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Heterotopic Ossification Prophylaxis in Acetabular Fracture Surgery: A Systematic Review.

Colin K Cantrell1, Erik B Gerlach1, Gregory H Versteeg1

  • 1Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois.

Journal of Surgical Orthopaedic Advances
|March 29, 2024
PubMed
Summary

Heterotopic ossification (HO) after acetabular fracture surgery is common. Prophylactic indomethacin and radiation therapy significantly reduce HO rates and severity, with minimal surgical risk.

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Area of Science:

  • Orthopaedic surgery
  • Trauma surgery
  • Medical research

Background:

  • Heterotopic ossification (HO) is a frequent complication following acetabular fracture surgery.
  • Understanding HO incidence and effective prevention strategies is crucial for patient outcomes.

Approach:

  • Systematic literature review of PubMed, MEDLINE, and Cochrane databases.
  • Inclusion of 66 English-language articles encompassing 5,028 patients undergoing acetabular fracture surgery.
  • Analysis of HO rates with and without prophylactic interventions.

Key Points:

  • Overall HO incidence was 30% (1,511/5,028 patients).
  • Indomethacin (27%) and radiation therapy (24%) showed lower HO rates than no prophylaxis (36%).
  • Severe HO rates were substantially reduced by radiation therapy (3%) and indomethacin (7%) compared to no prophylaxis (18%).

Conclusions:

  • Indomethacin and radiation therapy are effective in decreasing the incidence and severity of HO after acetabular fracture surgery.
  • These prophylactic measures appear to offer benefits without significantly increasing surgical morbidity.