One-time treatment used to prevent hipbone problem
A prophylactic procedure performed before surgery last fall on N.J. Gov. Jon Corzine could raise the public's awareness of using radiation to treat heterotopic ossification (HO), says Carol Kornmehl, MD, director of radiation oncology at St. Mary's Passaic (NJ) Hospital and author of the book, The Best News About Radiation Therapy.
HO is a non-malignant medical condition that involves the creation of rigid bone in areas where it isn't needed, particularly in the flexible muscles around the hip joint. The governor, who was involved in a well-publicized automobile accident months earlier, received a one-time radiation treatment to his hip area immediately before his hip replacement surgery scheduled later that day.
Without treatment, almost half of the individuals who have had total hip joint replacement surgery will develop bone formation around the hip joint, says David Hussey, MD, a professor emeritus at the University of Texas at San Antonio who specializes in radiation oncology.
This single radiation procedure is used in cases involving extreme trauma to the hip, Hussey said, but it is not used in cases involving cancer. Corzine had received a shattered hip and thighbone in the accident.
How HO occurs in the hip area is not completely known, but one idea is that when a hip trauma or surgery occurs, bone fragments may be cast off into nearby muscle tissue. When these connective tissue cells mature into bone cells, they can increase and form bone within the hip muscles.
According to Kornmehl, HO can be detected in hip X rays starting as early as 3-6 weeks following replacement surgery. However, symptoms such as hip pain and impaired joint mobility that limit an individual from getting out of a chair usually take 6-12 months to develop. Then, a re-operation to address the HO would be required.
The single radiation treatment to prevent HO can be done about four hours before the hip replacement procedure or within 72 hours afterward, Kornmehl says. "It's kinder and gentler, though, before the procedure because the patient is in pain [after the procedure]," she says. "I favor doing it beforehand."
Also, with the pre-operative setting, a "more generous field" is used for the treatment than post-operatively because the prosthesis has not been put into place yet, Kornmehl says. "Post-operatively, we have to take more films...to get to the right area," she says.
This one-time treatment to prevent HO will take about seven minutes. The radiation therapy will help stop the production of the immature connective tissue cells and prevent them from creating bone tissue where it does not belong. Radiation therapy will not help a patient once HO has set in.
Those at risk for HO may have a history of osteoarthritis, arthritis of the hip following a hip injury, a semi-debilitating type of ossification on the opposite hip following hip-replacement surgery, or previous surgery on the same hip. Generally individuals over the age of 60 are more likely at risk for HO.
However, recent media reports have noted an increase in the incidence of HO among members of the military recently returning from combat areas with amputated limbs. Reports have noted that exposing amputated sites to radiation could prevent HO if provided within two or three days of the injury, but the radiation treatment has not been readily available at many field health care facilities.
Younger individuals within child-bearing ages who are at risk for HO — and receive radiation therapy in the hip area — are encouraged to practice birth control for a year since the therapy area is near the reproductive organs.
The use of radiation therapy to decrease or eliminate the risk of HO has been practiced since the 1970s. When it's used usually can depend on the preference of the orthopedic surgeons in a hospital. "If you're in a setting where the orthopedic surgeons either don't know about it or aren't strong proponents about it, you might not see any patients [getting the therapy]," Kornmehl says.
The public may be becoming more aware of using this prophylactic radiation therapy to prevent HO and therefore are asking their physicians questions. Radiation therapy is being used as well with other joints such as the elbow, wrist, shoulder, and temporomandibular joint.
In terms of malignancy related to radiation exposure, Kornmehl says none have been documented in studies conducted since the 1970s. "There's always a theoretical risk, but no one's ever found a real risk," she says.
A prophylactic procedure performed before surgery last fall on N.J. Gov. Jon Corzine could raise the public's awareness of using radiation to treat heterotopic ossification (HO), says Carol Kornmehl, MD, director of radiation oncology at St. Mary's Passaic (NJ) Hospital and author of the book, The Best News About Radiation Therapy.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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