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Heterotopic Ossification in the Residual Limbs of Traumatic and Combat-Related Amputees

Dr. Potter is Chief Resident, Orthopaedic Surgery Service, Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC. Dr. Burns is Resident, Orthopaedic Surgery Service, Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX. Dr. Lacap is Resident, Orthopaedic Surgery Service, Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center. Dr. Granville is Director, Amputee Services, Brooke Army Medical Center. Dr. Gajewski is Director, Musculoskeletal Oncology and Orthopaedic Liaison, Amputee Service, Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Potter, Dr. Burns, Dr. Lacap, Dr. Granville, and Dr. Gajewski.

The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or United States Government. All authors are employees of the United States Government. This work was prepared as part of their official duties and as such, there is no copyright to be transferred.

Reports on the occurrence and treatment of heterotopic ossification in amputees are rare. Heterotopic ossification in the residual limbs of amputees may cause pain and skin breakdown and complicate or prevent optimal prosthetic fitting and utilization. Basic science research has shed light on the cellular and molecular basis for this disease process, but many questions remain unanswered. The recent experience of the military amputee centers with traumatic and combat-related amputations has demonstrated a surprisingly high prevalence of heterotopic ossification in residual limbs. Primary prophylactic regimens, such as nonsteroidal anti-inflammatory drugs and local irradiation, which have proved to be effective in preventing and limiting heterotopic ossification in other patient populations, have not been studied in amputees and generally are not feasible in the setting of acute traumatic amputation. When nonsurgical measures such as activity and repeated prosthetic modifications fail to provide relief, surgical excision has provided good early clinical results, with low rates of recurrence and acceptable complication rates in military amputees.

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