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Meta-Analysis
. 2009 Dec;467(12):3283-9.
doi: 10.1007/s11999-009-0924-5. Epub 2009 Jun 11.

Prophylaxis of heterotopic ossification of the hip: systematic review and meta-analysis

Patrick Vavken  1 , Lorenzo Castellani, Thomas P Sculco
Affiliations
Meta-Analysis

Prophylaxis of heterotopic ossification of the hip: systematic review and meta-analysis

Patrick Vavken et al. Clin Orthop Relat Res. 2009 Dec.

Abstract

Heterotopic ossification (HO) is a potentially severe, if infrequent, complication in hip surgery, and uncertainty exists regarding whether to use NSAIDs or radiation in its prevention. Thus, we systematically reviewed the literature in MedLine, EMBASE, CINAHL, and the Cochrane Controlled Trial Register and, after ruling out publication bias and data heterogeneity, performed a meta-analysis of randomized, controlled trials to assess effectiveness and complications of NSAIDs and radiation in the prevention of HO. We identified nine studies reporting on effectiveness and complications including a total of 1295 patients. The pooled risk ratio for the effectiveness in HO prevention was 0.96 (95% confidence interval, 0.88-1.06) and was independent of the type of surgery (THA or open reduction and internal fixation). There was no association with gender, age, length of followup, or year of publication. The risk ratio for associated complications was 0.79 (95% confidence interval, 0.45-1.41), and, again, was independent of the aforementioned factors. We found no evidence for a statistically significant or clinically important difference between NSAIDs or radiation in preventing HO.

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Figures

Fig. 1
Fig. 1
A flowchart illustrates the trial flow.
Fig. 2
Fig. 2
This forest plot shows the RR of HO despite prophylactic treatment in nine studies comparing NSAIDs and radiation, stratified by type of surgery. The diamonds give the 95% CI of the subgroup and the overall pooled estimate. There is no difference in effectiveness in patients receiving HO prevention after THA or ORIF. The heterogeneity, ie, incomplete overlap, of the individual study estimates, represented by horizontal lines with boxes corresponding to sample size, in the THA stratum can be seen.
Fig. 3
Fig. 3
This forest plot represents the pooling of RRs of complications. In contrast to the forest plot for effectiveness (Fig. 2), it seems the two studies at the top and the two studies at the bottom are more similar to each other than to all others (see text). Finally, the 95% CI of the pooled RR is quite wide and includes values ranging from an almost 60% risk decrease to a 40% risk increase. Although not statistically significant, the extreme values of the 95% CI included values potentially of clinical importance.
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1111/j.1445-2197.2007.04178.x', 'is_inner': False, 'url': 'https://doi.org/10.1111/j.1445-2197.2007.04178.x'}, {'type': 'PubMed', 'value': '17635276', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/17635276/'}]}
    2. Back DL, Smith JD, Dalziel RE, Young DA, Shimmin A. Incidence of heterotopic ossification after hip resurfacing. ANZ J Surg. 2007;77:642–647. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1136/bmj.38960.600822.80', 'is_inner': False, 'url': 'https://doi.org/10.1136/bmj.38960.600822.80'}, {'type': 'PMC', 'value': 'PMC1562461', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC1562461/'}, {'type': 'PubMed', 'value': '16960187', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/16960187/'}]}
    2. Birrell F, Lohmander S. Non-steroidal anti-inflammatory drugs after hip replacement. BMJ. 2006;333:507–508. - PMC - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1302/0301-620X.89B4.18845', 'is_inner': False, 'url': 'https://doi.org/10.1302/0301-620x.89b4.18845'}, {'type': 'PubMed', 'value': '17463108', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/17463108/'}]}
    2. Board TN, Karva A, Board RE, Gambhir AK, Porter ML. The prophylaxis and treatment of heterotopic ossification following lower limb arthroplasty. J Bone Joint Surg Br. 2007;89:434–440. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1055/s-2008-1039411', 'is_inner': False, 'url': 'https://doi.org/10.1055/s-2008-1039411'}, {'type': 'PubMed', 'value': '9446435', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9446435/'}]}
    2. Bremen-Kühne R, Stock D, Franke C. [Indomethacin: short-term therapy vs. single low dosage radiation for prevention of periarticular ossifications after total hip endoprosthesis] [in German]. Z Orthop Ihre Grenzgeb. 1997;135:422–429. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '11741055', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/11741055/'}]}
    2. Burd T, Lowry K, Anglen J. Indomethacin compared with localized irradiation for the prevention of heterotopic ossification following surgical treatment of acetabular fractures. J Bone Joint Surg Am. 2001;83:1783–1788. - PubMed

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