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Broke Hip. No Growth Of Bone. Taking Pain Medications. On Oxycodone. Suggest?

Posted on Thu, 17 Oct 2013

Question: I am looking for a doctor who treats HO. my husband fell about 11/2 years ago and broke his left hip and two weeks later HO set in. The doctor tells us the bone has stopped growing but he is in so much pain, he can hardly get out of his recliner. He takes pain meds until they stop helping and then the doc. ups the dose. right now he is on oxycodone 15 mg./4 times a day. All our doctors tell us is to take his meds and bear it, it won't get any better and may very well get worse. My husband is 72 and our "Golden Years" are not quite what we had hoped for.

Thank you for any information you can give.

Answered by Dr. K. Naga Ravi Prasad (4 hours later)

Brief Answer:
Treatment of HO is Multimodal.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

Treatment of heterotopic ossification (HO) is difficult, as little is understood about what triggers this condition to occur.

The management options of HO are as follows -

* PHYSICAL THERAPY -Therapy is an important part of treatment. Range of motion exercises will help to maintain mobility. It can also keep the disease from getting worse. Therapy may also include some stretching and strength training.

* MEDICATIONS - Medicines which are helpful in preventing further progression of HO include
- Bisphosphonate drug (eg:etidronate)-to block calcium from depositing in new bony growths
- Nonsteroidal antiinflammatory drugs (NSAIDs)-to help prevent more bone growth in soft tissue (Naproxen, Diclofenac or Indomethacin are useful)

* RADIATION THERAPY - Radiation is used to prevent abnormal bone growth

* SURGERY - Surgery may be helpful to remove the abnormal bone and increase range of motion. Radiation and medications are often given after surgery, to prevent the chances of recurrence.

So, I suggest you to approach an orthopedic surgeon for a detailed evaluation and further management.

Hope I have addressed your query. Happy to help further

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (13 hours later)

I appreciate your reply but I already know all of this information. The ossification has grown not only into the replaced bone and hip ball, it has grown into the tissue around the inside of the leg. The doctor has told us that if he replaced the whole hip in order to get this (he describes it as thin plates of ice between the muscles) HO out, XXXXXXX could not even stand with a walker because there would be nothing to stand on. We have come to terms that there is probable nothing to be done by a surgeon but my question was if there is a specialist for HO that can help him with the pain he is in. The pain is so bad it is and has ruined his life. Will any of the medications you have suggested above help pain? is there any need for radiation therapy at this late date? We have a "Pain" specialist that gives him his meds and an orthopedic surgeon (supposedly the best in San XXXXXXX ..he handles all the sports teams here). It is just that nobody is doing any good and I keep searching for help. I do thank you for your help but I believe that we are beyond your information. Are there any participating tests that he might consider being involved in? I understand that this is a very unknown problem and my heart and prays goes out the our military... that are coming home with HO. Thank you again for your help and if there is any other
HO specialist in the San XXXXXXX area, We would be open to a second opinion.
XXXXXX

Answered by Dr. K. Naga Ravi Prasad (52 minutes later)

Brief Answer:
The only effective treatment is Surgery.

Detailed Answer:
Hi, Nice to hear from you.

As on date, the only effective way of treating a symptomatic HO is by surgical resection, which is usually delayed for atleast one year after its formation so as to allow the maturation of the bone which facilitates resection and minimizes trauma to the surrounding soft tissues (which may again initiate the formation of HO).

The rest of all modes of treatment are only supportive.

Good luck.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (26 hours later)

9/25/2013

I know all the information you have given me...The REAL question I have is...are there any HO specialist in the San Antonin area that we might get a second opinion from? It has been over a year and we would just like to talk to a different doctor. The only doctor we have seen about this is a Dr. Fox.
Thank you XXXXX

Answered by Dr. K. Naga Ravi Prasad (5 hours later)

Brief Answer:
Sorry, I am not aware of any doctor.

Detailed Answer:
Hi, I am sorry to say this but I am not aware of a surgeon who is specialized in dealing with HO cases.

This is just to let you know that the treatment protocol remains the same, irrespective of the doctor and area you prefer.

Have a great day

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar