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Correspondence to Author: Esther de Oliveira Santos Gomes, Nathalia Résio Matsui, Lúcio Norio Watanabe, Ricardo Pereira da Silva, Mário Yoshihide Kuwae . 

Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil.
Cebrom – Oncoclínicas Goiânia, Goiânia, Goiás, Brazil.
Hospital de Acidentados, Goiânia, Goiás, Brazil.

DOI: 10.52338/tjop.2026.5775

Abstract:

Background: Heterotopic ossification (HO) is characterized by the formation of mature lamellar bone in soft tissues and periarticular structures. Clinically, it may lead to pain, joint stiffness, mechanical block, reduced range of motion, and functional impairment. Although surgical excision is indicated in symptomatic and function-limiting cases, postoperative recurrence remains a relevant concern, particularly in high-risk patients and in anatomical sites other than the hip.
Objective: To evaluate functional outcomes, postoperative complications, and recurrence rates in patients with symptomatic HO treated with open surgical excision followed by immediate postoperative prophylactic radiotherapy.
Methodology: This retrospective institutional case series included patients diagnosed with symptomatic HO who underwent open surgical excision followed by postoperative external-beam radiotherapy. Demographic characteristics, etiology, anatomical site, surgical and radiotherapyrelated variables, functional outcomes, complications, and recurrence were analyzed descriptively.
Results: Five patients were included, comprising four males and one female, with a median age of 35 years, ranging from 18 to 52 years. Seven anatomical sites were treated: four elbows, two hips, and one shoulder. The etiologies included neurogenic, autoimmune/inflammatory, posttraumatic, and postoperative causes of HO. All treated sites received a single 8 Gy fraction of postoperative radiotherapy using 6 MV photons delivered with three-dimensional conformal radiotherapy (3D-CRT) within 24 hours after surgery. Functional improvement was observed in all treated sites, including increased range of motion, pain relief, improvement in gait or upper-limb function, and restoration of activities of daily living. No cases of infection, wound-related complications, neurovascular injury, pathological fracture, radiotherapy-related toxicity, need for reintervention, or clinical or radiographic recurrence were observed during follow-up.
Conclusion: Open surgical excision combined with immediate single-fraction prophylactic radiotherapy was feasible, safe, and associated with favorable functional outcomes in this case series. These findings support open surgical excision combined with immediate postoperative radiotherapy as a feasible multimodal strategy for selected patients with symptomatic HO.

Keywords: Heterotopic ossification; surgical excision; prophylactic radiotherapy; orthopedic surgery; functional outcomes; recurrence.

Citation:

Dr. Esther de Oliveira Santos Gomes, Surgical Management And Immediate Postoperative Radiotherapy For Symptomatic Heterotopic Ossification: A Retrospective Institutional Case Series. The Journal of Orthopaedics 2026.