Selective versus non-selective NSAIDs as prophylaxis for heterotopic ossification following hip arthroplasty: a meta-analysis

Journal of Orthopaedics and Traumatology, vol. 23, pp. 30

Abstract

BACKGROUND: Some patients have demonstrated evidence of heterotopic ossification (HO) following total hip arthroplasty (THA). Selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) are used as prophylaxis for HO following THA. This meta-analysis compared selective versus non-selective NSAIDs as prophylaxis for HO following THA. MATERIAL AND METHODS: The present study was conducted according to the PRISMA 2020 guidelines. All the clinical investigations comparing selective versus non-selective NSAIDs as prophylaxis for HO following THA were accessed in February 2022. An assessment of the methodological quality and statistical analyses were performed through the risk of bias summary tool of the Review Manager 5.3 software (Cochrane Collaboration, Copenhagen). The modified Brooker staging system was used to rate the efficacies of the interventions. RESULTS: Data from 8 studies and 1526 patients were collected. 60.8% were female. No difference was found in the sample size, mean age, and percentage of females between the two groups at baseline. No statistically significant difference was found between selective and non-selective NSAIDs in term of efficacy. 72% (1078 of 1502) of the patients were classified as Brooker 0, 21% (322 of 1502) as Brooker I, 5% (80 of 1502) as Brooker II, 1% (16 of 1502) as Brooker III, and 0.1% (2 of 1502) as Brooker IV. CONCLUSION: Selective and non-selective NSAIDs were equally effective when used as prophylaxis for HO following THA. LEVEL OF EVIDENCE: Level III, systematic review and meta-analysis.

Authors 6

1. Filippo Migliorini corresponding Aachen Department of Orthopaedic, Trauma, and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. migliorini.md@gmail.com

   Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany

2. Andrea Pintore

   University of Salerno

   Affiliation as printed

   Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy

3. Alice Baroncini Aachen Department of Orthopaedic, Trauma, and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany

4. Torsten Pastor

   Luzerner Kantonsspital

   Affiliation as printed

   Department of Orthopaedic and Trauma Surgery, Cantonal Hospital of Lucerne, 6000, Lucerne, Switzerland

5. Frank Hildebrand Aachen Department of Orthopaedic, Trauma, and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany

6. Nicola Maffulli

   University of Salerno · Queen Mary University of London · Mile End Hospital · Keele University

   Affiliation as printed

   Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, E1 4DG, London, England

   Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy

   School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, ST4 7QB, Stoke on Trent, England