Surgical management of elbow heterotopic ossification: postoperative outcomes with and without continuous passive...

Continuous passive motion (CPM) has been an accepted method of orthopedic postoperative rehabilitation for decades. However, its efficacy remains disputed and there is a paucity of literature looking at the impact of CPM after operative management of elbow heterotopic ossification (HO). This retrospective study aims to compare long-term clinical outcomes after surgical excision of elbow HO between patients with and without postoperative CPM.

A retrospective case series was conducted on patients who underwent inpatient surgical excision of elbow HO at an academic level I trauma center between September 1999 and August 2022. Forty-eight patients (51 elbows) were identified, consisting of 16 cases that were rehabilitated with CPM and 35 cases that were not. Long-term follow-up examinations included measurement of elbow flexion-extension and pronosupination arcs, Mayo Elbow Performance Scores, and visual analog scale pain scores. Mann-Whitney U tests were used for statistical analysis.

Patients had a minimum follow-up of 2 years with an average follow-up of 8 years (range 2-24 years). Utilizing CPM vs. no CPM postoperatively was associated with a significantly greater gain in preoperative to final follow-up flexion-extension arc (100° vs. 50°, P = .003) and a significantly smaller loss in intraoperative to final follow-up flexion-extension arc (0° vs. -15°, P = .018). However, it should be noted that there were no significant differences in the final range of motion based on CPM usage (110° vs. 110°, P = .228). Additionally, patients that utilized CPM reported a significantly greater Mayo Elbow Performance score at final follow-up (P = .045).

A CPM rehabilitation regimen after surgical excision of elbow HO may result in improved long-term patient-reported functional outcomes, but further investigation with a prospective, randomized protocol should be pursued.