Bajracharya Gaurav Bir, Rc Dirgha Raj, Shrestha Shriraj, Bhandari Pramod, Thapa Anup
KIST Medical College and Teaching Hospital, TU, Nepal.
KIST Medical College and Teaching Hospital, TU, Nepal.
Int J Surg Case Rep. 2025 Apr;129:111161. doi: 10.1016/j.ijscr.2025.111161. Epub 2025 Mar 18.
Heterotopic ossification (HO) is a relatively uncommon yet significant complication following total knee arthroplasty (TKA), with an incidence ranging from 3.8 % to 42 %. While surgical trauma and inflammation are known risk factors, cultural practices such as traditional oil massages may contribute to HO formation, though this remains underexplored.
We present a case of a 65-year-old woman with severe knee osteoarthritis who had uncomplicated bilateral TKA. The patient recovered well after surgery, experiencing notable pain alleviation and improved mobility. Imaging was prompted by minor knee stiffness and soreness at follow-up, which showed bilateral HO, with right side more prominent. Regular post-operative conventional oil massages were shown to be a possible contributing factor. Conservative treatment was started and because of the patient's minimal symptoms and retained functionality, radiotherapy and surgical excision were postponed.
Due to surgical stress and local inflammation, mesenchymal stem cells most likely undergo a transition into osteoblasts in HO after TKA. This instance illustrates how cultural customs, including oil massages, may exacerbate inflammation and lead to HO. Achieving positive results requires early diagnosis, patient education, and a multidisciplinary care strategy comprising physiotherapists, orthopedic surgeons, and rehabilitation specialists.
This case emphasizes the importance of preoperative counseling on traditional practices that may interfere with recovery and early detection of complications such as HO. Conservative management is often sufficient for mild cases, while patient with functional limitation may require invasive interventions. Further research is needed to improve outcomes in TKA patients.
异位骨化（HO）是全膝关节置换术（TKA）后一种相对不常见但较为严重的并发症，发病率在3.8%至42%之间。虽然手术创伤和炎症是已知的风险因素，但传统油疗等文化习俗可能会促使HO形成，不过这方面仍未得到充分研究。
我们报告一例65岁患有严重膝关节骨关节炎的女性患者，其接受了双侧无并发症的TKA手术。患者术后恢复良好，疼痛明显减轻，活动能力改善。随访时因轻微膝关节僵硬和酸痛进行影像学检查，结果显示双侧HO，右侧更为明显。术后定期进行传统油疗被证明可能是一个促成因素。开始采取保守治疗，由于患者症状轻微且功能保留，放疗和手术切除被推迟。
由于手术应激和局部炎症，间充质干细胞在TKA术后HO形成过程中很可能转变为成骨细胞。这个病例说明了包括油疗在内的文化习俗如何可能加剧炎症并导致HO。要取得积极效果需要早期诊断、患者教育以及由物理治疗师、骨科医生和康复专家组成的多学科护理策略。
本病例强调了术前咨询可能干扰恢复的传统习俗以及早期发现诸如HO等并发症的重要性。对于轻度病例，保守治疗通常就足够了，而有功能受限的患者可能需要侵入性干预措施。需要进一步研究以改善TKA患者的治疗效果。
