1454 - It’s All In The Hips: Heterotopic Ossification in Paretic and Non-Paretic Limb After Stroke

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

TE

Tiffany Ezepue, MD

Resident Physician
Burke Rehabilitation Hospital
White Plains, New York, United States

Co-Author(s)

KM

Kenia Maldonado Vergara, MD

Resident Physician
Burke Rehabilitation Hospital
White Plains, New York, United States
RJ

Ricky Ju, DO

Resident Physician
Burke Rehabilitation Hospital
White Plains, New York, United States
NB

Normeda Balcetis, MD

Attending Physician
Burke Rehabilitation Hospital
White Plains, New York, United States
SA

Sabreen Abdullah, DO

Resident Physician
Burke Rehabilitation Hospital
White Plains, New York, United States

Case Diagnosis: Heterotopic Ossification (HO)

Case Description: A 42-year-old female with history of hypertension, stroke with residual right hemi-paresis, antiphospholipid syndrome, left hip HO status post excision 5/2022 complicated by thigh hematoma functioning at wheelchair level presented to a clinic with right hip pain for weeks. She had an associated difficulty moving her hip but denied any associated numbness or tingling to her right lower extremity. CT of pelvis and bone scan yielded findings consistent with HO of right hip. She underwent excision of right hip HO without complication.

Discussions: HO is an irregular formation of bone in soft tissue usually secondary to neurogenic or traumatic insult, however pathogenesis remains vague. Furthermore, HO due to neurogenic cause of stroke is rare, around 0.5-1.2%, with formation occurring in the post-stroke hemiplegic population rare as well. In our patient, she was found to have HO on her affected side and then had a recurrence in the unaffected side. It is more common that HO would appear in a paretic limb, moreover, reoccur in the same location after extraction due to traumatic insult, yet that did not happen. Theories speculate formation can be secondary to lack of ranging a limb, or the nervous system sending signals to increase morphogenic proteins versus promoting maturity of cells into osteoblasts to form bone ectopically. Whatever the pathogenesis, the formation in this pattern is not common and more providers should be aware.

Conclusions: HO is known to providers to be a complication that can occur in trauma, burn, spinal cord injury, or stroke patients. However, it is a less likely occurrence after stroke, especially in hemi-plegic patients. Given this information, providers should have a decreased threshold for HO when patients present with similar symptoms so that they can rule out or treat more effectively and quickly to avoid any possibility of further complications.