Assessing long-term outcomes after operative management of elbow stiffness secondary to heterotopic ossification.

Abstract

Background: Heterotopic ossification (HO) of the elbow resulting in limited motion is a relatively uncommon condition often caused by burns, trauma, and central nervous system injuries. This retrospective study presents the long-term outcomes of 51 cases of elbow HO treated with surgical excision and regimented postoperative rehabilitation protocol.

Methods: A retrospective case series was conducted on 48 patients (51 elbows) who underwent surgical excision of elbow HO. All procedures were performed in the inpatient setting at an Academic Level I Trauma Center between September 1999 and August 2022 by fellowship-trained upper extremity surgeons. Patient demographics and case characteristics such as age, gender, mechanism of injury, and comorbidities were collected for comparison. Long-term follow-up examinations were elbow flexion-extension arcs, prono-supination arcs, Visual Analog Scale pain scores, and Mayo Elbow Performance Score.

Results: Patients were followed for a minimum of 2 years with an average follow-up of 8 years (range, 2-24 years). The median flexion-extension arc at final follow-up was 110° (95°-130°), which was maintained at 85% of the intraoperative arc achieved. Prono-supination arc at final follow-up was 170° (105°-180°), which was maintained at 97% of intraoperative levels. The median reported Mayo Elbow Performance Score and Visual Analog Scale score were 80 (70-93) and 2 (0-4), respectively. Although it was not statistically significant, patients diagnosed with type II diabetes had the worst flexion-extension arcs at final follow-up and highest complication rates compared to other risk factors.

Conclusion: Surgical excision coupled with HO prophylaxis and a regimented rehabilitation program resulted in a lasting improvement in functional outcomes for patients with elbow dysfunction secondary to HO at long-term follow-up. Overall, patients maintained substantial reductions in pain, improvement in elbow range of motion, and increased overall elbow function.