Postoperative nonsteroidal anti-inflammatory drug prophylaxis for elbow heterotopic ossification: a systematic review and meta-analysis comparing COX-2 selective and nonselective inhibitors
Abstract
BACKGROUND: Heterotopic ossification (HO) is a significant complication following elbow trauma and surgery, leading to pain, stiffness, and functional impairment. While nonsteroidal anti-inflammatory drugs (NSAIDs) have been extensively investigated for HO prophylaxis, their effectiveness in preventing postoperative HO in the elbow remains unclear. This study aims to compare the efficacy of selective vs. nonselective NSAIDs in reducing postoperative HO rates after traumatic elbow surgeries.
METHODS: This systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search was performed in PubMed, Embase, Cochrane Library, and Web of Science from January 2004 to January 10, 2025. Level I-III studies were included if they examined patients who underwent elbow surgery following trauma and compared selective COX-2 inhibitors or nonselective NSAIDs to no prophylaxis, with reported postoperative HO formation rates.
RESULTS: A total of 2,429 articles were identified across the four databases. Following full-text review, 1 randomized control trial and 5 retrospective studies were included in the quantitative synthesis, comprising patients who underwent either acute post-traumatic surgery or postexcision/open arthrolysis for established HO. Both selective (celecoxib) and nonselective (indomethacin) NSAIDs demonstrated no statistically significant difference in reducing postoperative HO…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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