Prophylactic Radiotherapy to Prevent the Recurrence of Heterotopic Ossification after Surgical Intervention of the Elbow / 대한방사선종양학회지

ABSTRACT

PURPOSE: Heterotopic ossification is a well-known postoperative and post-traumatic complication of the elbow. We reviewed the treatment outcome for the use of low-dose radiation after surgical intervention of the elbow to prevent recurrence of heterotopic ossification (HO). MATERIALS AND METHODS: Forty-five patients with HO underwent surgical intervention and postoperative radiotherapy of the elbow. The median age of the patients was 29 years (16~75 years), and 27 of the patients were men and 18 were women. The occurrence of HO was mainly due to surgery after fracture (24/45) and traumatic injury (21/45). Limitation of the range of motion (ROM) was the most common symptom of the patients. Thirty-four patients received postoperative radiotherapy with a dose of 8 Gy in 2 fractions; 5 patients received a dose of 10 Gy in 5 fractions and 6 patients received a dose of 7 Gy in 1 fraction. Postoperative radiotherapy was given on the first two postoperative days for most of the patients. Sixteen patients were not given anti-inflammatory medication and 29 patients were given NSAIDs for 1~8 months. RESULTS: After a median follow-up period of 18 months (range 6~72 months), 41 patients showed clinical improvement and two patients did not show improvement. Assessment of the ROM showed a mean improvement from 0~135degrees to 60~145degrees (p=0.028), and assessment of the functional outcome according to MEPI was from (15~95) to (80~100) (p<0.0001). Two of the 34 patients that were followed-up with radiography had mild radiological recurrence of heterotopic ossification. No complications were observed after the radiotherapy. CONCLUSION: These results suggested that low-dose radiation administered after surgical intervention is safe and effective to prevent the recurrence of HO in the elbow.