Poster 169: Heterotopic Ossification Presenting as Knee Pain in a Critical Illness Patient: A Case Report

Abstract

Patients or Programs: A 27-year-old woman with het-erotopic ossification (HO). Program Description: A previously healthy woman presented to a local hospital in labor and delivered a full-term baby. However, postpartum, she developed bilateral H1N1 pneumonia, and multi-organ dysfunction including respiratory failure with acute respiratory distress syndrome. When she was weaned off the ventilator 6 weeks later, she had persistent complaints of bilateral upper and lower extremity pain, numbness, and weakness. Patient was transferred to our acute rehabilitation unit for an intensive regimen of physical and occupational therapies. Radiographs of her knees and elbows revealed extensive HO of the right elbow and bilateral knees. Patient was started on etidronate for treatment of HO and continued on a program that encouraged range of motion, stretching, strengthening, and pulmonary rehabilitation. Setting: Acute rehabilitation unit. Results: This patient tolerated a 3-week course of acute rehabilitation with improved elbow and knee range of motion and significantly reduced pain. On discharge to home, she was ambulating 250 feet at a supervised level with a walker. Discussion: There have been only a few case reports documenting HO in critical illness patients, mainly in patients with sepsis or respiratory failure. In the intensive care unit, this patient's joint pain was attributed to critical illness myopathy and the HO was not diagnosed until the patient was evaluated on our rehabilitation unit. This patient was managed accordingly, with significant improvement in function. Conclusions: HO is often diagnosed and treated by physiatrists in brain injury, spinal cord injury, burn, and trauma patients. It may occur early after an injury or after a period of critical illness, and may not be recognized. It is important for clinicians on both the acute medical and rehabilitation setting to recognize HO as both preventative and early treatment interventions lead to noteworthy functional outcomes