Selective and non-selective NSAIDs equally effective for preventing heterotopic ossification after THA

Some patients have demonstrated evidence of heterotopic ossification (HO) following total hip arthroplasty (THA). Selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) are used as prophylaxis for HO following THA. A meta-analysis by Migliorini et al compared selective versus non-selective NSAIDs as prophylaxis for HO following THA.

NSAIDs are typically divided into groups based on their cyclooxygenase (COX) selectivity: non-selective NSAIDs are directed to both COX-1 and COX-2, and selective NSAIDs are directed specifically to COX-2. Indomethacin is the NSAID most frequently used as prophylaxis for HO. Other non-selective NSAIDs such as ketorolac, acetylsalicylic acid, meloxicam, naproxen, ibuprofen, and diclofenac have also been employed successfully. Gastrointestinal complications are the most common reason for therapy discontinuation in patients treated with non-selective NSAIDs. Given their lack of interactions with platelet aggregation and gastrointestinal complications, selective NSAIDs are effective treatment alternatives to nonselective NSAIDs.

The study was conducted according to the PRISMA 2020 guidelines.

P (population): patients following THA

I (intervention): prophylaxis of HO

C (comparison): selective versus non-selective NSAIDs

O (outcomes): Brooker classification

All the clinical investigations comparing selective versus non-selective NSAIDs as prophylaxis for HO following THA were accessed. An assessment of the methodological quality and statistical analyses were performed through the risk of bias summary tool of the Review Manager 5.3 software. The modified Brooker staging system was used to rate the efficacies of the interventions.

The results of the study were:

• Data from 8 studies and 1526 patients were collected.

• 60.8% were female.

• No difference was found in the sample size, mean age, and percentage of females between the two groups at baseline.

• No statistically significant difference was found between selective and non-selective NSAIDs in term of efficacy.

• 72% (1078 of 1502) of the patients were classified as Brooker 0,

21% (322 of 1502) as Brooker I,

5% (80 of 1502) as Brooker II,

1% (16 of 1502) as Brooker III, and

0.1% (2 of 1502) as Brooker IV.

The authors concluded that - Selective and non-selective NSAIDs were equally effective when used as prophylaxis for HO following THA.

Level of evidence: Level III, systematic review and meta-analysis.

Further reading:

Selective versus non-selective NSAIDs as prophylaxis for heterotopic ossification following hip arthroplasty: a meta-analysis

Migliorini et al.

Journal of Orthopaedics and Traumatology (2022) 23:30

https://doi.org/10.1186/s10195-022-00646-7