Interventions for Heterotopic Ossification
The published literature on treatment of HO provides evidence for non-steroidal anti-inflammatory drugs, warfarin, bisphosphonates, pulse low-intensity electromagnetic field therapy, radiation and surgical excision.
Discussion
Three systematic reviews examined the effectiveness of HO management interventions. Aubut et al. (2011) found that pharmacological interventions were effective in the prophylaxis of HO. Teasell et al. (2010) also found that rofecoxib and indomethacin were effective in preventing HO after SCI. However, only limited evidence supported the use of radiotherapy, warfarin, or Pulse low intensity electromagnetic field therapy (PLIMF) for the prevention of HO after SCI. Once HO developed, only surgical resection was found to be effective, while bisphosphonates such as Etidronate Disodium and pamindronate were supported by limited evidence. Finally, Yolcu et al. (2020b) conducted a systematic review and meta- analysis comparing prophylactic medications to placebo for prevention of HO post- SCI. Although the overall analysis did not indicate a statistically significant benefit to use of prophylactic medication to prevent HO as compared to placebo, when only analyzing NSAIDs, patients who received prophylatic NSAIDs showed significantly lower incidence of HO. The authors pointed out that while promising for secondary prevention of HO among patients with SCI, further prospective studies with longer follow-ups are needed to explore other appropriate medications for HO prevention (Yolcu et al. 2020b).
