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207 - Polyarticular Lower Extremity Heterotopic Ossification After Severe COVID-19 Infection

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

FP

Félix J. Pérez Morciglio, MD

Resident Physician, PGY-4
University of Puerto Rico, Medical Sciences Campus
San Juan, Puerto Rico, United States

Co-Author(s)

JG

Jan I. Garcia Rivera, MD

Research Fellow
University of Puerto Rico School of Medicine, Department of Physical Medicine, Rehabilitation, & Rehab
Toa Alta, Puerto Rico, United States

Corresponding Author(s)

CL

Carmen Lopez-Acevedo, MD

Professor and Residency Program Director
University of Puerto Rico, Department of Physical Medicine, Rehabilitation, & Sports Medicine
San Juan, Puerto Rico, United States

Case Diagnosis: Polyarticular lower extremity heterotopic ossification

Case Description:
Our patient is a 52-years-old male who had severe COVID-19 infection in January 2022. He was admitted to an intensive care unit (ICU), and required mechanical ventilation, tracheostomy, and gastrostomy. The patient spent a prolonged hospitalization of around 1 month, and was discharged to an inpatient rehabilitation facility (IRF). His rehabilitation was complicated by severe, diffuse pain and limited range of motion (ROM) in his lower extremities, persisting with limited ambulation. Hip X-rays initially reported severe osteoarthritis. However, upon further work-up, computed tomography (CT) found diffuse heterotopic ossification (HO) of both hips. X-rays of the knees also found HO involving the medial joint space bilaterally.

The patient underwent surgery for excision of right knee HO. He continued physical therapy at home with emphasis on ROM, stretching, mobility, endurance, transfer training, and gait training. With time, he progressively gained knee flexion and was able to ambulate using a standard walker.

Discussions: To our knowledge, there have been few reported cases of polyarticular heterotopic ossification following severe COVID-19 infection.

Conclusions: During the acute phase of COVID-19 at the ICU, joint mobility should be emphasized to prevent development of HO. Physicians should keep a high index of suspicion for the possibility of HO in patients after COVID-19 infection.