Efficacy of NSAIDs versus Radiotherapy for Heterotopic Ossification Prophylaxis Following Total Hip Arthroplasty in High-Risk Patients: A Systematic Review and Meta-Analysis
Authors: Shapira J, Yelton MJ, Chen JW, Rosinsky PJ, Maldonado DR, Meghpara M, Lall AC, Domb BG
Background
Heterotopic ossification (HO) is the abnormal growth of bone in soft tissues and can occur after total hip replacement (THA), especially in high-risk patients. This study compares how well NSAIDs (nonsteroidal anti-inflammatory drugs) and radiotherapy (RT) prevent HO after THA.
Methods
A systematic review and meta-analysis of 37 studies were conducted, comparing HO rates in patients treated with NSAIDs or RT after THA. Both non-selective NSAIDs and COX-II selective NSAIDs were evaluated.
Key Findings
- NSAIDs were more effective than radiotherapy in preventing HO in high-risk patients.
- Non-selective and COX-II selective NSAIDs had similar effectiveness.
- Patients receiving NSAIDs showed lower rates of HO formation than those treated with RT.
Conclusions
NSAIDs, especially non-selective ones, may be the better choice to prevent HO after hip replacement in high-risk patients, although other factors like side effects and patient health should be considered.
What Does This Mean for Patients
If you have a high risk of developing unwanted bone growth after hip replacement, taking NSAIDs might better protect you than radiotherapy. Talk to your surgeon about the best prevention strategy based on your health.
What Does This Mean for Providers
- Consider prescribing NSAIDs over RT for HO prophylaxis in high-risk THA patients, balancing efficacy with patient comorbidities.
- Both non-selective and COX-II selective NSAIDs are effective; choose based on patient tolerance and risk profile.
- Monitor patients closely for NSAID-related side effects, especially gastrointestinal or cardiovascular risks.
- Use this evidence to guide shared decision-making and tailor prophylaxis to individual patient needs.