Primary Versus Secondary Radiotherapy for Heterotopic Ossification Prevention About the Elbow

Joseph S. Geller, Paul R. Allegra, Crystal S. Seldon, Benjamin O. Spieler, Lara L. Cohen, Spencer W. Barnhill, Samuel R. Huntley, Alberto De La Zerda, Stuart Samuels, Lora Wang, Derek Isrow, Aaron H. Wolfson, Raphael L. Yechieli

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To examine the efficacy and safety of radiotherapy for the prevention of heterotopic ossification (HO) about the elbow. Design: Retrospective chart review. Setting: Level 1 trauma center. Patients/Participants: Two hundred and twenty-nine patients who received prophylactic radiotherapy (XRT) over a 15-year period were identified. Patients were included if they received XRT to the elbow joint and had at least 12 weeks of follow-up after XRT. Fifty-four patients were ultimately included. Intervention: All patients were treated with a single dose of 7 Gy. Ninety-eight percentage of patients received XRT within 24 hours after surgery, and all patients received XRT within 72 hours after surgery. Main Outcomes Measurements: The primary study measures evaluated were the presence or absence of clinically symptomatic HO and the presence of radiographic HO after XRT to the elbow joint. Results: Eighteen patients were treated with XRT after a traumatic injury requiring surgery (primary prophylaxis), and 36 were treated with XRT after excision surgery to remove HO which had already formed (secondary prophylaxis). In the primary cohort, 16.7% developed symptomatic HO after XRT and 11.1% required surgery to resect the heterotopic bone. In the secondary cohort, 11.1% developed symptomatic HO after surgery and XRT and 5.5% required resection surgery. No secondary malignancies were identified. Conclusions: Our findings suggest that XRT for elbow HO may be safe and effective for both primary and secondary HO. XRT for HO was not shown to be associated with radiation-induced sarcoma in this series, at least in the short term. Further study in a large patient population with extended follow-up is required to better characterize populations at high risk for development of HO and secondary malignancy.

Original languageEnglish (US)
Pages (from-to)E56-E61
JournalJournal of orthopaedic trauma
Volume36
Issue number2
DOIs
StatePublished - Feb 1 2022

Keywords

  • Elbow trauma
  • Heterotopic ossification
  • Radiotherapy
  • Secondary malignancy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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