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J Korean Soc Ther Radiol Oncol > Volume 25(4); 2007 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2007;25(4): 206-212.
Prophylactic Radiotherapy to Prevent the Recurrence of Heterotopic Ossification after Surgical Intervention of the Elbow
Hak Jae Kim, Jin Ho Kim, Kyubo Kim, Ja Young Choi, Moon Sang Chung, Il Han Kim
1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ihkim@snu.ac.kr
2Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
3Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
4Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
5Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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).
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.
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.
These results suggested that low-dose radiation administered after surgical intervention is safe and effective to prevent the recurrence of HO in the elbow.
Key Words: Heterotopic ossification, Elbow, Radiotherapy
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