durnin - 11/17/2008

Question
QUESTION: I had iliopsoas release done after a hip revision. I now have heterotopic ossification it has been 6 months and is still growing. Is the surgery to remove this very tricky? Do I have to worry about nerve damage or muscle damage. It is very painful but the doctor would like to wait as long as possible. Is this heterotopic ossification common? Thank you for your time..

ANSWER: Hi Deb,

We used to refer to this condition in the past as myositis ossificans but since have changed the name. Surgery is not usually an option since this can only furhter the problem, a drug called Didronel is used to prevent calcium from being deposited in the bony matrix that has already been formed Therefore, it is essenial to make the diagnosis as soon as possible (preferably before any calcium shows up on x-ray) and start the Didronel immediately. Didronel will do nothing to remove calcium that has already been deposited. It is a preventative drug, and has no effect on existing ossification. It also has no effect on the underlying process which produces the bony matrix. There are no known side effects that would prohibit usage. Many physicians recommend prophylactic use of Didronel in all acute spinal cord injuries, but because of the cost this may not be practical. Some patients complain of nausea the first week, but this is rarely severe enough to stop treatment and usually subsides in a few days. There is no uniform agreement on how long the Didronel should be continued In most cases, there will be a brief flare-up of the heterotopic ossification following discontinuing the Didronel and some increase in the amount of calcium deposited There are no completely reliable tests to indicate that the heterotopic ossification is inactive and treatment can be safely stopped However, if the treatment was continued long enough this calcium deposition will be of minimal clinical significance. You need to be observed closely for signs of recurrence whenever treatment is discontinued. Therapeutic ultrasound may be beneficial in breaking up the calcium deposits as well. Many times these conditions are self limiting or go away with time. I would ensure it doesn't continue to grow by using the medication above.

Good Luck!

D. Timothy Durnin

---------- FOLLOW-UP ----------

QUESTION: Thank you for your answer but my ossification is 4 inches by 4 inches(at the last Xray) the doctor wants to do surgery. He never even talked about medicine. I have had to wait until it has stopped growing. At the last appt. it had not grown too much but it is interfering with my hip joint. I can not move the hip. No to mention it is VERY painful. Why does surgery make it worse? The surgeons are talking just surgery. Then they said I will have radiation treatment afterwards. What should I do to prepare myself for this surgery.  I have not seen anything much on this surgery and I am trying to prepare myself. Thank you for your reply. Deb

Answer
Hi Deb,

Surgery doesn't necessarily mean it makes the problem worse in that it usually causes a whole new set of problems. These arise from the infinite amount of possibilities of things that can go wrong. This includes infection, scar tissue proliferation, adverse drug and anaesthesia reactions, nerve damage and on and on. I would ask the doctor why the only option is to cut it out and what is going to replace the chunk of muscle he is going to remove. Ask how this is going to effect your hip motion. Just cutting something out usually has other consequences, I am sure removing a 4x4 piece of leg muscle is going create many problems, even if you successfully dodge all the possible negative side-effects and unintended complications. Make sure you get a second opinion, this is always good advice. Unfortunately, when you see a surgeon, you often get a surgical solution. Ask why other more conservative approaches are not being considered such as ultrasound or medication.

Good luck!

Dr. Timothy K. Durnin
[email protected]
Lansingspinaldecompression.com
drs.chiroweb.com