Radiation therapy for heterotopic ossification prophylaxis afer high-risk elbow surgery

Abstract

Heterotopic ossification (HO) is a common complication of elbow trauma or surgery. HO can impair joint function; when it does, surgical removal is required. Radiotherapy (RT) prevents HO formation in the hip. However, few data exist on the efficacy of RT in preventing HO formation in the elbow. We retrospectively analyzed the outcomes of elbow surgery followed by prophylactic single-fraction RT and use of nonsteroidal anti-inflammatory drugs (NSAIDs). All patients had ectopic bone resected at surgery or significant risk factors for development of ectopic bone. Of the 52 patients who underwent RT after high-risk elbow surgery, 44 had postoperative radiographs of the treated elbow available for evaluation. At a median follow-up of 136 days, 21 patients (48%) had radiographic evidence of HO. In all cases, however, the HO was small and not functionally significant. No complications were attributed to RT use. This retrospective review represents the largest published series of patients who have undergone postoperative RT to prevent HO formation in the elbow. Our findings support the idea that RT, in combination with NSAID use, is safe and efficacious in preventing development of clinically significant HO in the elbow.