180 - Post COVID-19 Heterotopic Ossification

Case Diagnosis: Heterotopic Ossification

Case Description: A 45-year-old male presented to inpatient rehabilitation post-surgical excision of bilateral Heterotopic Ossification. The patient developed Heterotopic Ossification after an 84-day-long hospitalization with COVID-19 and respiratory failure requiring mechanical ventilation. The patient initially presented to inpatient rehabilitation with pain and decreased range of motion and was discharged with mild improvement in pain but without improved range of motion. The patient opted for surgical resection, and upon second admission to inpatient rehabilitation, he presented with severe limitations in functionality and activities of daily living. The patient required maximal assistance for bed mobility and a dependent transfer grade. Upon discharge, he achieved a modified maximum assistance grade for bowel movements and transfers.

Discussions: Heterotopic Ossification is a pathologic process in which extraskeletal bone is formed in muscle and soft tissue. This condition is most associated with patients with a clear history of trauma or surgical intervention. Treatment and management plans for Heterotopic Ossification include prophylactic strategies to prevent or dissuade the worsening of the condition and a therapeutic rehabilitation approach to improve range of motion. If the patient’s pain symptoms and limited range of motion significantly affect functionality, then operative intervention may be indicated. Surgical Resection is typically performed once the ossification maturation process is complete, generally taking around six months.

Conclusions: Multiple HO cases have been reported in patients who have endured extended hospitalizations due to complications regarding COVID-19. The connection and etiopathogenesis between HO and COVID-19 infections is unknown. Increasing awareness of HO as a possible complication arising in patients with prolonged immobilization in COVID-19 patients can increase the likelihood of early diagnosis and early rehabilitation to manage the progression of HO.