Efficacy of NSAIDs versus radiotherapy for heterotopic ossification prophylaxis following total hip arthroplasty in high-risk patients: a systematic review and meta-analysis

2021 ◽  
pp. 112070002199111
Author(s):  
Jacob Shapira ◽  
Mitchell J Yelton ◽  
Jeffery W Chen ◽  
Philip J Rosinsky ◽  
David R Maldonado ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Comparable Efficacy ◽  
Total Hip ◽  
High Risk Patients ◽  
Randomised Control Trials ◽  
Risk Patients

Background: The aims of this systematic review were: (1) to investigate the prophylactic effect of radiotherapy (RT) and NSAIDs in high-risk patients following total hip arthroplasty (THA); and (2) to compare the efficacy of non-selective and COX-II selective NSAIDs in preventing post-THA HO, utilising a meta-analysis of randomised control studies. Methods: The PubMed, Embase, and Cochrane Databases were searched for articles regarding HO following THA in March 2019. Studies were included if they contained data regarding HO incidence after THA or contained data regarding HO prophylaxis comparison of NSAIDs and/or RT in terms of dosage or duration. Results: 24 studies reported on populations that were not at high-risk for HO. These studies reported between 47.3% and 90.4% of their patient populations had no HO formation; between 2.8% and 52.7% had mild formation; and between 0.0% and 10.4% had severe formation. A total of 13 studies reported on populations at high-risk for HO. Studies analysing RT in high-risk patients reported between 28.6% and 97.4% of patients developed no HO formation; between 1.9% and 66.7% developed mild HO formation; and between 0.0% and 11.9% developed severe HO formation. Studies analysing NSAID treatment among high-risk populations reported between 76.6% and 88.9% had no HO formation; between 11.1% and 23.4% had mild HO formation, and between 0.0% and 1.8% had severe HO formation. 9 studies were identified as randomised control trials and subsequently used for meta-analysis. The relative risk for COX-II in developing any HO after THA was not significantly different compared to non-selective NSAIDs (RR 1.00; CI, 0.801–1.256; p = 0.489). Conclusions: NSAIDs prophylaxis for HO may have better efficacy than RT in high-risk patients following THA. Non-selective and COX-II selective NSAIDs have comparable efficacy in preventing HO. Factors such as medical comorbidities and side-effect profile should dictate the prophylaxis recommendation.

Patient-Reported Outcomes Can Be Used to Streamline Post-Total Hip Arthroplasty Follow-Up to High-Risk Patients

2017 ◽  
Vol 32 (11) ◽  
pp. 3319-3321
Author(s):  
Jie J. Yao ◽  
Hilal Maradit Kremers ◽  
Cathy D. Schleck ◽  
Dirk R. Larson ◽  
Jasvinder A. Singh ◽  
...  
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Hip ◽  
High Risk Patients ◽  
Patient Reported ◽  
Risk Patients

scholarly journals Prevention of heterotopic ossification in high-risk patients with total hip arthroplasty: the experience of a combined therapeutic protocol

2006 ◽  
Vol 30 (2) ◽  
pp. 79-83 ◽  
Author(s):  
Emilios E. Pakos ◽  
Evita J. Pitouli ◽  
Pericles G. Tsekeris ◽  
Vasiliki Papathanasopoulou ◽  
Kosmas Stafilas ◽  
...  
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Heterotopic Ossification ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
High Risk Patients ◽  
Therapeutic Protocol ◽  
Risk Patients

scholarly journals Short-Term Results with a Constrained Acetabular Liner in Patients at High Risk of Dislocation after Primary Total Hip Arthroplasty

2016 ◽  
Vol 26 (6) ◽  
pp. 580-584 ◽  
Author(s):  
Kathryn Gill ◽  
Sarah L. Whitehouse ◽  
Matthew J.W. Hubble ◽  
Matthew J. Wilson
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Liner ◽  
Total Hip ◽  
High Risk Patients ◽  
Clinical And Radiological Outcome ◽  
Risk Patients ◽  
Component Loosening ◽  
Primary Total Hip Arthroplasty

Background Dislocation following primary total hip arthroplasty (THA) is a complication with an incidence of 2%-5%. This study examines the clinical and radiological outcome of a constrained acetabular implant used in primary THA in high-risk patients to prevent dislocation. Methods 54 patients with 55 constrained implants for primary THA were reviewed clinically and radiologically. Oxford, Harris Hip and Charlson scores were recorded. Results 54 patients, with an average age of 83.2 years, were followed up at a mean of 44.9 (20-74) months. 38 had an hydroxyapatite- (HA) coated acetabular shell with a constrained insert and 17 had a cemented constrained implant. The median Charlson score at surgery was 5 (4-10). There were significant improvements in Oxford, Harris hip pain and function scores and Charnley pain after surgery. 2 patients had radiolucent lines on the most recent radiograph. Neither was symptomatic and the acetabular components had not migrated. 3 patients developed postoperative infection, 1 deep requiring a 2-stage revision. Of the 29 patients who died, 1 required revision 2 months following surgery for dislocation of the constrained liner. This patient died 26 months later from unrelated causes having had no further complications from her surgery. There have been no further revisions or reoperations for dislocation in any of the other cases. Conclusions The use of a constrained acetabular liner at primary THA in high risk patients for dislocation can successfully prevent this complication without increasing component loosening. In this series of 55 constrained implants we have a postoperative dislocation rate of 1.8%.

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