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Meta-Analysis
. 2015 May;94(18):e828.
doi: 10.1097/MD.0000000000000828.

Nonsteroidal Anti-inflammatory Drugs as Prophylaxis for Heterotopic Ossification after Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Shun-Li Kan  1 , Bo Yang, Guang-Zhi Ning, Ling-Xiao Chen, Yu-Lin Li, Shi-Jie Gao, Xing-Yu Chen, Jing-Cheng Sun, Shi-Qing Feng
Affiliations
Meta-Analysis

Nonsteroidal Anti-inflammatory Drugs as Prophylaxis for Heterotopic Ossification after Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Shun-Li Kan et al. Medicine (Baltimore). 2015 May.

Abstract

Heterotopic ossification (HO) is a frequent complication after total hip arthroplasty (THA). Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used as routine prophylaxis for HO after THA. However, the efficacy of NSAIDs on HO, particularly selective NSAIDs versus nonselective NSAIDs, is uncertain.We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and clinicaltrials.gov to identify randomized controlled trials with respect to HO after THA. Two reviewers extracted the data and estimated the risk of bias. For the ordered data, we followed the Bayesian framework to calculate the odds ratio (OR) with a 95% credible interval (CrI). For the dichotomous data, the OR and 95% confidence interval (CI) were calculated using Stata version 12.0. The subgroup analyses and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach were used.A total of 1856 articles were identified, and 21 studies (5995 patients) were included. In the NSAIDs versus placebo analysis, NSAIDs could decrease the incidence of HO, according to the Brooker scale (OR = 2.786, 95% CrI 1.879-3.993) and Delee scale (OR = 9.987, 95% CrI 5.592-16.17). In the selective NSAIDs versus nonselective NSAIDs analysis, there was no significant difference (OR = 0.7989, 95% CrI 0.5506-1.125) in the prevention of HO. NSAIDs could increase discontinuation caused by gastrointestinal side effects (DGSE) (OR = 1.28, 95% CI 1.00-1.63, P = 0.046) more than a placebo. Selective NSAIDs could decrease DGSE (OR = 0.48, 95% CI 0.24-0.97, P = 0.042) compared with the nonselective NSAIDs. There was no significant difference with respect to discontinuation caused by non-gastrointestinal side effects (DNGSE) in NSAIDs versus a placebo (OR = 1.16, 95% CI 0.88-1.53, P = 0.297) and in selective NSAIDs versus nonselective NSAIDs (OR = 0.83, 95% CI 0.50-1.37, P = 0.462).NSAIDs might reduce the incidence of HO and increase DGSE in the short-term.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow chart of study selection.
FIGURE 2
FIGURE 2
Risk of bias assessment of each included study. (A) Risk of bias graph. (B) Risk of bias summary.
FIGURE 3
FIGURE 3
A forest plot of discontinuation caused by nongastrointestinal side effects: nonsteroidal anti-inflammatory drugs (NSAIDs) versus placebo.
FIGURE 4
FIGURE 4
A funnel plot of discontinuation caused by nongastrointestinal side effects of the included studies comparing nonsteroidal anti-inflammatory drugs (NSAIDs) with placebo.
FIGURE 5
FIGURE 5
Analysis and quality of the evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
FIGURE 6
FIGURE 6
A forest plot of discontinuation caused by nongastrointestinal side effects by subgroup analysis of sample size: nonsteroidal anti-inflammatory drugs (NSAIDs) versus placebo.
FIGURE 7
FIGURE 7
A forest plot of discontinuation caused by nongastrointestinal side effects by subgroup analysis of drug categories: nonsteroidal anti-inflammatory drugs (NSAIDs) versus placebo.
FIGURE 8
FIGURE 8
A forest plot of discontinuation caused by gastrointestinal side effects: nonsteroidal anti-inflammatory drugs (NSAIDs) versus placebo.
FIGURE 9
FIGURE 9
A funnel plot of discontinuation caused by gastrointestinal side effects of the included studies comparing nonsteroidal anti-inflammatory drugs (NSAIDs) with placebo.
FIGURE 10
FIGURE 10
A forest plot of discontinuation caused by gastrointestinal side effects by subgroup analysis of sample size: nonsteroidal anti-inflammatory drugs (NSAIDs) versus placebo.
FIGURE 11
FIGURE 11
A forest plot of discontinuation caused by gastrointestinal side effects by subgroup analysis of drug categories: nonsteroidal anti-inflammatory drugs (NSAIDs) versus placebo.
FIGURE 12
FIGURE 12
A forest plot of discontinuation caused by nongastrointestinal side effects: selective nonsteroidal anti-inflammatory drugs (NSAIDs) versus nonselective NSAIDs.
FIGURE 13
FIGURE 13
A forest plot of discontinuation caused by gastrointestinal side effects: selective nonsteroidal anti-inflammatory drugs (NSAIDs) versus nonselective NSAIDs.
FIGURE 14
FIGURE 14
A forest plot of discontinuation caused by gastrointestinal side effects by subgroup analysis of sample size: selective nonsteroidal anti-inflammatory drugs (NSAIDs) versus nonselective NSAIDs.
See this image and copyright information in PMC

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