Radiotherapy for the prophylaxis of heterotopic ossification: A systematic review and meta-analysis of published data

Popović, Marko; Agarwal, Arnav; Zhang, Liying; Yip, Cecil C.; Kreder, Hans J.; Nousiainen, Markku; Jenkinson, Richard; Tsao, May; Lam, Henry; Milakovic, Milica; Wong, Erin; Chow, Edward

doi:10.1016/j.radonc.2014.08.025

Cited by 72 publications

(62 citation statements)

References 60 publications

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“…We therefore chose 10-week followup as a minimum for inclusion. One recent study has shown that HO does not progress beyond 6 weeks [20], and another meta-analysis has shown that 89% of HO is present by 3 weeks and 100% by 8 weeks [19]. In a review of 508 patients treated by a single surgeon, only two of 508 (0.4%) patients had progression in Brooker HO class from 6 weeks postoperative radiographs to final followup [10].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with fewer than 10 weeks followup (n = 12) were excluded, because several studies [10,19,20] suggest that most HO that develops is visible by that point in time. Three of 27 patients in the radiotherapy and débridement group were excluded for insufficient followup and nine of 31 patients in the débridement-only group were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Initial reports found indomethacin to be effective in preventing clinically important HO, which has been defined as Brooker Classes III and IV HO [4], although more recent prospective studies have found increased risk of posterior wall nonunion and no change in rates of clinically important HO [22]. Radiotherapy prevents abnormal formation of bone by inhibiting the differentiation of mesenchymal stem cells to osteogenic pathways [8,19]. Although radiotherapy has been shown to be effective in numerous studies, the potential risk of malignant transformation and wound complications must be considered [1,4,9,17].…”

Section: Introductionmentioning

confidence: 99%

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Does Postoperative Radiation Decrease Heterotopic Ossification After the Kocher-Langenbeck Approach for Acetabular Fracture?

Davis¹,

Roper²,

Munz³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Controversy regarding heterotopic ossification (HO) prophylaxis exists after Kocher-Langenbeck for treatment of acetabular fracture. Prophylaxis options include antiinflammatory oral medications, single-dose radiation therapy, and débridement of gluteus minimus muscle. Prior literature has suggested single-dose radiation therapy as the best prophylaxis to prevent HO fo'rmation. However, recent reports have emerged of radiation-induced sarcoma after radiotherapy for HO prophylaxis, which has led many surgeons to reconsider the risks and benefits of single-dose radiation therapy. We set out to determine if radiotherapy, in addition to standard débridement of gluteus minimus muscle, affected postoperative HO formation after a Kocher-Langenbeck approach for acetabular fracture. Questions/purposes (1) After the Kocher-Langenbeck approach and gluteus minimus débridement, is single-dose radiotherapy associated with a decreased risk of HO? (2) Does addition of single-dose radiotherapy prolong length of stay after a Kocher-Langenbeck approach and gluteus minimus débridement as compared with patients without radiotherapy? Methods After institutional review board approval, all adult patients treated for acetabular fracture by a single surgeon with a Kocher-Langenbeck approach between August 2011 and October 2014 were identified (n = 60). Débridement of gluteus minimus muscle caudal to the superior gluteal bundle was standard in all patients. Radiotherapy was given with a single dose of 700 cGy within 72 hours of surgery from August 2011 until April 2013. Patients treated subsequently did not receive radiotherapy. Patients treated with indomethacin (n = 1) and with fewer than 10 weeks followup were excluded (n = 12) because several studies suggest that most HO that develops is visible by that point in time. Our study group totaled 46 patients with 24 in the radiotherapy and débridement group and 22 in the débridement group. Charts were reviewed to determine length of stay. Attending orthopaedic trauma surgeons who were blinded to the patient's treatment group graded all followup radiographs according to the Brooker system, and Classes III and IV HO were considered clinically important Fisher's exact test was used to analyze clinically significant differences HO between the two groups. Length of stay was compared using a t-test. Results Single-dose radiotherapy is associated with a decreased risk of clinically important (Brooker III-IV) HO Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any trea...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Does Postoperative Radiation Decrease Heterotopic Ossification After the Kocher-Langenbeck Approach for Acetabular Fracture?

Davis¹,

Roper²,

Munz³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Additionally, NSAID administration carries the risk of gastric irritation, occasionally preventing (20-37%) patients from completing treatment [14]. Single dose radiotherapy is widely used and there is persuasive clinical evidence demonstrating its effectiveness as a HO prophylactic following surgery [15][16][17]. Furthermore, radiotherapy and NSAIDs may be given in combination pre-or post-operatively for high-risk patients [18].…”

Section: Clinical Problemsmentioning

confidence: 99%

Identifying the Cellular Mechanisms Leading to Heterotopic Ossification

et al. 2015

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“…Ectopic ossification is a complex process characterized by the formation of ectopic bone or the deposition of calcium phosphate complexes within muscles, connective tissue, or nerves in aberrant locations (1)(2)(3)(4). The ossification processes may be caused by heredity, surgical intervention or trauma (2,3).…”

Section: Introductionmentioning

confidence: 99%

Tauroursodeoxycholic acid attenuates inorganic phosphate-induced osteoblastic differentiation and mineralization in NIH3T3 fibroblasts by inhibiting the ER stress response PERK-eIF2α-ATF4 pathway

Liu

Cui

et al. 2015

DD&T

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Radiotherapy for the prophylaxis of heterotopic ossification: A systematic review and meta-analysis of published data

Abstract: Decreases in rates of HTO over time in this patient population may be a function of more efficacious surgical regimens and prophylactic radiotherapy.

Cited by 72 publications

References 60 publications

Does Postoperative Radiation Decrease Heterotopic Ossification After the Kocher-Langenbeck Approach for Acetabular Fracture?

Does Postoperative Radiation Decrease Heterotopic Ossification After the Kocher-Langenbeck Approach for Acetabular Fracture?

Identifying the Cellular Mechanisms Leading to Heterotopic Ossification

Tauroursodeoxycholic acid attenuates inorganic phosphate-induced osteoblastic differentiation and mineralization in NIH3T3 fibroblasts by inhibiting the ER stress response PERK-eIF2α-ATF4 pathway

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