Heterotopic ossification reverse shoulder prosthesis

Case contributed by Dr Domenico Nicoletti

Presentation

Functional limitation of the shoulder in abduction and intra-rotation.

Patient Data

Age: 75 years
Gender: Female

Right shoulder x-ray (baseline)

X-ray

Normal post-operative findings of reverse total shoulder arthroplasty.

Right shoulder x-ray (3 years later)

X-ray

Gross heterotopic ossification located cranially to the prosthesis.
Another ossification is found in the axillary recess.

There are also new radiolucent lines at the level of the stem of the humeral component (thickness greater than 3 mm) and at the base of glenosphere, consistent with prosthesis instability.

New radiolucent lines at the level of the stem of the humeral component (thickness greater than 3 mm) and at the base of glenosphere, consistent with prosthesis instability.

Case Discussion

Heterotopic ossifications are due to bone metaplasia in the soft tissues.
  
Heterotopic ossifications can occur as a result of central nervous system lesions (traumatic brain injuries and spinal injuries), following surgical operations (prosthesis), or direct traumatic events.

They mainly develop on muscles, tendons, ligaments, and fascia, while they rarely affect the skin and organs.

Timing may be weeks or months after prosthetic surgery. Depending on the size of the calcification outbreaks they can cause pain or limit the mobility of the joint.

Case courtesy of Dr.ssa Sara Zanzani

 

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