Arthroscopy: The Journal of Arthroscopic & Related Surgery
Systematic ReviewEfficacy of Nonsteroidal Anti-inflammatory Drug Prophylaxis for Heterotrophic Ossification in Hip Arthroscopy: A Systematic Review
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)
- et al.
Trends in hip arthroscopy utilization in the United States
J Arthroplasty
(2013) - et al.
The incidence of heterotopic ossification in hip arthroscopy
Arthroscopy
(2013) - et al.
Cost of radiotherapy versus NSAID administration for prevention of heterotopic ossification after total hip arthroplasty
Int J Radiat Oncol Biol Phys
(2008) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Celecoxib and heterotopic bone formation after total hip arthroplasty
J Arthroplasty
(2014) - et al.
Trends in hip arthroscopy
J Bone Joint Surg Am
(2012) - et al.
Hip arthroscopy: Complications in 1054 cases
Clin Orthop Relat Res
(2003) - et al.
Pathogenesis and prevention strategies of heterotopic ossification in total hip arthroplasty: A narrative literature review and results of a survey in Germany
Arch Orthop Trauma Surg
(2015) - et al.
Heterotopic ossification
J Am Acad Orthop Surg
(2004)
Cited by (29)
A multidisciplinary approach to the surgical resection of severe heterotopic ossification: A case-report
2023, Orthoplastic SurgeryIncidence of Heterotopic Ossification with NSAID Prophylaxis Is Low After Open and Arthroscopic Hip Preservation Surgery
2021, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :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.
Osteoarthrosis, Advanced Age, and Female Sex Are Risk Factors for Inferior Outcomes After Hip Arthroscopy and Labral Debridement for Femoroacetabular Impingement Syndrome: Case Series With Minimum 10-Year Follow-Up
2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryA 2-Week Course of Naproxen for Heterotopic Ossification Prophylaxis Is Effective Following Hip Arthroscopy for Femoroacetabular Impingement
2020, Arthroscopy, Sports Medicine, and RehabilitationThe Association of Prescriber Awareness of Opioid Consumption Trends with Postoperative Opioid Prescription Volume in Hip Arthroscopy: Prescriber Awareness of Opioid Consumption
2020, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :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 SurgeryCitation Excerpt :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.
See commentary on page 526