Efficacy of naproxen prophylaxis for the prevention of heterotopic ossification after hip surgery: a meta-analysis
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RESEARCH ARTICLE
Open Access
Efficacy of naproxen prophylaxis for the prevention of heterotopic ossification after hip surgery: a meta-analysis Ran Ma†, Guan-Hong Chen†, Liu-Jing Zhao and Xi-Cheng Zhai*
Abstract Background: This meta-analysis aimed to assess whether the specific nonsteroidal anti-inflammatory drug (NSAID) naproxen has a role in reducing the occurrence of heterotopic ossification after hip surgery. Methods: Potential studies were identified in the following electronic databases: PubMed, EMBASE, Web of Science, Cochrane Library, and Google. We included studies involving hip surgery patients in which the intervention group received naproxen and the control group received placebo. The occurrence of heterotopic ossification and complications were the final outcomes. Stata 13.0 was used for the meta-analysis. Results: Four randomized controlled trials (RCTs) involving 269 patients were ultimately included in this metaanalysis. The use of naproxen was associated with a significant reduction in the occurrence of heterotopic ossification at 1.5-, 3-, 6-, and 12-month follow-ups (P < 0.05). There was no significant difference in the occurrence of complications between treatment and control groups (P > 0.05). Conclusion: Our analysis indicates that naproxen can decrease the occurrence of heterotopic ossification without increasing complications in hip surgery patients. Due to the limited number of studies included, more high-quality RCTs are needed to identify the optimal dose of naproxen. Keywords: Naproxen, Hip surgery, Heterotopic ossification, Meta-analysis
Background Heterotopic ossification (HO) was one of the most common complications of hip surgery. Indeed, HO, which is mainly induced by an inflammatory response to surgery, undermines the intended benefits of surgery [1, 2]. Due to variability in hip surgical techniques, the incidence of HO after such a procedure varies from 0 to 73% [3, 4]. Histologically, HO consists of lamellar bone derived from abnormity activity of osteoblast cells in atypical locations [5]. HO decreases range of motion (ROM) and causes hip pain, swelling, and joint stiffness. Nonsteroidal anti-inflammatory drugs (NSAIDs) and radiotherapy are often used to reduce the occurrence of HO after hip surgery [6, 7]. Although NSAIDs have been widely used for HO prophylaxis, the risk of
gastrointestinal side effects has drawn the attention of surgeons. Thus, radiotherapy may be a preferred option in very high-risk patients or in those with contraindications to NSAIDs. Nonetheless, NSAIDs are considerably more cost effective than radiotherapy. Different drugs have been used for HO prophylaxis, though NSAIDs have been the mainstay [7], with greatly variable efficacy. The efficacy of naproxen, a type of NSAID, for the prophylaxis of HO after hip surgery remains in debate, and there is yet no relevant metaanalysis on the use of naproxen in this application. The objective of this meta-analysis was to evaluate the efficacy of naproxen for prophylaxis of HO after hip surgery.
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