Survey: Trends in the prophylactic treatment and surgical management of heterotopic ossification of the elbow by U.S. academic orthopaedic surgeons

Background Complications caused by heterotopic ossification are a common concern after orthopaedic surgery of the elbow. Little effort has been directed at establishing best practices of management of heterotopic ossification in the elbow, in stark contrast to that in the hip. A survey was distributed to all orthopaedic residency programs in the United States to understand current management of heterotopic ossification in the elbow. Methods A survey was designed to query prophylaxis and surgical excision of heterotopic ossification in the elbow. Respondents were asked about their use of radiation therapy, nonsteroidal antiinflammatory drugs in the prophylaxis of heterotopic ossification or both, as well as the preference for delaying surgical excision of heterotopic ossification after specific index events. Levels of consensus were determined by one-way binomial tests. Responses were categorized as no consensus (50% or less), weak consensus (51-67%), moderate consensus (68-75%), and strong consensus (>75%) level practices. Results One third of the surveys were returned. A strong consensus (91%, P<0.001) indicated the use of prophylactic radiation therapy but there was no agreement on the appropriate dose. Indomethacin is the recommended nonsteroidal antiinflammatory drug (moderate consensus, 84%, P = 0.009) but with disagreement about the treatment duration. Finally, there is very little agreement concerning the time-delay for surgical excision for all index events. Conclusions The community of orthopaedic surgeons agrees on the prophylaxis and surgical management of heterotopic ossification in the elbow. However, there is less agreement about the appropriate dose, duration, and surgical delay. These uncertainties reflect the dearth of research about the management practices for heterotopic ossification in the elbow.