Operative treatment of heterotopic hip ossification in patients with coma after brain injury

In 13 joints of 12 patients who sustained traumatic brain injury, heterotop ic ossifications of the hip were surgically excised at an average of 15 mon ths after the patients' recovery from coma. All of the patients were referr ed by neurologists of the postcoma unit who deemed surgery necessary to spe ed up the rehabilitation program of the patients, Before surgery, three pat ients were able to ambulate, whereas nine were not ambulatory, Eight hips w ere ankylosed, whereas five had a severe painful limitation of joint motion , All of the patients were checked at regular intervals after the operation , and the final followup averaged 38 months. In an attempt to prevent posto perative recurrence of ossification, 100 mg of indomethacin was administere d daily after surgery for 6 weeks, At followup, 10 patients could ambulate and two were able to sit in a wheelchair. patients with poor neuromuscular control tended to lose part of their postoperative range of motion, and het erotopic periarticular ossification recurred in two of them (three hips), N o correlation was found between recurrence and the time that elapsed from h ead injury to the operation, but old ossifications continued to show osteog enic activity at the histologic level.