Systematic Review
Efficacy of Nonsteroidal Anti-inflammatory Drug Prophylaxis for Heterotrophic Ossification in Hip Arthroscopy: A Systematic Review

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Purpose

The purpose of this systematic review was to investigate the efficacy of nonsteroidal anti-inflammatory drug (NSAID) prophylaxis for preventing heterotopic ossification (HO) in the setting of hip arthroscopy.

Methods

A systematic search was performed in duplicate for studies comparing the use of NSAID prophylaxis for HO in the setting of hip arthroscopy until March 2015. Study parameters—including sample size, incidence of HO, adverse effects, and level of symptoms—were obtained. Furthermore, the level of evidence of studies was collected and quality assessment was performed. The difference in incidence as well as pooled odds ratios were calculated and analyzed to compare no prophylaxis versus NSAID prophylaxis.

Results

This systematic review identified 5 studies, consisting of 1,662 patients, investigating NSAID prophylaxis in hip arthroscopy. HO was diagnosed with the use of postoperative hip radiographs at follow-up, with 95% of cases classified using the Brooker classification. The incidence of HO was 13.4% without NSAID prophylaxis and 3.3% with NSAID prophylaxis. Pooled odds ratios from the prospective studies were 0.07 (95% confidence interval [CI], 0.02 to 0.28; P = .0002; I2 = 0%), showing with statistical significance that NSAID prophylaxis decreased the incidence of HO. The retrospective data similarly showed pooled odds ratios of 0.03 (95% CI, 0.00 to 1.43); P = .08; I2 = 84%), although it was not statistically significant. Most of the patients who experienced HO in both groups were not reported to be symptomatic. Adverse effects and compliance were not consistently reported.

Conclusions

The available orthopaedic literature suggests that the incidence of postoperative HO may be decreased with the use of NSAID prophylaxis in hip arthroscopy. However, the evidence is unclear regarding NSAID drug regimen choice, drug compliance, and adverse effects.

Level of Evidence

Level III, systematic review of Level I, Level II, and Level III studies.

Section snippets

Search Strategy

Electronic databases (MEDLINE, EMBASE, PubMed, and the Cochrane Library) were searched for surgical hip arthroscopy studies from origin until March 2015, when the search was performed. The search strategy used the following search terms: (1) “heterotopic ossification” or “myositis ossificans” AND (2) “hip arthroscopy,” “hip” AND “arthroscopy.” The “Ossification, heterotopic,” “Ossificans, myositis,” and “Hip [Surgery]” subheading in MEDLINE and the “hip arthroscopy,” “heterotopic ossification,”

Study Identification

The electronic searches yielded 152 studies, with 5 studies found to meet the inclusion criteria, which were included in the analysis (Fig 1). Statistical agreement analysis showed a κ value of 0.975 (95% CI, 0.962 to 0.983) for the title and abstract screen, and a κ value of 1.0 for the full-text review, which indicated excellent agreement for both reviews. Included in the study were 3 retrospective comparative cohort studies, 1 prospective cohort study, and the preliminary results of a

Key Findings

One of the purposes of this study was to assess the incidence of HO developing in the setting of hip arthroscopy with or without NSAID prophylaxis. It was hypothesized that NSAID prophylaxis would reduce the rate of postoperative HO. Indeed, the rate of HO was 13.4% in patients not receiving any NSAID prophylaxis but was decreased more than 4-fold with postoperative NSAID use. Although this is supported by the statistically significant pooled odds ratios of the prospective studies, we cannot be

Conclusions

The available orthopaedic literature suggests that the incidence of postoperative HO may be decreased with the use of NSAID prophylaxis in hip arthroscopy. However, the evidence is unclear regarding NSAID drug regimen choice, drug compliance, and adverse effects.

References (19)

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Cited by (29)

  • Incidence of Heterotopic Ossification with NSAID Prophylaxis Is Low After Open and Arthroscopic Hip Preservation Surgery

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    Our study broadens the scope to include additional hip preservation surgery procedures, including AIIS decompression, periacetabular osteotomy (PAO), and femoral osteotomy (FO) (Fig 2). While there are multiple reports of the incidence of HO with and without NSAID prophylaxis after hip arthroscopy,6,9 it is still unknown whether these concurrent procedures increase the rate of clinically relevant HO after hip arthroscopy.12-14 Two patients in our series developed grade I HO after PAO and AIIS decompression, but both did not require additional treatment.

  • The Association of Prescriber Awareness of Opioid Consumption Trends with Postoperative Opioid Prescription Volume in Hip Arthroscopy: Prescriber Awareness of Opioid Consumption

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    HO prophylaxis using NSAIDs has been shown to reduce the rate of radiographic HO 4-fold. However, 75% of HO is reported to be asymptomatic, and the side effects of NSAIDs can include gastrointestinal ulceration and renal injury.28 COX-2 selective inhibitors may reduce the rate of these side effects.

  • The Reduction of Heterotopic Ossification Incidence After Hip Arthroscopy in Patients Treated With Selective Cyclooxygenase 2 Inhibitor (Celecoxib)

    2020, Arthroscopy - Journal of Arthroscopic and Related Surgery
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    Of the aforementioned studies, only those of Bedi et al.15 and Randelli et al.21 assessed patients beyond 1 year postoperatively. This is an important aspect, as pointed out by a commentary and perspective written by Løken32 on the systematic review by Yeung et al.,12 which stated that questions as to whether the HO could be a temporary phenomenon are still unanswered. Our study does provide some insight into the follow-up of these patients past the 1-year postoperative time point.

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