Heterotopic ossification (HO) prophylaxis after distal biceps repair
Hypothesis and Background: A potential complication of distal biceps repair is heterotopic ossification (HO), which impacts both limb function and overall patient outcomes. Common HO prophylaxis methods include nonsteroidal anti-inflammatory drugs or localized radiation therapy. The purpose of this...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-11-01
|
| Series: | JSES Reviews, Reports, and Techniques |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666639124000877 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850282769620402176 |
|---|---|
| author | Udit Dave, BS Jayanth Mosalakanti, BS Pavan Guduri, BA Mia Rumps, MS Mary K. Mulcahey, MD |
| author_facet | Udit Dave, BS Jayanth Mosalakanti, BS Pavan Guduri, BA Mia Rumps, MS Mary K. Mulcahey, MD |
| author_sort | Udit Dave, BS |
| collection | DOAJ |
| description | Hypothesis and Background: A potential complication of distal biceps repair is heterotopic ossification (HO), which impacts both limb function and overall patient outcomes. Common HO prophylaxis methods include nonsteroidal anti-inflammatory drugs or localized radiation therapy. The purpose of this systematic review was to determine an effective means of providing HO prophylaxis following distal biceps repair. Methods: A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were searched for studies published after 1998: PubMed, Embase, and Cochrane Library. Studies were included if they compared patients who were placed on HO prophylaxis following distal biceps repair compared to those that were not placed on HO prophylaxis, were prospective randomized controlled trials or retrospective case-control studies, and evaluated HO prophylaxis regimens. Studies that were not written in English, analyzed animals or cadavers, and did not directly evaluate patients undergoing distal biceps repair, did not study HO rophylaxis, or had alternative study designs were excluded. Results: The initial search identified 134 studies, 4 of which met the inclusion criteria and were included in the study. Each of these 4 (100%) studies evaluated indomethacin, and 1 (25%) study evaluated both indomethacin and meloxicam. The included studies evaluated HO prophylaxis in the setting of both one- and two-incision distal biceps repairs. Overall, 2 of the 4 (50%) studies supported the use of indomethacin as HO prophylaxis, 1 of 4 (25%) did not support the use of indomethacin for HO prophylaxis, and 1 of 4 (25%) studies reported that indomethacin and meloxicam are similarly effective HO prophylaxis drugs. None of the studies meeting the inclusion criteria analyzed radiation therapy as a potential method for HO prophylaxis. Discussion and Conclusion: Indomethacin is commonly used as a prophylactic measure for HO following distal biceps repair; however, based on the results of this study, it is not necessary to use this routinely due to its limited efficacy in preventing HO and potential risks (eg, gastrointestinal upset, bleeding) associated with the medication. Future randomized studies should evaluate the use of other nonsteroidal anti-inflammatory drugs (eg, meloxicam) for HO prophylaxis in addition to not using any HO prophylaxis following either one- or two-incision distal biceps repairs. |
| format | Article |
| id | doaj-art-1c05ab8e9d0141f38cb9c691e3dc030c |
| institution | OA Journals |
| issn | 2666-6391 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES Reviews, Reports, and Techniques |
| spelling | doaj-art-1c05ab8e9d0141f38cb9c691e3dc030c2025-08-20T01:47:54ZengElsevierJSES Reviews, Reports, and Techniques2666-63912024-11-014471571910.1016/j.xrrt.2024.05.012Heterotopic ossification (HO) prophylaxis after distal biceps repairUdit Dave, BS0Jayanth Mosalakanti, BS1Pavan Guduri, BA2Mia Rumps, MS3Mary K. Mulcahey, MD4School of Medicine, Tulane University, New Orleans, LA, USASchool of Medicine, Tulane University, New Orleans, LA, USASchool of Medicine, Tulane University, New Orleans, LA, USADepartment of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine – Loyola University Chicago, Maywood, IL, USADepartment of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine – Loyola University Chicago, Maywood, IL, USA; Corresponding author: Mary K. Mulcahey, MD, Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine – Loyola University Chicago, 2160 S First Avenue, Maguire Building, Suite 1700, Maywood, IL 60153, USA.Hypothesis and Background: A potential complication of distal biceps repair is heterotopic ossification (HO), which impacts both limb function and overall patient outcomes. Common HO prophylaxis methods include nonsteroidal anti-inflammatory drugs or localized radiation therapy. The purpose of this systematic review was to determine an effective means of providing HO prophylaxis following distal biceps repair. Methods: A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were searched for studies published after 1998: PubMed, Embase, and Cochrane Library. Studies were included if they compared patients who were placed on HO prophylaxis following distal biceps repair compared to those that were not placed on HO prophylaxis, were prospective randomized controlled trials or retrospective case-control studies, and evaluated HO prophylaxis regimens. Studies that were not written in English, analyzed animals or cadavers, and did not directly evaluate patients undergoing distal biceps repair, did not study HO rophylaxis, or had alternative study designs were excluded. Results: The initial search identified 134 studies, 4 of which met the inclusion criteria and were included in the study. Each of these 4 (100%) studies evaluated indomethacin, and 1 (25%) study evaluated both indomethacin and meloxicam. The included studies evaluated HO prophylaxis in the setting of both one- and two-incision distal biceps repairs. Overall, 2 of the 4 (50%) studies supported the use of indomethacin as HO prophylaxis, 1 of 4 (25%) did not support the use of indomethacin for HO prophylaxis, and 1 of 4 (25%) studies reported that indomethacin and meloxicam are similarly effective HO prophylaxis drugs. None of the studies meeting the inclusion criteria analyzed radiation therapy as a potential method for HO prophylaxis. Discussion and Conclusion: Indomethacin is commonly used as a prophylactic measure for HO following distal biceps repair; however, based on the results of this study, it is not necessary to use this routinely due to its limited efficacy in preventing HO and potential risks (eg, gastrointestinal upset, bleeding) associated with the medication. Future randomized studies should evaluate the use of other nonsteroidal anti-inflammatory drugs (eg, meloxicam) for HO prophylaxis in addition to not using any HO prophylaxis following either one- or two-incision distal biceps repairs.http://www.sciencedirect.com/science/article/pii/S2666639124000877Distal biceps repairIndomethacinMeloxicamHeterotopic ossificationHO prophylaxisNSAID prophylaxis |
| spellingShingle | Udit Dave, BS Jayanth Mosalakanti, BS Pavan Guduri, BA Mia Rumps, MS Mary K. Mulcahey, MD Heterotopic ossification (HO) prophylaxis after distal biceps repair JSES Reviews, Reports, and Techniques Distal biceps repair Indomethacin Meloxicam Heterotopic ossification HO prophylaxis NSAID prophylaxis |
| title | Heterotopic ossification (HO) prophylaxis after distal biceps repair |
| title_full | Heterotopic ossification (HO) prophylaxis after distal biceps repair |
| title_fullStr | Heterotopic ossification (HO) prophylaxis after distal biceps repair |
| title_full_unstemmed | Heterotopic ossification (HO) prophylaxis after distal biceps repair |
| title_short | Heterotopic ossification (HO) prophylaxis after distal biceps repair |
| title_sort | heterotopic ossification ho prophylaxis after distal biceps repair |
| topic | Distal biceps repair Indomethacin Meloxicam Heterotopic ossification HO prophylaxis NSAID prophylaxis |
| url | http://www.sciencedirect.com/science/article/pii/S2666639124000877 |
| work_keys_str_mv | AT uditdavebs heterotopicossificationhoprophylaxisafterdistalbicepsrepair AT jayanthmosalakantibs heterotopicossificationhoprophylaxisafterdistalbicepsrepair AT pavanguduriba heterotopicossificationhoprophylaxisafterdistalbicepsrepair AT miarumpsms heterotopicossificationhoprophylaxisafterdistalbicepsrepair AT marykmulcaheymd heterotopicossificationhoprophylaxisafterdistalbicepsrepair |