The Unrecognized Orthopedic Burden of COVID-19: Heterotopic Ossification of the Hip Joint.

Abstract

COVID-19 has extensively affected the health-care organization with varying impact on different medical specialties. Long term ICU admission is associated with a less familiar complication: the formation of heterotopic ossifications (HO). In this case report we would like to emphasize the unrecognized burden of the coronavirus pandemic in patient care from the perspective of the orthopedic surgeon. We describe two patients with major HOs around their hip joints after COVID-19. Current literature underlines the increased prevalence of HO formation in COVID-19 patients requiring long-lasting mechanical ventilation and ICU admission including prone positioning. Preventing HO formation remains a difficult undertaking without obvious evidence supporting a golden standard treatment. We advice early passive mobilization during ICU stay, also during prone positioning, serum ALP follow-up during admission, NSAID administration if possible and a low threshold in the use of radiotherapy of joints with a limited range of motion.