The Incidence of Heterotopic Ossification in Hip Arthroscopy

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.…”

“…In the event that they disagreed, the opinion of a musculoskeletal radiologist was enlisted. Radiographs were considered adequate for determining the presence or absence of HO if they had been obtained at least seventy-five days postoperatively 2 . HO was classified according to the Brooker criteria, the largest two-dimensional measurement on either the anteroposterior or the lateral radiograph as previously described 5 , and the location relative to the hip joint (anterior or lateral).…”

“…Although there is mounting evidence to support prophylactic NSAID therapy following hip arthroscopy, the development of HO is multifactorial 4 . Consequently, there are potentially confounding explanations for the observed effects of NSAID prophylaxis in reported case series, including temporal variations in arthroscopic procedures, surgical techniques, and surgeon experience 2,5 . Without randomization of subjects, it is difficult to account for these inherent biases in case series and observational studies.…”

“…H eterotopic ossification (HO) is recognized as one of the most common complications associated with hip arthroscopy, occurring in 0% to 44% of individuals who did not receive prophylaxis 1,2 . It forms as a result of trauma to the soft tissues surrounding the joint, leading to an osteogenic response in the surrounding musculature 3 .…”