NSAIDs for Prophylaxis for Heterotopic Ossification After Total Hip Arthroplasty: A Bayesian Network Meta-analysis

Abstract

Non-steroidal anti-inflammatory drugs (NSAID) have been recommended to prevent of heterotopic ossification (HO) after total hip arthroplasty (THA), but debates are still ongoing. The present Bayesian network meta-analysis of randomized clinical trials (RCTs) compared all available pathways of NSAID treatment as prophylaxis for HO after THA. The present Bayesian network meta-analysis was conducted according to The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions guidelines. All randomized clinical trials comparing two or more interventions to prevent HO after THA were considered for analysis. HO was classified according to Brooker. The quality of the methodological assessment was performed through the risk of bias summary tool of the Review Manager Software 5.3 (The Cochrane Collaboration, Copenhagen). The network meta-analysis was performed through a STATA routine for Bayesian hierarchical random-effects model analysis, with log odd ratio (LOR) effect measure. Data from 26 studies (6396 THAs; 58% females) were collected. The mean follow-up was 10.50 ± 5.7 months. ANOVA showed good comparability among mean age and gender (P > 0.5). Celecoxib demonstrated the highest rate of Brooker class 0 (LOR 6.96), followed by diclofenac (LOR 6.94). Naproxen demonstrated the lowest rate of Brooker I HO (LOR 2.82), followed by celecoxib (LOR 3.52). Celecoxib demonstrated lowest rate of Brooker class II HO (LOR 1.66), class III (LOR), and class IV (LOR 0.25). The equation for global linearity detected no statistically significant inconsistency (P > 0.5) in all the comparisons. The present Bayesian network meta-analysis encourages the use of celecoxib as a prophylaxis for HO. These conclusions must be interpreted in light of the limitations of the present study. Future investigations are required to establish more definitely the role of celecoxib. Level of Evidence: I, Bayesian network analysis of RCTs.

Burn-induced heterotopic ossification from incidence to therapy: key signaling pathways underlying ectopic bone formation

“…The non-selective NSAID indomethacin and the selective NSAID celecoxib are commonly prescribed [75]. A subsequent updated Bayesian network metaanalysis also confirmed the effective role of celecoxib as a prophylaxis of HO [76]. However, it is worth noting that NSAIDs may delay bone healing [77,78].…”

Prophylactic Radiotherapy of Hip Heterotopic Ossification: A Narrative Mini Review

“…Several prophylactic treatments for HO have been proposed, such as non-steroidal anti-inflammatory drugs (NSAIDs), Noggin (an extracellular peptide that binds and antagonizes bone morphogenetic proteins), pulsed electromagnetic fields, and free radical scavengers (3)(4)(5)(6)(7)(8)(9)(10)(11).…”

“…However, optimal dose, technique and timing remain unclear, as does the usefulness of combining RT with drugs.Heterotopic ossification (HO) is defined as the formation of new bone in soft tissue outside the skeletal system (1). HO can be differentiated into three main groups: traumatic HO (mainly following fractures), non-traumatic HO (usually occurring after burns), and neurological HO (2).Several prophylactic treatments for HO have been proposed, such as non-steroidal anti-inflammatory drugs (NSAIDs), Noggin (an extracellular peptide that binds and antagonizes bone morphogenetic proteins), pulsed electromagnetic fields, and free radical scavengers (3)(4)(5)(6)(7)(8)(9)(10)(11).HO is a particularly frequent complication after total hip arthroplasty, with reported rates ranging from 15% to 90%. In patients with a significant amount of ossification, hip mobility can be impaired (12).…”

Heterotopic ossification after total hip arthroplasty: When is development completed?

“…In this context, only HO classified as Brooker grade III and IV seem to be clinically relevant [ 7 ]. Prophylactic therapy using radiation or drug prophylaxis with selective or non-selective antirheumatic drugs (NSAID) has proven to be effective in preventing HO [ 3 , 9 , 10 ]. The most common classification of HO is Brooker's classification, which divides the presence of HO in the radiograph of the hip in two planes into four grades of severity depending on its expansion and localization [ 11 ].…”