Chemoprophylaxis for Heterotrophic Ossification Following Hip Arthroscopy: A Systematic Review.
Journal of ISAKOS : joint disorders & orthopaedic sports medicine
INTRODUCTION: Heterotrophic ossification (HO) is a known complication diagnosed following hip arthroscopy.
PURPOSE/HYPOTHESIS: This study sought to review the current literature on chemoprophylaxis for HO following hip arthroscopy and to describe what agents and doses are being utilized.
STUDY DESIGN: Systematic Review.
METHODS: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines on the use of chemoprophylactic medications for HO prevention following hip arthroscopy. Mechanical and radiation prophylaxis were not included in the current analysis.
RESULTS: A total of 203 studies were identified, of which 15 were included with 6463 patients. There was one randomized control trial (RCT) and 4 additional comparative studies. The most commonly utilized chemoprophylactic agents were the following: naproxen (n=8), celecoxib (n=3), indomethacin (n=3), aspirin (n=1), etoricoxib (n=1), and etodolac (n=1), and non-specific Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) (n=1). Naproxen was either given at a dose of 500 mg once or twice daily for 2 to 4 weeks. RCTs and additional comparative studies showed significant HO prevention using chemoprophylactic agents following hip arthroscopy.
CONCLUSIONS: Heterotopic ossification is a known and common complication following hip arthroscopy. The current systematic review found significant heterogeneity across the literature with respect to specific chemoprophylactic agents and their dosing regimens aimed to reduce the incidence and severity of HO following hip arthroscopy. Additionally, this review demonstrates that most studies that utilize chemoprophylaxis use NSAIDs with successful reduction in the incidence of HO.
Dean RS, Hamama BA, Cavinatto L, Nho SJ, Chahla J, Hinckel BB. Chemoprophylaxis for heterotrophic ossification following hip arthroscopy: a systematic review. J ISAKOS. 2023 Aug 22:S2059-7754(23)00548-5. doi: 10.1016/j.jisako.2023.08.005. Epub ahead of print. PMID: 37619960.