Preoperative Irradiation for Prevention of Heterotopic Ossification Following Prosthetic Total Hip Replacement

Abstract

Preoperative radiotherapy on the evening before surgery is an effective treatment modality to reduce overall (Brooker 1-4) and clinically relevant, severe HOs (Brooker 3-4), and includes several advantages compared to postoperative irradiation. Previous ipsi- and contralateral HOs were identified as high risk factors for HO in this study. In patients with these risk factors, the incidence of HO increased.

Combined Radiotherapy and Indomethacin for the Prevention of Heterotopic Ossification after Total Hip Arthroplasty

“…Among the most widely accepted predisposing factors are previous formation of HO and hypertrophic osteoarthritis [7,15]. Two main preventative therapies have been used effectively: nonsteroidal anti-inflammatory drugs (NSAIDs) [8,9,19,28,33] and RT [20,28,34,36,37]. NSAIDs directly inhibit the differentiation of mesenchymal cells into osteogenic cells but also involve an indirect effect through inhibition of posttraumatic bone remodeling by suppression of the prostaglandin-mediated response [39,43].…”

Radiation Therapy for Prevention of Heterotopic Ossification about the Elbow

“…Administration of various nonsteroidal anti-inflammatory drugs, as well as pre-or postoperative radiation therapy (RT) has proven effective for successful prophylaxis. While the value of RT is systematically investigated in patients undergoing hip surgery [3,8,11,18,20,26,28,31,32], only a few reports have been published providing information about the efficacy of RT in sites other than the…”

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

“…However, the time of RT and the dose-response effect of RT on the incidence of HO is still a matter for investigation [5,8,11,13,[21][22][23]. On the other hand, NSAIDs have been extensively used perioperatively for the prevention of HO after THA.…”

“…We identified only one prospective study with a combination of RT at 7.0 Gy and diclofenac as analgesic therapy. However, the irradiation was delivered preoperatively and the duration of diclofenac was less than 1 week at different doses based on postoperative pain [11].…”