Migliorini Filippo, Trivellas Andromahi, Eschweiler Jörg, Driessen Arne, Tingart Markus, Maffulli Nicola
Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelstr. 31, 52074, Aachen, Germany.
Department of Orthopaedics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
Calcif Tissue Int. 2021 Feb;108(2):196-206. doi: 10.1007/s00223-020-00763-7. Epub 2020 Oct 12.
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.
非甾体抗炎药（NSAID）已被推荐用于预防全髋关节置换术（THA）后异位骨化（HO），但相关争论仍在继续。目前这项针对随机临床试验（RCT）的贝叶斯网络荟萃分析比较了NSAID治疗作为THA后HO预防措施的所有可用途径。本贝叶斯网络荟萃分析是根据《卫生保健干预措施网络荟萃分析系统评价报告的PRISMA扩展声明》指南进行的。所有比较两种或更多种预防THA后HO干预措施的随机临床试验均纳入分析。HO根据布鲁克分类法进行分类。方法学评估的质量通过Review Manager软件5.3（Cochrane协作网，哥本哈根）的偏倚风险汇总工具进行。网络荟萃分析通过STATA程序进行贝叶斯分层随机效应模型分析，采用对数比值比（LOR）效应量。收集了26项研究的数据（6396例THA；58%为女性）。平均随访时间为10.50±5.7个月。方差分析显示平均年龄和性别之间具有良好的可比性（P>0.5）。塞来昔布的布鲁克0级发生率最高（LOR 6.96），其次是双氯芬酸（LOR 6.94）。萘普生的布鲁克I级HO发生率最低（LOR 2.82），其次是塞来昔布（LOR 3.52）。塞来昔布的布鲁克II级HO发生率最低（LOR 1.66）、III级（LOR）和IV级（LOR 0.25）。全局线性方程在所有比较中均未检测到统计学上的显著不一致（P>0.5）。本贝叶斯网络荟萃分析鼓励使用塞来昔布作为HO的预防药物。这些结论必须结合本研究的局限性来解释。需要进一步的研究来更明确地确定塞来昔布的作用。证据水平：I，RCT的贝叶斯网络分析。
