Heterotopic ossification following COVID-19 infections: systematic literature review of case reports and case series.

BACKGROUND: This review aims to study the clinical characteristics, diagnostic results, treatments, and outcomes in patients with heterotopic ossification following COVID-19 infection. METHODS: A literature search for eligible articles was conducted using MEDLINE/Pubmed, Global Health, and Scopus databases (January 12th, 2023), including all case reports and case series from any country and language. The criteria for inclusion in this review were cases of COVID-19 infection subsequently developing heterotopic ossification. RESULTS: This systematic review analysed 15 reports (n = 20 patients) documenting cases of heterotopic ossification following COVID-19 infection. 80% of the patients were male, with a median age of 59 years. All patients required intensive care unit stay with an average duration of 48.5 days. Mechanical ventilation was necessary for all patients and 30% of them underwent tracheostomy. Common symptoms included stiffness and pain, most frequently affecting multiple locations (70%), with the hips and shoulders being predominantly involved. X-rays were the most commonly used imaging modality, followed by computed tomography. Although treatment was given, some of the patients continued to experience symptoms, particularly stiffness. CONCLUSION: 20 patients who developed heterotopic ossification after COVID-19 have been reported, the majority of which had at least two independent risk factors for this condition. The link between those two clinical entities is therefore uncertain, requiring further investigation. It is nonetheless important to suspect heterotopic ossification in patients with severe COVID-19 infection, prolonged immobilisation, mechanical ventilation, who develop joint pain and stiffness, as this condition can significantly impact patients' quality of life. PROTOCOL REGISTRATION: CRD42023393516.

Internal Fixation of an Intertrochanteric Fracture after Resurfacing Arthroplasty: A Case Report.

INTRODUCTION: Periprosthetic fracture is the most common cause of reoperation after resurfacing arthroplasty. The majority of fractures associated with this kind of arthroplasty are mostly subcapital fractures. Inter- and sub-trochanteric fractures after resurfacing arthroplasty are rarely reported, and there is no consensus regarding the treatment of such fractures. CASE REPORT: We present the case of a patient in whom an intertrochanteric femoral fracture distal to a hip resurfacing implant was successfully managed by internal fixation with the use of a locking compression plate (LCP), after failed conservative management. We also discuss an in-depth literature review on the topic. CONCLUSION: We believe that osteosynthesis is a better option than arthroplasty in the management of such injuries. Due to technical issues discussed in our paper, we believe LCP to be an optimal fixation device.

Bilateral Simultaneous Femoral Neck Stress Fracture Despite Clinical Recovery from Anorexia Nervosa: A Case Report.

CASE: A 38-year-old woman who had returned to sports activity (running) after having clinically recovered from anorexia nervosa presented with a bilateral femoral neck stress fracture that was treated with bilateral hip osteosynthesis. CONCLUSION: Although exercise is usually considered to be beneficial for health, heavy exercise (such as running) after recovery from anorexia nervosa may be associated with an increased risk of fracture.

Aseptic Loosening after Total Hip Arthroplasty in an Acromegalic Patient: A Case Report.

INTRODUCTION: Acromegaly is a rare disorder characterized by excess secretion of growth hormone and its principle mediator, insulin-like growth factor-1. Although acromegaly is frequently associated with osteoarthritis, the outcome of arthroplasty in this population is not documented. CASE REPORT: We report here a case of aseptic loosening of an uncemented total hip arthroplasty acetabulum in an acromegalic patient that was revised with a cemented cup. It has been suggested that the incidence of this complication is increased in other pathology with a similarly high bone-turnover (e.g., Paget's disease), but this complication has however not yet been reported in the setting of acromegaly. CONCLUSION: Although coincidence cannot be ruled out, multiple metabolic hypotheses could account for an altered osseointegration process in the presence of acromegaly, which could lead to a higher risk of loosening.

Management of greater trochanteric pain syndrome : a systematic review.

Greater trochanteric pain syndrome is characterized by pain at or around the greater trochanter. Numerous management modalities have been proposed, with varying success. Cochrane and Pubmed database have been searched from 1990 for studies focusing on the management of this syndrome. We only selected studies with a validated outcome measure. 11 studies met our inclusion criteria. Evidence points towards a pain reduction in the first months after a corticosteroid injection, but this effect does not persist with time. Low energy shock wave therapy also has a positive effect in the short term, the longer term results being more controversial. Although surgery is poorly documented, authors agree to reserve this option only for greater trochanteric pain syndrome failing to respond to conservative measures. The complication and re-intervention rate should not be underestimated.