A systematic review and meta-analysis of naproxen for prevention heterotopic ossification after hip surgery.
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ABSTRACT: Background
The aim of this study was to assess the efficacy of naproxen in preventing heterotopic ossification (HO) after hip surgery (total hip arthroplasty [THA] and hip arthroscopy).Methods
Using databases (PubMed, EMBASE, and Web of Science), we conducted an electronic, systematic search of randomized controlled trials (RCTs) comparing naproxen versus placebo on HO after hip surgery. The risk ratio (RR) of the dichotomous data, weighted mean difference (WMD) of continuous data, and 95% confidence intervals (CIs) were calculated to assess the effects of naproxen in patients with hip surgery.Results
A total of 4 studies including 269 patients were analyzed. Risk of bias was relatively high in allocation concealment and blinding. Compared with control group, administration naproxen was associated with a significantly reduction of the occurrence of HO at final follow-up after hip surgery (P < .05). What's more, naproxen was associated with a reduction of the Brooker I and II HO (P < .05). However, there was no significant difference between the Brooker III HO between naproxen and control groups (P > .05). Furthermore, there was no significant difference between the complications (P > .05) between naproxen and control groups.Conclusion
Naproxen has a beneficial role in reducing the total occurrence of HO, Brooker I and II HO after hip surgery. However, conclusions are limited due to the lack of high-quality studies. More high quality studies may help in a more reliable therapy for HO.
SUBMITTER: Zhang AH
PROVIDER: S-EPMC6455982 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Heterotopic ossification (HO) is a known complication of hip arthroscopy. Our objective was to determine the effect of postoperative naproxen therapy on the development of HO following arthroscopic surgery for femoroacetabular impingement.Between August 2011 and April 2013, 108 eligible patients were enrolled and randomized to take naproxen or a placebo for three weeks postoperatively. Radiographs were made at routine follow-up visits for one year following surgery. The primary outcome measure was the development of HO, as classified with the Brooker criteria and two-dimensional measurements on radiographs made at least seventy-five days postoperatively (average, 322 days). The primary analysis, performed with a Fisher exact test, compared the proportion of subjects with HO between the treatment and control groups. A single a priori interim analysis was planned at the midpoint of the study.Our data safety and monitoring board stopped this study when the interim analysis showed that the stopping criterion had been met for demonstration of efficacy of the naproxen intervention. The prevalence of HO was 46% (twenty-two of the forty-eight in the final analysis) in the placebo group versus 4% (two of forty-eight) in the naproxen group (p < 0.001). Medication compliance was 69% overall, but it did not differ between the naproxen and placebo groups. Minor adverse reactions to the study medications were reported in 42% of the patients taking naproxen versus 35% of those taking the placebo (p = 0.45).In this trial, prophylaxis with naproxen was effective in reducing the prevalence of HO without medication-related morbidity.
| S-EPMC4673445 | biostudies-literature
Project description:PurposeTo evaluate the effectiveness of 2 weeks of naproxen prophylaxis for heterotopic ossification (HO) after primary hip arthroscopy for femoroacetabular impingement (FAI).MethodsAll consecutive hip arthroscopy cases by a single surgeon from January 1, 2015, to December 31, 2016, were retrospectively reviewed. Cases were included if they met the following criteria: (1) Primary hip arthroscopy, including femoral neck osteoplasty, for FAI; (2) naproxen prophylaxis for 2 weeks' duration; and (3) radiographic follow-up at a minimum of 3 months postoperatively. Radiographic imaging for each patient was evaluated for the presence of HO, and independent radiology reports were used to confirm patients with HO. Maximal size of HO was measured and classified according to the Brooker criteria. Demographic and operative variables of the patients included in this study who received naproxen prophylaxis for 2 weeks were formally compared with a cohort of patients who received naproxen prophylaxis for 3 weeks in a previous randomized controlled trial.ResultsA total of 185 patients who received naproxen prophylaxis for 2 weeks were included in the study, 5 of whom developed HO (3%). A total of 48 patients who received naproxen prophylaxis for 3 weeks were included for comparison, 2 of whom developed HO (4%). There was no significant difference in the rate of HO formation between 2 weeks and 3 weeks of naproxen prophylaxis (P = .597). All 7 cases of HO were classified as Brooker class 1.ConclusionsThe observed rate of postoperative heterotopic ossification after 2 weeks of naproxen prophylaxis in this study was equivalent to that observed after 3 weeks' prophylaxis in a previously published study. Two weeks of naproxen prophylaxis may be a sufficient treatment course for the prevention of heterotopic ossification after primary hip arthroscopy for FAI.Level of evidenceLevel III - Retrospective Comparative Study.
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Project description:BackgroundWhether selective non-steroidal anti-inflammatory drugs (NSAIDs) has equally efficacy with non-selective NSAIDs in preventing heterotopic ossification (HO) after total hip arthroplasty (THA) was controversial. The purpose of this meta-analysis was to assess the efficacy and safety of selective NSAID versus non-selective NSAIDs for the prevention of HO after THA.MethodsPubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Google Search Engine, and China National Knowledge Infrastructure databases was searched for randomized controlled trials (RCTs) were comparing selective NSAID versus non-selective NSAIDs for preventing HO after THA. The primary outcomes were overall HO incidence, Brooker classification HO incidence, gastrointestinal side effects, the occurrence of excessive bleeding and discontinuation caused by gastrointestinal side effects (DGSE). Data were analyzed using Stata 12.0.ResultsA total of 8 RCTs involving 1636 patients were included in the meta-analysis. There was no significant difference between the nonselective NSAIDs group and the selective NSAIDs group in the overall incidence of HO (relative risk, RR?=?0.91, 95% confidence intervals, CI 0.78-1.06, P?=?.203), Brooker I HO (RR?=?1.02, 95% CI 0.85-1.23, P?=?.794), Brooker II HO (RR?=?1.00, 95% CI 0.66-1.52, P?=?.996). Brooker III HO (RR?=?0.98, 95% CI 0.37-2.62, P?=?.971). And the occurrence of excessive bleeding (RR?=?0.67, 95% CI 0.24-1.92, P?=?.458). The selective NSAIDs group was associated with a significant decrease in gastrointestinal side effects (RR?=?0.35, 95% CI 0.18-0.71, P?=?.004) and discontinuation caused by gastrointestinal side effects compared with the nonselective NSAIDs group (RR?=?0.28, 95% CI 0.11-0.66, P?=?.004).ConclusionThe available evidence indicates selective NSAIDs were as effective as non-selective NSAIDs in preventing HO after THA. And selective NSAIDs were associated with less gastrointestinal side effects than non-selective NSAIDs. Considering the limitation of current meta-analysis, more RCTs need to identify the optimal NSAIDs drug for HO after THA.
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Project description:Heterotopic ossification (HO) is a diverse pathologic process, defined as the formation of extraskeletal bone in muscle and soft tissues. HO can be conceptualized as a tissue repair process gone awry and is a common complication of trauma and surgery. This comprehensive review seeks to synthesize the clinical, pathoetiologic, and basic biologic features of HO, including nongenetic and genetic forms. First, the clinical features, radiographic appearance, histopathologic diagnosis, and current methods of treatment are discussed. Next, current concepts regarding the mechanistic bases for HO are discussed, including the putative cell types responsible for HO formation, the inflammatory milieu and other prerequisite "niche" factors for HO initiation and propagation, and currently available animal models for the study of HO of this common and potentially devastating condition. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Project description:Study designA systematic review and meta-analysis.ObjectivesCervical total disc replacement (CTDR) can preserve range of motion (ROM) of the operated spinal segment in cadaver studies. Evidence is less clear in clinical trials. The present study aims to investigate the differences in cervical biomechanics before and after CTDR and its association with heterotopic ossification (HO) development.MethodArticles that reported the rate of HO and ≥1 difference in cervical biomechanics were included in quantitative analyses. We pooled the mean difference (MD) of cervical biomechanics before and after CTDR. Subgroup analyses and metaregression analyses were conducted to identify potential contributors to heterogeneity.ResultsOf the 599 studies screened, 35 studies were included in the final analysis. In comparison with preoperative values, ROM of the spinal segment inferior (MD: 0.38; 95% CI: 0.02 to 0.74) and superior (MD: 0.43; 95% CI: 0.12 to 0.75) to the surgical spinal segment, functional spinal unit (FSU) angle (MD: 2.23; 95% CI: 1.11 to 3.35), and C2/C7 Cobb angle (MD: 3.49; 95% CI: 1.73 to 5.25) significantly increased after CTDR. In contrast, FSU and cervical ROM at baseline were no different from follow-up. On multivariable meta-regression analyses, HO and ROM-limiting HO were not associated with changes in cervical biomechanics. Single-level CTDR and duration of follow-up were associated with changes in cervical biomechanics.ConclusionOur study reported the pooled mean of biomechanics at baseline and final follow-up and their differences. The changes in biomechanics were not associated with the rates of HO and ROM-limiting HO.
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Project description:Heterotopic Ossification (HO) is a potential long-term complication in orthopaedic surgery. It is commonly classified according to the Brooker classification, which is based on radiological findings. To our knowledge the correlation of histological features to the Brooker grade is unknown as is the association between HO and the indication for revision. The aim of this paper is to analyze the ossification grade of HO tissue in patients undergoing revision hip and knee arthroplasty and to propose a histologically based classification system for HO. We also assess the relationship between the grade of HO and the indication for revision (septic and aseptic revision). From January to May 2019 we collected 50 human HO samples from hip and knee revision arthroplasty cases. These tissue samples were double-blinded and sent for histopathological diagnostic. Based on these results, we developed a classification system for the progression of HO. The grade of ossification was based on three characteristics: Grade of heterotopic ossification (Grade 1-3), presence of necrosis (N0 or N1) and the presence of osteomyelitis (HOES-Score Type 1 to 5). Demographic data as well as surgical details and indication for surgery was prospectively collected from clinical records. Fifty tissue samples were harvested from 44 hips and 6 knee joints. Of these 33 exhibited Grade I ossifications (66%), followed by 11 Grade II (22%) and one Grade III (2%). Necrosis was noted in two tissue samples (4%) and 2 more had osteomyelitis findings according to HOES-Score. Six samples (12%) with radiologically suggestive of HO turned out to be wear-induced synovitis, SLIM Type 1. Of these cases 16 were septic (32%) and 34 aseptic (68%) revisions. Most of the HO tissue samples were classified as a low-grade. High-grade ossification-Score is rare. Higher grades of ossification seem to be associated with septic revision cases. Wear-induced synovitis potentially influences HO development. A histological scoring system for ossification grading can be derived from the data presented in this study.
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Project description:IntroductionIncreasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important questions about patients' prefracture quality of life (QOL) and future perspectives should be asked before considering different treatment options to assess what kind of treatment is advisable in frail elderly high-risk patients with a hip fracture.ObjectiveThe aim of this review was to provide an overview of differences in mortality, health-related QOL [(HR)QOL], functional outcome, and costs between nonoperative management (NOM) and operative management (OM) of hip fractures in patients above 65 years.MethodsA systematic literature search was performed in EMBASE, OvidSP, PubMed, Cochrane Central, and Web of Science for observational studies and trials. Observational studies and randomized controlled trials comparing NOM with OM in hip fracture patients were selected. The methodological quality of the selected studies was assessed according to the Methodological Index for Nonrandomized Studies (MINORS) or Furlan checklist.ResultsSeven observational studies were included with a total of 1189 patients, of whom 242 (20.3%) were treated conservatively. The methodological quality of the studies was moderate (mean: 14.7, standard deviation [SD]: 1.5). The 30-day and 1-year mortalities were higher in the nonoperative group (odds ratio [OR]: 3.95, 95% confidence interval [CI]: 1.43-10.96; OR: 3.84, 95% CI: 1.57-9.41). None of the included studies compared QOL, functional outcome, or health-care costs between the 2 groups.ConclusionThis systematic review and meta-analysis demonstrated that only a few studies with small number of patients comparing NOM with OM were published. A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. No data were found examining (HR)QOL and costs. Further work is needed to enable shared decision-making and to initiate NOM in frail elderly patients with advanced comorbidity and limited life expectancy.
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Project description:BackgroundHeterotopic ossification (HO) is a common complication following orthopedic and trauma surgery, which may have substantial negative effects on the postoperative outcome. Angiogenesis appears to play a critical role in heterotopic ossification. One of the involved signaling molecules is platelet-derived growth factor (PDGF) which may be inhibited by imatinib.Questions/purposesOur goal was to prevent HO by pharmacologically interfering with the molecular signaling pathways involved in the developmental process. We hypothesized that by administering a proven inhibitor of PDGF expression, heterotopic bone formation may be prevented.MethodsThe effect of imatinib on HO formation was studied in a murine model which reliably produces islets of HO within the soft tissue following Achilles tenotomy. The control group underwent Achilles tenotomy only. The imatinib group received imatinib mesylate. After trial completion, the limbs were harvested and scanned by micro-CT. Heterotopic bone volume was then identified and quantified.ResultsThe mean volume of heterotopic bone formed in the control group was 0.976mm(3) compared to 0.221 mm(3) in the imatinib group. The volume of HO in the treatment group was reduced by 85% compared to the control group.ConclusionsThe administration of imatinib was associated with a significantly reduced volume of HO. This may be due to the inhibitory effect of imatinib on the PDGF signaling pathway during development of HO.Clinical relevanceThe successful reduction of HO formation following imatinib administration has led to further insight concerning the pathogenesis of HO which in the future may lead to new clinical approaches towards the prevention of HO.
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Project description:Heterotopic ossification (HO) is defined as the process by which trabecular bone forms outside of the skeletal structure, occupying space in soft tissue where it does not normally exist. The current popular prophylactic treatment modalities include non-steroidal anti-inflammatory drugs (NSAIDs) and radiation therapy, although the literature remains inconclusive as to which is superior. Additionally, both treatments can lead to adverse effects to the patient. Recently there have been several studies attempting to identify new aspects of the etiology of heterotopic bone formation and introduce new prophylactic modalities with increased efficacy and fewer side effects. For this review, we selectively retrieved articles from Medline published from 1958-2008 on the prophylaxis of HO with the aim of assisting readers in quickly grasping the current status of research and clinical aspects of HO prophylaxis.
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Project description:Heterotopic ossification (HO) can occur as a complication of various pathologies affecting the hip including trauma, tendon avulsions, chronic injury, spinal cord injury, and soft-tissue disruption caused by surgery. When HO is present alongside intra-articular hip pathology such as femoroacetabular impingement syndrome (FAIS) or labral pathology, consideration should be made to combine the surgical excision of the HO with the FAIS decompression or labral repair if the location and size of the HO is appropriate for arthroscopic excision. Often times, the HO is located in such a position that any central compartment work can be completed before turning to the HO excision. If an open approach is required, the modified Gibson approach can be used for lateral hip access, whereas the Smith-Petersen approach provides anterior hip access. In this Technical Note we discuss arthroscopic techniques for excision of HO in the setting of concomitant FAIS, with discussion of when HO excision occurs in relation to cam decompression and labral repair, and mention tips on how to approach HO excision through an open approach.
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