Selective COX-2 inhibitor versus nonselective COX-1 and COX-2 inhibitor in the prevention of heterotopic ossification after total hip arthroplasty: a meta-analysis of randomised trials

Abstract

Whether selective cyclo-oxygenase-2 (COX-2) inhibitors are equally effective compared to nonselective NSAIDs for the prevention of heterotopic ossification (HO) after total hip arthroplasty (THA) is still unclear. We carried out a comprehensive search strategy, in which only randomised controlled trials were included. Two reviewers independently assessed methodological quality and extracted outcome data. Analyses were performed using Stata version 10.0. Four eligible randomised controlled trials totalling 808 patients were included. Meta-analysis results showed that no statistically significant difference was found in overall incidence of HO (RR 1.08; 95% CI 0.71-1.64), incidence of moderate severe HO (Brooker II and III) (RR 0.83; 95% CI 0.48-1.42) and any grade of Brooker classification between two groups. In summary, the selective COX-2 inhibitors are equally effective as nonselective NSAIDs for the prevention of HO after THA. Considering the gastrointestinal side effects of nonselective NSAIDs, we recommend selective COX-2 inhibitors for the prevention of HO after THA. However, future well-designed, randomised controlled trials are still needed to further confirm our results.

Is etoricoxib effective in preventing heterotopic ossification after primary total hip arthroplasty?

“…Meta-analyses on randomised clinical trials on the efficacy of selective COX-2 inhibitors and non-selective NSAIDS found both medications equally effective in the prevention of HO after THA [10]. Considering the side effects of nonselective NSAIDs, selective COX-2 inhibitor was recommended as the preferable medication for the prevention of HO after THA [9,10,17].…”

“…This selective COX-2 inhibitor is associated with significantly fewer gastrointestinal side effects [9] and is therefore recommended [10]. In a prospective two-stage study design for phase 2 clinical trials, we investigated the efficacy of etoricoxib 90 mg once daily oral dose for seven days in a small sample of patients.…”

Extracorporeal shock wave therapy as a treatment for heterotopic ossification

“…Pharmacological interventions in the form of NSAID's, COX-2 inhibitors, 30 bisphosphonates, 31 or anti-coagulants such as warfarin 32 are currently used in the early stages of HO or MO as prophylactics. All these treatments carry with them potentially harmful side-effects such as adverse gastro-intestinal and cardiovascular effects 33 .…”

Have nonsteroidal anti-inflammatory drugs a pathogenetic action?

“…Так, в 2009 г. опуб-ликовано исследование D. Xue и соавт. [70] -метаанализ 4 РКИ, в которых сравнивали эффективность для профила-ктики ГО сНПВП и нНПВП. Препараты назначали на 7-14 дней пациентам, перенесшим ортопедические опера-ции (n=808).…”