Assessing Long-Term Outcomes after Operative Management of Elbow Stiffness Secondary to Heterotopic Ossification

Stanley Liu; Andrew L Chen; Krishin Shivdasani; Nickolas G Garbis; Dane H Salazar

doi:10.1016/j.jse.2024.11.019

Assessing Long-Term Outcomes after Operative Management of Elbow Stiffness Secondary to Heterotopic Ossification

J Shoulder Elbow Surg. 2025 Jan 9:S1058-2746(25)00019-9. doi: 10.1016/j.jse.2024.11.019. Online ahead of print.

Authors

Stanley Liu¹, Andrew L Chen², Krishin Shivdasani³, Nickolas G Garbis³, Dane H Salazar³

Affiliations

¹ Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA.
² Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA. Electronic address: andrew.chen@luhs.org.
³ Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA.

PMID: 39798839
DOI: 10.1016/j.jse.2024.11.019

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 heterotopic ossification. 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, pronosupination arcs, Visual Analog Scale (VAS) pain scores, and Mayo Elbow Performance Scores (MEPS).

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. Pronosupination arc at final follow-up was 170° (105°-180°), which was maintained at 97% of intraoperative levels. The median reported MEPS and VAS scores were 80 (70-93) and 2 (0-4), respectively. Although it wasn't 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 heterotopic ossification at long term follow-up. Overall, patients maintained substantial reductions in pain, improvement in elbow range of motion, and increased overall elbow function.

Keywords: Elbow; HO excision; MEPS; heterotopic ossification; long-term outcomes; range of motion; surgical management.