Olivero Matteo, Capurro Bruno, Reis-Campos Pedro, Aprato Alessandro, Ayeni Olufemi, Chawla Anuj, Larrainzar Garijo Ricardo, Marín-Peña Oliver
Centro Traumatológico Ortopédico, (CTO), University of Torino, 10126 Torino, Italy.
Department of Orthopaedic Surgery and Sport Traumatology, IMSKE Hospital, 46024 Valencia, Spain - European Hip Preservation Associates, EHPA-ESSKA Section, Europe.
SICOT J. 2023;9:27. doi: 10.1051/sicotj/2023024. Epub 2023 Sep 5.
Heterotopic ossification (HO) is a well-known complication of arthroscopic and open surgical treatment of femoroacetabular impingement (FAI). Incidence of heterotopic ossification has been reported in the literature between 0% and 44% after hip arthroscopy and between 18.2% and 25% after anterior mini-open surgery. Currently, pharmacological prophylaxis with NSAIDs and selective COX-2 inhibitors are commonly used and their effectiveness is well documented in literature.
We hypothesized that the low-dose prophylaxis protocol with selective cox-2 inhibitors decreases the risk of heterotopic ossification in open or arthroscopic hip preservation surgery in athletes.
This study is an analysis of prospectively gathered data on 98 sport participant patients who underwent arthroscopic or anterior mini-open treatment for FAI between April 2008 and April 2018. All the patients received postoperative oral prophylaxis with 60 mg etoricoxib once daily for two weeks. Post-operative X-rays were performed at 1, 3, and 12 months after surgery and reviewed by two orthopedic surgeons blinded to the type and side of surgery. HO were graded according to the Brooker classification. Descriptive statistics was used to analyze demographic data. Bivariate analysis was performed to analyze the association of HO with each of the following variables: type of surgery, physical activity, time of evolution of symptoms, age at surgery, and sex. Finally, a regression model analysis was performed to determine the presence of confounding effects between variables.
The study cohort was composed of 54 patients in the arthroscopic treatment group and 44 patients in the anterior mini-open group. HO was identified in 6 (13.6%) patients in the mini-open group. No HO was identified in the arthroscopic group. In the bivariate analysis, "type of surgery" was the only variable that showed a statistically significant association with HO (p = 0.007).
Results of this study suggest that anterior mini-open treatment was characterized by a higher risk of HO development compared to hip arthroscopy for femoroacetabular impingement treatment regardless of pharmacological prophylaxis. The treatment regimen of 60 mg etoricoxib daily for two weeks was an effective prophylaxis for HO formation in sport participant patients compared with data available in the literature.
异位骨化（HO）是股骨髋臼撞击症（FAI）关节镜手术和开放手术治疗中一种众所周知的并发症。文献报道髋关节镜检查后异位骨化的发生率在0%至44%之间，前侧小切口手术后的发生率在18.2%至25%之间。目前，非甾体抗炎药（NSAIDs）和选择性环氧化酶-2（COX-2）抑制剂的药物预防方法被普遍使用，其有效性在文献中有充分记载。
我们假设，使用选择性COX-2抑制剂的低剂量预防方案可降低运动员开放性或关节镜下髋关节保留手术中异位骨化的风险。
本研究对2008年4月至2018年4月间接受关节镜或前侧小切口治疗FAI的98名运动参与者患者的前瞻性收集数据进行分析。所有患者术后口服预防药物，每日一次，每次60毫克依托考昔，持续两周。术后在1、3和12个月进行X线检查，并由两名对手术类型和手术侧别不知情的骨科医生进行评估。根据布鲁克（Brooker）分类法对异位骨化进行分级。使用描述性统计分析人口统计学数据。进行双变量分析以分析异位骨化与以下各变量之间的关联：手术类型、体力活动、症状演变时间、手术年龄和性别。最后，进行回归模型分析以确定变量之间是否存在混杂效应。
研究队列包括关节镜治疗组的54名患者和前侧小切口组的44名患者。在前侧小切口组中，6名（13.6%）患者发现有异位骨化。关节镜组未发现异位骨化。在双变量分析中，“手术类型”是唯一与异位骨化有统计学显著关联的变量（p = 0.007）。
本研究结果表明，对于股骨髋臼撞击症的治疗，无论采用何种药物预防措施，与髋关节镜检查相比，前侧小切口治疗发生异位骨化的风险更高。与文献中的现有数据相比，每日60毫克依托考昔持续两周的治疗方案对运动参与者患者的异位骨化形成是一种有效的预防措施。
