Selective COX-2 inhibitor versus nonselective COX-1 and COX-2 inhibitor in the prevention of heterotopic ossification after total hip arthroplasty: a meta-analysis of randomised trials.

Whether selective cyclo-oxygenase-2 (COX-2) inhibitors are equally effective compared to nonselective NSAIDs for the prevention of heterotopic ossification (HO) after total hip arthroplasty (THA) is still unclear. We carried out a comprehensive search strategy, in which only randomised controlled trials were included. Two reviewers independently assessed methodological quality and extracted outcome data. Analyses were performed using Stata version 10.0. Four eligible randomised controlled trials totalling 808 patients were included. Meta-analysis results showed that no statistically significant difference was found in overall incidence of HO (RR 1.08; 95% CI 0.71-1.64), incidence of moderate severe HO (Brooker II and III) (RR 0.83; 95% CI 0.48-1.42) and any grade of Brooker classification between two groups. In summary, the selective COX-2 inhibitors are equally effective as nonselective NSAIDs for the prevention of HO after THA. Considering the gastrointestinal side effects of nonselective NSAIDs, we recommend selective COX-2 inhibitors for the prevention of HO after THA. However, future well-designed, randomised controlled trials are still needed to further confirm our results.