Puga Troy B, Box McKenna W, Dieu Vincent M, Marchese Charles R, Riehl John T
Department of Orthopaedics, Medical City Denton, Denton, TX, United States of America.
College of Medicine, University of Oklahoma, Oklahoma City, OK, United States of America.
Bone Rep. 2025 Jan 25;24:101828. doi: 10.1016/j.bonr.2025.101828. eCollection 2025 Mar.
Heterotopic ossification (HO) is a somewhat common occurrence after total hip arthroplasty (THA), particularly with certain approaches. This complication can be detrimental to the success of the surgical outcome. Indomethacin and radiotherapy remain common treatment modalities; however, no true gold-standard treatment is universally agreed upon. This study aims to evaluate Level I and Level II evidence for treatment practices of HO prophylaxis since 2000.
To evaluate HO prophylaxis in total hip arthroplasty, a search was conducted across MEDLINE/Pubmed, Cochrane, and Embase databases using keywords and Medical Subject Heading (MeSH) terms. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and included if they met eligibility criteria.
HO chemical prophylaxis was more effective than no HO prophylaxis, except for aspirin. Multiple NSAIDs showed equivalence and better side effect profiles than indomethacin. No one superior NSAID was found, and numerous modalities showed efficacy. The most effective dosages of radiation therapy and combination therapy remain unclear. Additionally, both etidronate and salmon calcitonin showed benefit in preventing HO in one study each.
Radiation, NSAIDs, and combination therapy all showed efficacy as HO prophylaxis modalities. HO prophylaxis treatment and modalities should be guided upon patient and surgical factors such as surgical approach, side effects and tolerability of modalities, comorbidities, and available facility resources to optimize the prevention of HO.Level of evidence: Level IV Therapeutic.
异位骨化（HO）在全髋关节置换术（THA）后较为常见，尤其是采用某些手术入路时。这种并发症可能会影响手术效果的成功。吲哚美辛和放射治疗仍然是常见的治疗方式；然而，目前尚无普遍认可的真正金标准治疗方法。本研究旨在评估自2000年以来预防HO治疗方法的一级和二级证据。
为评估全髋关节置换术中HO的预防情况，使用关键词和医学主题词（MeSH）在MEDLINE/Pubmed、Cochrane和Embase数据库中进行检索。对标题和摘要进行筛选，以确定是否符合纳入标准。如果全文符合纳入标准，则进行筛选并纳入。
除阿司匹林外，HO化学预防比不进行HO预防更有效。多种非甾体抗炎药（NSAIDs）显示出等效性，且副作用比吲哚美辛更好。未发现一种更优的NSAID，许多方法都显示出疗效。放射治疗和联合治疗的最有效剂量仍不清楚。此外，依替膦酸盐和鲑鱼降钙素在各自的一项研究中均显示出预防HO的益处。
放射治疗、NSAIDs和联合治疗均显示出作为HO预防方式的疗效。HO预防治疗和方式应根据患者和手术因素进行指导，如手术入路、方式的副作用和耐受性、合并症以及可用的设施资源，以优化HO的预防。证据级别：四级治疗性。
