Low-dose prophylaxis protocol for heterotopic ossification after hip preservation surgery in a sport participants cohort.

IF 1.8 Q2 ORTHOPEDICS SICOT-J Pub Date : 2023-01-01 DOI:10.1051/sicotj/2023024
Matteo Olivero, Bruno Capurro, Pedro Reis-Campos, Alessandro Aprato, Olufemi Ayeni, Anuj Chawla, Ricardo Larrainzar Garijo, Oliver Marín-Peña
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Abstract

Background: 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.

Hypothesis: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

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一项运动参与者队列中髋关节保存手术后异位骨化的低剂量预防方案。
背景:异位骨化(HO)是关节镜和开放手术治疗股髋臼撞击(FAI)的常见并发症。文献报道髋关节镜术后异位骨化的发生率为0% ~ 44%,前路小切口手术后异位骨化的发生率为18.2% ~ 25%。目前,非甾体抗炎药和选择性COX-2抑制剂的药物预防是常用的,它们的有效性在文献中得到了很好的证明。假设:我们假设选择性cox-2抑制剂的低剂量预防方案降低了运动员在开放或关节镜下髋关节保留手术中异位骨化的风险。方法:本研究是对2008年4月至2018年4月期间接受关节镜或前路小开放治疗的98名运动参与者患者的前瞻性数据进行分析。所有患者术后均给予口服预防药依托妥昔布60mg,每日1次,持续2周。术后1个月、3个月和12个月进行x光检查,由两名不知道手术类型和侧边的整形外科医生检查。根据Brooker分类对HO进行分级。采用描述性统计方法分析人口统计数据。采用双变量分析来分析HO与以下变量的关系: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。结果:研究队列由关节镜治疗组54例患者和前路小切口组44例患者组成。小切口组6例(13.6%)患者出现HO。关节镜组未发现HO。在双变量分析中,“手术类型”是唯一显示与HO有统计学意义相关的变量(p = 0.007)。结论:本研究结果表明,与髋关节镜治疗股骨髋臼撞击相比,前路小切口治疗的特点是HO发展的风险更高,无论药物预防如何。与文献资料相比,每日60mg依托妥昔布治疗方案连续两周有效预防运动参与者患者HO的形成。
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来源期刊
SICOT-J
SICOT-J ORTHOPEDICS-
CiteScore
3.20
自引率
12.50%
发文量
44
审稿时长
14 weeks
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