Managing Unique Cases: Heterotrophic Ossification Hip Replacement & More
In this episode of The Week in Review from The FARM, the team dives into four fascinating cases that highlight the complexity and nuance of musculoskeletal medicine: heterotrophic ossification after hip replacement, a “McKenzoid” home run for cervical spine-related neck pain, a challenging case of chronic foot pain, and the rare presentation of double insertional knee tendinopathy. Each case underscores the team’s commitment to problem-solving, pattern recognition, and looking beyond surface-level diagnoses to uncover deeper drivers of dysfunction.
The discussion begins with a patient experiencing heterotrophic ossification following a hip replacement. This complication, characterized by abnormal bone formation in soft tissue, is often underappreciated in its impact on mobility, pain, and rehabilitation outcomes. The FARM doctors explore the mechanisms behind this condition, including post-surgical inflammatory cascades and genetic predispositions. They discuss treatment considerations such as the timing of imaging, rehabilitation strategies to preserve mobility, and the limitations of traditional interventions like stretching or force-based modalities when bone formation itself is the limiting factor. It’s a prime example of how careful clinical reasoning—rather than rushing into aggressive rehab—can make the difference in long-term outcomes.
Next, the team highlights what they call a “McKenzoid Neck Home Run,” a case where applying principles of mechanical diagnosis and therapy produced dramatic results for a patient with stubborn cervical pain. The conversation showcases how simple, well-chosen movements can outperform more invasive or complex interventions when properly matched to a patient’s presentation. The team reflects on the importance of testing, retesting, and observing changes in real time rather than relying purely on theory. In this case, the outcome served as a reminder of the power of clinical precision: sometimes the “home run” is not a flashy procedure, but a patient’s first pain-free movement in weeks.
The third case centers on chronic foot pain—a notoriously stubborn and multifactorial problem. The FARM doctors dissect the possible causes, from nerve entrapments and regional interdependence with the hip or low back, to local overload syndromes in the plantar fascia, tendons, or intrinsic foot muscles. The discussion emphasizes the importance of looking at the whole kinetic chain rather than isolating the foot. What makes this case particularly educational is the way the team demonstrates a systematic approach: ruling out red flags, considering systemic contributors, and using functional assessments to guide care. Their breakdown illustrates why chronic pain demands patience and creativity from both clinician and patient.
Finally, the episode explores double insertional knee tendinopathy—a rare and frustrating condition involving pathology at both the quadriceps and patellar tendon insertions. The team unpacks the challenges of managing load in such cases, where both the extensor mechanism above and below the knee are compromised. They talk through strategies for progressive loading, pain management, and how to balance activity modification with the athlete’s drive to stay active. This case serves as a masterclass in tendon care, where small adjustments in exercise prescription and long-term planning can be the key to recovery.
Together, these four cases remind listeners why The FARM’s approach stands out. By blending advanced knowledge, clinical reasoning, and practical solutions, the team continues to illuminate the art and science of musculoskeletal care.
