Have you ever felt like a small piece of bone growing in a place where there is usually no bone, that is, in soft tissue like muscle? Or, after a major injury or surgery, do you feel something strange, like a lump, a little hard, in that area? Maybe it feels like it's getting bigger and bigger. You may be wondering what this is really about and why it happens. That's what we're going to talk about today. In medical terms, this condition is called (Heterotopic Ossification) , or (HO) for short.
What is this (Heterotopic Ossification)? To put it very simply...
Simply put, Heterotopic Ossification is the process of new bone cells growing and forming bone outside of our skeletal system, in soft tissues outside our skeleton . These are like extra bone fragments . These often form after an injury . However, sometimes this condition can occur without any obvious reason.
Keep in mind, for most people, the extra bone fragments that form in this way are very small. Therefore, they do not cause any major symptoms. However, sometimes, if these bone fragments grow a little larger, they can limit your movements and even cause serious problems.
What are the main types of Heterotopic Ossification?
This (Heterotopic Ossification) can be divided into two main types:
1. Nongenetic type:
- This is the most common type . It can occur at any age.
- Although it is sometimes said to occur for no reason, most often it occurs as a response to some kind of trauma . That trauma can be an injury from an accident, or it can be an impact on the tissues due to surgery. Imagine, you fell and hurt your hand, or you had to undergo a major operation, that's when this condition is likely to occur.
2. Genetic type:
- This is very rare . There are very few people in the world with this genetic variant (HO).
- When HO is caused by genetic causes, it can be a little more complicated . For example, malformations of the back, arms, or legs can occur. This genetic condition can sometimes be very severe .
Who is more likely to develop this (Heterotopic Ossification)?
Nongenetic HO can actually develop in anyone. However, if you have had a previous injury or surgery , you are more likely to develop this condition.
About three-quarters of people with HO, or about 75% , can trace their condition to some form of trauma . People with the following conditions are particularly at risk of developing HO:
- Spinal cord injuries: Out of 10 people with these injuries, about 2 to 3 will develop HO.
- Head trauma: This can occur in about 1 or 2 in 10 people who have had an injury to the brain, especially a closed-head injury.
- Total hip replacement: The occurrence of HO after hip replacement surgery is usually mild. However, it can sometimes cause limited movement and stiffness in the hip area.
- Amputation after traumatic injury: It has been found that more than 9 out of 10 people who have had to have a body part removed due to a severe injury may develop this condition (HO).
About half of people with non-genetic (HO) are young adults in their 20s and 30s . Also, men are slightly more likely to develop the condition than women.
Speaking of genetic variants, they are very rare. According to experts, there are fewer than 5,000 people worldwide who have the genetic disease that causes (HO).
How does Heterotopic Ossification affect my body?
(HO) can actually occur anywhere on the body. However, it is most often seen in areas that are most prone to injury . For example:
- Elbow
- Fingers
- Neck or head
- Pelvis
- Shoulder
- Thigh
What are the causes of Heterotopic Ossification?
HO often occurs after an injury . It can also occur after surgery. For example, people who have had a total hip replacement sometimes develop HO, but most of the time it doesn't cause any major symptoms.
You are at higher risk of developing HO if you have:
- Bone fracture
- Burn
- Spine injury
- Total joint replacement surgery
- Traumatic brain injury (TBI)
Very rarely, certain genetic diseases can also cause HO. Some of these diseases include:
- Fibrodysplasia Ossificans Progressiva (FOP): This is a very rare genetic disease. Previously known as Myositis Ossificans Progressiva , this disease causes the soft tissues of the body to gradually turn into bone.
- Progressive Osseous Heteroplasia (POH): This is another rare genetic condition.
What are the symptoms of Nongenetic Heterotopic Ossification?
The symptoms of Heterotopic Ossification can vary from person to person. They also depend on how far the disease has spread and how severe it is. In the early stages of the disease, symptoms such as:
- Pain
- Swelling
- Tenderness
As Heterotopic Ossification progresses , you may begin to feel a lump under your skin. This lump can sometimes grow very quickly and become a large lump . It may be difficult to move with your fingers. It may also be painful to touch.
In the later stages of the disease, the lump can become even harder . If it's near a joint, like your hip or shoulder, it can also limit the movement of your joint . Think about it, making it difficult to raise your arm or bend your leg.
What are the symptoms of Genetic Heterotopic Ossification?
Now let's see what symptoms can occur due to those rare genetic (HO) types. If you have a genetic disease called (FOP) (Heterotopic Ossification), you may see symptoms like these:
- Misshapen big toe
- Spinal malformations
- Structural problems in your fingers
As the disease progresses, many people develop very severe symptoms . For example, it becomes difficult to walk, and some people even have difficulty breathing . This rare (HO) condition can sometimes shorten life expectancy .
In another genetic disease, POH, the symptoms are mostly seen in the skin . In this, bones first form in the subcutaneous tissue . As the disease progresses, bones also begin to form in the connective tissues deep inside the body.
How is Heterotopic Ossification diagnosed?
To find out exactly if you have Heterotopic Ossification, your doctor may perform some tests . The most important of these are imaging tests . These include:
- (CT scan)
- (MRI scan)
- (Positron Emission Tomography - PET scan)
- (Ultrasound scan)
- (X-ray)
These tests can accurately determine the location and size of the extra bone fragments.
Important: If your doctor suspects that you have heterotopic ossification, he or she may choose not to perform a biopsy , which involves taking a piece of tissue and testing it. This is because there are some types of heterotopic ossification that, even with minor surgery, increase the risk of the bone growth spreading to other parts of the body.
How is post-hip replacement (HO) diagnosed?
If you have developed HO after hip replacement surgery, doctors will use special grading scales to assess how far the HO has spread.
One of the most commonly used of these is the Brooker classification . According to this system, heterotopic ossification is divided into four levels:
- Grade 1: There are small pieces of bone in the tissue around your hip.
- Grade 2: You have irregular bone spurs (called bone spurs ) around your pelvis or femur. But there is at least 1 centimeter of space between these bone spurs.
- Grade 3: The bone spurs are located around either the pelvis or the femur, but the distance between them is less than 1 centimeter .
- Grade 4: Your hip joint is stiff (rigidity) or has become ankylosis (locking together of the bones) . This means that the joint cannot move properly.
There are other classification methods like this. All of them look at similar features of (HO). The main factor that determines the severity of (HO) is whether those bone spurs are present and how far apart they are .
How is Heterotopic Ossification treated?
Treatment for heterotopic ossification (HO) varies depending on your symptoms, the type of HO, and how far the disease has spread. In general, your doctor may recommend the following treatments:
- Medication: For people with genetic (Heterotopic Ossification), medications such as corticosteroids can be given during periods of sudden exacerbation of the disease.
- Physical therapy: This can help increase the range of motion in your joints and reduce pain. A physical therapist will teach you exercises that are right for you.
- Surgery: If you have severe pain due to heterotopic ossification, or if your mobility is so limited that you can't do your daily activities , surgery can be a last resort to remove the extra bone. However, there is a small risk that HO may recur after surgery . In most cases, if surgery is decided, you may need to take medication and even radiation therapy to prevent the bone from growing back.
Can Heterotopic Ossification be prevented?
If you are scheduled to have orthopedic surgery, your doctor may prescribe certain treatments to reduce your risk of developing HO. In particular, you are at higher risk of developing HO after hip replacement surgery if you have any of the following conditions:
- (Ankylosing Spondylitis) (This is a disease that causes inflammation of the joints of the spine)
- (Osteoarthritis) (Degenerative joint disease)
- If there has been a history of (HO) before (History of HO)
In these cases, your doctor may recommend preventive treatment to help maintain the results of your surgery. Some studies have shown that taking nonsteroidal anti-inflammatory drugs (NSAIDs) before and shortly after surgery can reduce the risk of developing postoperative otitis media (HO).
However, there is no guaranteed way to completely prevent the development of Heterotopic Ossification. However, there are some things you can do to reduce your risk. For example, treat an injury properly as soon as it occurs . That means using the RICE method :
- R - Rest
- I - Ice (Icing)
- C - Compression
- E - Elevation (keeping the injured area elevated)
Also, strength training, stretching, and getting enough rest can help prevent injuries.
If (Heterotopic Ossification) occurs, will it go away?
Sometimes, yes . Most people with nongenetic HO recover completely . In most cases, HO that develops after an injury gets better with nonsurgical treatments, such as rest, ice, and light stretching exercises.
However, there is no cure for the genetic type (HO) . Although treatment can control the symptoms, the disease gradually worsens.
What else should I ask the doctor?
If you find out you have (HO), it's normal to have a lot of questions. You may want to ask your doctor things like:
- "What type of (HO) do I have?"
- "What is the most likely cause of this?"
- "What are the treatments for (Heterotopic Ossification)?"
- "Are there any lifestyle changes I can make to prevent this?"
- "What are the chances of passing on the gene (HO) to my children?" (If you have the gene)
Is (Heterotopic Ossification) painful?
Yes . Pain in the affected area is the main and most common symptom of Heterotopic Ossification. Often, the pain increases as the bone growths grow larger.
However, if you have heterotopic ossification after an injury or surgery, there is good news . Most people with non-genetic (HO) make a full recovery with treatment.
Does osteoporosis affect the risk of developing HO after surgery?
No. Some medical conditions can increase the risk of developing (HO) after surgery. However, there is no proven link between (Osteoporosis) and (HO).
Finally, things to remember (Take-Home Message)
So, you probably now understand that (Heterotopic Ossification) is the formation of new bone within the soft tissues of our body, in places where there is normally no bone. This can sometimes be due to injury or surgery, or it can also be due to very rare genetic causes.
- Don't worry: Most of the time, especially if it's caused by an injury, it's not dangerous and can be cured with proper treatment.
- Be aware of the symptoms: If you notice a new lump on your body, if there is pain or swelling in that area, especially in an area where there has been an injury, it is a good idea to see a doctor.
- Genetic types are rare: Genetic (HO) types are very rare, but they can be a little more severe.
- There are treatments: Non-genetic (HO) can often be relieved with things like medication and physical therapy.
If you have any further questions about this, be sure to talk to your doctor. He or she will explain it to you in detail.
` Heterotopic Ossification, bone growth, soft tissue, injury, surgery, genetic diseases, pain, swelling, joint movement, extra bone
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