Abstract
Non-steroidal anti-inflammatory drugs (NSAID) have been recommended to prevent of heterotopic ossification (HO) after total hip arthroplasty (THA), but debates are still ongoing. The present Bayesian network meta-analysis of randomized clinical trials (RCTs) compared all available pathways of NSAID treatment as prophylaxis for HO after THA. The present Bayesian network meta-analysis was conducted according to The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions guidelines. All randomized clinical trials comparing two or more interventions to prevent HO after THA were considered for analysis. HO was classified according to Brooker. The quality of the methodological assessment was performed through the risk of bias summary tool of the Review Manager Software 5.3 (The Cochrane Collaboration, Copenhagen). The network meta-analysis was performed through a STATA routine for Bayesian hierarchical random-effects model analysis, with log odd ratio (LOR) effect measure. Data from 26 studies (6396 THAs; 58% females) were collected. The mean follow-up was 10.50 ± 5.7 months. ANOVA showed good comparability among mean age and gender (P > 0.5). Celecoxib demonstrated the highest rate of Brooker class 0 (LOR 6.96), followed by diclofenac (LOR 6.94). Naproxen demonstrated the lowest rate of Brooker I HO (LOR 2.82), followed by celecoxib (LOR 3.52). Celecoxib demonstrated lowest rate of Brooker class II HO (LOR 1.66), class III (LOR), and class IV (LOR 0.25). The equation for global linearity detected no statistically significant inconsistency (P > 0.5) in all the comparisons. The present Bayesian network meta-analysis encourages the use of celecoxib as a prophylaxis for HO. These conclusions must be interpreted in light of the limitations of the present study. Future investigations are required to establish more definitely the role of celecoxib.Level of Evidence: I, Bayesian network analysis of RCTs.
Highlights
Heterotopic ossification (HO) is common after total hip arthroplasty (THA) [1], and is characterized by the formation of ectopic bone within the surrounding muscle and soft tissues
Several meta-analyses have been performed, but the drug of choice has not yet been identified, and debates are ongoing. The limit of these articles is intrinsic in the Non-steroidal anti-inflammatory drugs (NSAID) for Prophylaxis for Heterotopic Ossification After Total Hip Arthroplasty: A Bayesian
The literature search resulted in 302 articles, of which 97 were randomized clinical trials (RCTs)
Summary
Heterotopic ossification (HO) is common after total hip arthroplasty (THA) [1], and is characterized by the formation of ectopic bone within the surrounding muscle and soft tissues. NSAID have been recommended to prevent HO after THA [6]. Several studies compared the use of NSAIDs against HO after THA [7–11], but the most effective prophylactic treatment remains elusive, and no evidence-based guidelines to prevent HO after THA are available. Several meta-analyses have been performed, but the drug of choice has not yet been identified, and debates are ongoing. The limit of these articles is intrinsic in the NSAIDs for Prophylaxis for Heterotopic Ossification After Total Hip Arthroplasty: A Bayesian
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