Indomethacin versus Ketorolac for the prevention of heterotopic ossification in hip arthroscopy patients.

Abstract

Nonsteroidal anti-inflammatory drugs are commonly utilized to reduce the risk of developing heterotopic ossification (HO) after hip arthroscopy. However, it is not known which regimen is optimal. The purpose of this study is to determine the rate of HO formation after hip arthroscopy in response to different NSAID protocols. Consecutive cases of a single fellowship-trained surgeon at a tertiary referral center were retrospectively reviewed. Patients received a regimen of two medications, starting with four days of either Ketorolac or Indomethacin and ending with either Celecoxib, Meloxicam, Diclofenac, or Naproxen. Two reviewers assessed HO on postoperative radiographs. 323 cases were included for retrospective review. 48 (15 %) were found to develop HO after hip arthroscopy. Patients who also underwent labral repair (p = 0.046) and those with larger corrections in alpha angle (p = 0.048) were found to have higher rates of HO. Multivariate regression found that receiving Meloxicam as a second medication was found to have a significantly higher risk of HO than Celecoxib (OR 4.72, p = 0.035). Male gender (OR 2.36, p = 0.013), was also found to be associated with a higher likelihood of HO formation according to the model. While taking Meloxicam as the second NSAID was associated with a significantly higher rate of HO than Celecoxib, no one regimen was found to be superior. Additionally, male gender was found to be a significant predictor of HO development.