2019 ISAKOS Biennial Congress ePoster #506
Heterotopic Ossification After Total Elbow Arthroplasty: A Systematic Review
Eva Liu, BHS Cand., Hamilton, ON CANADA
Alexandra Hildebrand, BHSc Cand., St. Clements, ON CANADA
Nolan Horner, MD, Hamilton, ON CANADA
Moin Khan, MD, MSc, FRCSC, Hamilton, ON CANADA
Bashar Alolabi, MD, MSc, FRCSC, Hamilton, ON CANADA
McMaster University, Division of Orthopaedic Surgery, Hamilton, ON, CANADA
FDA Status Not Applicable
Summary
Heterotopic Ossification (HO) is a known complication that can arise after total elbow arthroplasty (TEA). This review assesses and reports incidence, risk factors, and management of HO after TEA.
Abstract
Introduction
Heterotopic Ossification (HO) is a known complication that can arise after total elbow arthroplasty (TEA). It can limit range of motion and lead to poor postoperative patient outcomes. The objective of this review is to assess and report incidence, risk factors, and management of HO after TEA.
Methods
MEDLINE, EMBASE, and Pubmed were searched to retrieve all relevant studies. Relevant data was abstracted. The search included all studies discussing the occurrence of heterotopic ossification after total elbow arthroplasty and its management.
Results
A total of 1907 studies were retrieved, of which 45 studies were included. Most of the included studies were level IV. The mean MINORS score for non-comparative and comparative studies were 9.7 ± 1.9 out of 16 and 14.8 ± 1.5 out of 24 respectively. A total of 2256 TEA patients were analyzed. Out of those patients, 233 (10.3%) developed HO based on radiographic evidence. Fifty-nine patients (2.6%) were reported to be symptomatic. However, only 13 of 59 patients (22.0%) underwent surgical intervention due to HO which led to good or excellent outcomes in range of motion and Mayo Elbow Performance Scores (MEPS). Prophylactic procedures using Indomethacin and/or radiotherapy were used in two studies in 5 high-risk patients and did not appear to decrease the incidence of HO. Four of those 5 patients (80%) developed HO despite perioperative prophylactic measures. However, this was likely due to selective reporting by study authors and more studies are needed to investigate the effectiveness of prophylactic therapy for high-risk patients.
Discussion And Conclusion
HO appears to be an uncommon complication after TEA with most of the HO patients being asymptomatic and requiring no management. The effectiveness of prophylaxis in high-risk patients is uncertain and future studies are needed to clarify its usefulness. The strength of these conclusions is limited by inconsistent reporting in the available literature.