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

Dow, Todd; King, John-Paul; Wong, Ivan

doi:10.1016/j.arthro.2019.08.034

Cited by 14 publications

(15 citation statements)

References 29 publications

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“…42,81 Although widely studied, the exact mechanism by which HO develops has not yet been well established. 3,27,81,88 A suggested model is that the interaction between the injured periosteum and necrotic or damaged muscle may induce periosteal bone production. 2 Additionally, direct trauma to the soft tissue causes the release of bone morphogenic protein 2, which upregulates the release of inflammatory markers; this results in the recruitment of immune cells and the initiation of processes essential for nerve remodeling, fibroproliferation, and angiogenesis, which are necessary for HO formation.…”

Section: Resultsmentioning

confidence: 99%

“…Intrinsic factors are male sex, a history of HO, and hypertrophic osteoarthritis. 3,[6][7][8]27,42,64,88 Other postulated factors include hips with markedly diminished range of motion, age >60 years, and coexisting bony pathologies, such as ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, and Paget disease. 22,32,52,63 Relative tissue hypoxia has been associated with periosteal bone formation, placing smokers and patients with chronic obstructive pulmonary disease at an inherently higher risk profile.…”

Section: Risk Factorsmentioning

confidence: 99%

“… ¶ References 3 -6, 8, 9, 14 -16, 18, 19, 21, 23, 27, 30, 31, 33, 42, 43, 45, 47, 50, 53 -55, 57, 59, 61, 63 -68, 70, 75, 77, 78, 81, 83, 86 -88 …”

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confidence: 99%

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Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature

Zhou

Gee

Hansen

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Heterotopic ossification (HO) is the formation of bone in soft tissue resultant from inflammatory processes. Lesion formation after arthroscopic procedures is an uncommon but challenging complication. Optimal prophylaxis and management strategies have not been clearly defined. Purpose: To present a scoping review of the pathophysiology, risk factors, diagnostic modalities, prophylaxis recommendations, and current treatment practices concerning HO after arthroscopic management of orthopaedic injuries. Study Design: Scoping review; Level of evidence, 4. Methods: A scoping review via a PubMed search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The search strategy was based on the terms “heterotopic ossification” AND “arthroscopy.” The clinical outcomes review included studies on the arthroscopic management of orthopaedic injuries in which the primary subject matter or a secondary outcome was the development of HO. An analysis of the pathophysiology, diagnostic modalities, and management options was reported. Results: A total of 43 studies (33,065 patients) reported on HO after hip arthroscopy, while 21 (83 patients) collectively reported on HO after arthroscopic procedures to the shoulder, elbow, knee, or ankle; however, management techniques were not standardized. Identified risk factors for HO included male sex and mixed impingement pathology, while intraoperative capsular management was not suggested as a contributing factor. Diagnosis of ossification foci was performed using radiography and computed tomography. The rate of HO after hip arthroscopy procedures approached 46% without prophylaxis, and administration of nonsteroidal anti-inflammatory drugs (NSAIDs) decreased occurrence rates to 4% but carries associated risks. External beam radiation has not been exclusively studied for use after arthroscopic procedures. Conclusion: HO is a known complication after arthroscopic management of orthopaedic injuries. NSAID prophylaxis has been demonstrated to be effective after hip arthroscopy procedures. Patients with persistent symptoms and mature lesions may be indicated for surgical excision, although variability is present in patient-reported outcome scores postoperatively.

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Section: Resultsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature

Zhou

Gee

Hansen

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…More recent studies have examined using more selective NSAIDs, such as celecoxib as HO prophylaxis after hip arthroscopy alone. 10 , 19 Selective cyclooxygenase 2 (COX-2) inhibitors have been shown to reduce gastrointestinal side effects and reduce HO after total hip arthroplasty. 20 , 21 However, COX-2 is important for fracture healing, and the effect of selective COX-2 inhibitors on nonunion rates is mixed and has yet to be fully determined.…”

Section: Discussionmentioning

confidence: 99%

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

Schaver

Willey

Westermann

2021

Arthroscopy, Sports Medicine, and Rehabilitation

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We evaluate the incidence of heterotopic ossification (HO) development with nonsteroidal anti-inflammatory drug (NSAID) prophylaxis in patients after open and arthroscopic hip preservation surgery. Methods: A retrospective review identified patients who underwent hip preservation surgery at a single institution within the past 3 years. Patients who underwent hip arthroscopy with or without periacetabular osteotomy (PAO) or femoral osteotomy (FO) were included. Those who did not receive 3-month postoperative radiographs were excluded. The incidence and Brooker classification (BC) of HO in patients taking Naproxen or another NSAID (meloxicam, celecoxib, indomethacin, or aspirin alone) was assessed using AP radiographs available from 3-, 6-, and 12-month follow-up appointments. Univariate analysis was conducted to compare numerical means and categorical data (significance level P ¼ .05). Results: A total of 328 hips (284 patients) were included. All patients received hip arthroscopy, while 71 patients (21.6%) received concurrent periacetabular osteotomy (PAO; n ¼ 65) or femoral osteotomy (FO; n ¼ 6). Overall, 276 hips (84.4%) received Naproxen for HO prophylaxis. In total, 5 of 328 hips (1.5%) developed HO (4, BC I; 1, BC III). The rate of HO development was significantly higher in males versus females (4 of 121 (3.31%) vs 1 of 207 (.48%), P ¼ .0441). All 5 patients received arthroscopic cam resection and labral repair, and 1 patient also received PAO. Three patients in the Naproxen group (.91%) developed HO, which was not statistically different from those taking a different NSAID (.61%, P ¼ .1797). Conclusion:The incidence of HO development was low with NSAID prophylaxis after hip preservation surgery.

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“… 8 9 22 23 Recently, lower prevalence rates have been reported according to miscellaneous articles. 24 25 Even though the appearance of HO is highly variable, 2 the postoperative use of specific antiinflammatory medication such as celecoxib has been proved to reduce the number of HO cases, 26 with some case series describing an HO prevalence lower than 2 and 10%. 1 2 9 25 27 The rate of HO presented in this study is low compared with previous analysis.…”

Section: Discussionmentioning

confidence: 99%

Heterotopic Ossification in Hip Arthroscopy

et al. 2023

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Introduction Hip arthroscopy is a rising surgical technique due to the increase in hip diseases, especially femoroacetabular impingement. One of the several complications related to such procedures is heterotopic ossifications (HO). The aim of this study is to describe the prevalence of HO after hip arthroscopy in a series of patients with femoroacetabular impingement and to compare its preoperative and intraoperative variables with a matched control group of patients without HO. Methods All patients who underwent hip arthroscopy for femoroacetabular impingement between 2010 and 2017 with a minimum follow-up of 2 years were included in this analysis. Radiographic examinations were recorded to select cases with HO. A case-control analysis was performed comparing preoperative and intraoperative variables between cases with HO and a matched control group without HO. Results A total of 700 cases were included in the analysis. HO was found in 15 (2.14%) of subjects. Cases with HO showed more severe cartilage injuries, less cam morphology ratio, and a higher proportion of partial labrectomies than the control group. No significant differences were observed in preoperative hip pain or function between groups. Conclusions The prevalence of HO after hip arthroscopy in subjects with femoroacetabular impingement was 2.14%. Cases with HO had more severe cartilage injuries, lower ratio of cam morphology, and higher proportion of partial labrectomies than the control cases without HO. Level of Evidence Level III.

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

Cited by 14 publications

References 29 publications

Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature

Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature

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

Heterotopic Ossification in Hip Arthroscopy

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