Heterotopic ossifications after arthroscopic management of femoroacetabular impingement: the role of NSAID prophylaxis

Abstract

BackgroundOpen hip surgery is known to be a risk for heterotopic ossification (HO), and nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely recognized as an effective prevention. Hip arthroscopy is gaining popularity thanks to the possibility of treating femoroacetabular impingement (FAI) with a minimally invasive technique, however little is known about its rate of postoperative HO. The aim of the present study is to evaluate HO prevalence after hip arthroscopy for FAI and its relationship with NSAID prophylaxis.Materials and methodsWe retrospectively reviewed 300 FAI cases who have been managed with hip arthroscopy in two different hospitals from April 2006 to May 2009. All medical records and indications at discharge were analyzed, focusing on administration of NSAIDs, as well as follow-up roentgenograms with regard to presence of HO around the hip joint. The patients were divided into two groups: a treatment group of 285 hips which received NSAID prophylaxis and a control group of 15 hips which did not.ResultsFive hips presented HO, with overall prevalence of 1.6%. All five patients with HO belonged to the control group. No HO was observed in the treatment group. Thus, HO rate turned out to be significantly higher (P < 0.001) in patients who did not receive NSAIDs after surgery.ConclusionArthroscopic treatment of FAI is not exempt from potential development of HO. NSAIDs after arthroscopic FAI treatment seem to be an effective prevention.

Effect of Naproxen Prophylaxis on Heterotopic Ossification Following Hip Arthroscopy

“…Several other studies have suggested interventions to reduce the rate of HO, but because they were not randomized trials it is difficult to assess the effect of these interventions. Rath et al postulated that capsular repair might decrease the high HO prevalence of 44% found in their study 2 ; however, capsular repair was either not reported or was performed only following implementation of routine NSAID prophylaxis in previous studies 2,[5][6][7] . Less traumatic surgical techniques and greater surgical experience have been hypothesized to reduce soft-tissue trauma and curtail HO, but clinical data to support this hypothesis are limited.…”

“…In this trial, we found a 46% prevalence of HO in patients who did not take naproxen, a rate that was reduced to 4% (relative risk = 0.09, 95% CI = 0.02 to 0.38) when naproxen prophylaxis was used postoperatively. The prevalence of HO has been reported to be 0% to 44% without NSAID prophylaxis, compared with 0% to 8.3% with prophylaxis 1,2,[5][6][7] . Our findings confirm a significantly higher rate of HO in patients who do not receive NSAID prophylaxis than in those who are prescribed naproxen therapy.…”

“…Prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs) have become the recommended treatment strategy for HO prevention on the basis of several retrospective case series showing that their use resulted in large reductions in the prevalence of HO following hip arthroscopy [5][6][7] . Although there is mounting evidence to support prophylactic NSAID therapy following hip arthroscopy, the development of HO is multifactorial 4 .…”

A Less-Invasive Technique for Capsular Management During Hip Arthroscopy for Femoroacetabular Impingement

“…Soft-tissue care during surgery improves the postoperative pain and stiffness and reduces some of the postoperative complications associated with surgical trauma (e.g., heterotopic ossification). 13,14 Capsular integrity during surgery also minimizes fluid leakage. Although the use of the described system achieves minimum capsular damage, careless placement could cause chondral lesions; therefore, training and practice are required, which will increase surgical time (Tables 2 and 3).…”

“…An alpha angle greater than 50 was considered pathologic. 14 Under general anesthesia, the patient is positioned supine on a fracture table for hip distraction. Access to the hip joint is performed systematically through 2 portals (anterolateral and anterior).…”