Heterotopic ossification (HO) prophylaxis in total hip arthroplasty (THA): A systematic review of level I and level II evidence since 2000

IF 2.1 Q3 ENDOCRINOLOGY & METABOLISM

Bone Reports Pub Date : 2025-01-25 DOI:10.1016/j.bonr.2025.101828

Troy B. Puga , McKenna W. Box , Vincent M. Dieu , Charles R. Marchese , John T. Riehl

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引用次数: 0

Abstract

Introduction

Heterotopic ossification (HO) is a somewhat common occurrence after total hip arthroplasty (THA), particularly with certain approaches. This complication can be detrimental to the success of the surgical outcome. Indomethacin and radiotherapy remain common treatment modalities; however, no true gold-standard treatment is universally agreed upon. This study aims to evaluate Level I and Level II evidence for treatment practices of HO prophylaxis since 2000.

Methods

To evaluate HO prophylaxis in total hip arthroplasty, a search was conducted across MEDLINE/Pubmed, Cochrane, and Embase databases using keywords and Medical Subject Heading (MeSH) terms. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and included if they met eligibility criteria.

Results

HO chemical prophylaxis was more effective than no HO prophylaxis, except for aspirin. Multiple NSAIDs showed equivalence and better side effect profiles than indomethacin. No one superior NSAID was found, and numerous modalities showed efficacy. The most effective dosages of radiation therapy and combination therapy remain unclear. Additionally, both etidronate and salmon calcitonin showed benefit in preventing HO in one study each.

Conclusion

Radiation, NSAIDs, and combination therapy all showed efficacy as HO prophylaxis modalities. HO prophylaxis treatment and modalities should be guided upon patient and surgical factors such as surgical approach, side effects and tolerability of modalities, comorbidities, and available facility resources to optimize the prevention of HO.

Level of evidence: Level IV Therapeutic.

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全髋关节置换术（THA）中异位骨化（HO）预防：自2000年以来I级和II级证据的系统回顾

异位骨化（HO）是全髋关节置换术（THA）后的常见现象，特别是在某些入路中。这种并发症对手术结果的成功是不利的。吲哚美辛和放疗仍然是常见的治疗方式；然而，没有一种真正的黄金标准治疗方法得到普遍认可。本研究旨在评估自2000年以来HO预防治疗实践的I级和II级证据。方法为了评估全髋关节置换术中HO的预防作用，使用关键词和医学主题标题（MeSH）在MEDLINE/Pubmed、Cochrane和Embase数据库中进行了检索。筛选标题和摘要是否符合纳入标准。如果全文符合资格标准，则对其进行筛选并纳入。结果除阿司匹林外，HO化学预防比无HO预防更有效。多种非甾体抗炎药表现出与吲哚美辛等效且副作用更好的特点。没有一种更好的非甾体抗炎药被发现，许多治疗方式显示出疗效。放射治疗和联合治疗的最有效剂量尚不清楚。此外，在一项研究中，依地膦酸盐和鲑鱼降钙素都显示出预防HO的益处。结论放疗、非甾体抗炎药及联合治疗均可作为HO的预防方式。HO预防治疗和模式应根据患者和手术因素，如手术方式、副作用和模式的耐受性、合并症和现有设施资源来指导，以优化HO的预防。证据等级：IV级治疗性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bone Reports Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

4.00%

发文量

444

审稿时长

57 days

期刊介绍： Bone Reports is an interdisciplinary forum for the rapid publication of Original Research Articles and Case Reports across basic, translational and clinical aspects of bone and mineral metabolism. The journal publishes papers that are scientifically sound, with the peer review process focused principally on verifying sound methodologies, and correct data analysis and interpretation. We welcome studies either replicating or failing to replicate a previous study, and null findings. We fulfil a critical and current need to enhance research by publishing reproducibility studies and null findings.