A comprehensive update on the pharmacological management of heterotopic ossification following hip arthroplasty: a level I evidenced based expert opinion

ABSTRACT

Introduction

Heterotopic ossification (HO) of the hip joint may happen accompanying skeletal muscle trauma or surgical procedures. The pharmacological prophylaxis of heterotopic ossification (HO) following total hip arthroplasty (THA) is debated.

Areas covered

This expert opinion aims to systematically investigate the efficacy of current pharmacological options as prophylaxis for HO following THA.

Expert opinion

The current evidence identified celecoxib, naproxen, and diclofenac as best option for the prevention of HO in patients who undergo primary THA. The most appropriate pharmacotherapy for the prevention of HO is still debated and should be customized according to patients’ comorbidities and medical history. For patients with cardiovascular comorbidities, naproxen, or diclofenac should be considered along with proton pump inhibitors to prevent gastrointestinal complications. For patients with history of gastrointestinal disease, celecoxib can be recommended. These conclusions must be considered within the limitations of the present investigation. Between studies, heterogeneities in the administration protocols were evident. In some RCTs, the length of the follow-up was shorter than 12 months. The current clinical practice would benefit of high-quality recommendations and the development of the shared official guidelines.

KEYWORDS:

• Heterotopic ossification
• total hip arthroplasty
• pharmacological management
• prophylaxis

Article highlights

• The most appropriate pharmacotherapy for the prevention of heterotopic ossification is still debated, and should be customized according to patients’ comorbidities and medical history.

• The current evidence identified celecoxib, naproxen, and diclofenac as best option for the prevention of heterotopic ossification in patients who undergo primary total hip arthroplasty.

• For patients with cardiovascular comorbidities, naproxen, or diclofenac should be considered along with proton pump inhibitors to prevent gastrointestinal complications.

• For patients with history of gastrointestinal disease, celecoxib can be recommended.

• The current clinical practice would benefit of high-quality recommendations and the development of the shared official guidelines.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.