Non-steroidal anti-inflammatory drugs for preventing heterotopic bone formation after hip arthroplasty

Prophylaxis of Heterotopic Ossification of the Hip: Systematic Review and Meta-Analysis

“…Concerning the optimal NSAID regimen, however, there are ample published studies on dosage and duration, and it seems even only week-long treatments at fairly low dosages produce convincing results [2,18]. Such optimized regimens, in turn, have been proven to cause no increase in the incidence of gastrointestinal bleeding or other gastrointestinal problems, the most common argument against NSAIDs [10]. Our findings are supported by a smaller systematic review by Pakos and Ioannidis [25] focusing only on the efficacy of NSAIDs and radiotherapy, which presents similar findings.…”

“…Although most patients are asymptomatic, two articles including 10,826 subjects from 37 studies suggest HO may be associated with substantial compromise of function and range of motion even at low grades, although most studies report high functional levels except at the highest grades using various outcome measures [10,22]. However, it is not surprising a couple studies recommend prevention in patients undergoing hip surgery [3,9,10]. NSAIDs and radiation, two distinct treatment options, are the mainstays of HO prevention, both of which are reportedly effective for that purpose [9,10,19].…”

“…However, it is not surprising a couple studies recommend prevention in patients undergoing hip surgery [3,9,10]. NSAIDs and radiation, two distinct treatment options, are the mainstays of HO prevention, both of which are reportedly effective for that purpose [9,10,19]. Numerous randomized, controlled trials comparing NSAIDs and radiation in the prevention of HO have been published, but their results are inconsistent [2,5,18,25,28].…”

Free radical scavengers are more effective than indomethacin in the prevention of experimentally induced heterotopic ossification

“…9 NSAID inhibit the differentiation of mesenchymal cells into osteogenic cells and suppress the post-traumatic prostaglandin-mediated inflammatory response. 10,11 In a meta-analysis published in 2000, 12 13 randomized trials of NSAID for the prevention of HO after major hip surgery (elective surgery, internal hip, and acetabular fracture fixation) were compared. The occurrence of HO was reduced by a mean of 57% and the risk of gastrointestinal side effects was increased by 22%.…”

“…Fransen and Neal suggested that perioperative NSAID reduce the risk of HO by one half to two thirds. 13 However, the short-term side effects and the long-term functional outcome remain uncertain. Randomized trials are mandatory to clarify these issues.…”