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Prophylaxis of Heterotopic Ossification of the Hip: Systematic Review and Meta-Analysis

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Clinical Orthopaedics and Related Research®

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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Authors and Affiliations

  1. Department of Orthopedic Surgery, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Enders 1016, Boston, MA, 02115, USA

    Patrick Vavken MD, MSc

  2. Department of Orthopaedic Surgery and Traumatology, Istituto Clinico S. Ambrogio, Milano, Italy

    Lorenzo Castellani MD

  3. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Thomas P. Sculco MD

Authors
  1. Patrick Vavken MD, MSc
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  2. Lorenzo Castellani MD
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  3. Thomas P. Sculco MD
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Correspondence to Patrick Vavken MD, MSc.

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Each author certifies that he or she has no 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.

This work was performed at Children’s Hospital of Boston.

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Vavken, P., Castellani, L. & Sculco, T.P. Prophylaxis of Heterotopic Ossification of the Hip: Systematic Review and Meta-Analysis. Clin Orthop Relat Res 467, 3283–3289 (2009). https://doi.org/10.1007/s11999-009-0924-5

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  • DOI: https://doi.org/10.1007/s11999-009-0924-5

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