Resnik et al. (2017a)

Australia

Pre-Post

N_initial=11, N_final=9

Population: TBI=11; Mean Age=41yr; Gender: Male=9, Female=2.

Intervention: Patients with TBI and chronic neurogenic heterotopic ossification (NHO) at the hip or knee received 4 applications of high-energy extracorporeal shock wave therapy (ESWT) delivered to the affected joint over 8wk (one treatment every 2wk).

Outcome Measure: Faces Rating Scale (FRS) for pain; NHO size.

1.        Patients receiving high-energy ESWT experienced a significant reduction in pain intensity from baseline to post-intervention as measured by the FRS (p=0.002).

2.        There was no significant mean difference from baseline to post-intervention in NHO size.

Resnik et al. (2017b)

Australia

Pre-Post

N_initial=11, N_final=11

Population: TBI=11; Mean Age=41yr; Gender: Male=9, Female=2.

Intervention: Patients with TBI and chronic neurogenic heterotopic ossification (NHO) at the hip or knee received 4 applications of high-energy extracorporeal shock wave therapy (ESWT) delivered to the affected joint over 8 wk.

Outcome Measure: Range of motion (ROM); Functional Reach (FR); Modified Functional Reach (MFR).

1.        Patients receiving high-energy ESWT showed significant improvement in ROM (flexion) of the NHO-affected knee (p=0.002, n=4) from baseline to post-treatment. No significant effect of treatment on knee extension was observed. No significant results were found for hip ROM.

2.        Patients receiving high-energy ESWT showed significant improvement in FR (p=0.006, n=5) score from baseline to post-treatment.

3.        No significant effect of treatment on MFR scores was observed.

Lee et al. (2016)

Korea

Pre-Post

N_initial=3, N_final=3

Population: TBI=1, meningioma=1, spontaneous intracranial hemorrhage=1; Mean Age=37yr; Gender: Male=3; Mean Time Post Injury=4.5yr.

Intervention: Three cases of neurogenic HO were treated with radiation therapy (RT). Patients received 10 days of RT for a total dose of 20 Gray (Gy) in 2 Gy fractions to each affected joint. The results of 4-6mo follow-up evaluation after brain injury are reported.

Outcome Measure: Serum alkaline phosphatase (ALP) level; serum bone-specific ALP (BALP); HO involved joint range of motion (ROM); pain severity.

1.        All 3 patients had decreased serum ALP, decreased BALP levels, decreased pain, and increased joint ROM immediately after RT.

2.        No further growth of the HO was indicated by post-treatment imaging.

3.        At 4 or 6 months after RT, all patients maintained clinical and laboratory improvements.