Prophylaxis of heterotopic ossification of the hip: systematic review and meta-analysis

Clin Orthop Relat Res. 2009 Dec;467(12):3283-9. doi: 10.1007/s11999-009-0924-5. Epub 2009 Jun 11.


Heterotopic ossification (HO) is a potentially severe, if infrequent, complication in hip surgery, and uncertainty exists regarding whether to use NSAIDs or radiation in its prevention. Thus, we systematically reviewed the literature in MedLine, EMBASE, CINAHL, and the Cochrane Controlled Trial Register and, after ruling out publication bias and data heterogeneity, performed a meta-analysis of randomized, controlled trials to assess effectiveness and complications of NSAIDs and radiation in the prevention of HO. We identified nine studies reporting on effectiveness and complications including a total of 1295 patients. The pooled risk ratio for the effectiveness in HO prevention was 0.96 (95% confidence interval, 0.88-1.06) and was independent of the type of surgery (THA or open reduction and internal fixation). There was no association with gender, age, length of followup, or year of publication. The risk ratio for associated complications was 0.79 (95% confidence interval, 0.45-1.41), and, again, was independent of the aforementioned factors. We found no evidence for a statistically significant or clinically important difference between NSAIDs or radiation in preventing HO.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Evidence-Based Medicine
  • Female
  • Hip Joint / drug effects
  • Hip Joint / radiation effects
  • Hip Joint / surgery*
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Orthopedic Procedures / adverse effects*
  • Ossification, Heterotopic / etiology
  • Ossification, Heterotopic / prevention & control*
  • Patient Selection
  • Radiation Dosage
  • Radiotherapy / adverse effects
  • Risk Assessment
  • Risk Factors


  • Anti-Inflammatory Agents, Non-Steroidal