ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Experimental Pharmacology and Drug Discovery
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1601349
This article is part of the Research TopicInnovations in Immunometabolic Treatment and Controlled Release Systems for Bone and Joint DisordersView all 7 articles
Effectiveness and Priority of Irradiation and Six NSAIDs in Prevention Heterotopic Ossification After Total Hip Arthroplasty: a network metaanalysis of Randomized Controlled Studies
Provisionally accepted
Fei Yang1,2*
Wen Lei3Changshun Chen3Qiao Zhao2Zhiwei Feng1,2Bin Ran2Xuwei Luo2
Dongqin Xiao2,4Qifan Fang2,5- 1Lanzhou University, Lanzhou, China
- 2Nanchong Central Hospital, Nanchong, Sichuan Province, China
- 3The Affiliated Hospital of Yunnan University, Kunming, Yunnan Province, China
- 4Research Institute of Tissue Engineering and Stem Cells, Nanchong Central Hospital, Nanchong, Shanxi Province, China
- 5The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
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Background: Heterotopic ossification (HO) involves the ectopic deposition of bone in soft tissues, frequently occurring as a complication post-hip trauma or surgery. To prevent HO following total hip arthroplasty (THA), irradiation has been extensively employed, alongside the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Given the extensive range of NSAIDs available, determining the most effective NSAID or irradiation protocol for prophylaxis continues to be a matter of debate.Methods: Adhering to the PRISMA guidelines, a comprehensive search was conducted across PubMed, Embase, Cochrane Library, and Web of Science to identify relevant randomized controlled trials. We systematically extracted and assessed data according to the level of evidence presented in the articles. A Bayesian network meta-analysis (NMA) was implemented to evaluate and contrast the efficacy of irradiation and six distinct NSAIDs in preventing HO after THA. The protocol for this study was officially registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY).Results: The meta-analysis incorporated data from 3014 patients: 629 administered ibuprofen, 54 with naproxen, 117 receiving celecoxib, 426 on indomethacin, 295 treated with diclofenac, 45 on etoricoxib, 522 subjected to irradiation, and 926 serving as controls. The most likely ranking for the effectiveness of preventing HO after THA is as follows: diclofenac > etoricoxib > irradiation > naproxen > indomethacin > celecoxib > ibuprofen.Conclusion: In terms of preventive efficacy, diclofenac and etoricoxib demonstrated the most favorable performance in preventing HO after THA within this network meta-analysis. Irradiation, naproxen, and indomethacin are also satisfactory options, while ibuprofen is ineffective. Given the advantages shown by etoricoxib and celecoxib, further randomized controlled trials are recommended to clarify their effects. Our conclusions require confirmation through additional high-quality studies.
Keywords: heterotopic ossification, Total hip arthroplasty, prevention, network metaanalysis, NSAIDs
Received: 27 Mar 2025; Accepted: 30 Apr 2025.
Copyright: © 2025 Yang, Lei, Chen, Zhao, Feng, Ran, Luo, Xiao and Fang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fei Yang, Lanzhou University, Lanzhou, China
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