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Herzberg R, Tracey OC, Tahvilian S, Baksh N, Zikria B, Naziri Q. Incidence of heterotopic ossification following total hip arthroplasty by approach: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2089-2098. [PMID: 38536499 DOI: 10.1007/s00590-024-03896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/28/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Heterotopic ossification (HO) formation has been increasingly recognized as a complication of major orthopedic surgeries, particularly total hip arthroplasty (THA). Though, the overall incidence of HO following THA has been well-documented, it is often not reported by severity or by surgical approach. QUESTIONS/PURPOSES (1) What are the demographics of patients with HO? (2) What is the severity of HO following THA using the Brooker classification? (3) What is the incidence and class of HO following different THA approaches (anterior, posterior, posterolateral, anterolateral, superior, lateral, trans-gluteal)? (4) What are the number and training level of surgeons who performed each procedure? METHODS The PubMed, Embase, and Web of Science databases were queried, and PRISMA guidelines were followed. Qualitative and quantitative analyses were performed using Microsoft Excel. RESULTS We isolated 26 studies evaluating 6512 total hip arthroplasties (THA). The mean HO percentage overall was 28.8%, mostly Class I (54.2%) or Class II (29.6%). The highest percentage of HO was associated with the modified direct lateral (57.2%) and the traditional lateral (34.6%) approaches. The lowest HO percentages were identified following posterolateral (12.8%) and direct superior approaches (1%). Most studies reported a singular senior surgeon operating within the same approach for all patients. CONCLUSIONS The traditional lateral and modified direct lateral approaches to THA resulted in the highest percentage of HO postoperatively. However, most ossification cases were not clinically significant and did not strongly affect overall patient morbidity. Further studies are warranted to identify an association between severity of ossification and different arthroplasty approaches.
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Affiliation(s)
- Rex Herzberg
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Olivia C Tracey
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Shahriar Tahvilian
- Touro College of Osteopathic Medicine, 230 W 125th St 3rd Floor, New York, NY, 10027, USA
| | - Nayeem Baksh
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Bashir Zikria
- Department of Orthopedic Surgery, Johns Hopkins Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Qais Naziri
- Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA.
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Wang Z, Mao Z, Yu M, Li H, Chen G, Wang Y, Yao Q. Role of aspirin in the prevention of heterotopic ossification following total hip replacement: a systematic review and meta-analysis. ANZ J Surg 2023; 93:1907-1916. [PMID: 37043691 DOI: 10.1111/ans.18447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/03/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND To systematically investigate if aspirin (ASA), used as venous thromboembolism (VTE) prophylaxis, plays a role in the prevention of heterotopic ossification (HO) following total hip arthroplasty (THA) and if ASA dosage impacted the rate of HO. METHODS Eligible studies published from January 2000 to July 2022 were identified from the computerized searching of PubMed, Scopus and Web of Science. HO was defined according to Brooker Classification. Pooled risk ratios (OR) and 95% confidence interval (CI) were estimated under a random-effect model. Additionally, combined HO incidences were compared according to ASA dosage (a regular dose of 325 bid vs. a low dose of 81 mg bid/162 mg qd). RESULTS Thirteen studies were included. ASA administered for VTE prophylaxis was significantly associated with a reduced risk of all-grade HO following THA (univariate, OR: 0.50, 95% CI: 0.34-0.74, P < 0.001; multivariate, OR: 0.60, 95% CI: 0.49-0.73, P < 0.001). Similar results could be observed for high-grade HO (univariate, OR: 0.57, 95% CI: 0.36-0.89, P = 0.015; multivariate, OR: 0.50, 95% CI: 0.27-0.92, P = 0.026). There was a non-significant trend towards a higher incidence of HO formation for low-dose ASA (31%, 95% CI: 29-34%), compared with regular-dose ASA (21%, 95% CI: 11-33%) (P = 0.069 under test of interaction). CONCLUSIONS ASA can be an effective option for HO prophylaxis. More well-designed trials with long-term follow-ups are encouraged to confirm the current findings and to investigate the effect of ASA dosage on HO reduction.
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Affiliation(s)
- Zhenwei Wang
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Zimu Mao
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Meng Yu
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Hongchuan Li
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Guoqiang Chen
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yang Wang
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Qi Yao
- Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
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Comeau-Gauthier M, Zura RD, Bzovsky S, Schemitsch EH, Axelrod D, Avram V, Manjoo A, Poolman RW, Frihagen F, Heels-Ansdell D, Bhandari M, Sprague S. Heterotopic Ossification Following Arthroplasty for Femoral Neck Fracture. J Bone Joint Surg Am 2021; 103:1328-1334. [PMID: 33764913 PMCID: PMC8388546 DOI: 10.2106/jbjs.20.01586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) is a frequent complication following hip surgery. Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we aimed to (1) determine the prevalence of HO following total hip arthroplasty (THA) for femoral neck fracture in patients ≥50 years of age, (2) identify whether HO is associated with an increased risk of revision surgery within 24 months after the fracture, and (3) determine the impact of HO on functional outcomes. METHODS We performed a multivariable Cox regression analysis using revision surgery as the dependent variable and HO as the independent variable. We compared Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between participants with and those without HO at 24 months. RESULTS Of 1,441 participants in the study, 287 (19.9%) developed HO within 24 months. HO was not associated with subsequent revision surgery. Grade-III HO was associated with statistically significant and clinically relevant deterioration in the total WOMAC score, which was mainly related to the function component of the score, compared with grade I or II. CONCLUSIONS The impact of grade-III HO on the functional outcomes and quality of life after THA for hip fracture is clinically important, and HO prophylaxis for selected high-risk patients may be appropriate. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Robert D. Zura
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Sofia Bzovsky
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Emil H. Schemitsch
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Daniel Axelrod
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Victoria Avram
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ajay Manjoo
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Rudolf W. Poolman
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, and OLVG (Onze Lieve Vrouwe Gasthuis), Amsterdam, the Netherlands
| | - Frede Frihagen
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sheila Sprague
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Ricciardi BF. CORRInsights®: How Can We Differentiate Local Recurrence From Heterotopic Ossification After Resection and Implantation of an Oncologic Knee Prosthesis in Patients with a Bone Sarcoma? Clin Orthop Relat Res 2021; 479:1144-1146. [PMID: 33337603 PMCID: PMC8052090 DOI: 10.1097/corr.0000000000001613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/25/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Benjamin F Ricciardi
- B. F. Ricciardi, University of Rochester School of Medicine, Department of Orthopedic Surgery, Rochester, NY, USA
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Azboy I, Groff H, Parvizi J. Reply to Letter to Editor: Low-Dose Aspirin is Adequate for Venous Thromboembolism Prevention Following Total Joint Arthroplasty: A Systematic Review. J Arthroplasty 2020; 35:2296-2297. [PMID: 32359960 DOI: 10.1016/j.arth.2020.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Ibrahim Azboy
- Department of Orthopaedics and Traumatology, Istanbul Medipol University School of Medicine, Istanbul, Turkey
| | - Hannah Groff
- Nassau University Medical Center, East Meadow, NY
| | - Javad Parvizi
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Fulin P, Pokorny D, Hert J, Sosna A. Results of 198 primary total hip arthroplasties using the Delta PF-FIT system with ceramic-on-ceramic articulating surfaces with average seven years follow up. BMC Musculoskelet Disord 2020; 21:311. [PMID: 32429881 PMCID: PMC7236923 DOI: 10.1186/s12891-020-03253-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/31/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The lifetime implants is a key parameter that the surgeon should take into account at the time of the primary total hip arthroplasty (THA). The aim of this study was a clinical and radiographical evaluation of the Delta PF-FIT (LimaCorporate, Italy) THA system with ceramic-on-ceramic articulations. We have not found a clinical or radiographical assessment of this implant in available published literature. METHODS A total of 197 (F = 94, M = 103) primary THAs were evaluated in 163 patients with a mean follow-up of 7.7 years (range 5.1-11.2 years (SD ± 1.5)) Harris hip Score (HHS) and the Western Ontario and McMaster Universities Arthritis index (WOMAC) were used for the clinical evaluation. The statistical evaluation was processed by standard statistical methods. The study was approved by Ethic Committee of the University Hospital Motol (Reference No. EK-73/19). RESULTS The mean HHS score was found to be 97.59 points (61-100 range with a ± 5.13 SD, preoperative HSS was 51.21, range 28-73 with a ± 4,77 SD). 186 THAs were evaluated as excellent (90-100 points), 9 THAs rated as good (80-89 points), 1 THA was rated as fair (70-79) points and 1 THA rated as poor (less than 70 points). The mean WOMAC score was 97.38 points (65-100 range with a ± 5.18 SD, preoperative was 50,12, range 27-69 with a ± 4.85 SD). We documented an overall 99.49% Kaplan-Meier survival with a mean follow-up of 7.7 years with the FIT (LimaCorporate) stem revision and any component revision as the endpoint. With the Delta PF (LimaCorporate) cup revision as the endpoint, the survival was 100%. We have not found a previously published clinical or radiographical review of this THA system, the study shows a comparison with other THA implants. CONCLUSION Evaluation of the Delta-PF-FIT (LimaCorporate, Italy) THA system with the use of ceramic-on-ceramic BIOLOX®Delta articulation surfaces shows very good outcomes.
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Affiliation(s)
- Petr Fulin
- Orthopaedic Clinic 1st Faculty of Medicine Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - David Pokorny
- Orthopaedic Clinic 1st Faculty of Medicine Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Jan Hert
- Orthopaedic Clinic 1st Faculty of Medicine Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Antonin Sosna
- Orthopaedic Clinic 1st Faculty of Medicine Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
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Vaz KM, Brown ML, Copp SN, Bugbee WD. Aspirin used for venous thromboembolism prophylaxis in total hip arthroplasty decreases heterotopic ossification. Arthroplast Today 2020; 6:206-209. [PMID: 32577463 PMCID: PMC7303487 DOI: 10.1016/j.artd.2020.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/06/2020] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background Heterotopic ossification (HO) is a known complication of total hip arthroplasty (THA) that can lead to persistent pain, stiffness, nerve impingement, and instability. Aspirin (ASA) has become an increasingly popular method of venous thromboembolism (VTE) prophylaxis, given its availability, ease of use, and relative safety. Although indomethacin has been commonly used for HO prophylaxis, we wanted to determine whether ASA, given the similar mechanism of action, may be effective in reducing the risk of HO in routine unilateral, primary THA when already being used for VTE prophylaxis. Methods The postoperative radiographs of 222 consecutive patients undergoing unilateral, primary THA with cementless fixation were evaluated for HO formation using the Brooker classification immediately before and after surgeon protocol shifted to routine utilization of ASA as VTE prophylaxis in low-risk patients. Results HO was detected in 13 of 99 (13.1%) THAs prescribed ASA for VTE prophylaxis (11 grade I, 1 grade II, 1 grade III) compared with 38 of 123 (30.9%) THAs prescribed non-ASA chemoprophylaxis (26 grade I, 7 grade II, 4 grade III, 1 grade IV). Significantly more THAs in the non-ASA cohort developed HO (P < .01). There was no significant difference in the distribution of HO severity between cohorts (P = .61). Conclusions ASA may be effective as monotherapy for both VTE and HO reduction in low-risk patients undergoing unilateral primary arthroplasty with cementless fixation.
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Affiliation(s)
| | | | | | - William D. Bugbee
- Corresponding author. Department of Orthopaedic Surgery, Scripps Clinic, 10666 N. Torrey Pines Road, La Jolla, CA 92037, USA. Tel.: +1 858 554 7993.
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Hönle W, Scheller A, Goyal T, Schuh A. [Painful total hip arthroplasty - operative and conservative therapy]. MMW Fortschr Med 2019; 161:66-70. [PMID: 31691217 DOI: 10.1007/s15006-019-1064-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Wolfgang Hönle
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland.
| | - Alexander Scheller
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland
| | - Tarun Goyal
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland
| | - Alexander Schuh
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland
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Meyer HL, Burggraf M, Polan C, Husen M, Dudda M, Kauther MD. Lollipop Sign - Ossification at Wire Ends after Osteosynthesis? J Orthop Case Rep 2019; 9:52-55. [PMID: 31534935 PMCID: PMC6727445 DOI: 10.13107/jocr.2250-0685.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Heterotopic ossification (HO) is abnormal formation of new bone in the soft tissue. HO occurs outside the normal bone within soft tissues such as muscles and tendons, and histologically, it is no different from skeletal bone. It is still not clear what factors stimulate HO. The soft tissue around the hip joint has been identified as the most common location for HO. Patients with HO usually have no clinical symptoms; however, it can become very painful and lead to severe functional limitations. The standard diagnostic procedure consists of conventional X-ray diagnostics and/or skeletal scintigraphy. Local radiation and nonsteroidal anti-inflammatory drugs are the classical options for treatment and prophylaxis of HO. We describe two pediatric patients with “lollipop-like” HO at the end of Kirschner wires (K-wires, steel) and titanium elastic nails (TENs, titanium). Case Report: A 9-year-old girl, 1 year after Salter and Pemberton osteotomy with K-wires, and a 15-year-old boy, 1 year after fracture of the right femur treated by osteosynthesis with TENs, were treated in our department due to HO. The girl did not report any symptoms, while the boy had pain in the location where the ossification had formed. However, examination of the girl’s hip showed that the range of motion in the hip affected by HO was limited in comparison with the opposite unaffected hip. Conclusion: To the best of our knowledge, lollipop-like HO around protruding K-wires or TENs has not yet been described. According to literature, HO is mainly located in the pelvic region and at the elbow. Most studies investigating HO describe cases which have occurred after cemented or uncemented hip replacement surgery. In the cases presented here, HO might have been stimulated by repetitive muscle trauma above the protruding K-wire and TENs, the trauma caused by the operation, bone marrow cells dispersed intraoperatively, or by a combination of these and other factors. There are numerous studies on strategies to prevent HO after joint replacement. We suggest “lollipop sign” as a name for this rare type of HO around the end of K-wires/TENs in pediatric patients.
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Affiliation(s)
- Heinz-Lothar Meyer
- Department for Trauma, Hand and Reconstruction Surgery, University Hospital Essen Germany, Hufelandstraße 55, Essen, Germany
| | - Manuel Burggraf
- Department for Trauma, Hand and Reconstruction Surgery, University Hospital Essen Germany, Hufelandstraße 55, Essen, Germany
| | - Christina Polan
- Department for Trauma, Hand and Reconstruction Surgery, University Hospital Essen Germany, Hufelandstraße 55, Essen, Germany
| | - Martin Husen
- Department for Trauma, Hand and Reconstruction Surgery, University Hospital Essen Germany, Hufelandstraße 55, Essen, Germany
| | - Marcel Dudda
- Department for Trauma, Hand and Reconstruction Surgery, University Hospital Essen Germany, Hufelandstraße 55, Essen, Germany
| | - Max Daniel Kauther
- Department for Trauma, Hand and Reconstruction Surgery, University Hospital Essen Germany, Hufelandstraße 55, Essen, Germany
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Zhang AH, Chen X, Zhao QX, Wang KL. A systematic review and meta-analysis of naproxen for prevention heterotopic ossification after hip surgery. Medicine (Baltimore) 2019; 98:e14607. [PMID: 30946309 PMCID: PMC6455982 DOI: 10.1097/md.0000000000014607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the efficacy of naproxen in preventing heterotopic ossification (HO) after hip surgery (total hip arthroplasty [THA] and hip arthroscopy). METHODS Using databases (PubMed, EMBASE, and Web of Science), we conducted an electronic, systematic search of randomized controlled trials (RCTs) comparing naproxen versus placebo on HO after hip surgery. The risk ratio (RR) of the dichotomous data, weighted mean difference (WMD) of continuous data, and 95% confidence intervals (CIs) were calculated to assess the effects of naproxen in patients with hip surgery. RESULTS A total of 4 studies including 269 patients were analyzed. Risk of bias was relatively high in allocation concealment and blinding. Compared with control group, administration naproxen was associated with a significantly reduction of the occurrence of HO at final follow-up after hip surgery (P < .05). What's more, naproxen was associated with a reduction of the Brooker I and II HO (P < .05). However, there was no significant difference between the Brooker III HO between naproxen and control groups (P > .05). Furthermore, there was no significant difference between the complications (P > .05) between naproxen and control groups. CONCLUSION Naproxen has a beneficial role in reducing the total occurrence of HO, Brooker I and II HO after hip surgery. However, conclusions are limited due to the lack of high-quality studies. More high quality studies may help in a more reliable therapy for HO.
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Affiliation(s)
- Ai-Hua Zhang
- Department of Animal Laboratory of Scientific Research
| | | | | | - Ke-Lai Wang
- Department of Pediatric Orthopaedic Surgery, Qi1u Hospital, Shandong University, People's Republic of China
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Ma R, Chen GH, Zhao LJ, Zhai XC. Efficacy of naproxen prophylaxis for the prevention of heterotopic ossification after hip surgery: a meta-analysis. J Orthop Surg Res 2018; 13:48. [PMID: 29506541 PMCID: PMC5839069 DOI: 10.1186/s13018-018-0747-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/19/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This meta-analysis aimed to assess whether the specific nonsteroidal anti-inflammatory drug (NSAID) naproxen has a role in reducing the occurrence of heterotopic ossification after hip surgery. METHODS Potential studies were identified in the following electronic databases: PubMed, EMBASE, Web of Science, Cochrane Library, and Google. We included studies involving hip surgery patients in which the intervention group received naproxen and the control group received placebo. The occurrence of heterotopic ossification and complications were the final outcomes. Stata 13.0 was used for the meta-analysis. RESULTS Four randomized controlled trials (RCTs) involving 269 patients were ultimately included in this meta-analysis. The use of naproxen was associated with a significant reduction in the occurrence of heterotopic ossification at 1.5-, 3-, 6-, and 12-month follow-ups (P < 0.05). There was no significant difference in the occurrence of complications between treatment and control groups (P > 0.05). CONCLUSION Our analysis indicates that naproxen can decrease the occurrence of heterotopic ossification without increasing complications in hip surgery patients. Due to the limited number of studies included, more high-quality RCTs are needed to identify the optimal dose of naproxen.
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Affiliation(s)
- Ran Ma
- Department of Orthopedics, Shanxian Central Hospital, No.1 Wenhua Road, Shanxian, Shandong, 274300, China
| | - Guan-Hong Chen
- Department of Orthopedics, Shanxian Central Hospital, No.1 Wenhua Road, Shanxian, Shandong, 274300, China
| | - Liu-Jing Zhao
- Department of Orthopedics, Shanxian Central Hospital, No.1 Wenhua Road, Shanxian, Shandong, 274300, China
| | - Xi-Cheng Zhai
- Department of Orthopedics, Shanxian Central Hospital, No.1 Wenhua Road, Shanxian, Shandong, 274300, China.
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