Detaillierte Beitrags-Information
| Beitragstitel | Myositis ossificans of the thigh reducing hip flexion after THA |
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| Beitragscode | P042 |
| Autoren | |
| Präsentationsform | Poster |
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| Abstract |
Matteo Izzo, Jonathan Laurençon, Emanuel Gautier Department of Orthopaedic Surgery and Traumatology, HFR – Cantonal Hospital, Fribourg, Switzerland Introduction Myositis ossificans is a benign but frequently overlooked disease. It is characterized by non-tumoral heterotopic ossifications of muscular tissue. In most cases it represents late sequelae of trauma und thus, is most common in young active males. Its spontaneous evolution is generally favorable and no surgical treatment is needed. Methods We present a case of myositis ossificans of the right adductor magnus muscle interfering with hip flexion after total hip arthroplasty. A 70-year-old male patient with a history of bilateral total hip arthroplasty (2012 left hip; 2013 right hip) presented in our outpatient clinic with pain free but severe restriction of the range of motion of his right hip impeding normal sitting position. Physical examination showed a tumoral mass inside the adductor muscles. Hip motion was found to be restricted to 40° of flexion. Radiography showed a radiopaque mass originating from the postero-medial mid-diaphyseal region of the femur towards the ischial tuberosity. CT scan and MRI revealed a large ossification inside the adductor magnus and partially the adductor longus muscles. Because of the important functional impairment the ossifications were partially removed through a Ludloff approach and the adductor muscles detached from its origin at the ischial tuberosity resulting in 85° of hip flexion intraoperatively. Postoperative regimen included administration of Indocid 75mg/day for a four weeks period as well as a physical rehabilitation program using a continuous passive motion apparatus (Arthrotec). Six months postoperatively the patient maintained 75° of hip flexion, sitting position was normalized and radiographically no local reappearance of ossifications was observed. Conclusion Myositis ossificans is a non-tumoral heterotopic ossification of muscular tissue, mainly of post-traumatic etiology. It is a self-limited pathology with a possibility of spontaneous regression. Thus, surgical intervention is rarely indicated. In our patient hip flexion was severely reduced to 40° due to the ossifications localized mainly inside the adductor magnus muscle. Anatomically, the main muscle mass of the adductor magnus is localized posteriorly to the center of rotation of the hip joint, which explains mechanically the very limited hip flexion in this patient. |