Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Department of Surgery, St Joseph's Healthcare, Hamilton, ON, Canada.
J Shoulder Elbow Surg. 2019 Mar;28(3):587-595. doi: 10.1016/j.jse.2018.10.003. Epub 2019 Jan 11.
Heterotopic ossification (HO) is a known complication that can arise after total elbow arthroplasty (TEA). In most cases, it is asymptomatic; however, in some patients, it can limit range of motion and lead to poor outcomes. The objective of this review was to assess and report the incidence, risk factors, prophylaxis, and management of HO after TEA.
A systematic search was conducted using MEDLINE, Embase, and PubMed to retrieve all relevant studies evaluating the occurrence of HO after TEA. The search was performed in duplicate, and a quality assessment of all included studies was performed.
A total of 1907 studies were retrieved, of which 45 were included involving 2256 TEA patients. HO was radiographically present in 10% of patients and was symptomatic in 3%. Fewer than 1% of patients went on to undergo surgical excision of HO, with outcomes after surgery reported as good or excellent as assessed by range of motion and the Mayo Elbow Performance Score. HO appears more likely to develop in patients undergoing TEA because of ankylosis, primary osteoarthritis, and distal humeral fractures. Surgical intervention is more likely to be required in patients in whom HO develops after TEA performed for ankylosis and post-traumatic osteoarthritis.
HO is an uncommon complication after TEA, with most patients in whom HO develops being asymptomatic and requiring no surgical management. Routine HO prophylaxis for TEA is not supported by the literature. The effectiveness of prophylaxis in high-risk patients is uncertain, and future studies are required to clarify its usefulness.
异位骨化（HO）是全肘关节置换术（TEA）后可能出现的已知并发症。在大多数情况下，它是无症状的；然而，在一些患者中，它可能会限制活动范围并导致不良后果。本综述的目的是评估和报告 TEA 后 HO 的发生率、危险因素、预防和管理。
使用 MEDLINE、Embase 和 PubMed 进行系统检索，以检索评估 TEA 后 HO 发生情况的所有相关研究。搜索是重复进行的，对所有纳入研究进行了质量评估。
共检索到 1907 篇研究，其中 45 篇纳入了 2256 例 TEA 患者。10%的患者出现 HO 影像学表现，3%的患者出现症状。不到 1%的患者接受了 HO 的手术切除，术后的结果根据活动范围和 Mayo 肘关节功能评分评估为良好或优秀。HO 似乎更有可能在因粘连、原发性骨关节炎和肱骨远端骨折而接受 TEA 的患者中发生。HO 发生在因粘连和创伤后骨关节炎而接受 TEA 的患者中，更可能需要手术干预。
HO 是 TEA 后的一种罕见并发症，大多数发生 HO 的患者无症状且无需手术治疗。HO 预防措施在 TEA 中没有得到文献的支持。HO 高危患者预防措施的有效性尚不确定，需要进一步研究阐明其有效性。
