Incidence of heterotopic ossification following hip arthroscopy is low: considerations for routine prophylaxis

Abstract

Purpose This scoping review aims to map and summarise the available literature on heterotopic ossification (HO) following hip arthroscopy, with particular focus on incidence, distribution as per Brooker classification, efficacy of prophylactic measures and factors that may influence the likelihood of production of HO. Methods A computer-based search was performed on PubMed, Embase, Emcare, Cinahl, ISI web of science and Scopus using the terms ‘heterotopic ossification’ and ‘hip arthroscopy’. Articles reporting heterotopic ossification following hip arthroscopy for any condition were included after two-stage title/abstract and full-text screening. Results Of the 663 articles retrieved, 45 studies were included. The proportion of patients with HO ranged from 0 to 44%. The majority of the cases were either Brooker grade I or II. Of the six studies investigating the effect of NSAID prophylaxis, five reported a significantly lower incidence of heterotopic ossification associated with its use. Weak evidence suggests that an outside-in arthroscopic approach, no capsular closure, male sex and mixed cam and pincer resection may be associated with an increased risk of HO. Conclusion Although there is a large variation in rates of HO following hip arthroscopy in the current literature, the majority of studies report a low incidence. Evidence exists advocating the administration of post-operative NSAIDs to reduce the incidence of HO following hip arthroscopy. This, combined with the low risk of complications, means there is a favourable risk–benefit ratio for prophylactic NSAID used in HA. Future research should work to identify patient clinical and demographic factors which may increase the risk of development of HO, allowing clinicians to risk stratify and select only specific patients who would benefit from receiving NSAID prophylaxis.

Heterotopic Ossification in Hip Arthroscopy

“…11,[25][26][27][28][29][30][31][32] Several studies have demonstrated that the use of NSAIDs diminishes the rate of HO after hip arthroscopy. 3,4,33 Bedi et al described an important HO rate decrease from 8.1 to 1.8% with the systematic use of NSAIDs, 11 similar to the results showed by Randelli et al, with a notable decrease from 33 to 0% after the prophylactic use of NSAIDs for 3 weeks after the arthroscopic surgery. 25 However, there is a concern regarding the use of NSAIDs due to their intrinsic side effects, especially in older patients, that can cause gastrointestinal problems, bleedings or renal alterations, and blood pressure modifications.…”

“…HO has been observed in 0 to 44% of hip arthroscopies and 2 to 90% of total hip replacements. 1 2 3 4 5 6 7 8 9 10 While most of the patients with HO remain asymptomatic, patients with large ossifications or concomitant femoroacetabular impingement can present stiffness and discomfort, for which surgical treatment is indicated. 1 11 12 13 …”

Low-dose prophylaxis protocol for heterotopic ossification after hip preservation surgery in a sport participants cohort

“…Despite the evidence for the efficacy of prophylaxis in reducing the incidence of HO, its clinical importance is still debated in the literature [ 16 , 26 , 27 ]. Kurz et al [ 12 ] in their review reported that only 25% of HO post-hip arthroscopy were symptomatic.…”