# Integrated Clinical Workflow for Preoperative Planning and Resection of Giant Iliofemoral Heterotopic Ossification Using Three-Dimensional Technologies

## TL;DR

This paper describes a 3D technology-based workflow for planning and performing surgery to remove large bone growths near the hip in spinal cord injury patients.

## Contribution

A structured six-stage 3D-assisted workflow for preoperative planning and resection of complex heterotopic ossification is introduced and clinically applied.

## Key findings

- The physical 3D model enabled detailed surgical rehearsal and safe planning of neurovascular dissection.
- The hip joint was preserved, and postoperative rehabilitation improved range of motion and patient handling.
- The workflow enhanced anatomical understanding and surgical precision in a complex case of heterotopic ossification.

## Abstract

Background/Objectives: Neurogenic heterotopic ossification (HO) is an abnormal formation of lamellar bone in soft tissues, frequently developing near major joints in patients with spinal cord injury. While imaging provides valuable diagnostic insights, large and anatomically complex HO often requires advanced preoperative planning to minimize surgical risks. This study presents the development and clinical application of a structured six-stage workflow integrating three-dimensional (3D) technologies for the preoperative planning and surgical resection of giant iliofemoral HO. Materials and Methods: A workflow was developed comprising: (1) 3D imaging acquisition, (2) creation of a virtual model, (3) production of a life-size physical model, (4) preoperative simulation, (5) surgical resection, and (6) postoperative imaging validation. The workflow was applied to a 50-year-old male with paraplegia after a T12 fracture who developed a 26 cm iliofemoral bony bridge, confirmed by computed tomography and 3D reconstruction. Results: The physical model provided a precise anatomical reference, enabling detailed surgical rehearsal and safe planning of neurovascular dissection. Resection was performed using combined orthopedic and vascular techniques. The hip joint was preserved, and postoperative rehabilitation achieved improved range of motion and patient handling without major complications. Conclusions: This structured 3D-assisted workflow enhanced anatomical understanding and surgical precision in this complex case. The framework is applicable to other extensive ossifications with intricate anatomical relationships and warrants further evaluation in larger series.